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Resources to Drive Performance and Profitability:

Readmission Insights Tied To Patient’s Socio-Demographic Status

Many post-acute care organizations are asking CMS to account for differences in patient populations. CMS is shaping a framework intended to allow better comparisons of post-acute care provided in four different settings. A roughly $60 billion annual expense for Medicare, the field involves the work...

Care Coordination High Priority For Bundled Payment Models

The Centers for Medicare & Medicaid Services recently proposed a new payment model that would bundle payment to acute care hospitals for heart attack and cardiac bypass surgery services. In 2014, more than 200,000 Medicare beneficiaries were hospitalized for heart attack treatment or underwent...

Home-Based Medical Care: The Top Six Types Of Providers

The top six types of providers who provided home-based medical care (non-podiatry) in both 2012 and 2013 were physicians in internal medicine, family practice, geriatric medicine, or general practice; nurse practitioners; and physician assistants – providers we termed primary care providers.

Seven Key Things You Should Know About the MACRA

MACRA is a transformative law that builds a new, fast-speed highway to take the health care system away from the fee-for-service system and toward new risk-bearing, coordinated care models. “Once the program is up and running, physicians can pick one of two routes that will determine how they...

Physician Transformation Models – What Are MIPS and APMs?

CMS released the first major regulation under MACRA, setting forth the new rules under this game-changing law. For now, only physician offices – not hospitals – are governed by MACRA rules. CMS published a rule on Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models...

Readmission Risks After Surgical Procedures

Older adults are at increased risk for adverse events after surgical procedures. Loss of independence (LOI), defined as a decline in function or mobility, increased care needs at home, or discharge to a non-home destination, is an important patient-centered outcome measure. “Readmission...

Largest Value-Based Comprehensive Primary Care Model Launched

Comprehensive Primary Care Plus (CPC+) is a national advanced primary care medical home model that aims to strengthen primary care through a regionally-based multi-payer payment reform and care delivery transformation. CPC+ will include two primary care practice tracks with incrementally advanced...

Champions of Change: Primary Care Caring for Older Adults

We share a case study on caring for older adults in a value-based model. Key takeaways from the perspective of primary care office help stakeholders to better understand care management population health models. Based in Chicago, Oak Street Health provides value-based primary care exclusively to...

ACOs: Lowering Medicare Spending Per Beneficiary for High-Need Patients

A study by Dartmouth Institute For Policy and Clinical Practice finds coordinated care for patients with complex needs a big winner for ACOs. Currently there are now over 700 Accountable Care Organizations (ACO) in place across the country, covering 23 million Americans and making them one of the...

MedPAC: Unified Post-Acute Payment Within Reach

“The PPS prototype that the Commission developed accurately predicts resource needs for nearly all patient groups, indicating that it can be used to set fair and accurate payments,” MedPAC adds in a News Release with the June 15 report which addresses issues affecting the Medicare program as well...

Palliative Care Oncology Guidelines

A new guidance statement to define high-quality primary palliative care delivery in medical oncology has been developed by the American Society of Clinical Oncology (ASCO) and the American Academy of Hospice and Palliative Medicine (AAHPM). The two organizations have partnered to develop these...

Palliative Care and Cancer Insights

Despite recommendations to the contrary, only about half of elderly patients with advanced cancer receive palliative care, according to new findings. Many of the patients who do receive it late in the course of their disease, as opposed to immediately after diagnosis, which is recommended in...

Medicare Advantage Beneficiaries Have Fewer Readmissions

Greater use of Medicare Advantage (MA) over traditional fee-for-service Medicare (TM) in certain populations, and even across small areas, has been associated with fewer overall hospitalizations and avoidable hospitalizations. Proponents attribute these associations to successful care...

MACRA’s Quality Measure Development Plan (MDP)

CMS will collaborate with a broad group of stakeholder organizations and persons to develop measures that are important to both patients and clinicians and that represent important performance gaps in the targeted quality domains. MACRA identifies five quality domains: clinical...

Medicare Population Characteristics

In 2011, two-thirds of beneficiaries (66%) had three or more chronic conditions, more than one quarter of all beneficiaries (27%) reported being in fair or poor health, and just over 3 in 10 (31%) had a cognitive or mental impairment. (Figure1). Nearly one in six beneficiaries (17%) were under age...

Hospice Quality Of Care Varies

In a large cohort study published in JAMA Internal Medicine, hospice visits in the last 2 days of life by professional staff varied by race, hospice program, and geographic region, with visits less likely if the patient was black, dying on a Sunday, or receiving care in a nursing home. These...

Palliative Care and Payor Value-Based Contracting

Payors are supporting palliative care through value-based contacts. Highmark is a regional payer organization that serves members throughout Pennsylvania, Delaware and West Virginia. It offers unique palliative care services to its Medicare Advantage members and supports hospital palliative...

Physician Leadership: Why Post-Acute Integration Matters

Brian D. Amdahl, MD, FCCP, MMM, is Executive Medical Director, VP for Post-Acute Services at HealthEast Care System, St. Paul, MN. This medical leadership role includes oversight for Bethesda Hospital, Home Care, LTACH, Hospice/Palliative Care, SNF/TCU, Community Care Management, and Medical Care...

EHRs Get Medicaid Funding

CMS announces an initiative to bring interoperable technology to a broader universe of health care providers, including long-term care, behavioral health providers, substance abuse treatment centers, and other providers that have been slower to adopt technology. The announcement will help to...

Aetna’s Compassionate Care Program for Advanced Illness

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 44 million people with information and resources to help them make better decisions about their health care. Their goal is to build a simpler, more integrated health care system that makes the...

Montefiore Health System’s Care Management Program

Located in the Bronx and Hudson Valley, New York, Montefiore Health System (MHS) serves one of the poorest and most disproportionately disease-burdened counties in the nation with nearly 80% of the payer mix from Medicare and Medicaid. The integrated delivery system includes 10 hospitals and...

Nine Building Blocks of Care Management

Successful care coordination programs employ a variety of tools to improve quality of care and reduce costs. To be effective, these programs must be flexible in design, implementation, and evaluation, rely on robust data sharing, incorporate patient engagement, and adapt to local needs. In...

Quality Measures Development The IMPACT Act

Congressional approval of H.R. 4994, the IMPACT Act in October 2014, mandates the development and implementation of a standardized post-acute care assessment tool, and paves the way for effective payment reforms. The IMPACT Act: What’s Ahead  Preventable Readmission Measures CMS has...

Case Study: A Comprehensive Care Management Model: Case Study

The FirstHealth Care Management Model FirstHealth of the Carolinas, a comprehensive rural health care system based in Pinehurst, North Carolina, has developed an innovative care delivery model to ef­fectively manage high-risk patients with chronic disease. This model, referred to as the...

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