In the ongoing transition to value-based care (VBC), provider contracting poses challenges for health plans and providers. In my past role as the VP of Quality at a large health plan, I was part of the team that reviewed provider contracts that included risk around quality. Adding my role to the review process reduced the frustration of the Network and Quality teams because I could identify the reporting requirements that the health plan couldn't meet and create alignment with measure
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ACO | Accountable Care Organization | Policy, News, Analysis, Insights - HIT Consultant
Medical Home Network Expands Value-Based Care Reach with 64 FQHCs in New ACOs
What You Should Know: - Medical Home Network (MHN), a leader in transforming care in the safety net, announced today its partnership with 64 federally qualified health centers (FQHCs) across seven states. These FQHCs will participate in two key CMS value-based care programs: ACO REACH and MSSP (Medicare Shared Savings Program). - This expansion comes on the heels of an impressive achievement by existing MHN partners: $10.1M in gross savings and a perfect quality score in the 2022
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Ohio State & CVS Form ACO to Elevate Medicare Care in Central Ohio
What You Should Know: The Ohio State University Wexner Medical Center and CVS Accountable Care, part of CVS Health® (NYSE: CVS), today announced the creation of an accountable care organization (ACO) to improve the quality of care for Medicare beneficiaries by Ohio State providers in central Ohio.This coordinated approach to delivering care is centered around each patient’s unique needs and emphasizes preventive wellness and proactive treatment of chronic conditions. CVS ACO and
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FQHCs Shine in Value-Based Care: MHN Partners Achieve $10M Savings and Perfect Quality Score
What You Should Know: - Medical Home Network (MHN), a leading care enablement partner for FQHCs, announced that its partners participating in the NeueHealth Premier ACO achieved $10.1 million in gross savings and a perfect 100% quality score in the 2022 performance year. - This accomplishment, under the ACO Realizing Equity, Access, and Community Health (REACH) Model, involved 20 FQHCs across Ohio, Missouri, and Illinois serving approximately 10,000 Medicare beneficiaries. The success
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Clover Health Exits CMS ACO REACH Program to Focus on Medicare Advantage
What You Should Know: - Clover Health, a physician enablement company committed to bringing access to great healthcare to everyone on Medicare announced that it has delivered notice to the Centers for Medicare and Medicaid Services (“CMS”) that it will exit the CMS ACO REACH Program at the end of the 2023 performance year. - Written notification will also be sent to all participating physicians in accordance with CMS requirements. - The decision will have no impact on its ACO REACH
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NextGen’s Value-Based Care Solutions Unlocks $82M in Medicare Savings
What You Should Know: NextGen Healthcare, Inc. a leading provider of innovative, cloud-based healthcare technology solutions, today announced that its clients participating in the Medicare Shared Savings Program (MSSP) leveraged NextGen® Population Health to achieve a cumulative $82 million in total Medicare savings last year.The MSSP incentivizes hospitals, associations of physicians, and other healthcare facilities to form accountable care organizations (ACOs) that
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NorthShore – Edward-Elmhurst Health Signs Largest VBC Deal in 5 Years
What You Should Know: - Edward-Elmhurst Health (NS-EEH) has announced a significant, long-term partnership with Lumeris, a pioneer in value-based care (VBC). This partnership is a major development in the healthcare industry, representing the largest VBC provider deal since 2018. - With rising expenses outpacing reimbursement rates, health systems and physician organizations are increasingly turning to value-based care to avoid layoffs and service cuts. NS-EEH, the third largest healthcare
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Chatbot Care Managers? Why ACOs Should Be Cautious in AI Adoption
Given Artificial Intelligence’s potential to improve patient care and reduce costs, it’s no surprise that AI applications are gaining momentum in health care. As your organization explores the benefits of AI in your journey towards Value-Based Care, however, you need to carefully assess the implications, for better and worse. Evaluating AI implications can be tricky. Healthcare AI varies widely, with clinical technology paving the way for advancements in diagnostics and treatment. But
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Chatbot Care Managers? ACOs Should Be Cautious in AI Adoption
Given Artificial Intelligence’s potential to improve patient care and reduce costs, it’s no surprise that AI applications are gaining momentum in health care. As your organization explores the benefits of AI in your journey towards Value-Based Care, however, you need to carefully assess the implications, for better and worse. Evaluating AI implications can be tricky. Healthcare AI varies widely, with clinical technology paving the way for advancements in diagnostics and treatment. But
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What VBC Providers Demand From Their IT Solutions
Value-based care (VBC) is a healthcare delivery model that differs from traditional fee-for-service because rather than compensating providers based on the number of services provided, it ties the amount providers earn to the results they deliver for their patients. The quality of these healthcare services is measured by patient outcomes that are based on metrics such as rate of hospital readmission, timeliness of care, and overall patient satisfaction. This VBC model holds providers
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