Podcasts about aco reach

In today's episode we continue our conversation with @American_Heart Senior Advocacy Advisor of Health System Transformation Melanie Phelps, who was integral in the recently published study on the benefit of Accountable Care Organizations. The findings support that managed care provided by ACOs not only improves outcomes for the medically complex patient, but also benefits every patient, family caregiver, provider, and healthcare team member. www.heart.org/bettercareYates Lennon Melanie Phelps, welcome back to the move to Value podcast. So let's try to pick up where we where we finished last time. Melanie and I wanted to go back to really to sort of the heart of your research in the medically complex patient. So we know these folks require hard higher touch and really need coordinated, managed coordinated care. And, wanted to talk about why it's crucial for the American Heart Association to understand and advocate for better models of care for this patient population. And then we'll after that, we'll follow up on sort of how we can work together to do that.Melanie PhelpsYeah. So medically complex patients are of course more complex and more costly.They require a lot more services and the burden of navigating a fragmented fee for service system adds to their already very stressful lives and the chances of things falling through the cracks or delayed care is pretty high in a payer fee for service system, the ACO provides those extra layers of support, communication and enhanced access that really do lead to better outcomes, reduce stress on the patient and their caregivers, which is pretty important. We also believe they are more likely to get the most up to date care under these arrangements because the incentive to do better is there and that is not there in the case of fee for service. So, we all know that there is a pretty significant lag between new innovations and evidence-based solutions and adoption or implementation in reality, and we see ACOs as a vehicle for expediting adoption of those. The other piece on medically complex patients, why we wanted to focus on those is when talking to other patient and consumer advocacy organizations, which is a key target audience of this of this study, there was a lot of apathy and even skepticism about ACOs, OK. They're not involved in the advocacy. They're not steeped in the details and they are very suspicious of ACO's of value based care. They're thinking there's a lot of stinting going on. They think that they're being, you know, medically complex patients are being denied care and being kicked out of ACO's. And that certainly was not my experience when I worked with the ACO's in North Carolina. So, one of the reasons we focused on medically complex patients was to be able to say, OK, you know, are they getting the care that they need? What do they have to say about it? And that's why. I mean these are the people that really need the extra care and support and the results really showed that they were getting much better care and support, which should be important to everybody.Yates LennonYes, absolutely. That's that's interesting. I never would have. I guess I never would have thought about that kind of skepticism from consumer advocacy groups around value based care, and certainly my experience has been the exact opposite is the ACO model is a ideal model to have those patients in because you have the sustainable, a sustainable path to provide these wrap around services to both, both the provider and the patient and their families. I can think of multiple instances where these like in our NextGen days and our ACO REACH nursing facility waiver as an...

In this episode, we'll take a deep dive into the unseen wounds we carry—those moments when something inside just doesn't feel right. We're talking about moral injury, a struggle that goes beyond physical or emotional pain. Whether it's from a difficult decision, a betrayal of values, or witnessing something that shook you to your core, moral injury can leave a lasting impact.​WHAT YOU WILL LEARN:This conversation is for anyone who has ever questioned, "Why doesn't this sit right with me?" and is looking for a path forward. - Recognize the Signs – Understand what moral injury is and how it might be affecting your well-being, even if you've never put a name to it.- Find Healing – Explore real, practical ways to work through the emotional weight and start your journey toward recovery.- Hear Stories of Resilience – Learn from those who have faced and overcome moral injury, with insights from professionals who specialize in healing and self-repair.- Recognize You're Not Alone – If you've ever felt that inner conflict, regret, or emotional exhaustion, this episode will help you make sense of it and take steps toward feeling whole again.***ABOUT OUR GUEST:Dr. Jennie Byrne is an advisor for healthcare innovators to help shape the future of healthcare. She is a Co-Founder of Belong Health, a made-for-purpose healthcare company that serves vulnerable populations through health plan partnerships and ACO-REACH. She has a dual background as an MD/PhD in neuroscience and a board-certified psychiatrist, an entrepreneur who previously founded, grew, and exited a clinical organization, and served in a C-suite executive at a national level. She is a speaker and the best-selling author of "Work Smart", a book on how to use brain and behavior science to work smarter. Her second book, "Moral Injury : Healing the Healers" focuses on the clinician crisis facing the American healthcare system today. Finally as a practicing psychiatrist she focuses on caring for other physicians with mental health needs, including depression, anxiety, ADHD, burnout, and moral injury.***IF YOU ENJOYED THIS EPISODE, CAN I ASK A FAVOR?We do not receive any funding or sponsorship for this podcast. If you learned something and feel others could also benefit, please leave a positive review. Every review helps amplify our work and visibility. This is especially helpful for small women-owned boot-strapped businesses. Simply go to the bottom of the Apple Podcast page to enter a review. Thank you!***LINKS MENTIONED IN EPISODE:www.gotowerscope.comhttps://www.linkedin.com/in/drjenniebyrne/https://drjenniebyrne.com/https://www.constellationpllc.com/Tune in for this empowering conversation at TalkRadio.nyc

Today we continue our ACO REACH conversation with Kim Williams, who discusses how this model facilitates enhanced care for the patient. She also shares insights on measuring success, engaging providers, and the broader impact of ACO REACH on healthcare equity and value-based careThomas Royal Kim Williams, welcome back. Thanks for sticking around so we could continue our conversation here today.Kim Williams Thank you, Thomas.I'm happy to be back and ready to continue our conversation.Thomas Royal So last time you know, we discussed a lot of the nuts and bolts of ACO reach.You know what it is, how it helps us, the various entities that are involved.One of the things that I want to talk about a little bit is the is the patient.So we, you know, previously you mentioned a HealthEquity plans sdoh screenings.What beyond that and including that specific advantages, does ACO reach offer to the patient compared to traditional fee for service models?Kim Williams Yes. So, in ACO reach the advantages for patients are actually quite substantial.Especially in care delivery through waivers or what they call benefit enhancements and incentives. So, for example, with the public health emergency coming to an end, a lot of the telehealth flexibilities that existed during the pandemic are no longer an option after March of this year. So if you were if you are an ACO reach, this is still an option through the telehealth waiver, which removes geographic restrictions and allow patients to get care from their provider regardless of where they are. So you know they can be in their living room doing a check in visit. It is so beneficial for rural communities and patients with mobility issues. I've had site visits with providers that really stress the importance of telehealth because they are in a more rural setting where it's not, you know, good for the patient with mobility issues to go back and forth to the offices. So I think that's definitely a huge plus for those types of population. There is also a financial benefit play that patients can take advantage of, and that's through the cost sharing for Part B services. Now this one allows reach ACOs to reduce or eliminate cost sharing for Part B services and remove financial barriers for things like a primary care visit or your chronic care management, even preventative services. So for instance, CHESS has it set up right now to where we can waive chronic care management co-pays. And so the hope is that. If we're able to waive those co-pays, patients will be more willing to seek intervention. And really participate in chronic care management programs when you know they're not too worried about those co-pays. Chronic care management is just super important in this model, alongside of transition of care management because it focus on preventions. And so I think again this is a win win situation for both providers and patients and also ACOs alike.Thomas Royal Well, that's fascinating.I so I I know that when we talk about there's options of care and financial efficiency for the patient, how does the program ensure patient receives more coordinated and personalized care?Kim Williams Yes, so care coordination plays a huge role in ACO reach. And you heard me mention earlier that implementing the HealthEquity plan requires coordination from everyone. But I want to specifically highlight the great work that care coordination teams put into personalizing the care for our traditional Medicare patients in this population, right? So first the the outreach to the patients are beyond the normal amounts and I'm I'm using our HealthEquity plan as an example here because our care management teams spend more time on the phone with patients, really to better understand why. Why are they not getting their cancer screenings, for example? And...

In this episode we hear from Kim Williams, Senior Manager of Government Programs at CHESS Health Solutions about the value of ACO REACH. She shares her expertise on what it is, why it was created, and how it benefits the patient and provider by being a care collaboration model that improves quality while incentivizing health equity.Kim Williams, welcome to the Move to Value podcast.Kim Williams Yeah. Thank you so much for having me.It's really a pleasure to be here.Thomas Royal So Kim, today I want to explore some of your knowledge that you have and your expertise.So let's talk about ACO reach first.Can you explain what ACO reach stands for and how it differs from the other ACO models?Kim Williams Sure, I'm happy to.ACO REACH stands for realizing equity access and community health.And really, the differentiator of this model is in the name itself.It's looking at HealthEquity and getting patients access to care in a timely fashion, but it's also looking at social needs and also working with community health providers to have a more coordinated approach in the patient's care journey. And so a lot of the programs requirements that we seeare centered around those core principles.And this is a huge shift away from your traditional fee for service model, where everything is based on quantity of services to now looking at value.Now we are looking at not just at the bigger picture. We're looking at the entire picture.We're looking under the rugs and we're addressing root causes in this ACO reach model, also part of what makes this model unique is in the innovative payment structure and that is what I call a capitation-like model.So this means that CMS will give us a prospective payment upfront and providers have the flexibility to structure that payment however they want to do that in a multitude of different ways.So one option is that a provider can elect to do a fee-for-service pass through where you are paid 100% of what you Bill to Medicare. Or you can elect to get 90% of what Medicare pays you.With an option to earn back bonus payments.Or if you don't want any of those options, you can also say, hey, just pay me a per member per month payment upfront.So that's called pmpm.Pay me that amount monthly or however they want to structure that arrangement with the ACO.So there's a multitude of different ways that you can go about this, and really the idea is that if the provider knows how much they're receiving up front to care for their beneficiaries, then they will be motivated to stay under that threshold and that benchmark.And that's really where the shared savings comes in.So I think the ability to select these payment options based on what you're comfortable with is not something you typically would see in other models outside of ACO reach.Thomas Royal Oh, that does sound pretty unique.Kim Williams Yeah.Thomas Royal So he touched on this a little bit, but I'd like to dig a little bit deeper and and if you could tell me what are the core goals of ACO reach and how does it align with the broader shift towards value based care and how does this model prioritize Health Equity and patient centered care in its design?Kim Williams Yeah. So, earlier you heard me mention that the goals of this model are centered around Health Equity access and community health.And so I want to camp on certain components of those levers.So I want to expand on why that matters and talk about the Health Equity for example. So as we're moving away from again the traditional fee for service and moving towards value based care, you see more and more payers prioritizing patient, HealthEquity and social determinants of...

Value-based care (VBC) is critical to the evolving healthcare landscape. As the U.S. population ages and healthcare costs continue to rise, achieving value-based care success has become a primary goal for the system, which seeks to optimize care while maintaining financial sustainability. According to the Centers for Medicare & Medicaid Services (CMS), by 2030, all Medicare beneficiaries are expected to be enrolled in accountable care arrangements.The stakes are high with this impending shift. How can healthcare providers deliver better outcomes while also cutting costs? What does the future of value-based care hold, and how are healthcare leaders preparing to adapt?On this episode of I Don't Care, hosted by Kevin Stevenson, healthcare expert John Carter, Brand Ambassador for Pinnacle Healthcare Consulting, sheds light on the evolution of VBC, key challenges, and emerging solutions to ensure value-based care success.Key Points from the Episode:Evolution of Value-Based Care: Carter tracks the progression from the Affordable Care Act's early initiatives to newer models like ACO REACH and the upcoming AHEAD model, emphasizing the need for innovative approaches to managing healthcare costs.The Role of Preventative Care: Both Carter and Stevenson stress that the healthcare industry must focus on preventative care and early intervention, especially as the baby boomer generation becomes fully Medicare-eligible by 2030.Specialist Integration in VBC: With a shortage of physicians, especially in specialty care, Carter highlights the need for better integration between primary and specialty care providers within VBC models to improve efficiency and patient outcomes.John Carter is the Brand Ambassador for Pinnacle Healthcare Consulting, where he works closely with teams across five companies under Pinnacle's umbrella to deliver tailored solutions for large national healthcare clients. Carter has become a key figure in advancing value-based care and has extensive experience in optimizing accountable care organizations (ACOs) and working with healthcare providers across the country.

This week on Faisel and Friends, we are discussing Embracing the Future of Advanced Primary Care. Faisel and Dan are talking with Dr. Vikki DiGennaro, CEO of Pioneer Physicians Network, and Dr. Kevin Spencer, Chief Clinical Officer of Agilon Health.Our conversation explores the proven outcomes of risk bearing primary care, the benefits of going into a patient's environment to provide more personalized care, and the impact of changes to medicare advantage policy and ACO Reach.

A medical journal retracts three papers on MDMA-assisted psychotherapy following the FDA's rejection of the treatment. CMS outlines updates for its ACO REACH model for 2025. And the DOJ finalizes a rule to improve access to medical care for people with disabilities. That's coming up on today's episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Founded in 2020, Pearl Health was incubated by AlleyCorp and has raised a total of $95M in funding from 8 investors, led by Andreesen Horowitz and Viking Global Investors. Pearl now has over 100 employees and closed a $75M Series B in January of 2023. Pearl Health is a provider enablement and value-based care technology company that helps primary care providers and healthcare organizations succeed in value-based care, starting with ACO REACH and, soon, MSSP and Medicare Advantage.. Pearl does this by helping PCPs and their staff focus attention on high-risk patients and conditions, enabling practices with insights to programs deliver high quality, holistic care to patients at the right time. In 2024, Pearl is partnering with about 1,800 primary care providers, who collectively serve more than 80,000 patients, across the US in 43 states and Washington, D.C. With over 20 years of experience in healthcare, Jennifer started her career at Triage Consulting Group. She then served as a consultant at Deloitte for 5 years and moved on to Takeda Oncology where she was an Associate Director in market access. She then spent six years at athenahealth where she served in a series of roles in product management, ultimately concluding as an Executive Director for product management.  After Athena, Jennifer moved onto a VP / Head of Product role at Hint Health and finally became the Chief Product Officer at Pearl Health in 2021. Jennifer holds a BA from University of California, Berkeley and an MHA from University of North Carolina at Chapel Hill. In this episode, we learn how Pearl Health is trying to improve primary care provider workflows in value-based care, how Jennifer thinks about product management, and where Pearl Health is going next, with their partnerships with retail pharmacies.

This time on Code WACK!    Why is tying a medical provider's pay to the outcomes of their patients a bad idea? Why else should we be concerned about Accountable Care Organizations and the privatization of traditional Medicare?  To find out, we spoke to Dr. Ana Malinow,  who spent three decades working as a pediatrician with immigrant, refugee and underserved children before retiring as Clinical Professor of Pediatrics from the University of California San Francisco School of Medicine. She's past president of Physicians for a National Health Program and is currently a lead organizer for National Single Payer and The Movement to End Privatization of Medicare.  This is the second episode in a two-part series with Dr. Malinow.   Check out the Transcript and Show Notes for more!

We have a broken healthcare system. Too often, individuals today experience care that is fragmented, duplicative, wasteful, and confusing.  Through value-based care, we can improve the health care experience by coordinating care, creating care teams that communicate with one another, and supporting individuals in their care journey with services that address their medical and non-medical needs. Accountable for Health is a nonpartisan national advocacy and policy analysis organization accelerating the adoption of effective accountable care. Their members are advocating for value-based care on Capitol Hill so policymakers can understand how best to move American healthcare towards a model that achieves better outcomes, improved care experiences, increased access, and lower costs. Joining us on the podcast this week is Mara McDermott, the Chief Executive Officer for Accountable for Health.  She is an accomplished healthcare executive with deep expertise in federal healthcare law and policy, including delivery system reform, physician payment and payment models. Take this opportunity to learn from a leading expert on accountable care as she translates the truth in building a bridge towards a more broad-based understanding of health value.  And make sure to tune in to Mara's special announcement about Health Care Value Week at the end of the interview so you don't miss out on important educational events occurring January 29th thru February 2nd. Episode Bookmarks: 01:30  The need for accountable care policies that create better health outcomes and patient experiences. 02:00  Introduction to Accountable for Health (A4H) and its Founder/CEO Mara McDermott, JD, MPH 03:00  Interview topics discussed (e.g. the meaning of VBC, MSSP vs. MA, MACRA 2.0, advanced APMs, integrated specialty care, Medicaid transformation, and the upcoming Health Care Value Week event). 06:00  How A4H is translating thought leadership to action in the advocacy arena. 06:30  Accountable care as the solution to fragmented, uncoordinated care. 07:00  Political turnover in D.C. has made VBC a "new" health policy solution. 07:30  Educating the Hill comes down to conveying enthusiasm for health care transformation. 08:00  Accountable for Health Members are shaping the national conversation for payment and delivery system reform. 09:00  The health policy controversy of the Global and Professional Direct Contracting model (the precursor to ACO REACH). 11:30  If Direct Contracting was the natural evolution of a series of advanced ACO options, why was there such strong criticism? 12:00  The need to overcome misunderstandings about what ACOs are trying to achieve. 13:00  Providing education to dispel the myth that ACOs can actually limit services. 14:00  How uninformed policy decisions could potentially create a catastrophic blow to the value movement. 14:45  "Accountable care is integral to care delivery system reform." 15:45  Confusion with the term "value-based care" and why it will fail unless people understand the truest aims of the movement. 17:00  The need for effective storytelling to advance care delivery transformation. 18:00  Prioritizing care experience over cost reforms (delivery innovation will address costs!) 20:00  The topline takeaways from CMS model evaluations and whether or not programs should be expanded. 21:00  What do most people think when they hear the word "value"? (the need to reframe the conversation with more precise language) 22:00  The MSSP and the Medicare Advantage programs as two distinct approaches to healthcare delivery and reimbursement. 24:00  Mara provides a brief comparison between MSSP and MA (e.g. beneficiary assignment, risk adjustment, benchmarking). 25:30  How strong relationships between MA plans and provider networks (underpinned by capitation) drive value. 26:30  Understanding provider compensation in MA value-based payment and the synergies between managing MSSP and MA populations.

Does every nursing home need a value-based care strategy today? The answer, says Brian Fuller, ATI Advisory's new managing director of value-based care design and delivery, is “unequivocally yes.” The Centers for Medicare & Medicaid Services continues to promote a shift to have all Medicare beneficiaries engaged in some type of value-based care by 2030, with the goal to be at 60% by the end of 2024. That's bringing added pressure to skilled nursing providers, many of whom may still be confused about exactly what value-based care is, how they can participate, and how they might benefit under newer, more nuanced programs. The time to prepare is now, says Fuller. “The work is incredibly complex and difficult, and it simply doesn't happen overnight,” Fuller tells McKnight's Long-Term Care News Senior Editor Kimbelry Marselas in this episode.. “And so any strategy is a multi-year process. The longer an organization takes to make sure that they have a clear and actionable strategy, the more they risk that they fall further behind in their marketplace and being able to optimize their opportunities.” Listen in to learn about data tools and partnerships that can help any provider excel under a variety of models ranging from Institutional-Special Needs Plans to the year-old ACO Reach.

Why Fed-Up Doctors are Going DPC Christopher Habig discusses why direct primary care is growing. As Cofounder and CEO of Freedom Healthworks, Chris helps launch DPC practices across the nation, so he shares the value propositions for how clinicians, consumers, and yes, even startups and entrepreneurs, are benefiting from this often-misunderstood care model.  All that, plus the Flava of the Week about VillageMD's part in helping reduce costs of care through direct contracting. How did ACO Reach reduce costs by over $800 million in 2022, and how can we better focus on the financial models that provide opportunities to be more consumer-centered?  Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

Christopher Habig discusses why direct primary care is growing. As Cofounder and CEO of Freedom Healthworks, Chris helps launch DPC practices across the nation, so he shares the value propositions for how clinicians, consumers, and yes, even startups and entrepreneurs, are benefiting from this often-misunderstood care model.  All that, plus the Flava of the Week about VillageMD's part in helping reduce costs of care through direct contracting. How did ACO Reach reduce costs by over $800 million in 2022, and how can we better focus on the financial models that provide opportunities to be more consumer-centered?  This show is produced by Shift Forward Health, the consumer advisory firm and community that's writing the playbook for consumer-first health. (#296) See omnystudio.com/listener for privacy information.

In the Race to Value, we must recognize that quality of life is the ultimate currency of healthcare, and this aim is all the more important in senior living facilities.  Transforming health outcomes for skilled nursing and senior living populations is not just a goal; it's a commitment to providing the care and dignity our elders deserve.  This week, we profile a leader in the value movement who leads a company on a mission “to improve the health, happiness, and dignity of senior living residents”. We are joined by Mark Price, CEO of Curana Health – a leader who lives by the mantra that “extreme passion” is the single most important ingredient to reform the American healthcare system. Curana Health is a provider of value-based primary care services exclusively for the senior living industry, including in nursing homes, assisted/independent living facilities, CCRC/life plan communities and affordable senior housing communities. Curana Health serves more than 1,100 senior living community partners across 30 states and participates in the MSSP ACO, ACO Reach and Medicare Advantage programs with CMS. Backed by more than $300M in venture capital funding, the organization is poised to disrupt care delivery in senior living on a meaningful scale through innovative care models and applied analytics. In this episode, you will learn about how to transform health outcomes for skilled nursing and senior living populations through extreme passion.  We cover such topics as how to leverage APMs such as MSSP and ACO REACH in the senior living setting, the performance results of Curana Health across their value-based portfolio, technology innovation, palliative care, the state of the nursing home industry, and future trends in the shift to home-based care delivery. Episode Bookmarks: 01:30 Introduction to Mark Price, CEO of Curana Health. 03:45 An estimated 27M more people are aging into the 75+ cohort through 2050, resulting in rising age and higher health acuity levels of residents moving into senior living. 05:00 Curana Health has achieved a 39% reduction in 30-day hospital readmissions and a 37% reduction in total hospital admissions among Medicare Advantage I-SNP members. 06:00 “There are many subsectors in the industry where value-based care can succeed.  The important thing is ensuring that your people have an extreme amount of passion for making it work.” 07:00 Founding story of Curana Health based on how we would want our loved ones to be cared for at the end of life. 08:45 The majority of Americans will spend some time in senior living or skilled nursing in the final years of their life. 10:00 Elite Patient Care ACO performed in the top 1% of ACOs in its first year of operation, achieving PBPY savings amount of $2,235—the highest PBPY for any first-year MSSP ACO since 2012. 11:30 Curana Health also has one of the top performing ACO REACH and risk-based MA I-SNP programs in the country. 11:45 “Our core business is not a payment model. It is a clinical model that produces health outcomes which, in turn, enables affordability as well.” 13:00 Developing a population health playbook for the senior living space. 14:00 Success in developing a level of clinical integration within a senior living facility that is now owned by the company. 15:00 MA Institutional Special Needs Plans (I-SNPs) are designed to meet the needs of people living in long-term care settings such as long-term care nursing, skilled nursing facilities, and inpatient psychiatric facilities. 16:45 Facilities are taking an ownership position of MA plans for senior living and skilled nursing residents. 17:00 Mark provides perspective on I-SNPs and how the Curana Health clinical model is achieving results to improve clinical outcomes. 18:30 Performing well by recognizing the commonality between MSSP, ACO REACH, and Medicare Advantage. 20:00 How CMS and CMMI is incorporating innovation to value-based payment models (e.g.SNF 3-Day Rule Waiver).

Data interchange and interoperability are the keystones of a united ecosystem for value-based care, where information flows seamlessly, connecting patients, providers, and payers to drive better outcomes, lower costs, and improved patient experience. Overcoming siloed information is the key to breaking down the barriers that fragment care delivery, and in doing so, we unlock the potential for a healthier future for all. While health data interoperability has arguably become an industry buzzword over the past decade, the concept's importance for digital health transformation cannot be understated. The benefits of optimal interoperability in healthcare includes improved care coordination for patients and reduced administrative burden for healthcare payers and providers. Interoperability also supports public health surveillance and population health initiatives that are so critical to value-based care transformation. In this podcast episode, you will hear from two executives on a mission to unlock greater value in American healthcare by aggregating, normalizing, and unifying data.  Venkat Kavarthapu and Dr. Summerpal Kahlon are the Chief Executive Officer and Chief Medical Officer for Edifecs, a Best in KLAS interoperability platform that serves as the foundation for the solutions that eliminate stakeholder friction to overcome healthcare's biggest challenges. We discuss how interoperability will accelerate value-based payment adoption and help providers obtain more complete and accurate care funding for alternative payment models. We cover such topics as the future of AI, the potential for automated prior authorization, how ACO REACH will drive population health management, and the collaboration that is enabled by technology. Episode Bookmarks: 01:30 Introduction to Venkat Kavarthapu and Dr. Summerpal Kahlon and their company Edifecs that provides a leading interoperability platform. 04:00 Industry struggles to implement interoperability requirements of the CMS Interoperability and Patient Access Final Rule. 04:30 The benefits of interoperability and how it serves as a foundation for value-based care. 05:30 Venkat discusses how value-based care is the only path forward in creating a sustainable healthcare system. 06:30 The need for data to improve patient experience and quality of care. 07:00  “True value-based care can only be accelerated if information is available to all entities in all three dimensions – clinical, administrative, and financial.” 08:00 Exchanging information across organizations and between systems without friction, while ensuring privacy and security. 09:00 How data siloes create healthcare dysfunction. 10:00 Extreme data siloing increases data management costs (25-30% of total cost spent to ensure data accuracy). 10:30 Payer-provider collaboration supports value-based care but is still limited by interoperability adoption. 12:00  “Driving interoperability is not a burden on the industry, but a true competitive advantage for the industry.” 12:30 How interoperability reduces administrative burden and the cost of human capital. 13:45 “An interoperability framework can drive a meaningful dialogue, and communication is key to driving good patient outcomes.” 14:30 Summer describes how an overly-fragmented healthcare system that still relies on fax machines contributes to data inaccuracy. 16:00 Emphasizing data accuracy within an interoperability framework ensures patient safety. 16:30 How Natural Language Processing and AI can provide context and improve communication at the point-of-care. 19:00 CMS Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule 20:00 The need for fully automated Prior Authorization (PA) enabled by EDI processing, FHIR-based APIs, AI/ML, and NLP. 21:45 Electronic PA will foster payer-provider collaboration and drive clinical decision support. 23:30 PA transactions are only automated 30% of the time at present (compared to 90% or more ...

The Centers for Medicare and Medicaid Services updates its ACO REACH model. Oregon's governor signs a nurse-to-patient staffing ratio bill into law. And, new data show that private-equity healthcare deals slowed amid higher interest rates. That's coming up on today's episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

CVS Accountable Care's Formula For Healthier Communities We continue our series with leaders in retail health by welcoming Dr. Mohamed Diab, CEO of CVS Accountable Care. Dr. Diab dives into CVS Accountable Care's recently announced partnership with Catholic Health, how it fits into CVS Health's overarching care delivery strategy, and the role of ACO REACH and other value-based solutions in accelerating progress.  All that, plus the Flava of the Week about H-E-B opening more primary care clinics in their grocery stores. What's the endgame for grocery chains, and how can we see the value of care that's being offered in nontraditional settings?  Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

In this episode we hear the second half of the conversation between CHESS' own Melissa Pollock and Advocate Health's Vice President of Population Health Midwest Megan Reyna as they discuss navigating the data and quality measures for success in Value-based care.So Megan thank you so much for coming back to the Move to Value podcast. I'm really excited to talk to you a little bit more about population health at Advocate and curious - we did talk last time about ACO REACH. I was just curious a little bit about provider buy-in. How did you message ACO REACH and the model to providers? What did that look like? How were you able to get providers on board with this new innovative model?Thanks for having me back, Melissa, happy to be here. Yes so everything that we do within population health in the Midwest really goes through a strong physician governance model and it is a true partnership with our physicians to participate in in in our value based care contracts. So ACO REACH as well, we really educated the practices who we thought would be good participants based on the data that we talked about last time to participate in ACO REACH would benefit from this program and we had conversations with them, really educated them on this program and the why and what the wraparound services would look like and then we continue to have conversations with them around what where we need to innovate within this model. The Medical Group as well because our Medical Group does participate in both Wisconsin and Illinois again in the areas of Milwaukee and then the South side of Chicago around what their needs are and really um what the practices, that entire care team, is needing umm in order to help patients manage their chronic diseases. And that's a conversation that we have with our practices and we continue to look at our data to say what are we seeing within the data to provide different services as we move forward. It will be a care model that continues to iterate um as we move along within this program to make sure that we're successful and patients are getting the needed care that they need.Did you find it difficult to get providers on board with downside risk or, I know you mentioned in the last podcast that you guys have been doing capitation for a long time, but I didn't know was there any pushback that you felt or any kind of hurdles you had to jump over in those conversations with some of the providers maybe some of the independent ones?So our aligned practices that are participating we did have um intentional conversations around capitation for this population. This is a population we were very intentional with what population we were participating in and this is a tough population that often is not going in to see the primary care provider. And so you know I think COVID also um brought a unique opportunity for our physician practices to think differently about capitation and what are benefits of capitation and so really looking at this population and providing an upfront payment to those practices, we are in total care um capitation for ACO REACH, um really provided them an opportunity to think differently. And I think our strong history with value-based care contracts and success that they've been able to see they were able to view it as a true partnership. And it wasn't a one and done we meet with these practices on a monthly basis and we are continuing to look at the finances and make sure that our model makes sense and that they're successful because if they're not successful within the model then the model isn't successful for us and so they really need to be able to provide the needed services and say something's working or not working um for the success of our entire project participation.So, you guys are really providing data to those providers on a monthly basis of performance I would guess and metrics, is that right?...

We continue our series with leaders in retail health by welcoming Dr. Mohamed Diab, CEO of CVS Accountable Care. Dr. Diab dives into CVS Accountable Care's recently announced partnership with Catholic Health, how it fits into CVS Health's overarching care delivery strategy, and the role of ACO REACH and other value-based solutions in accelerating progress.  All that, plus the Flava of the Week about H-E-B opening more primary care clinics in their grocery stores. What's the endgame for grocery chains, and how can we see the value of care that's being offered in nontraditional settings?  This show is produced by Shift Forward Health, the channel for change makers. Subscribe to Shift Forward Health on your favorite podcast app, and you'll be subscribed to our entire library of shows. See our full lineup at ShiftForwardHealth.com. One subscription, all the podcasts you need, all for free. (#273)See omnystudio.com/listener for privacy information.

In this podcast, Chris interviews Dr. Katy Lanz, Founder and Principal of TopSight Partners, a boutique advisory innovation partner, focusing on care at home.  Dr. Lanz started out her career as a hospice nurse and helped build one of North Carolina's first palliative care programs in the early 2000s.  She later became the Chief Clinical Officer of Aspire, and led through partnerships with over 20 health plans, in 28 states. Katy has led two CMMI demonstrations, an ACO Reach practice and she is now one of the country's most sought after thought leaders on innovative healthcare projects and the future of serious illness.  Chris and Katy discuss many topics that hospice and palliative care leaders and Boards need to be thinking about like Medicare Advantage Plans, how disruptive innovations and substitution competition could and are impacting hospice and palliative care, and what they should be doing to position their organizations into the future.  Katy also talks about the competency of managing risk and how important this competency is to the future.  She does an incredible job breaking this down for staff by the bedside to understand what that means and how important our interdisciplinary team members are to that competency, which is going to get even more important in the future.  This one segment of the podcast is one you will want to pay forward to all your hospice and palliative care staff and also your Board. Chris and Katy also discuss some of the interesting innovative projects that are emerging and she gets exposed to, including a project with Dollar General.  Did you know that nearly all Americans are within 5 mile radius of a Dollar General?  And did you know they are thinking about how to help their customers and their healthcare needs?  That and many more pearls are waiting for you in this episode.This is a great listen for staff, leaders, and Board's of hospice and palliative care organizations.  Join us, this is timely and relevant. Guest: Dr. Katy Lanz, Founder & Principal of TopSight PartnersHost: Chris Comeaux, President / CEO of TCNPodcast quote:"If we want the rainbow we have to put up with the rain."  – Dolly Partonhttps://www.teleioscn.org/tcntalkspodcast/reading-the-tea-leaves-and-practical-advice-for-the-futureTeleios Collaborative Network / https://www.teleioscn.org/tcntalkspodcast

Today we have the second in a series of conversations about ACO REACH with Melissa Pollock, Director of ACO Compliance and Regulatory Affairs at CHESS Health Solutions, who continues to navigate and lead through the intricacies of the newest CMS payment model. So, last time we talked about a lot of the history behind the reimbursement models for CMS and went over some of the history, and what CMS is trying to achieve, and how they've moved down this timeline and value, and we've landed on an ACO REACH model. What happened from “hey let's do this,” to “we're doing this now.” Because it seems really easy to say but I know that a lot went into it. Can you walk us through that?Yeah. So, I think we had looked at the direct contracting model and just financially it didn't make sense. So, you know, we talked a little bit about the Next Gen model coming before it and how it was never really certified as a as a full program because CMS didn't think that it created as much savings as that should have. You go to direct contracting and they've kind of put into direct contact some very steep discounts. Discount not being a good thing. Right? Discount being they're going to take money straight off the top to make sure that they get the savings that they're trying to generate in the model. When they revamped direct contracting, renamed it, refocused it as ACO REACH they kind of backed off on some of those discounts, which was helpful I think to a lot of us that were in the healthcare space. So, you know, all the Next Gens are providers. We're all providers. We're, you know, trying to do value within the health systems. We don't have, for most of them, a lot of you know commercial companies outside of this. And so, as we started to look at ACO REACH and the requirement or the ability within the model to take on claims processing, that is a whole other realm that we had not been. In claims processing, I mean, obviously, there are entire companies that do nothing but claims processing. And so, we had to decide is this something we're going to take on? Do we outsource it? What kind of you know organization do we partner with to do this? And we have to go through the entire process of an RFP, a request for proposals, to determine OK who can do this, who's done it before in direct contracting that we can also use in this process, and how do we move forward. So, there was a lot of time spent in determining number one what is our downstream model going to look like, how are we going to reimburse these providers, and number two, can we do it, can we set it up in a relatively quick time frame and do we have the expertise in-house to do that or do we need to look outside. So, there was a lot of conversation around that. I mean, obviously, the application process for ACO REACH was a lot. It was unlike any other application that CMMI had ever put out, the Innovation Center, had ever put out. It was very detailed. They were asking very specific questions about governance structure. They were asking a lot of questions about health equity, what are you already doing in the health equity space, which is you know what they're looking towards. They're looking at this focus of how are we going to really affect care in the underserved communities that has traditional Medicare beneficiaries. And so, there were, you know, we had to look at what do we have now, what are our gaps in care, where do we think our populations are, what zip codes are they in. It was kind of a new foray into looking at data from a lens that we hadn't really looked at before. Or if we had, hadn't done a really deep dive into. So, I think those were kind of the two big things that we had to really prepare for. From a compliance and governance standpoint, we were set. That wasn't different. And having been in Next Gen, we were very used to those types of you know the audits and the things that come with being in an innovation model that's...

Kevin Siebs, Moore & Van Allen, and Derek Skoog, Principal, PricewaterhouseCoopers, discuss the Center for Medicare and Medicaid Innovation's (CMMI's) latest ACO model, ACO Realizing Equity Access and Community Health (REACH) Model. They cover reasons for provider participation in ACO REACH and common characteristics among participants, the model's payment mechanisms, aspects of the model's benchmark methodology, and key compliance issues related to the model. From AHLA's Regulation, Accreditation, and Payment Practice Group.To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.

Jacob and Nikhil sit down with Mike Kopko, CEO and co-founder of Pearl Health to discuss Pearl's care model and what it's been like building the company as ACO Reach evolved. Mike also shares some great stories negotiating claims in the early days of Oscar.

Today we have the first in a series of conversations about ACO REACH with Melissa Pollock, Director of ACO Compliance and Regulatory Affairs at CHESS Health Solutions, who was instrumental in navigating all of the processes for acceptance into the newest CMS payment model. I want to talk about the new ACO REACH model. Before we dig into the nuts and bolts of how it works, can you tell us briefly what has been happening at CMS and how we got here?Yeah, that's a great question. So, you know, historically beginning with the Affordable Care Act, really CMS has been focusing a lot on how do we fix the healthcare system, what can we do. We know the Medicare Trust Fund is going to run out of money eventually. So, you know, how are we going to fix this? And over the course of the past 10 to 12 years, have been looking at so many different models of what's going to work and most of those models are coming out of the Innovation Center at CMS. So, what's going to work and how do we fix these different problems? And then that, you know, kind of birthed the value movement as we know it today. And then you see kind of the models that we know that have been kind of tried and true, which is the Medicare Shared Savings Program model which has you know multiple tracks and different levels of participation for different health care systems. Again, all focused on traditional Medicare patients.And then in I think it was 2016, 2017 I can't remember exactly they started the Next Generation ACO model, which was kind of the precursor to ACO REACH. So, Next Gen was really kind of a way for healthcare systems to take on 100% shared savings, upside, downside shared savings. And what that means is that they're completely accountable for the care that they provide for these patients. And that's slowly morphed into, we'll probably talk about this later, but direct contracting is morphed into this direct contracting which then was renamed and revamped into ACO REACH.Can you tell me why did they sunset NextGen? Was it not working or was it just not fulfilling the need?Yeah, that's a good question too. So, I think part of the issue was that you know these models have to go through the process of being certified if they're going to be put into regulation. So, all the models that the Innovation Center does are kind of like testing grounds. Let's see what's going to work and are we actually going to save money with this model. And then, after they've run their course, they go through a process where they are looked at under scrutiny trying to determine “hey did this model actually save us money or is the money that we paid out to the health system, did we really not save a whole lot of money for the for the Medicare trust fund?” And so there was, you know, they have like the OMB and different arms of the government that are looking specifically at the model to figure out did we save money or did we not. So, that certification process came back saying we did not save as much money in this model as we thought we would. Now I will say that there are a lot of people that say that there are some issues with the underlying methodology of how they went through the process of determining whether savings were there or not. And a lot would say there is savings, you're measuring the savings in an incorrect manner or there's intangible ways to measure value being created in these health systems that you can't really put a price tag on. So, there was a lot of back and forth in that arena, but it kind of came down to CMS as a whole does not believe that this model saved as much as it should have. So we need to go ahead and sunset it and come up with another model that is going to advance care and value and really kind of do a little bit more to save the Medicare Trust Fund money. Is ACO REACH an acronym?It is an acronym. So ACO, obviously accountable care...

This is episode 92, “More on ACO REACH and Why We Need to End It.” My guest is Ed Weisbart, MD, and he explains some basics about ACO REACH, why we need to end it, how to end it, why it is a threat to seniors and Medicare, and why we should be optimistic about working to end REACH.   Dr. Weisbart is a retired family physician, the national board secretary of Physicians for a National Health Program, and president of Consumers Council of Missouri. He received his medical degree at the University of Illinois in Chicago in 1979, and completed his family medicine residency and a fellowship in family medicine education at Michigan State University in 1982. Do not miss this episode as Dr. Weisbart explains why ACO REACH is a threat to seniors and Medicare, and why we need to end REACH. For information on how to end ACO REACH and protect Medicare, here is the link for ProtectMedicare.net. 

This time on Code WACK! What's the latest threat to original Medicare? What could happen if we link health outcomes to physician compensation? How is it that a whole new program affecting millions of Americans on original Medicare can be rolled out without congressional oversight? To find out, we spoke to the new president of Physicians for a National Health Program (PNHP), Dr. Philip Verhoef, an adult and pediatric intensivist and Clinical Associate Professor of Medicine at the John A. Burns School of Medicine at the University of Hawaii-Manoa. Learn more about the new program called ACO REACH, and the issues it raises around physician compensation. Could ACO REACH threaten the trust between patients and their doctors?

This time on Code WACK! What's the latest threat to original Medicare? What could happen if we link health outcomes to physician compensation? How is it that a whole new program affecting millions of Americans on original Medicare can be rolled out without congressional oversight? To find out, we spoke to the new president of Physicians for a National Health Program (PNHP), Dr. Philip Verhoef, an adult and pediatric intensivist and Clinical Associate Professor of Medicine at the John A. Burns School of Medicine at the University of Hawaii-Manoa. Learn more about the new program called ACO REACH, and the issues it raises around physician compensation. Could ACO REACH threaten the trust between patients and their doctors?

The message from state and federal regulators, healthcare leaders, and our society-at-large is being heard loud and clear:  Health equity is a moral imperative. A cultural zeitgeist for health equity has been awakened in the collective consciousness of all ethnicities in the context of COVID-19 health disparities and the ongoing fight for civil rights and social justice. The economic imperative for equity is also too big to ignore, given that inequities in the US health system cost approximately $320 billion today and could eclipse $1 trillion in annual spending by 2040 if left unaddressed.  The future of equitable health is important to the future of our country, and we must address this moral imperative with business solutions. Joining us this week in the Race to Value is Jay Bhatt, D.O., MPH, MPA – a leading physician executive, internist, geriatrician, and public health innovator. Dr. Bhatt is the Executive Director of the Deloitte Center for Health Solutions (DCHS) and the Deloitte Health Equity Institute (DHEI), Dr. Bhatt directs the research, insights, and eminence agenda across the life sciences and health care industry while driving high-impact collaborations to advance health equity. He is a prominent thought leader around the issues of health equity, health care transformation, public health, and innovation. Do you want to learn more about how we can create a catalytic engine for equitable health? Tune in to this podcast to learn from one of the nation's leading minds on how to advance health equity through business solutions.  In this episode, we discuss collaboration with life sciences and health care industry to advance health equity, digital transformation, ACO REACH, and climate-related strategies.   Episode Bookmarks: 01:30 Introduction to Jay Bhatt, D.O., MPH, MPA – a leading physician executive, internist, geriatrician, and public health innovator. 03:00 Subscribe to the Race to Value weekly newsletter and leave us a review and rating on Apple podcasts! 04:30 The three root causes of health equity:  1) socioeconomic, gender, racism and other biases, 2) disparate circumstances in the drivers of health, and 3) inadequately designed healthcare systems. 06:15 Creating a catalytic engine for the future of equitable health and why the Deloitte Center for Health Solutions and The Deloitte Health Equity Institute (DHEI) are so critical to the health of this country. 06:30 “There is a workforce imperative, a market imperative, and a moral imperative for health equity. We must address the moral imperative through business solutions.” 07:00 Deloitte Report: “Inequities in the US health system cost approximately $320 billion today and could eclipse $1 trillion in annual spending by 2040 if left unaddressed.” 07:30 Collaboration with life sciences and health care industry to advance health equity, digital transformation, and climate-related strategies. 08:30 Engaging key decision makers and global leaders in health equity through Deloitte's involvement in the World Economic Forum. 09:00 Activating Boards and C-Suite leaders in health equity and implementing place-based change through community outreach and population health interventions. 09:40 Health equity innovation through an accelerator that supports minority-led non-profit organizations and social entrepreneurs. 10:00 Addressing access to maternity care deserts that contribute to inequities throughcollaboration with the March of Dimes. 10:45 A recent research report conducted by the Deloitte's Health Equity Institute and other partners entitled, "Collection of Race and Ethnicity Data for Use by Health Plans to Advance Health Equity." 11:45 “Continuing to analyze the delivery of care and examine patient outcomes across demographics, including race and ethnicity but also sexual orientation, gender identities, and language is critical to administering more equitable and inclusive care, and building trust with communities across America.”

This time on Code WACK!  What's the latest threat to original Medicare? What could happen if we link health outcomes to physician compensation? How is it that a whole new program affecting millions of Americans on original Medicare can be rolled out without congressional oversight?    To find out, we spoke to the new president of Physicians for a National Health Program (PNHP), Dr. Philip Verhoef, an adult and pediatric intensivist and Clinical Associate Professor of Medicine at the John A. Burns School of Medicine at the University of Hawaii-Manoa.   Learn more about the new program called ACO REACH, and the issues it raises around physician compensation. Could ACO REACH threaten the trust between patients and their doctors?    Check out the Show Notes  and Transcript for helpful links and more!  

Shelley Davis, MSN, RNC, CCM, is the VP of Clinical Strategy at Lightbeam Health Solutions expert in moving from the traditional fee-for-service model to a value-based care system. Working alongside providers, Lightbeam is identifying opportunities to provide education and better care to underserved communities with less administrative burden. As part of the ACO Reach model, providers must develop annual health equity plans to identify gaps in access for the most at-risk patients. Shelley explains, "We look at population health management as a way to identify patients, identify members, identify those at the greatest risk to fall through the gaps, those that have the most complex conditions. We offer solutions through patient and provider engagement tools, leveraging technology to be successful in value-based contracts. We are continuing to offer new services as we evolve as a company to ensure that we are meeting the needs of the next generation of value-based contracts."  "What we've done at Lightbeam and certainly other population health vendors are doing or should be doing is leveraging analytics, identifying those opportunities to surface those patients who are experiencing or those most at-risk members. Then developing initiatives around that, identifying those who are facing transportation barriers, those living in a food desert, those most likely to have utility instability. You can partner with a community-based organizations, you can develop organizational initiatives, and you can address educational gaps to make sure that they're getting the care that they deserve." #LightbeamHealthSolutions #PopHealth #PopulationHealth #ACOReach #CareDelivery #HealthEquity #RiskBearing #PatientOutcomes #SDoH #SocialDeterminantsofHealth lightbeamhealth.com  Listen to the podcast here

Shelley Davis, MSN, RNC, CCM, is the VP of Clinical Strategy at Lightbeam Health Solutions expert in moving from the traditional fee-for-service model to a value-based care system. Working alongside providers, Lightbeam is identifying opportunities to provide education and better care to underserved communities with less administrative burden. As part of the ACO Reach model, providers must develop annual health equity plans to identify gaps in access for the most at-risk patients. Shelley explains, "We look at population health management as a way to identify patients, identify members, identify those at the greatest risk to fall through the gaps, those that have the most complex conditions. We offer solutions through patient and provider engagement tools, leveraging technology to be successful in value-based contracts. We are continuing to offer new services as we evolve as a company to ensure that we are meeting the needs of the next generation of value-based contracts."  "What we've done at Lightbeam and certainly other population health vendors are doing or should be doing is leveraging analytics, identifying those opportunities to surface those patients who are experiencing or those most at-risk members. Then developing initiatives around that, identifying those who are facing transportation barriers, those living in a food desert, those most likely to have utility instability. You can partner with a community-based organizations, you can develop organizational initiatives, and you can address educational gaps to make sure that they're getting the care that they deserve." #LightbeamHealthSolutions #PopHealth #PopulationHealth #ACOReach #CareDelivery #HealthEquity #RiskBearing #PatientOutcomes #SDoH #SocialDeterminantsofHealth lightbeamhealth.com Download the transcript here

This is episode 91, “End ACO REACH.” In this episode, I discuss why we need to end the Medicare ACO REACH program. ACO REACH or REACH is a program that transfers people from traditional Medicare to private health insurance.   ACO is an acronym for “Accountable Care Organization” and REACH is an acronym for “Realizing Equity, Access, and Community Health.” Do not miss this episode as I discuss why REACH is bad for individuals and the nation. 

Medicare Advantage and ACO REACH are privatization Right Wing schemes that will put Standard Medicare and, with that, the health and financial well-being of all Americans. --- Send in a voice message: https://anchor.fm/politicsdoneright/message Support this podcast: https://anchor.fm/politicsdoneright/support

President and Co-Founder of One Payer State join us to discuss a Medicare killer, ACO REACH. Nicolle Wallace and Matthew Dowd explain the death of the Republican Party --- Send in a voice message: https://anchor.fm/politicsdoneright/message Support this podcast: https://anchor.fm/politicsdoneright/support

Co-Founder & President of One Payer States Chuck Pennacchio understands that Medicare is under attack, and he exposes its methodical destruction. ACO REACH one tool. --- Send in a voice message: https://anchor.fm/politicsdoneright/message Support this podcast: https://anchor.fm/politicsdoneright/support

CMS replaced the Global and Professional Direct Contracting (GPDC) Model with the redesigned ACO Realizing Equity, Access, and Community Health (REACH) Model in 2023. ACO REACH is the first accountable care model to directly address health equity and access to care, with a specific directive to meet the needs of patients from marginalized and underserved communities.    Whether you are participating in ACO REACH, the model provides vital insights into the future of value-based care and care collaboration. This panel will discuss the incentives and requirements laid out by the new ACO REACH model and how organizations can develop action plans to identify differences or disparities in their members' health status.   Panelists: Gary Jacobs, Executive Director, Center for Government Relations and Public Policy, VillageMD; Kate Casaday, MPH, Director of Market Operations, CareMount Health Solutions; Ashley Perry, MPH, Chief Solutions Officer, Socially Determined   Bios: https://www.sharedpurposeconnect.com/events/aco-reach-advancing-equity-and-optimizing-performance/   This episode is sponsored by Socially Determined Socially Determined is leading the transformation of healthcare delivery and payment through social risk analytics and solutions. Our SocialScapeⓇ SaaS platform, data and industry-leading expertise empower health systems, plans and other risk-bearing organizations to manage risk better, improve outcomes and advance equity at scale. Recently named by Fierce Healthcare as one of the 15 most promising healthcare companies, Socially Determined is headquartered in Washington, DC. Visit the website at www.sociallydetermined.com.

For all of you leaders out there on a value-based care journey, it is not lost on any of you that health value has become synonymous with health equity. We are at an inflection point in our society in the recognition that everyone needs a fair and just opportunity to attain their highest level of health. Achieving this will require ongoing societal efforts to address injustice, overcoming socioeconomic barriers to health, and eliminating preventable health disparities. But we cannot do that as a healthcare industry without the proliferation and scale of payment models that align incentives so we can realize true change for the better. On the Race to Value this week, you will hear from one of the foremost leaders on the national scene who is shaping the landscape for accountable care delivery that can advances health equity. Dr. Dora Hughes is someone who has taken this charge to lead in service to the underserved so that we may realize the dream of a more equitable and healthy society. She is the chief medical officer at the CMS Innovation Center at the Centers for Medicare & Medicaid Services (otherwise known as CMMI). She leads the Center's work on health equity, provides clinical leadership and input on models, serves as the Innovation Center's primary liaison with medical and clinical stakeholders, and provides leadership to the Innovation Center's clinician community. In addition, Dr. Hughes is part of the CMS Innovation Center's Senior Leadership Team, helping to provide enterprise-level leadership and strategic direction to the Center.  In this interview, we discuss the elevated national consciousness to advance health equity, how ACOs and other risk bearing entities can succeed with a health equity strategy, and the work being done by the Innovation Center to redesign alternative payment models for equity.  We spend considerable time discussing ACO REACH and value-based Medicaid transformation as well.  This is certainly a conversation you should listen to as you plan for success in your Race to Value!   Episode Bookmarks: 01:30 Health Value has become synonymous with Health Equity -- everyone needs a fair and just opportunity to attain their highest level of health. 02:30 Introduction to Dora Hughes, M.D., M.P.H., the chief medical officer at the CMS Innovation Center (CMMI) 04:30 If you control for all variables that may contribute to health disparities, African Americans still get the worst quality of healthcare of any demographic in the country. 05:30 The first pillar of CMS' Strategy Plan is Health Equity 06:30 Cara James, Ph.D., president and CEO of Grantmakers in Health: "I'm someone who's working on equity before it became cool to work on equity." 07:00 Referencing the seminal findings of the Heckler Report in the 1980s that investigated racial and ethnic disparities in the United States. 08:00 Momentum has been building towards addressing health inequities, despite the historical lack of national prioritization. 08:30 “It really took the pandemic and police brutality to blast the issues of health inequities into the national consciousness.” 09:00 Disparities go beyond COVID (e.g. black disparities in maternal health, colorectal cancer, kidney disease) 09:45 “Executive pay is now being tied to reduction in disparities. You wouldn't have heard that 10 years ago or even perhaps five years ago.” 10:00 Referencing CCSQ Deputy Jean Moody-Williams: "For those of us engaged in health equity, this is our moment, but it is only a moment." 10:30 Actions Needed: collecting and analyzing demographic and health data,  knowing patients individually and at the population level, identifying disparities, implementing evidence-based interventions. 11:45 “It takes vibrancy, resiliency, and an indomitable spirit to tackle disparities and scale progress at a national level.” 13:00 CMMI's work to address Social Determinants of Health (SDOH), e.g. ACOs, Accountable Health Communities (AHC) Model

America's Physican Groups' New President and CEO Susan Dentzer joins the podcast to share about her first 9 months in the role as well as what's to come in 2023, including ACO Reach and direct contracting, for the organization that is "taking responsibiity for America's health."

Are you ready for the risk-based tsunami on the horizon?  If you are a frequent listener to this show, you understand just how seismic this shift to value-based care really is and why we need the right culture, people, processes -- fueled by capital – to spawn care delivery innovation.  It is in reimagining care delivery that we can truly deliver on the aims of improved outcomes, lower cost, better patient experience, and equity for all populations. Joining us in this Race to Value this week are two outstanding leaders in the value movement, Drs. Brian Silverstein and Yates Lennon.  We discuss how organizations should be preparing for the risk-based tsunami on the horizon through care delivery innovation. Dr. Brian Silverstein is the Chief Population Health Officer for Innovaccer, a leading healthcare technology company committed to helping healthcare care as one. He is an expert in value-based care delivery and health system transformation with vast experience in helping providers improve population health initiatives.  And joining him in this interview is Dr. Yates Lennon, the President of CHESS Health Solutions – a population health MSO empowering physicians and health systems to make the transition to value-based care. Dr. Lennon has extensive experience in quality, practice transformation, and physician engagement and has been instrumental in teaching health systems and providers across the country how to transform patient care and shift to value-based payment. If you are looking to understand the state and science of value-based care, look no further than this conversation with two of the leading minds in industry transformation!   Episode Bookmarks: 01:30 The seismic shift towards value-based care and the risk-based tsunami on the horizon. 02:00 Introduction to Dr. Brian Silverstein and Dr. Yates Lennon 04:30 Progressing in the value journey by understanding the landscape 05:45 Dr. Lennon provides an overview of the value ecosystem with varying adoption of risk in provider organizations. 07:00 “The days of sitting on the sideline are running out.  It is time to get started with value-based care if you haven't already.” 08:00 The State and Science of Digital Maturity at U.S. Healthcare Providers (a recent report from Frost & Sullivan, commissioned by Innovaccer) 09:30 Dr. Silverstein on the legitimacy of the value movement with perspective on how digital infrastructure impacts the pacing of adoption. 10:45 The differentiation of the technology stack utilized by providers accepting full risk-based payment. 12:00 Traversing the value landscape with emerging changes in payment model design focused on the reduction of health disparities. 13:30 Dr. Lennon on how VBP and population health technology tools are perfectly suited to address problems in health disparities. 14:00 Codifying the health equity design of the ACO REACH payment model into operational programs. 14:30 Ensuring access to care in a medical home – an example from Atrium Health Wake Forest Baptist 15:30 “Access is important in value-based care when attempting to address health equity.” 16:00 Focusing on the quality and performance improvement measures that can improve equity. 16:30 Clinical workflow optimization and the use of Community Health Workers to conduct patient outreach. 17:00 Leveraging community resources to address Social Determinants of Health (SDOH). 17:30 findhelp (formerly Aunt Bertha) and Unite Us as examples of technology platforms that can improve SDOH interventions and community partnerships. 18:15 Lifestyle coaching to improve health outcomes with dual eligible populations. 19:00 Dr. Silverstein explains how traditional healthcare will not able to improve population health outcomes in a silo. 20:00 The correlation between a patient's zip code and their overall health and wellbeing. 20:30 Dr. Lennon provides perspective on how the creativity of value-based care will improve models for patient engagement and care de...

Federal Funding Deadline Fast Approaches as Congress Negotiates Year-End Package, Warnock Victory Secures 51-Seat Majority for Senate Democrats, House Passes FY2023 NDAA, House Passes Bill to Help Address Maternal Mortality, Warren, Jayapal Press USPTO on Drug Prices, Democrats Warn Against Fraud, Abuse in ACO REACH, Future of Select COVID Panel Unclear as Final Report Released, Walensky Voices Support for Public Health Data Bill, Longtime NIAID No. 2 to Serve as Acting Director, New Tool Launched to Determine App Compliance with Rules and Regulations, The Rundown

The Health Care Payment Learning & Action Network (HCP LAN or LAN) is an active group of public and private health care leaders dedicated to providing thought leadership, strategic direction, and ongoing support to accelerate our care system's adoption of alternative payment models (APMs). The LAN mobilizes payers, providers, purchasers, patients, product manufacturers, policymakers, and others in a shared mission to lower care costs, improve patient experiences and outcomes, reduce the barriers to APM participation, and promote shared accountability. Last month the LAN held their 2022 Summit, and this year's event featured appearances by CMS and CMS Innovation Center leadership, the release of the 2022 APM Measurement Effort results, a discussion on the HEAT's Social Risk Adjustment Guidance for APMs, and the announcement of the LAN's 2030 APM Adoption Goals for Medicare, Medicaid, and commercial plans.  Joining us this week in the Race to Value are LAN Executive Forum Co-Chairs, Dr. Judy Zerzan-Thul and Dr. Mark McClellan.  They discuss the overall goal of the LAN and the LAN Summit is to collaborate and act on strategies that will accelerate the transition to innovative, patient-centered payment models by focusing on equity, access to high-quality and affordable care, engagement of patients, and reduced provider burden. https://www.advancinghealthvalue.org/hpclan_summit_22/ Visit the Institute for Advancing Health Value's website. Download their recently released Intelligence Brief summarizing the 2022 LAN Summit. Visit the LAN's website: Learn more about 2020 & 2021 APM Measurement Efforts Consult the HEAT's APM Design Guidance  –  Advancing Health Equity Through APMs   Episode Bookmarks: 01:30 The purpose of the Health Care Payment Learning & Action Network (HCP LAN) 03:00 Introduction to Dr. Mark McClellan and Dr. Judy Zerzan-Thul 05:45 Dr. Mark McClellan speaks to the impact of the pandemic on value-based health reforms 06:45 “Payment flexibilities are one of the unsung heroes in the pandemic when it comes to value transformation.” 07:15 How capitation enabled some to navigate the pandemic favorably, while others struggled with FFS revenue disruption, team-based care, and telehealth deployment. 08:45 CMS payment flexibilities will soon go away so prepare for continued focus on patient-longitudinal well-being and outcomes tracking. 09:45 The especially challenging times of high inflation and workforce resilience and how value transformation is a strategy for sustainability. 12:00 Dr. Zerzan-Thul speaks about the Accountable Care Commitment Curve and how that can guide organizations to advancements in Health Equity. 13:30 The LAN's Health Equity Advisory Team (HEAT) and its recommendations for developing a Health Equity action plan. 14:30 Measuring equity outcomes through an enhanced data infrastructure and community partnerships. 15:45 Dr. McClellan speaks to how Social Risk Adjustment (SRA) can advance health equity through APMs (starting with ACO REACH) 17:30 The challenges of implicit biases in individual measures of social risk. 18:15 “Risk factors like food insecurity and transportation will eventually get more built in to our approach to health care.” 19:00 The additional considerations of community engagement, peer transformation, and other payment incentives to advance health equity. 20:30 The recent release of the APM Measurement Effort (survey data compiled the HCP LAN). 21:30 Dr. McClellan discusses the current status of 2022 APM adoption (see interactive graphic showing that nearly 20% of payments flowing through Category 3B-4 models.) 24:30 Dr. Zerzan-Thul comments on trajectory of APM adoption and current status of Medicaid transformation in population-based payment. 27:00 Dr. McClellan discusses the Accountable Care Commitment Curve more at length. 29:00 “You can't get to a critical mass of value transformation in the U.S.

America is still the richest country in the world. It could create a humane template that could guide the world into a new existence. So what does my America look like? This morning I woke up with that on my mind after someone called me idealistic. He said that I negate human nature. The thing is, I believe in human nurture. In other words, our environment influences most of us positively or, for that matter, negatively. I contend that our economic system, in many instances created by psychopaths, has created an environment that nurtures too many negatively. Progressive Lawmakers Demand Fraud Probe Into Medicare Privatization Scheme: "We have long been concerned about ensuring this model does not give corporate profiteers yet another opportunity to take a chunk out of traditional Medicare," wrote Sen. Elizabeth Warren, Rep. Pramila Jayapal and other lawmakers. A group of progressive lawmakers led by Sen. Elizabeth Warren and Rep. Pramila Jayapal is calling on Biden health officials to immediately launch a fraud probe into the organizations taking part in ACO REACH, a slightly reformed version of a Medicare privatization scheme that the Trump administration set in motion during its final months in power. --- Send in a voice message: https://anchor.fm/politicsdoneright/message Support this podcast: https://anchor.fm/politicsdoneright/support

Chronic Obstructive Pulmonary Disease (COPD) afflicts 24 million adult Americans and represents the 3rd leading cause of death. COPD is also the 5th most costly chronic disease in the US with attributable direct healthcare costs estimated at $49 billion! Given the edifice of fee-for-service payment in US healthcare, we have allowed the care of COPD patients to become fragmented and inconsistent.  We continue to see care of this chronically ill population wrought with poor clinical outcomes and a high economic burden. However, we are now seeing that value-based care is beginning to catalyze COPD care delivery innovation for a more promising future! Our guests this week are Geoff Matous and Dr. Abi Sundaramoorthy of Wellinks – a digital health company offering the first-ever integrated, virtual chronic obstructive pulmonary disease management solution.  These two leaders are connecting the dots on COPD to create a constellation of care that includes pulmonary rehabilitation, personalized coaching and monitoring, and connected devices. Disruption in payment incentives have spawned care delivery innovation at Wellinks, and they are poised for further success of their platform with the promise of global capitation in ACO REACH and MA plans. Don't miss out on the important conversation to learn how partnership and innovation can transform your healthcare organization's COPD population health playbook strategy! Episode Bookmarks: 01:30 Register today for the “Population Health Equity: The North Star for Value”(December 1, 2022) 03:00 COPD affects 24 million adults and represents the 3rd leading cause of death and the 5th most costly chronic disease in the US. 03:30 The direct healthcare costs of COPD is $49 billion (and growing!) with COPD-related hospital admissions costing upwards of $40k 04:00 Introduction to Geoff Matous and Dr. Abi Sundaramoorthy 05:00 November is National COPD Awareness Month 06:00 COPD is an Ambulatory Care Sensitive Condition (i.e. a chronic disease for which good outpatient care potentially prevent the need for hospitalization) 07:30 Balancing the population health management requirements for COPD (Coding and Documentation, Quality measures, and Cost Reduction) 08:30 Impacting patient behavioral change to impact COPD-related healthcare utilization 09:30 “COPD Total Cost of Care reduction is a significant opportunity in value-based care that has been left untouched for far too long.” 10:00 Why are we still in the early stages of COPD Care Delivery Innovation? 11:00 Employer-sponsored plans will not drive digital health innovation for improved COPD management – it must be driven by ACOs and MA plans. 12:00 Geoff speaks to the advantages of virtual-first COPD care in a risk-based payment model. 12:30 75% of the total direct COPD cost is tied to exacerbations -- how can chronic care management programs work to more effectively manage COPD patients?   14:00 Dr. Abi speaks about the challenges of health systems and ACOs developing a robust infrastructure for COPD virtual care. 15:30 43% of patients with COPD exacerbation will die within one-year of being discharged from hospital! 16:00 How the Wellinks Virtual COPD Management Solution approaches patient behavioral change. 17:30 The difference in approaches between “Pulmonary Health” and “Pulmonary Rehab” and how SDOH-based interventions can improve COPD management. 19:00 Health system attempts to help COPD patients self-manage their disease will fail if it is a “hero project” tied to temporary grant funding. 20:00 “Our call to action is to explore what can be done beyond the standard COPD care management playbook to improve patient outcomes and experience.” 21:00 99% of COPD patients have 1 comorbid condition, 87% have 3+ comorbidities! 22:00 Dr. Abi explains why COPD is a complex disease to manage and why addressing comorbidities alone will not be enough to reduce COPD exacerbations. 23:00 Behavioral health challenges associated with ...

When you hear about value-based care, do you get tired of hearing about concepts without tangible best practices?  Do you ever wish you could just acquire insights from a leader who navigated a successful value journey?  If you want to learn from one of the best in the “value game”, look no further than Dr. Bill Wulf, the CEO of Central Ohio Primary Care (COPC). Dr. Wulf is a respected leader in the value movement and leads the largest physician-owned primary care group in the United States.  During his leadership tenure, COPC has grown to over 480 physicians and 83 locations in central Ohio. The growth of the practice has empowered a successful value journey, with COPC caring for 75,000 senior patients in full-risk arrangements with Medicare Advantage and ACO REACH in partnership with Agilon Health (and the current move to full-risk in commercial plans with employers in partnership with Vera Whole Health). Dr. Wulf describes a value journey that has been over two decades in the making.  It started with a merger in the late 90's to create a fully-integrated primary care practice platform. And then in 2010, a Patient-Centered Medical Home (PCMH) transformation led to unprecedented success in full-risk Medicare Advantage.  COPC has built upon their MA success to now partner with large employers in full-risk programs, and they are also one of the new participants in the ACO REACH program. In this interview, Dr. Wulf goes into great depth on the care delivery innovations that were made possible by prospective payment and capital investment. He discusses hospitalist and ER care coordination programs, home-based care delivery, after-hours primary care access, telehealth, onsite clinics at employer locations, and the importance of data-driven insights from a unified EHR. You will also hear about how COPC has benefited from successful partnerships to build an even more effective infrastructure for population health outcomes. Most importantly, you will hear how COPC playing the “value game” helps their independent physicians take better care of patients! Episode Bookmarks: 03:30 The origin story of Central Ohio Primary Care (COPC) – the nation's largest independent primary care practice that is leading in VBC 05:30 Dr. Wulf describes how a practice merger in the late 90's led a successful hospitalist program, contracting strategy, and ancillary services model 07:00 Post-merger growth of practice because of better contracting rates and ancillary services revenue 07:30 “Our growth in the last 10 years has been a result of us playing the “value game” in helping physicians take better care of patients.” 08:00 This year COPC is integrating 3 practices (30 physicians) at a time when there aren't as many independent PCPs available. 09:00 COPC's commitment to physician independence, where physicians have the freedom to care for their patients without interference. 09:30 Beginning the value journey through the decision to transform into a Patient Centered Medical Home (PCMH) 11:00 How physician independence leads to freedom to make data-driven referrals that improve population health outcomes. 12:00 A unified Electronic Health Record (EHR) led to the identification of the “best” doctors in the practice. 13:00 “The best physicians in the practice were not the busiest ones…but these physicians (pre-value journey) were making the least income.” 13:45 “Our best physicians were creating value for the payer, employer, and the government, but they were not recognized for value in a FFS world.” 14:30 Dr. Wulf describes how Level 3 PCMH recognition led to value creation (“a stepping stone”) 16:00 PMPM payments from commercial and MA plans led to programs that improved outcomes with high-risk patients. 16:30 COPC's Hospitalist Program (100 physicians) and ER Care Coordination Program 17:00 Nursing care coordination that leads to effective post-discharge planning and transitions of care from the hospital.

In the uncertainty of today's healthcare industry, we must continue to persevere towards our true north.  The moral imperative to improve the quality of care for patients through better care coordination, including those are underserved, can only be achieved by the realities of the digital age. This transformation will require the medical profession to create a modernized Hippocratic Oath that extends to the broader health ecosystem. The proliferation of interoperable technology and digital health tools has the potential to catalyze value-based care delivery innovation and transparency. However, it must come along with an ethical commitment to guide data sharing, integration, and technical processes. True North will ultimately prevail in connecting value-based networks to those most in need; however, it will take continued progress in amplifying the demand signal for value-based care. On the Race to Value this week, you will hear from one of the top healthcare revolutionaries in our country.  We are honored to bring you, the one and only,Aneesh Chopra - the first chief technology officer of the United States who was appointed by President Obama and the Co-Founder and President of CareJourney. In this episode, you will be party to a powerful conversation on the promise of the digital age in healthcare.  You will learn about how health policy and innovation is ushering in a new era of data flow and interoperability, consumer-driven innovation, price transparency, and clinically-relevant analytics for the future of value-based care delivery transformation. Aneesh Chopra also explains why he feels so strongly why ACO REACH will help us reach True North. Episode Bookmarks: 01:30 Introduction to Aneesh Chopra -  - the first Chief Technology Officer of the United States and Co-Founder and President of CareJourney 04:00 The need for the medical profession to galvanize around the immense opportunity to transform care delivery by embracing the realities of digital age. 06:30 Why do we need a digital Hippocratic Oath to transform medicine? 08:00 The gap between patients being seen on a given day and the 98% of the patient panel that are not. 08:30 Designing database queries and algorithms to Identify patients in need of care. 09:30 Creating a compact between analytics communities and physicians to ensure patients are getting appropriate care. 10:45 The self-imposed barriers to technical and semantic interoperability that come from our current FFS model. 12:00 How the HITECH Act manifested in technology gaps, despite widespread EHR penetration. 14:00 “The delay in the demand signal for value-based care resulted in the de-prioritization in the market for interoperability.” 15:30 The regulatory goals of the 21st Century Cures Act to scale interoperability and eliminate information blocking. 16:45 Cures Act regulatory emphasis on population health is now reaching the market. 17:00 FHIR Interoperability Standards will ultimately deliver on the promise of population health through widespread data exchange and API-led connectivity. 18:00 Ensuring value-based care organizations a “plug and play” approach to unify electronic health records. 19:00 The promise of widespread data exchange in value-based care delivery and how it parallels with the consumer banking industry. 20:30 Similarities between Dodd-Frank Act (banking sector) and the Cures Act (healthcare sector) in regard to consumer data protections. 22:30 JPMorgan cutting off access to Mint because screen-scraping was far less secure than API connectivity. 25:00 If value-based care became the dominant delivery model, the industry wouldn't need so much regulatory oversight. 26:00 The Cures Act is beginning to reverse FFS-driven market failures in order to create a much more rational economic model. 27:00 Referencing the opinion piece in STAT by Aneesh Chopra and Seema Verma about the new price transparency regulations in healthcare.

The Institute for Advancing Health Value has recently released two new Intelligence Briefs highlighting two major impactful events in the movement to value-based care. 2021 MSSP Performance Results Analysis:  The Institute analyzes 2021 performance data, sharing high-level program performance and examining savings across participation tracks, by the provider type, size and location of ACOs, and their experience in the program, and reflects on the future of the MSSP in light of the recently proposed changes to the program and the beginning of CMS's new capitated total cost of care model, ACO REACH. The ACO REACH Final Cohort:  The Institute analyzes the incoming final cohort of provisionally-accepted REACH ACOs within the context of the model's history, analyzing the roster relative to GPDC's current participants, and sharing expectations for the future.  (This Intelligence Brief was sponsored by Bamboo Health.) Check out this special bonus episode where Eric and Dan interview Kate de Lisle on her research analysis on these recent CMS announcements.  You may also download these Intelligence Briefs at  https://www.advancinghealthvalue.org/analysis-of-mssp-2021-and-aco-reach-2023/ Episode Bookmarks: 01:30 Download the new Institute intelligence briefs on the 2021 MSSP Performance Results and the ACO REACH Final Cohort 02:30 Background on Kate de Lisle, Senior Manager of Payment & Delivery Transformation at Leavitt Partners 04:00 Recently announced MSSP Results as an important bellwether for the success of the value movement 05:30 Total program savings of nearly $5.4 billion over the model's lifetime 06:30 5th consecutive year of net savings – has the MSSP demonstrated proof of concept? 07:00 Was 2021 a good year for the MSSP since the net savings wasn't quite as large as the year prior? 07:30 The average per beneficiary PMPM savings amount was $164 (double what it was in 2019) 08:00 81% of ACOs generated savings and 58% earned a Shared Savings bonus.  Quality scores were also high. 08:45 89% of ACOs taking downside risk generated savings (compared to 76% that saved in an upside-only track) 09:15 Risk-bearing ACOs generated $5.3M per ACO (compared to $2.9M for non-risk bearing) 09:45 ACOs led by physician groups realized the most savings. 10:00 Hospital-led ACOs realized a decline in savings. 10:30 Years of experience in the MSSP is no longer a straightforward predictive indicator of performance success. 14:00 Last month, CMS released the names of the 110 provisionally-accepted organizations selected to join the ACO REACH model starting in 2023 15:30 Only 47% of REACH applicants were provisionally accepted. 17:30 New cohort had similar profiles of selected groups accepting Global and Professional Risk. 18:00 New entrants are serving vulnerable and high-risk populations. 19:00 Groups moving from Next Gen ACO to ACO REACH 20:30 Far fewer payer-led ACOs in the new REACH cohort 21:30 What considerations did CMS take into account when selecting for participation in the new REACH program? 22:00 Sustained interest in ACO REACH from VBP enablement companies (e.g.Aledade, agilon health) 23:30 Provider-owned enablement companies participating REACH (e.g. Castell Health) 24:30 Upstart primary care companies accepted into ACO REACH (e.g. Oak Street Health, Iora Primary Care, ChenMed, Cano Health, Cityblock, ConcertoCare) 25:00 ChenMed  (a leading full-risk MA primary care practice in the country) is included in the new ACO REACH cohort. 25:30 OneMedical has also been accepted into the program. 26:30 The Institute for Advancing Health Value has a complimentary membership for provider organizations! 27:00 Will CMMI be sunsetting various APMs, including specialty care models like BPCI and CJR programs? 28:30 Kate speaks about the “weak signals” being broadcasted by CMMI around the future of the APM portfolio. 30:00 What impact will ACO REACH have on the CMS 2030 Goal?

Meet Keith Pitts:Keith Pitts is the Operating Advisor for Clayton Dubilier and Rice. Previously, he was the Vice Chairman of Tenet Healthcare Corporation and the Vice Chairman of Vanguard Health Systems. Prior to Vanguard Health Systems, Keith served as the Chairman and CEO of Mariner Post-Acute Network as well as the Executive Vice President and CFO for OrNda HealthCorp. He received a Bachelor's in Business Administration from the University of Florida.  Key Insights:Change in healthcare is evolutionary, not revolutionary. Keith Pitts explores the progression of healthcare from the 90s to today, and provides insights to where the industry is headed next. Healthcare Evolution. Consumers have changed their healthcare preferences. More than ever, patients accept virtual care and receiving health in non-hospital environments, such as at-home care. Keith predicts there will be a trend towards the “de-institutionalization” of low-acuity care.Government's Role in Healthcare. The U.S. government is the largest payer in healthcare, and plays a role in innovating payment models. CMMI is constantly testing new models, such as the recent ACO REACH. Keith sees the government as leading the way in pushing providers into value-based care models.The Cost of Standby. Healthcare operates on slim margins. A problem with this financing is that ER's and ambulatory services are needed 24/7, but few want to pay the standby costs of having those services always available.  Relevant Links: Learn more about Keith Pitts

Many roads will bring us to health value, but some roads will get us there faster than others. As we reimagine our nation's healthcare system, we must build alternative avenues to value beyond the conventional fee-for-service approaches to transformation. In building a superhighway that fully unleashes the power of independent and accountable physician groups, we will produce faster and better results. Joining us this week on the Race to Value is Susan Dentzer, the President and Chief Executive Officer of America's Physician Groups (APG), the organization of more than 335 physician practices that provide patient-centered, coordinated, and integrated care for patients while being accountable for cost and quality.  APG members provide care to nearly 90 million patients nationwide and are leading this nation's superhighway in the race to value. In this podcast episode, we discuss advanced primary care transformation, restructuring of payment models to reach scalability and impact, health policy reforms, PCP employment trends, the M&A landscape in provider consolidation, Medicare Advantage, and the power of tech-enabled asset-light care delivery. Episode Bookmarks: 01:30 Introduction to Susan Dentzer, President and Chief Executive Officer of America's Physician Groups (APG) 04:30 More than 60% of health care payments in 2020 included some form of quality and value component 05:30 Despite traction, moving to value at a glacial pace (reference recent surveys fromMGMA and HCP-LAN) 06:30 Susan discusses the entrenchment of FFS and how difficult it is to change the payment edifice in U.S. healthcare 09:00 Overcoming the extraordinary backlash and resistance to realigning payment incentives in American healthcare 12:00 How APG is approaching the national transition to value 13:30 The need for advanced primary care in helping CMS achieving its 2030 goal to drive accountable care 14:45 The systematic undervaluing of primary care and overemphasis on hospitalizations 16:00 How the payment structure was hijacked by proceduralists and specialty care 16:30 Clinton era health policy reforms that attempted to restructure Medicare payments to primary care 17:30 Where would we have been if we tackled primary care reimbursement and workforce challenges in the 1990's? 18:30 Limited progress in voluntary innovation models to advance primary care effectiveness (e.g. PCMH, team-based care) 19:30 How the NHS in England created state-of-the-art primary care through 24/7 access 20:45 The private sector stepping up to modernize care delivery access and infrastructure where public policy failed 21:30 Investment in primary and secondary prevention to address chronic disease 22:00 Transitioning from a cottage industry to a well-funded, risk-based primary care strategy to improve population health 24:00 PCP employment by hospitals often not an driver of value-based care due to referral maximization objectives 24:30 Independent PCPs will need to find investment partners to advance risk-based transformation 24:45 Susan discusses the success of Central Ohio Primary Care's partnership with agilon health 29:00 Medicare Trust Fund solvency will be depleted by 2026, but APM adoption could help avoid this fate. 30:30 “Many roads can bring you to value, but some roads will get you there faster than others.” 31:00 MACRA legislation created MIPS and APMs using the current fee-for-service chassis 31:45 The importance of the 5% bonus/incentive payments to QPP participants that are a part of Advanced APM models 32:30 Hospitals pocketing APM incentive payments for employed providers will not accelerate path to value. 32:45 Results comparison between physician-led and hospital-led ACOs 34:00 Susan explains why America's physicians are the superhighway to Value Transformation 36:00 Capitation within the ACO REACH model as a continuation of full-risk success in Medicare Advantage 38:00 “Alternative avenues to value – beyond the conventional F...

Virsys12 founder and CEO Tammy Hawes and her co-host Clark Buckner talk with Aneesh Chopra, president and co-founder of CareJourney, about the work he's doing to standardize provider directory data. Chopra also shares his vision for a truly integrated health system and explains why he believes ACO Reach can help us get there. Chopra served as the United States' first Chief Technology Officer under President Barack Obama. Chopra believes that in order for healthcare to truly become patient-centered, we need to make it easy for them to find providers that meet their needs and aggregate all of their health data in one place. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

When patients can access accurate, easy-to-understand information about the providers in their network, their care outcomes improve. This is one of the problems CareJourney President and former U.S. CTO Aneesh Chopra has spent his career working to solve. In this episode, Aneesh shares his vision for a healthcare landscape that makes both patients' and providers' lives easier. He also breaks down the pros and cons of different payment models and explains the benefits of ACO Reach.

Democratization of value can only happen through the replication of full-risk APM adoption in primary care.  As a country, we must accelerate primary care progression towards fully-capitated risk by thoughtful health policy and payment model redesign.  Change is underway -- primary care is already moving to a capitated model of reimbursement, and ACO REACH is our first real test of realigning financial incentives to improve care of patients living with chronic conditions.  Furthermore, this inflection point in the value movement is finally bringing much needed emphasis to those living in underserved communities facing health inequities.  So how do we operationalize primary care transformation at scale?  Is it possible to replicate a ‘clinical flywheel' that provides RN care coordination, home-based care, embedded pharmacists, and floating health concierges to close care gaps and addressing health inequities? This week we are joined by two executives from UpStream, a billion-dollar, full-risk health services organization that embeds clinicians into participating doctors' offices as an advanced, full-risk Medicare program for network physicians.  By focusing on patients living with chronic conditions, and physically embedding highly trained prescribing pharmacists and coordination nurses at each primary care physician office, UpStream partners with its client practices to create the right infrastructure and resources for the whole-person care experience. Their approach has been to fully invest in primary care delivery models accountable for Total Cost of Care, whereby reducing care fragmentation for chronically ill patients while also achieving the best clinical and financial outcomes. Dr. Sanjay Doddamani (CEO and Co-Founder of Upstream) and Valinda Rutledge (Chief Corporate Affairs Officer of Upstream) are two of the biggest thought leaders in the value movement. In this episode, they talk about the transformation opportunity of massively powerful primary care, the impact of COVID-19 on the value movement, technology innovation, health equity, capital investment in primary care infrastructure, collaborative care models, and the new ACO REACH payment model. Together they are leading one of the most innovative companies out there supporting primary care physicians in the Race to Value! Episode Bookmarks: 01:30 Upstream – the fastest-growing healthcare solution provider in the country 02:30 Introduction to Dr. Sanjay Doddamani and Valinda Rutledge 04:00 The transformation opportunity of massively powerful primary care within a value-based purchasing construct 05:00 Can we reach a “Win-Win-Win” for patients, primary care physicians, and patients? 06:00 Valinda on the impact of the pandemic on the value-based care movement and how it unleashed tech-enabled consumerism in primary care 08:00 Payment reforms and looming insolvency of Medicare and how it will impact the independent Primary Care landscape 09:00 The development of ACO REACH as a model for capitated primary care reimbursement 09:30 Sanjay speaks to the challenges of the post-pandemic environment and the ‘Great Resignation' on physician networks 10:00 “Primary Care physicians influence 90% of all medical costs.” 11:00 PCP burnout and recent findings on how family medicine is one of the five most stressful specialties 13:00 “If you continue to practice in a fee-for-service environment, it is like being on a hamster wheel with no way to get off.” 13:30 Sanjay speaks about the need to reallocate investment dollars to build primary care infrastructure for the 21st century 15:00 Critical Success Factors: Pharmacy integration, home-based primary care, and advanced data science capabilities 16:00 Valinda speaks to the challenges of decreasing PCP panel size when there are access barriers in underserved communities 18:00 Population health infrastructure requirements as the table stakes needed to play the game of value-based ...

While there have been meaningful improvements in healthcare delivery over the last decade, they have not catalyzed the transformation necessary to advance health value and equity. The promulgation of health policy and the implementation of new alternative payment models have created a landscape for experimentation in value-based care, yet the seismic shift needed to facilitate long-term and sustainable improvements has yet to occur. The key enabler for the future of our industry is workforce readiness to deliver on the promise of high-value, high-quality care that delivers equitable outcomes for all. This week on the Race to Value podcast, you are going to hear from a distinguished panel of industry experts on the importance of workforce development in value transformation.  Workforce development will drive success in value-based care by ensuring industry capability, and it will help underserved communities thrive through population health interventions that improve societal outcomes and reduce inequities. As you listen to this discussion with Dr. Jim Walton, Christina Severin, Dr. Joy Doll, and Dr. Richard Walker, think about how the scale and impact of workforce skill and knowledge is either a force multiplier or an impedance for change. If you want to learn more about affordable educational pathways for reskilling and upskilling in preparing for risk-based payment after hearing this discussion, please reach out to the Institute for Advancing Health Value – your partner in developing a competent workforce to win this Race to Value! Episode Bookmarks: 01:30 The key enabler for the future of our industry is workforce readiness to deliver on the promise of high-value, high-quality care that delivers equitable outcomes for all. 02:00 Workforce development will drive success in value-based care by ensuring industry capability, and it will help underserved communities thrive through population health interventions. 03:00 The Institute for Advancing Health Value – your partner in developing a competent workforce for the future of value-based care 03:30 Introduction to expert panelists:  Dr. Jim Walton, Christina Severin, Dr. Joy Doll, and Dr. Richard Walker 06:00 The imperative to ensure health equity and reduce disparities in our most vulnerable populations 07:00 Dr. Walker shares the vision to serve underserved populations through reengineered primary care 08:45 How TVP-Care access to care with both a “high touch” and “high tech” model that reaches patients in their homes 09:30 Dr. Doll on how CyncHealth addresses health equity through data democratization within a longitudinal health record and community-based SDOH support ecosystem 10:30 Dr. Walton speaks to the importance of building an engaged ecosystem and how GPG realizes that “equity is a valuable business model for the future of private practicing physicians” 11:00 The impact of burnout and moral injury and how that will become a “self-fulfilling prophecy” without a value-based business model and workforce strategy 12:00 “We must have an ROI attached to social interventions; otherwise, we are just tilting at windmills.” (Harnessing AI/ML for predictive risk stratification of the patient population) 13:00 Christina Severin on how C3 approaches team-based care, social interventions, behavioral health in its FQHC network 14:00 Establishing a diversity, equity, and racial justice committee and building a data infrastructure to drive health equity 16:00 How CMS is integrating health equity in every stage of payment model development, including the new ACO REACH program 17:30 Christina Severin discusses on ACO REACH is a great step forward in program redesign to have a more adequate benchmark that represents the complexity of the population 18:30 Taking the time to understand the legacy of white supremacy in this country and how it impacts healthcare delivery 20:00 Dr. Walker on the importance of developing trust wi...

In this second installment of the Medicare Meet-up Health Equity Mini-Series – and the last episode of Season 2 – Meg, Melissa and Brede chat about the latest Medicare news and the recent Aurrera Health Group webinar – Making Sense of Payment Mechanisms in ACO REACH. They continue the discussion of health equity and interview Leon Caldwell, Ph.D., American Hospital Association's senior director for health equity strategies and innovation at the Institute for Diversity and Health Equity about how hospitals can be community leaders in advancing equity.

Donald Trump claimed to be a supporter of Medicare, yet his administration took numerous steps to cut its budget and introduce schemes to privatize it, including the Direct Contracting Entity (DCE) program, also known as ACO REACH. Rather than overturn this program, President Biden and his administration have been quietly letting it continue. As Branko Marcetic recently wrote in Jacobin magazine, "ACO REACH's continued existence is a serious looming threat to Medicare as we know it and to seniors themselves. And in a sadly typical trend, it's a Democratic president who's trying to get away with gutting Medicare, something a Republican could never hope to get away with."In the latest installment of The Marc Steiner Show, Marc talks with Marcetic about his recent Jacobin piece, the corporate-serving "logic" behind the push to privatize Medicare, and about the grassroots effort to fight against it.Branko Marcetic is a Jacobin staff writer based in Toronto, Canada, and the author of Yesterday's Man: The Case Against Joe Biden.Read the transcript of this episode: https://therealnews.com/trump-wanted-to-privatize-medicare-bidens-letting-it-happenTune in for new episodes of The Marc Steiner Show every Monday on TRNN, and subscribe to the TRNN YouTube channel for video versions of The Marc Steiner Show podcast.Pre-Production/Studio: Adam ColeyPost-Production: Stephen FrankHelp us continue producing The Marc Steiner Show by following us and becoming a monthly sustainer:Donate: https://therealnews.com/donate-pod-mssSign up for our newsletter: https://therealnews.com/nl-pod-stGet The Marc Steiner Show updates: https://therealnews.com/up-pod-stLike us on Facebook: https://facebook.com/therealnewsFollow us on Twitter: https://twitter.com/therealnews

Donald Trump claimed to be a supporter of Medicare, yet his administration took numerous steps to cut its budget and introduce schemes to privatize it, including the Direct Contracting Entity (DCE) program, also known as ACO REACH. Rather than overturn this program, President Biden and his administration have been quietly letting it continue. As Branko Marcetic recently wrote in Jacobin magazine, "ACO REACH's continued existence is a serious looming threat to Medicare as we know it and to seniors themselves. And in a sadly typical trend, it's a Democratic president who's trying to get away with gutting Medicare, something a Republican could never hope to get away with."In the latest installment of The Marc Steiner Show, Marc talks with Marcetic about his recent Jacobin piece, the corporate-serving "logic" behind the push to privatize Medicare, and about the grassroots effort to fight against it.Branko Marcetic is a Jacobin staff writer based in Toronto, Canada, and the author of Yesterday's Man: The Case Against Joe Biden.Read the transcript of this episode: https://therealnews.com/trump-wanted-to-privatize-medicare-bidens-letting-it-happenTune in for new episodes of The Marc Steiner Show every Monday on TRNN, and subscribe to the TRNN YouTube channel for video versions of The Marc Steiner Show podcast.Pre-Production/Studio: Adam ColeyPost-Production: Stephen FrankHelp us continue producing The Marc Steiner Show by following us and becoming a monthly sustainer:Donate: https://therealnews.com/donate-pod-mssSign up for our newsletter: https://therealnews.com/nl-pod-stGet The Marc Steiner Show updates: https://therealnews.com/up-pod-stLike us on Facebook: https://facebook.com/therealnewsFollow us on Twitter: https://twitter.com/therealnews

The Centers for Medicare & Medicaid Services (CMS) earlier this year rebranded an aspect of the Medicare program that used to be called Direct Contracting. The newly named ACO REACH stands for “Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health.”

In February, CMS announced a redesign of the Global and Professional Direct Contracting Model for 2023. The Center for Medicare and Medicaid Innovation also released an RFA to solicit a cohort of participants for the new version of Direct Contraction, the ACO REACH Model. Aisha Pittman and Mara McDermott discuss how the renamed model better aligns with the purpose of encouraging providers to coordinate care to people with Medicare and better reach participants in underserved communities.

The fee-for-service model of healthcare has been reexamined over the past few years, with alternative models increasingly gaining traction. Zak Holdsworth, CEO and co-founder of Hint Health, tells Healthcare Finance News Executive Editor Susan Morse he believes the status quo payment models are on their way out – and the question isn't "if," but "when."Talking points:-How Hint Health got started-How the direct primary care model works-The benefit for health systems-What about specialty care?-Employers are starting to explore new options -Should insurers be scared?-The difference between this model and the ACO REACH model-The future for Hint HealthMore about this episode:Employees want direct primary care from their employer plansFlat-fee primary care model helping fill a niche in Texas, but it isn't insuranceFueled by health law, 'Concierge Medicine' reaches new marketsHint Health rolls out value-based primary care direct contracting networkHow a direct primary care model provider benefits from an easy-to-use EHR

The recent dust-up over Direct Contracting and its ultimate rebranding as the ACO REACH model may have led some to believe that our path forward is unclear. That couldn't be further from the truth. On this episode, we talk with François de Brantes, Senior Vice President of Episodes of Care at Signify Health, about where we are on the pathway to escaping the tyranny of Fee-For-Service healthcare. It's tyranny because it prevents us from delivering care the way we want to and need to. Advanced Alternative Payment Models like ACO Reach allow organizations to separate payment from delivery, stop focusing their efforts on top-line revenue, and begin to operate like typical P & L driven companies. The promise, of course, is that this will change the way healthcare is delivered in the U.S., improve outcomes and lower costs. We discuss: - Has utilization and payment returned to pre-pandemic norms? - Why are commercial carriers lagging behind Medicare and Medicaid in launching Advanced Alternative Payment Models? - Will the shift to value and consumer-centric delivery methods like telemedicine diminish uncompensated care? - Is it possible to be proactive and patient-centric in Fee-for-service? - Are provider systems ready for AAPMs? - Can employers band together to create enough demand for AAPMs in the under-65 commercial market? - What were the arguments against the Direct Contracting Model? - Did they have merit? - What changes were made to Direct Contracting as part of the rebrand to ACO Reach? - How does this dust-up over Direct Contracting confirm we are on a bi-partisan, unwavering march toward value and never going back? - Why did Signify Health acquire Caravan Health?   For full show notes and links: https://thehcbiz.com/189-escaping-the-tyranny-of-fee-for-service-healthcare-francois-de-brantes/

In episode #20, Nick Desai (host) rolls solo to discuss DCE becoming ACO reach - lip service or real reform? Subscribe for future updates with Nick's Notes.Sponsored by: HeyRenee - your care concierge. For more information, be sure to follow Nick's Notes on all social channels:- Website - Facebook - LinkedIn - Twitter - YouTubeThis podcast is produced by Slice of Healthcare LLC. 

Brian (@chiglinsky) is joined by Aledade's Policy Dream Team: Sean Cavanaugh (@dc_cavanaugh), Chief Policy and Chief Commercial Officer, Travis Broome (@Travis_Broome), Senior Vice President for Policy and Economics, and Casey Korba (@casey_korba), Director of Policy, as they share an overview of Healthcare Value Week and CMS' changes to Direct Contracting, now known as ACO Reach.

On February 24th, the Centers for Medicare & Medicaid Services (CMS) revealed the highly-anticipated fate of the Innovation Center's (CMMI) Direct Contracting model options, announcing a redesign of the Global Professional Direct Contracting (GPDC) Model and the permanent cancellation of the Geographic Direct Contracting (“Geo”) Model. The revamped and rebranded GPDC model—now called Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH)— aims to better reflect the agency's vision and Administration's priorities for system transformation.  The new ACO REACH model has incorporated stakeholder feedback to alleviate the concerns of GPDC's critics while maintaining the key features of the model and building on the momentum of the accountable care movement. ACO REACH also adds in exciting new components aimed at closing health equity gaps in keeping with the Innovation Center's Ten Year Plan released late in 2021. This special podcast episode offers a short background on the model's history and recent controversies leading up to the announcement, summarizes the major provisions of the new ACO REACH Model, outlining the key changes from the GPDC design, and considers potential implications for the Direct Contracting Entities (DCEs) currently participating in the GPDC model as well as the broader value movement. Joining this week we have two leading strategists in value-based care, Joe Satorius and Rick Goddard. They come to us from Lumeris - an accountable care delivery innovation company that enables health systems to deliver value-based care through advanced technology, risk-management, and outcome-based managed services. The ACLC and Lumeris have partnered to bring you the most in-depth information on the ACO REACH model. In addition to this episode, please download our free Intelligence Brief. Episode Bookmarks: 02:00 Background on the new ACO REACH payment model and its focus on health equity 03:00 Don't forget to download the Intelligence Brief on ACO REACH released by the ACLC in conjunction with this podcast episode! 04:00 Background on Joe and Rick and their work at Lumeris 05:00 The complete redesign of the Global Professional Direct Contracting (GPDC) model 07:00 Rick and Joe provide perspective on the future of the Value-Based Care movement and the unsustainability of fee-for-service 08:30 CMMI's Goal to have all Medicare beneficiaries in an accountable care relationship by 2030 11:00 Joe discusses CMS' newly-refined eligibility criteria and why that matters when it comes to advancing health equity, promoting provider leadership and engagement, and enhancing beneficiary protections 12:00 The new ACO REACH requirement for 75% board representation from participating providers. 13:00 How ACO REACH incentivizes providers to address social disparities with underserved beneficiaries 15:00 The progression of capitation options in the ACO REACH model 16:30 Rick provides an extensive overview of the professional and global tracks of ACO REACH and the various capitation options that drive economics 20:00 The strategic implications of Total Care Capitation (TCC) and how network curation and design can support performance success and aligned behavioral economics 22:00 The Primary Care Capitation (PCC) + Advanced Payment Option (APO) 22:45 The importance of assessing risk appetite and value-based care readiness 25:00 Rick discusses the Health Equity Benchmark Adjustment – a new change to benchmarking methodology in the ACO REACH model 29:00 Providing greater and more equitable access to underserved communities, while leveraging telehealth and other value levers 32:00 Joe discusses risk adjustment methodology within ACO REACH and addresses concernsabout risk score gaming and over-coding 34:00 The 3% cap, the coding intensity factor, and demographic adjustments that serve as guardrails to inappropriate risk score increases

Join Health Affairs Insider.Late last month, the Centers for Medicare & Medicaid Services (CMS) announced its redesign of its Global and Professional Direct Contracting Model to its now-branded Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) Model. The agency stated the redesign is meant to advance health equity and was in response to stakeholder feedback and participant experience.On today's episode of Health Affairs This Week, Harvard Medical School's Michael Chernew joins Health Affairs Forefront Editor Chris Fleming to talk about the new CMS model for ACOs, and where Medicare Advantage could improve.Related Links: Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) Model (CMS) The Case For ACOs: Why Payment Reform Remains Necessary (Health Affairs Forefront) Podcast: Michael Chernew Makes The Case for Payment Reform (Health Affairs This Week) Medicare Advantage, Direct Contracting, And The Medicare 'Money Machine,' Part 2: Building On The ACO Model (Health Affairs Forefront) Subscribe: RSS | Apple Podcasts | Spotify | Castro | Stitcher | Deezer | Overcast

Last week, Medicare announced the next phase of its plan to transform traditional Medicare. Critics argue that the planned transformation of the fee-for-service program will amount to a dramatic expansion of privatization. And, if you are enrolled in traditional Medicare, or expect that you will be in the future know this: no matter if you want it or not, Medicare plans to enroll you in this new model by the end of this decade, as early as next year in some cases. Millions of retirees have opted out of traditional Medicare over the past two decades. Instead, they have joined Medicare Advantage, which is a privatized, managed-care version of the program. But the choice between those two options might not be in their hands much longer.Medicare has been quietly testing a new model for traditional fee-for-service Medicare. Medicare enters into contracts with healthcare provider groups that receive a flat annual payment to provide care for enrollees in the traditional program. Up until this point, Medicare called the health care contractors involved in this experiment “Direct Contracting Entities,” but starting next year they will be known as Accountable Care Organizations, or ACOs.The concept of ACOs is not new - many health care experts say they have the potential to improve health care by incenting healthcare providers to work together as teams. But this particular version of ACOs is drawing criticism from some health policy experts, who view it as unwarranted - and unwise - further privatization of Medicare.The new model launching next year is called ACO REACH. The word REACH is an acronym, standing for Realizing Equity, Access, and Community Health. Medicare is pitching the program as a way to advance health equity for underserved communities. And that’s a very laudable goal. But ACO Reach providers actually will have much in common with Medicare Advantage, Like Advantage plans - which usually are HMOs or PPO plans - ACO Reach plans will create networks of preferred healthcare providers, and they can retain as profit the portion of the annual per-patient payments that are not spent on healthcare.A big worry here is the rush of private equity firms and other investment groups into the business, which points to even more privatization of Medicare than we’ve seen already. And here’s something important to know if you are enrolled in traditional Medicare, or expect that you will be in the future. Medicare plans to enroll everyone who uses traditional Medicare in an ACO by 2030. And starting next year, if you live in an area where a REACH ACO operates, you can be assigned to one without your consent.This week on the podcast: Joining me on the program this week to talk about the REACH ACO model is Dr. Ed Weisbart. Ed is a family medicine practitioner. And he chairs the Missouri chapter of Physicians for a National Health Program, a national group of 21,000 physicians and other health professionals who support single-payer national health insurance. PNHP has taken a leading role in opposing Medicare’s ACO plans.I’ve been really surprised that this topic hasn’t surfaced much in general media yet, considering its importance to millions of seniors. After Medicare announced its plans for ACOs last week, it seemed like a good idea to turn up the volume a bit. Click the player icon at the top of this post to listen to the podcast. The podcast also can be found on Apple Podcasts and Stitcher.Further reading on Medicare ACOsA quiet experiment is testing further privatization of Medicare Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,’ Part 1: The Risk-Score Game.Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,’ Part 2: Building On The ACO ModelBiden Pursues Trump Plan That Creates Big Profits by Denying Health CareTrump-era Medicare program under increased scrutinyPhysicians for a National Health Program - page of resources on ACO Reach.What I’m readingIRS releases long-awaited Secure Act RMD regulations . . . Medicare’s finances and the saga of the Alzheimer’s drug Aduhelm . . . The pandemic pummeled long-term care – it may not recover quickly. Subscribe at retirementrevised.substack.com