Roji Intel Blog

Theresa Hush 0
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Episodes of CareFuture of Health CareRiskValue-Based Health Care
July 20, 2020

Episodes Are More Than Payment Models: They’re Key to Improving Care

For many health systems and groups, episodes are esoteric. Providers often think of them only in context of risk-based payment models like bundled payments and capitation. Navigating Value-Based Health Care contracts, providers analyze and model performance under Fee-for-Service and episode-based payments to decide their course of action. Or, if already in Value-Based reimbursement, they use them as targets for costs to pinpoint physicians who exceed the targets. These strategies are shortsighted and limited. Even at best, they do nothing to address what is actually driving cost of care. By using payer-constructed episode specifications, such strategies potentially obscure valuable clinical and…
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Theresa Hush 0
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Future of Health CarePopulation HealthRacial Inequities in Health CareValue-Based Health Care
July 1, 2020

How to Start Redressing Racial Bias and Reducing Health Care Inequities

In recent weeks there have been many cries for the health care system to finally address racial inequities. Now is the moment to harness that energy toward a process of substantive change. Value-Based Health Care is not achievable without addressing racial inequities that drive costs and poor outcomes: patient disengagement, higher risk factors, greater admissions, and emergency room usage. Fully acknowledging the issues is the first step. Creating better methods to evaluate how race affects decisions and to innovate change is the next. Racial inequities in health care in the U.S. are well documented, including: Higher maternal mortality, with Black…
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Dave Halpert 0
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COVID-19Merit-Based Incentive Payment System (MIPS)RiskValue-Based Health Care
June 26, 2020

The Fallacy of “Relief”: The Dangers of MIPS Extreme and Uncontrollable Circumstances Applications

Under the banner of “relief,” CMS has announced that clinicians will have the opportunity to file an Extreme and Uncontrollable Circumstances  application to qualify for re-weighting in some or all components of the Merit-Based Incentive Payment System (MIPS). This possibility may sound intriguing, but don’t be fooled—those who take this route are overlooking the longer-term consequences of maintaining and expanding MIPS efforts. MIPS Is Not Going Away The day before releasing 2020 MIPS flexibility guidance, CMS announced the creation of the Office of Burden and Health Informatics, which has grown out of the Patients Over Paperwork initiative. In this notice…
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Dave Halpert 0
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ACO ReportingCOVID-19RiskValue-Based Health Care
May 6, 2020

The Interim ACO Rule Explained: A Pause, Not a Reprieve

As the coronavirus pandemic continues to upend health care in the U.S., pressure has mounted on CMS to adjust its efforts to drive providers to adopt risk. In response, at the end of last week CMS announced a carve-out of COVID-19 patient expenses from certain reporting requirements. In this round, ACOs were on the receiving end, being largely excused from remaining 2019 reporting and 2020 enrollment obligations. True to our predictions, this will slow, but not reverse CMS’s ultimate agenda to push providers to manage under risk. Those who interpret the Interim Rule as a reprieve will do so at…
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Theresa Hush 0
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ACOsCOVID-19Future of Health CareValue-Based Health Care
April 15, 2020

Stretched to the Limit by COVID-19, Will Providers Get Relief from Medicare Value-Based Programs?

This article originally appeared in the April 2020 edition of Accountable Care News . COVID-19 continues its inexorable, exponential spread here in the U.S. Hospitals in New York City, now accounting for more than 7 percent of confirmed cases worldwide, have less than a quarter of the critical equipment and supplies needed to serve an overwhelming surge of patients. Our health care providers are facing impossible choices, even considering universal Do Not Resuscitate orders for patients with COVID-19. Less than one month ago, CMS was closing applications from providers willing to be part of a major movement to adopt financial…
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Theresa Hush 0
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Future of Health CareRiskValue-Based Health Care
March 11, 2020

Value-Based Care Defined: Know the Vocabulary of Health Care Reform

Today, as we confront a viral threat that is challenging our health system, its capacity, and how care is financed, it seems appropriate to review some fundamentals. Health care reform has been speeding down a particular track, changing how health care is covered, paid, delivered, and organized. These reforms may seem to be about health care financing, but will make a future difference in health care access and patient outcomes. Medicare is driving the train with its huge budget and rulemaking capabilities. But insurance companies, in lockstep, are rapidly implementing similar changes. Understanding all those changes is no easy task.…
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Theresa Hush 0
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ACOsDirect ContractingFuture of Health CareValue-Based Health Care
February 27, 2020

ACO Path to Viability: Direct Contracting May Be the Opportunity

What if your best route to viability was the high-risk path you feared the most, because that failure might destroy you? That's the question Accountable Care Organizations (ACOs) have been asking this week—whether to participate in Medicare's new Direct Contracting (DC) initiative. With a shift in payments from Fee for Service (paid per-provider service), to Global Capitation (paid per-beneficiary), DC completely changes the incentives for the health care system. Whether Direct Contracting is a boon or a bust to ACOs depends on their ability to control the costs of patient care long-term—and whether they have the leverage to do so.…
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Thomas Dent, M.D. 0
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Artificial IntelligenceFuture of Health CarePopulation HealthValue-Based Health Care
February 5, 2020

How AI Can Engage Consumers to Reduce Disease Risk: The Case of Atrial Fibrillation

In our last article, we assessed how AI could be used to achieve clinical success for individual conditions, and to apply the technology to broad cost reduction efforts and population health interventions. But here's the real test: Can we effectively apply AI technology to help patients better engage in lifestyle risk reduction—particularly for specific conditions at higher risk? To examine the feasibility and issues, let’s take a closer look at Atrial Fibrillation (AFib), an increasingly common and expensive condition. In AFib, the upper part of the heart (the atrium) has ineffectual contraction, causing sludging of the blood and lessened cardiac…
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Theresa Hush 0
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Artificial IntelligenceFuture of Health CareRiskValue-Based Health Care
January 29, 2020

Can Artificial Intelligence and Machine Learning Reduce Health Care Costs?

All the experts’ 2020 health care technology predictions have one trend in common—more Artificial Intelligence. AI and its subset Machine Learning are tagged as the winning ticket to advances not only in clinical medicine and research, but also in administration and management. The hype promotes so many potential applications for AI that it begs for an answer to one of its key claims: Can AI reduce health care costs? I'm referring particularly to Artificial Intelligence that is beyond clinical medicine and new medical technology. AI focused on clinical medicine, from genomics to the latest radiology and cardiology diagnostic capabilities, uses…
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Theresa Hush 0
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Future of Health CareRiskValue-Based Health Care
January 22, 2020

Can Hospitals Still Lead Health Care Under Risk?

As the millennium's third decade begins, Risk has taken hold as THE strategy for tackling health care costs. Virtually overnight (in health care years) the industry has moved—albeit not uniformly—to accept Risk. This transition is already beginning to impact hospitals and hospital-based systems, and raises serious questions about the viability of their role as the primary financial engine bankrolling health care operations, reforms and modernization. Just one year ago, the concept of provider risk in Accountable Care Organizations (ACOs) was anathema to most participants. Despite initial misgivings, however, most ACOs remained in the system after CMS pushed forward with its…
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