NY Rural Providers Turn Medical Homes into an ACO
What makes this medical home project different from many others around the country is that it is an all-payer pilot. After lengthy negotiations between providers and payers, the health plans agreed to pay the medical homes $7 per member per month to care for some 100,000 patients during the first year.
HFMA Comments on the Proposed Rule on the Medicare Shared Savings Program
HFMA commended CMS for its efforts to modify the Medicare Shared Savings Program (MSSP) to ensure its sustainability. However, HFMA had specific recommendations for improvement.
Determining Your Options: Educating Your Board
It is essential to keep your organization's board of directors up to date on your organization's current situation, capabilities and needs, and potential options for acquisition or affiliation. As you narrow in on the most viable options and partners for your organization, the PowerPoint template tools below outline key elements of your proposed course of action that should be shared with the board. Options are provided for proposals involving both less than fully integrated and fully integrated acquisition and affiliation models. Tool: Educating Your Board: Less than Fully Integrated Models Tool: Educating Your Board: Fully Integrated Models Go to Next Page Home
Medicare Shared Savings Program Proposed Rule Fact Sheet
This fact sheet summarizes proposed changes by CMS that would update policies governing the Medicare Shared Savings Program.
Price Transparency for Health Plans
Because health plans will in most instances have the most accurate data on prices for their members, HFMA’s Price Transparency Task Force recommends that health plans serve as the principal source of price information for their members. Many health plans have already developed or are in the process of developing web-based or telephonic transparency tools for their members. There are also a growing number of independent vendors that use data from health plans and/or employers in web-based tools and telephonic products to inform employees about price.
Accounting for Non-Performance-Related Variation in Shared Savings Contracts
Variation between targeted and actual PMPM costs can be due to numerous factors, including many that have nothing to do with the quality or cost of care provided to ACO members.
Six Ways to Address Non-Performance-Related Variation in ACO Contracts
While not yet a perfect science, payers and providers can begin to address non-performance-related variation in a number of ways.
Value-Based Reimbursement Resource
This too contains useful information on CMS's Value-Based Purchasing Program and other initiatives that will help improve the quality of care in hospitals.
CY15 OPPS Final Rule Fact Sheet
This fact sheet highlights payment rate updates under the OPPS for CY15.
A Closer Look at a Health System’s Strategic Options
An example of the evolving physician strategy of a health system with a clinically integrated network is shown below: Manage the mix of independent and employed relationships. Rationale: The right mix varies depending on the hospital, market and service, even within a highly aligned, integrated system. Failure to balance and coordinate incentive structures and approaches between independent and employed physicians is a threat to the system. Create financial and non-financial incentives for independent and employed practices to reduce leakage out of the system. Rationale: Keep all elements of the CIN moving forward at roughly the same pace with respect to the journey from fee-for-service to value-based payment. Accept specialty facilities and specialists back into the system. Rationale: It is becoming less attractive for specialty centers to remain independent, and it behooves the system to work out a path for them to move from competitor to ally. Some of these specialists are particularly good, and the system does not want them going to a competitor. Also, since the system’s payments are still significantly fee-for-service, these specialists create profits that can be re-directed to strengthen the financial base. Use changes in physician relationships to manage the physician/patient ratio. Rationale: The greatest cause of “excessive” investments in employed physician practices is a shortage of patients per physician. For example, some employed physicians place restrictions on their schedules that hinder filling them with patients. Also some employed specialists have too few patients because they don’t have enough referrals from independent physicians in their service area. Continue to adjust employed physicians’ compensation packages as the ratio of value-based to fee-for-service revenues changes. Rationale: Relying on leadership is not enough; compensation has to remain aligned.