What Motivates ACOs to Make Home Visits?
March/April 2023 Issue
SUBSCRIBER CONTENT Learn the seven reasons why ACOs use home care and what’s behind the motivation.
Senior Care Profiles
March/April 2023 Issue
SUBSCRIBER CONTENT The profile of seniors is changing according to the Administration on Aging. Get the latest information.
Why Collaboration Across the Care Continuum Improves ACO Patient Experience
March/April 2023 Issue
SUBSCRIBER CONTENT A study out of the Ohio State University Fisher College of Business explores factors that can help ACOs deliver more efficient and effective health care, by how much and the costs associated with these improvements.
5 Trends and Policies Impacting Social Determinants and Outcomes
The focus on social determinants of health in 2023 is uniting payers and providers to increase their efforts to find solutions and improve outcomes. Driven by policy and payments, change is coming.
5 Changes to Social Determinants of Health Quality Measures Across the Continuum 2023
January/February 2023 Issue
SUBSCRIBER CONTENT New social determinants of health (SDOH) quality measures will be required by hospitals, health plans, and multi-payer federal and state programs. We provide details on how each healthcare sector will be incorporating SDOH quality measures.
Trends Driving Home-Based Care’s Contracting Options with Medicare Advantage Plans
January/February 2023 Issue
SUBSCRIBER CONTENT Home care is big business for payers. No better industry is more aligned with payer goals than home-based care. We address six strategies to evaluate contracting with Medicare Advantage plans.
5 Ways Health Equity is Advancing in Medicare Models
January/February 2023 Issue
SUBSCRIBER CONTENT In this article, we explore the models of care advancing health equity and the closer connection to value-based care.
Electronic Visit Verification Systems Required January 1, 2023
January/February 2023 Issue
SUBSCRIBER CONTENT Medicaid-funded personal care services and home healthcare services will need to be fully compliant with their state’s electronic visit verification systems by January 1, 2023. We review the oversight and details.
9 Key Trends: How CMS is Aligning Value-Based Arrangements Across Traditional Medicare Programs
January/February 2023 Issue
SUBSCRIBER CONTENT CMS has indicated that the agency intends for anyone with Medicare coverage to be under a value-based payment arrangement by 2030. Learn which fee-for-service programs are advancing value-based care.
Do You Know Which Principal Diagnosis Has the Highest Rate of 30-Day Readmissions?
As a home-based care provider, all referral partners have the same goal – how to reduce readmissions and the cost. It’s important to continue to hone in on data that can help your organization better understand your role in preventing readmissions and reducing the cost of care.
Clinical Service Lines that Reduce the Cost of the Top 5 Medical Conditions
New information will help your organization better align clinical services to reduce the cost of the highest medical conditions and their expenditures. The data can be used in conversations with various payer sources to align your organization’s services to reduce the cost of care and readmissions.
Care Transitions Intervention Model to Manage Social Determinants of Health
November-December 2022 Issue
SUBSCRIBER CONTENT The focus on social determinants of health is a hot topic in healthcare. Multidisciplinary teams and a care transition model in the case study resulted in reduced readmissions and improved outcomes. The model is scalable and a win-win for healthcare and the patient.
2023 Providers are Responsible for Social Determinants of Health Quality Measures
Research shows that social determinants can be more important than health care or lifestyle choices in influencing health. Numerous studies suggest that SDOH account for between 30-55% of health outcomes.
What are the Highest Chronic Care Conditions in Medicare, Medicare Advantage Plans, and Special Needs Plans?
Payers are developing care models specific to the level of need. There is not a one-size-fits-all care-management strategy. Payers tend to categorize medical conditions by risk.
Trend #1: Payers Are Accelerating Into the Home-Based Care Market
July/August 2022 Issue
SUBSCRIBER CONTENT How should your organization be responding to payers expanding their position in home-based care? What key trends support this advancement? What are key strategies to partner and align with payers? In this article, we cover the key market changes, the disruption, and growth opportunities for home-based care organizations.
Trend #2: Payers Expanding Home-Based Care Models Nationally
July/August 2022 Issue
SUBSCRIBER CONTENT Payers are deepening their care delivery models focused on the home. In the past, we may have thought of payers in traditional roles as a medical-cost manager. Today, they are acquiring home-based care organizations to control readmissions, cost, and outcomes.
Trend #3: Highest Chronic Care Conditions in Medicare, Medicare Advantage Plans, And Special Needs Plans
July/August 2022 Issue
SUBSCRIBER CONTENT Different payers such as Medicare, Medicare Advantage, and Special Needs Plans are focusing on the highest chronic care conditions to reduce the cost of care. In this article, is the data by payer and a discussion about how organizations can support a better aligned financial and quality partnerships.
Trend #4: Growth in Medicare Advantage Plans 2022 Signals Future in Managed Care Contracting
July/August 2022 Issue
SUBSCRIBER CONTENT Medicare Advantage enrollment is growing at a fast pace. The number of plans is expanding geographically, and payers will continue to invest in the Medicare Advantage market. In this article, we dig deep into the growth of Medicare Advantage by enrollment, states, and the future. The market signal is strong to put Medicare Advantage contracting as a high priority.
Trend #5: Payer and Home-Based Provider Partnering to Reduce the Cost of Care
July/August 2022 Issue
SUBSCRIBER CONTENT Important to all payers is the value your organization brings to reducing the cost of care. Available data can gear-up your partnership value quickly. In this article, we sliced and diced data to provide an overall macro/micro picture of how to reduce the cost of care.
ACOs Perspective About Home-Based Care
A recent study in the Journal of Managed Care was an eye-opener when it comes to better understanding home-based care from an ACO perspective.
OIG Report: Medicare Payments of $6.6 Billion Provided to Medicare Beneficiaries Outside the Medicare Hospice Benefit
Analysis of trends and payment patterns indicate non-hospice payments for Medicare Part A and B items and services totaled $6.6 billion from 2010 through 2019.
DataPoint: Readmissions By Payer
March/April 2022 Issue
FREE CONTENT Data Sharing: Number of readmissions, readmission rates, and average cost of readmissions
Is Socioeconomics a Main Influencer of Readmissions?
March/April 2022 Issue
SUBSCRIBER CONTENT Researchers examined the common reasons why some hospitals have more readmissions treating a disproportionate share of patients with low incomes, poor health and other negative circumstances.
Hospital Readmissions, Ages 65-74, by State
March/April 2022 Issue
FREE CONTENT Percentage of Medicare aged 66-74 enrolled in Medicare fee-for-service within 30-days of hospital discharge.
Medicare Advantage: 5 Care-At-Home Supplemental Benefits Skyrocket in 2022
January/February 2022 Issue
SUBSCRIBER CONTENT CMS’s reinterpretation of “primarily health-related” benefits has led to more Medicare Advantage (MA) plans offering services.
7 Trends Changing Medicare Advantage Plans In 2022
January/February 2022 Issue
SUBSCRIBER CONTENT CMS projects that nearly 30 million people are signing up for MA in 2022. Here are seven trends to watch for.
5 Things to Know About Hospice Benefits 2022
January/February 2022 Issue
SUBSCRIBER CONTENT CMS is testing a broad array of complementary MA health plan innovations designed to reduce Medicare program expenditures, enhance the quality of care for Medicare beneficiaries
Diabetes Rehospitalizations Tied to Timing of Home Healthcare Services
November-December 2021 Issue
SUBSCRIBER CONTENT Learn the association between the timing of home healthcare start of care and 30-day rehospitalization outcomes for Medicare beneficiaries following a diabetes-related hospitalization.
Study: 61% of Seniors will Require Long-Term Care Services and Supports
November-December 2021 Issue
SUBSCRIBER CONTENT This study provides insight into the long-term care services and support needs of seniors that help shape the future.
Four Key Trends Impacting Chronic Care Management, Physician Practices, and Payers
July/August 2021 Issue
SUBSCRIBER CONTENT Four significant trends are impacting chronic care management and the future of physician groups and payers. Moving forward this can change your referral growth and the need to expand your managed care contracts.
Five Payer Strategies Ramping-up Home Care Usage
July/August 2021 Issue
SUBSCRIBER CONTENT Payers are targeting their member populations that will benefit the most from at-home care. The center of their home health offerings is focused on high-cost patients, palliative care, diabetes, home care visits, telehealth, and at-home testing.
Administering Specialty Drugs at Home
July/August 2021 Issue
SUBSCRIBER CONTENT A recent study found receiving certain forms of care at home instead of in the hospital can lower healthcare spending. Administering specialty drugs at home or in a provider’s office lowered healthcare spending by $4 billion.
Nine Payer and State Medicaid Managed Care Investments in Social Determinants
July/August 2021 Issue
FREE CONTENT In this article, we take a look at social determinant insights and investments from the perspective of Medicare Advantage plans, Medicaid managed care and healthcare providers.
Does Your Organization Have the Right Clinical Service Lines to Reduce the Cost of the Top Five Medical Conditions and Expenditures?
March/April 2021 Issue
New information will help your organization better align clinical services to reduce the cost of the highest medical conditions and their expenditures. The data can be used in conversations with various payer sources to align your organization’s services to reduce the cost of care and readmissions.
How to Accelerate Business Growth and Technology Innovation for Home Health, Hospice, Palliative Care, and Private Duty Providers
March/April 2021 Issue
National leaders discuss how to lean into new approaches to accelerate growth, improve performance, and address technologies that create faster reimbursement, better work-life balance for clinicians, and optimal patient outcomes.
7 Models That Will Accelerate Value Based Payments in 2021
This year, several value-based payment models will begin the shift from fee for service to value-based. Earmark this as the transformation of payment reform for care-at-home providers and how they will be paid in the future. This white paper explains the seven value-based models impacting care-at-home providers.
Should Your Organization Be Preparing for Greater Value-Based Payments?
January/February 2021 Issue
Beginning in 2021, several value-based payment models will begin the shift from fee-for-service to value-based. Earmark this as the transformation of payment reform for care at home providers and how they will be paid in the future.
2021 Regional Outcomes for Medicare Require Full Financial Risk
January/February 2021 Issue
Geographic direct-contracting model (GEO) is the latest CMS Center for Medicare and Medicaid Innovation (CMMI) model which allows Direct Contracting Entities to accept full financial risk for all traditional Medicare enrollees in their region. Three options enhance Medicare benefits and provide waivers for care in the home.
DATA POINT: 2021 Medicare Advantage Membership Growth Continues to Outpace Medicare Fee-For-Service Growth
January/February 2021 Issue
Medicare Advantage growth continues to outpace overall Medicare FFS membership growth, according to the latest statistics.
2021 Payer Opportunities Collection
Your organization has new opportunities to grow and expand payer partnerships. A one-size-fits-all approach no longer exists, which is why we have bundled four articles from the Nov-Dec 2020 issue of The Remington Report into this complimentary compendium. Read about how to expand internal and external education, leverage critical investments in your workforce, and enhance actionable data needed by payers.
Payers Expanding Care at Home Models
November-December 2020 Issue
Building home care capacity will give plans more flexibility to meet patients on their own terms and could improve outcomes. Learn what is changing models of care in the home.
State Medicaid Programs are Expanding Value-Based Payments
November-December 2020 Issue
States are developing plans to increase Medicaid provider participation in and adoption of value-based care models. How will these new payment models work?
Medicare Advantage Plans Expand Supplemental Benefits
November-December 2020 Issue
Medicare Advantage Plans are expanding supplemental benefits in 2021. Learn what services are expanding and how this expands your partnerships.
Medicaid Managed Care are Linking Bonus Programs Tied to Performance
November-December 2020 Issue
States are expanding value-based payments (VBP) in Medicaid and leveraging their Medicaid managed care programs to advance their payment reform goals. We discuss the details.
New Care Models Allow Payers to Take on Risk for Dual-Eligible Beneficiaries
November-December 2020 Issue
CMS' innovation center (CMMI) is about to roll out a new model allowing insurance plans to take on financial risk for patients enrolled in both Medicare and Medicaid. How will this affect payers? What other new models can you expect in the future?
The Vulnerabilities of COVID-19 Expand Insurers Capabilities In the Home
September/October 2020 Issue
Insurers' strategies to provide greater services in the home are moving rapidly. Changing models have insurers partnering-up with primary care physicians, telehealth, and pharmacies to deliver care in the home. We provide insights to insurers' reactions post COVID-19 and beyond.
Stronger Strategic Partnerships: Data Exchange is a Driving Factor
September/October 2020 Issue
Payers are interested in talking about the data. In particular, they are interested in understanding how home care providers are able to reduce their penalties and increase their rewards in a value-based payment system. Learn how one organization is advancing conversations.
Strategy Insight: How To Align Financial and Clinical Incentives with Payers and the Most Costliest Medical Conditions
In this article, we take a look at data reflecting the costliest medical conditions by payers. This becomes an important strategy as payers begin to move more value-based care contracting into the home care space and look to treating higher acuity patients in the home.
DataPoint: Medicare Advantage Penetration Reaches 36% in 2020
July/August 2020 Issue
Medicare Advantage penetration continued to grow following the 2020 Medicare Annual Election Period, reaching 36.0% in 2020, according to CMS’s March data release.
COVID-19 Medicare Emergency Waivers For Discharge Planning And Home Care Providers
July/August 2020 Issue
CMS has provided blanket waivers with a retroactive effective date of March 1, 2020 through the end of the emergency declaration to help providers during COVID-19. We gathered the waivers for discharge planning, in-home care providers, and other post-acute care settings.
Seniors Using Telehealth in Medicare Advantage Plans are Highly Satisfied
July/August 2020 Issue
Amid COVID-19 pandemic, 91% of Medicare Advantage beneficiaries using telehealth report favorable experiences while a record-setting 99% express satisfaction with their MA plan. 78% are willing to use it again.
Payers: 2020 Supplemental Benefits for Chronic Conditions Doubled
In 2020, Medicare Advantage (MA) plans have doubled the number of condition-specific supplemental benefits from approximately 820 to 1,850. However, the new Special Supplemental Benefits for the Chronically Ill (SBBCI) for 2020 didn’t fare as well.
COVID-19 Healthcare Workforce and Revenue Reductions: Aides and Personal Care Workforce
3.5 million low-wage workers are in the health and social services industry, with the greatest number of those (1.3 million) working as aides or personal care workers
Payment Recommendations for 2021
In its March 2020 report to the Congress, MedPAC makes payment policy recommendations for provider sectors in fee-for-service (FFS).
Report: Medicare’s Hospital Post-Acute Care Transfer Policy to Hospice
The Bipartisan Act (BBA) of 2018 Act updated the hospital transfer policy for early discharges to hospice care. The law required that, beginning in FY 2019, discharges to hospice care would qualify as a post-acute care transfer and be subject to payment adjustments.
Payers Advancing Knee Replacement Care Into the Home
Aggressive moves by payers teaming up with big players such as CVS are advancing their healthcare programs into the home. How does this impact healthcare organizations?
Case Study: Payer and Provider Model: Managing Higher Acuity in the Home
Landmark estimates about 20 percent of chronically ill patients currently experience a gap in the care they are receiving, which can be addressed through medical care, support and education provided in the home.
Medicare’s Option to Avoid the Emergency Department
The Center for Medicare and Medicaid Innovation’s Emergency Triage, Treat, and Transport (ET3) Model is designed to test expanded care destination alternatives to the ED for Medicare beneficiaries who call 911.
CMS Is Rolling Out Community Care Corps: Volunteer Caregivers
How can providers offer support for caregivers? A key way for providers to assist may be to collaborate with charitable organizations in the community.
Medicare Advantage Plans Proposed Rules 2021-2022 Changes Care Management Requirements
Medicare Advantage and Part D programs for contract years 2021 and 2022 has provisions changing care management requirements for special needs plans.
End-Stage Renal Disease Beneficiaries Can Enroll in Medicare Advantage Plans
In a proposed rule issued on February 5, CMS announced that beneficiaries with ESRD will be able to enroll in Medicare Advantage Plans starting in 2021.
Medicare Advantage Plans Expanding Telehealth Usage
CMS issued a proposed rule and the Advance Notice Part II to further strengthen and modernize the Medicare Advantage and Part D prescription drug programs.
2020 Senior Living Communities Are Aligning with Medicare Advantage Plans to Address High-Cost, High-Need Patients
An integrated program of services can contribute to reducing the cost of care and services to Medicare beneficiaries residing in seniors housing.
2020 New Models For Chronic Care Management In The Home
The tides are shifting the expectations of home care. Pressure from reimbursement, shifting payment models, and value-based care are driving the change.
Prior Authorizations: The Saga Continues For Providers
Starting November 1, UnitedHealthcare will not pay for unplanned surgeries in an outpatient setting unless it determines the site is medically necessary.
Medicare Advantage Plans: 11 Major Changes In 2020
Private Medicare plans will soon include expanded plan options for seniors, more telehealth, and innovative plan designs and payment models.
Medicare Advantage Plans Add New Risk Codes For Dementia
Medicare Advantage (MA) Plans are adding two new dementia codes in their risk adjustment payment system and expanding flexibility in the MA benefit design.
Post-Acute Unified Value-Based Incentive Program: 5% Withhold Recommended
A unified value-based incentive program for SNFs, home health services, inpatient rehabilitation facilities, and long-term care hospitals is recommended.
Care Management Challenges and Barriers for High-Cost Medicaid Beneficiaries
A GAO report explored the efforts to manage high-expenditure beneficiaries, which are 5% of all Medicaid beneficiaries but nearly half of all expenditures.
Five Payer and Provider Strategies Changing the Status Quo
Payers and providers are redefining and rethinking how new models of care can move the needle toward value-based care.
Managed Care Organization and Visiting Nurse Association’s Elderly Heart Failure Program – A Pilot Study
SUBSCRIBER CONTENT Kaiser Permanente Colorado and VNA-Denver jointly offer intense, consistent education to elderly heart failure patients discharged from the hospital.
Payer and Physician Models for Chronic Care Management
SUBSCRIBER CONTENT Fragmentation of the care delivery system is widely recognized as a cause of missed opportunities to treat both acute and chronic conditions.
Medicare Advantage vs. Medicare Fee-for-Service Longitudinal Site of Death Study
People who are continuously enrolled in Medicare Advantage are less likely to die in a hospital than those continuously enrolled in Medicare fee-for-service.
Examples of Payer Value-Based Incentives with Providers
SUBSCRIBER CONTENT A recent filing by Humana indicates the insurer is instituting a new bonus plan that is not just tied to financial performance, but also to health outcomes.
Care Coordination High Priority for Bundled Payment Models
CMS recently proposed a new payment model that would bundle payment to acute care hospitals for heart attack and cardiac bypass surgery services.
Payers Expanding Into Palliative Care
Payers and Alternative Payment Models (APMs) are turning to palliative care programs as a way to offer value-based end-of-life care.
What Happens to Medicare Costs When Beneficiaries Do Not Receive Help With Daily Activities?
One of five people with self-care disabilities reported negative consequences from not having help with activities they had trouble performing on their own.
Medicaid and Medicaid Managed Care Models Prepare for Value-Based Models
Medicaid’s reform will lead to greater care coordination, a focus on reducing costs and more possibilities of risk and preferred provider networks.
Aetna’s Compassionate Care Program for Advanced Illness
SUBSCRIBER CONTENT Aetna’s Compassionate Care Program is designed to improve the quality of patient care for individuals with life-threatening illnesses.
Medicaid ACO Market Scan
17 states are implementing accountable care strategies in Medicaid or state employee health programs and patterns have begun to emerge.
How Bundled Payments Support the Move to Value-Based Models
Early evidence suggests that, under episode-based incentives, clinicians and organizations can improve the value of care for certain episodes.
The ACO Medicare-Medicaid Model for Managing High-Risk Patients
The ACO Medicare-Medicaid Model is focused on improving quality of care, improved care coordination, and reducing costs for Medicare-Medicaid enrollees.
Medicare Advantage Beneficiaries Have Fewer Readmissions
Greater use of Medicare Advantage over traditional fee-for-service Medicare has been associated with fewer overall hospitalizations.
Telehealth: 5 Things to Know About Payer Reimbursement
Telehealth policy develops much more slowly than the rapidly advancing technology, but incremental changes are taking place.
Readmission Analysis By Payer: 7 & 30 Day By Diagnosis
In 2014, 14% of inpatient stays were readmitted within 30 days. More than one-third of these readmissions occurred within seven days.
How a Payer and In-Home Physician-Led Model Create New Solutions for Complex Care
This issue of FutureFocus highlights the innovation of an in-home, physician-led model working collaboratively with a payer to manage complex care.
