As healthcare technology continues to advance, it presents ample opportunities for health systems and hospitals to enhance the patient experience. But implementing a new patient engagement technology is easier said than done, as organizations struggle with the technology selection process. The request for proposal (RFP) process is fraught with tough vendor decisions and an onslaught…
While CMS has embraced value-based reimbursement, the country’s health insurance companies are still far from widespread adoption, according to a new survey. The HealthEdge Voice of the Market survey revealed (PDF) that different payers and their affiliates will reach value-based care at different times, as clear discrepancies exist among adoption rates. About half (46.4%) of the 150 executives surveyed…
Why do medical practices reach out to their patients? The answer seems obvious — because patients who are engaged in their own care tend to be healthier, which makes the job of the physician easier and helps control costs. But if the answer is so obvious, why don’t more practices have effective Patient Engagement? A…
Dive Brief: Despite the momentum associated with value-based contracting, a new survey found that payers continue to struggle with the transition to a payment model that rewards value — facing external and internal barriers. HealthEdge’s latest Voice of the Market Survey was based on interviews with 151 health insurance executives and found little agreement about the best…
Like many accountable care organizations, Austin Regional Clinic (ARC) in Texas is building a record of success on the Medicare Shared Savings Program’s (MSSP) so-called “Track One.” Now looming, however, is an automatic transfer of ARC to the MSSP’s riskier “second track” after years of hard work implementing our value-based, population health treatment model. On…
Dive Brief: CMS is launching a project to share Medicare claims data with accountable care organizations in bulk, Administrator Seema Verma announced Tuesday at HIMSS19 in Orlando, Florida. The project, called the Beneficiary Claims Data API (BCDA), will allow ACOs participating in the Medicare Shared Savings Program to retrieve Part A, B and D claims data…
ORLANDO, Fla.—For the thousands of people attending the 2019 HIMSS conference this week, there is no escaping the buzz about the proposed new interoperability rules issued by the U.S. Department of Health and Human Services (HHS) on Monday. Centers for Medicare & Medicaid Services Administrator Seema Verma is the ubiquitous face of the news at the event,…
Starting in 2020, Medicare Advantage plans will be allowed to offer supplemental, “non-primarily health-related” benefits to help certain eligible chronically ill patients with unmet social needs. Put simply, this represents a large source of reimbursement for social determinants of health (SDOH) solutions in the high-growth MA market. While this represents a real opportunity for SDOH…
ACO Repayment Mechanisms – Surety Bonds Medicare Shared Savings Program (“MSSP”) Tracks 1+, 2, and 3; Pathways to Success Tracks C, D, E, and Enhanced; and NextGen ACOs, have two-sided risk. CMS requires these ACOs to provide a repayment mechanism to assure that shared losses can be repaid. Depending on its track, a Pathways to…
Providence St. Joseph Health leveraged data to reduce its knee replacement costs by more than $1 million a year. The Renton, Wash.-based integrated health system first analyzed what drove variation across its 51-hospital network and targeted the use of antibiotic-infused bone cement. Hypothetically, it can stave off infections. But the pre-mixed product added significant cost…
