Roji Intel Blog

Theresa Hush 0
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Consumers & PatientsFuture of Health CareMedical Decision-MakingValue-Based Health Care
January 15, 2020

Can Consumers Be the Answer to Health Care Cost Control?

In the intense ramp-up to accepting Value-Based Health Care payment models that include financial risk, providers have implemented an array of technologies and programs to improve cost performance. They are in a race against time. Capitation is re-emerging as a dominant payment type under Medicare Value-Based Primary Care Models and commercial contracts. Alternative Payment Models demand payback for excess costs. In the crunch, however, the most important health care goal is getting lost: how to reduce long-term costs while improving patient outcomes. The most effective solutions will require more than just technology. They will require provider-consumer partnering, facilitated by consumer-focused…
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Theresa Hush 0
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Consumers & PatientsFuture of Health CareValue-Based Health Care
January 9, 2020

Get the eBook: Turn Health Care Chaos into Value – Give Voice to Providers and Consumers

Are we on a real path to reducing health care costs and improving our citizens' health? Those were stated goals in the early 2000s that developed into what is now called Value-Based Health Care (VBHC). VBHC has come to mean a major reform effort to slow the pace of cost increases through changes in incentives for both providers and health care consumers. So far, however, the gains have fallen short of expectations. VBHC reforms require significant changes in the role of providers and consumers in order to succeed. These role changes are evolving too slowly. Health care costs continue to…
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Theresa Hush 0
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Consumers & PatientsFuture of Health CareValue-Based Health Care
December 18, 2019

Bottom Line: Can Consumers Survive Value-Based Health Care?

As 2019 nears its close, health care has reached a crossroads. Value-Based Health Care was intended to clarify consumer choices and motivate providers to offer high value services that improved outcomes, as well as to improve patient access to those services. But has that goal been realized? Has anything really changed? Or are health care consumers even worse off than before? Since September, we've been evaluating the consumer perspective of Value-Based Health Care, examining whether the movement is helping consumers achieve affordability, better choices, and good quality. We’ve focused on two central questions: Is Value on the right track? Has…
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Theresa Hush 0
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Consumers & PatientsFuture of Health CareValue-Based Health Care
November 13, 2019

How to Manage Your Health Care Costs – Beyond Just Coverage Costs and Gaps

Consumers are rapidly becoming aware that costs for health care coverage extend well beyond premiums, copays, and deductibles—costs such as additional charges for out-of-network physicians and facilities. There is also a growing understanding that different providers charge varying costs for services—and that other hidden variables can increase the final bill for treatment. But consumer health care costs are not only a price issue. The cost of health care is the final sum of many decisions that are—at least partly—controllable by consumers or providers. Unfortunately, most consumers don't know all the factors that make up health care costs, and why those…
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Dave Halpert 0
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Alternative Payment Models (APM)Merit-Based Incentive Payment System (MIPS)Quality Payment ProgramValue-Based Health Care
November 6, 2019

The Final 2020 Quality Payment Rule: Playing It Safe with MIPS No Longer Works

The common refrain within the 2475-page Medicare Final Rule for the Physician Fee Schedule and Updates for the Quality Payment Program (QPP) is “we are finalizing our policy as proposed.” This Rule follows the formula CMS adopted in its “Pathways to Success” ACO Rule: Propose a shake-up, reply to concerned commenters, and finalize policy without significant changes. CMS’s desire to move providers into Alternate Payment Models (APMs) comes through loud and clear, both in terms of its vision for MIPS 2.0 and in its more stringent scoring policies. As it stands now, MIPS has not evolved into the program CMS envisioned…
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Theresa Hush 0
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ACOsConsumers & PatientsFuture of Health CareNarrow NetworksValue-Based Health Care
October 30, 2019

Is Patient Lock-In the Next Step in Value-Based Care?

Hoping to safeguard survival under financial risk, health care providers are courting a contentious issue: how patients select primary providers. During the HMO heyday , health care risk economics depended on patient selection of primary providers as part of coverage selection that “locked” them into those PCPs and their referral networks. PCPs operated as gatekeepers to the rest of the health care system, authorizing services (or not) for specialists and other care. It’s well known that the HMO’s Primary Care gatekeeper model generated a backlash among private sector consumers. In fact, the gatekeeper was so unpopular with patients that it…
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Evelyn Herwitz 0
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ACOsAlternative Payment Models (APM)Merit-Based Incentive Payment System (MIPS)Primary Care PracticesValue-Based Health Care
October 23, 2019

Roji News Roundup: Fall 2019 Edition

In a range of recent industry publications, Roji Health Intelligence CEO Terry Hush shares her insights on the latest moves by CMS and health care trends: Are Value-Based Models Helping or Hindering Care Delivery for Primary Care Providers AJMC Managed Markets Network, October 10, 2019 This article by Jaime Rosenberg summarizes Terry’s presentation at the National Managed Care Physicians 2019 Fall Managed Care Forum in Las Vegas. Value-based models continue to enter the health care system, affecting a variety of fields, including primary care. And while success stories have been shared by payers and CMS touts these models as a…
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Theresa Hush 0
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Consumers & PatientsFuture of Health CareValue-Based Health Care
October 16, 2019

The Hedge Bet for Risk is Patient Experience

Creating a good Patient Experience in health care has gained little traction, despite being touted as one of the Triple Aim’s key goals in Value-Based Health Care. Health systems have been more focused on how to increase patients via health plan negotiations and consolidating regional providers, rather than focusing on the slower paced process of improving customer appeal. But now Patient Experience appears to be gaining some attention, and some forward-thinking providers are innovating to be more attractive to patients. Why? Because in the fiscal landscape of Risk, growing patient volume is essential. Providers are beginning to realize that there…
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Thomas Dent, M.D. 0
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ACOsSpecialty PhysiciansSpecialty ServicesValue-Based Health Care
October 9, 2019

How Physicians Can Navigate to Get Better Value from Specialty Services

In recent articles, we’ve discussed how Value-Based Health Care must help consumers make good decisions. Equally as important, CMS is now emphasizing how physicians should serve as navigators for their patients, providing information and guidance. Let’s take a closer look at how the triad of primary care physician, specialist consultant, and patient can effectively engage in a process that improves Value through better outcomes and lower cost. To focus on the shifting role of primary care physicians (PCPs), we use “physician navigation” to describe PCP actions to coordinate care for their patients. To emphasize continuity of care at stake for…
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Theresa Hush 0
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Consumers & PatientsFuture of Health CareMedical Decision-MakingValue-Based Health Care
October 2, 2019

How Consumers Can Choose Quality in Value-Based Health Care

In our last article on how Quality should be reflected in Value-Based Health Care, we looked at the problematic route of quality measurement and reporting. The intent to develop payment for quality has resulted in a complex measurement system that produced provider-specific performance scores across hundreds of measures, yet has failed to advance achievement of better health care outcomes. The system creates flexibility for providers by allowing choice of measures, which eliminates consumers’ ability to see differences among providers. The quality agenda needs to mature. In its developmental period, there was a need to achieve consensus on the standard of…
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