Serving the Value-Based Care Community |
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EHRIntelligence | April 28, 2023
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Many referral decisions for post-acute care hinge on electronic order capability and interoperability, according to a new survey of more than 130 hospital and physician entities. Referrals are a vital part of the US healthcare system, with over a third of patients receiving specialist referrals annually. As such, obtaining a referral is a relatively common occurrence. In fact, a 2018 study conducted by the Institute for Healthcare Improvement and the National Patient Safety Foundation highlighted that close to 100 million subspecialty referral requests are generated each year from outpatient centers alone. Given this high volume of subspecialty referrals, experts have stated it is essential to ensure that patient records can be quickly shared to facilitate easier communication between primary caregivers and specialists.
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On March 31, 2023, Centers for Medicare and Medicaid Services (CMS) released the annual 2024 Medicare Advantage and Part D Rate Announcement (Rate Notice), which is the final guidance on rates for Medicare Advantage in 2024. As we explained in our prior blog posts, one of the more substantial changes proposed for Medicare Advantage in 2024 is in the way risk scores are calculated. As a very brief primer, risk scores are one of the key elements for determining how much money a Medicare Advantage payer will receive for a beneficiary. Risk scores reflect both the demographics of the beneficiary in the demographic relative factors and the illness burden of the beneficiary in the disease relative factors.
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Health Affairs | May 3, 2023
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Most agree health disparities are a moral problem. Yet there are disagreements about how to reduce them. Some believe that in health systems, equity and efficiency are incompatible, requiring stark and painful tradeoffs. Others, myself included, believe that achieving equitable health outcomes can, in fact, be accomplished by improving efficiency. The existing structure of the US health system – including how it’s organized and paid for — is designed to increase health gains irrespective of whether those gains are maintained and concentrated in a subset of the overall population – such as the wealthy, for example. Despite the inefficiencies in the system, it was, nevertheless, designed with efficiency in mind. In this case, efficiency serves the production, intentionally or not, of inequitable outcomes. Equity is treated as a complementary rather than central goal of the system.
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All ACOs, regardless of payment model, are built on a vision of primary care services to patients. Medicare attributes patients to your ACO based on the plurality of primary care services. CMS attributes a patient to a participating specialist only if the patient has not seen a primary care physician in the ACO or at other providers, and the specialist is providing “primary care” services to the patient. But the vision of the primary care ACO rarely holds up to reality—for either care delivery or economics. The shortage of primary care physicians, complicated by time constraints, often dictates that patients who could be managed by primaries are referred to specialists. Conversely, complex conditions in patients are often appropriately treated by specialists, not primaries. |
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UPCOMING WEBINARS:
Success Snapshot: How UCSF Health is improving patient outcomes through timely access to high-quality post-acute care
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Topic: Case study of post-acute care at UCSF Health and how it has bridged care gaps, streamlined workflows, and reduced healthcare disparities, leading to improved patient access and outcomes
May 18, 2023 | 1 PM EST
RECORDED WEBINARS:
Access up to $5.6M from CMS to start your ACO Journey (AIP)
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Topic: How to start becoming an ACO, receive investment payments while remaining independent, and be innovative with patient care
Improving Patient Outcomes with Equitable Health Journeys
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Topic: Examining and utilizing data, insights, trends, and techniques for building health equity and improving patient outcomes
Check our our Webinar Archive to view past webinars on a variety of value-based care related topics!
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2023 Pinnacle Best Practices Symposium
May 10 | Virtual
APG Annual Spring Conference 2023: Going the Distance
May 31-June 2, 2023 | San Diego, CA
2023 Virtual National Advanced Healthcare at Home Summit
July 11-14, 2023 | Virtual
Activate2023
September 27-28, 2023 | Minneapolis, MN
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Platinum Level Exhibitors
Thank you to our Platinum Level exhibitors. These organizations offer the absolute highest quality products & services to the ACO & IPA community. To learn more & visit their interactive booths, click on the logos below:
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Gold Level Exhibitors
Thank you to our Gold Level exhibitors. To learn more & visit their interactive booths, click on the logos below:
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Our thoughts and prayers are with the people of Ukraine. |
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