POPULARITY
7 episodes with Chronic care management
6 episodes with Chronic care management
3 episodes with Chronic care management
2 episodes with Chronic care management
2 episodes with Chronic care management
2 episodes with Chronic care management
2 episodes with Chronic care management
2 episodes with Chronic care management
2 episodes with Chronic care management
This week their guests are Mike Hoxter, Chief Technology Officer, and Briana Rodriguez, RN, BSN, the Director of Clinical Programs at Lightbeam Health Solutions, specializing in Chronic Care Management, Transitional Care Management, Remote Patient Monitoring and Annual Wellness Visits. The company builds customized operational solutions to align ancillary care teams as seamless members of their partners' value-based care goals. They discuss: empowering ACOs, predictive analytics in population health, closing care gaps, reducing healthcare costs, and the future of value-based care. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. 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
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About Mark Whittington:Mark Whittington is the Managing Director at HealthXL, a company focused on improving healthcare outcomes for patients with chronic conditions through chronic care management and remote patient monitoring. Mark is passionate about helping people stay healthy longer and improving their quality of life, especially those in vulnerable stages of their health journey.Things You'll Learn:Chronic care management and RPM can alleviate the burden on primary care physicians, allowing them to focus on patients who need face-to-face care while managing routine cases remotely.Devices used for remote patient monitoring (blood pressure cuffs, pulse oximeters, etc.) should be simple and familiar. Accountability and consistent use are the most critical factors for success.Transparency and communication with patients through various channels (devices, texting, apps) will improve patient engagement and access to care.AI has the potential to glean insights from patient data, predict health issues, and enable earlier interventions, ultimately improving patient outcomes.Chronic care management and RPM are key components of value-based care. They enable providers to proactively manage patient health and prevent costly complications.Resources:Connect with and follow Mark Whittington on LinkedIn.Learn more about HealthXL on their LinkedIn and website.Email Mark directly here.
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In this episode, BerryDunn experts Robyn Hoffmann, Natalie Laaman, and Olga Gross-Balzano discuss Chronic Care Management (CCM) services in Medicare and what your organization needs to be audit-ready. You'll hear a quick overview of Medicare practice requirements with detail on who can provide Chronic Care Management, how to oversee contractor's deliverables, whether CCMs can be provided by a contractor who is outside of the United States, how to handle new patients (or those not seen in a year or more,) and how to prepare and respond to a post-payment audit.
In this exciting kickoff to 2025, Jamie sits down with Your Health CEO Matt Staub to discuss the organization's latest groundbreaking initiatives. From the expansion of the Community Health Integration (CHI) program to the launch of a new Durable Medical Equipment (DME) division and a return to hospice care, Your Health is reshaping the way healthcare is delivered. They also dive into the organization's expansion into Florida, how healthcare is moving beyond the four walls of a hospital, and why integrated care teams are the future. Tune in for an insightful conversation about the future of patient-centered care and how Your Health is leading the charge!
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So as you are well aware, at CHESS we often refer to the seven pillars of value-based care. What are these pillars and how does each impact fee-for-value? So, we've tended to use these pillars, if you will, to think about the process. Really, it follows our implementation process in many ways. So, I would start with practice transformation. So, that involves ensuring that physicians, advanced practice providers, office staff from CMA to nurses to even front desk staff, has some awareness of value-based care, understand why it is important, and then are engaged in the process of transforming that practice to a infrastructure that supports the delivery of the value-based care models and success in those models, both clinically, which is ultimately what this is really all about, and financially.From there, you can begin to layer on other services or pillars if you will. These don't necessarily have to happen in this order, but we often start with thinking about quality. Most organizations today have some quality efforts already in place just due to primarily to the fact that CMS and other payors are pushing those. And most people have at least some pay-for-performance type of arrangements, where they're paid for closing quality care gaps. But quality goes beyond just thinking about closing quality care gaps. For our quality team, we're thinking about optimizing the annual wellness visit so that the template within the EMR is just capturing data points and discrete fields. That makes reporting easier back to CMS as well as to the private insurance companies, Medicare Advantage, as well as commercial.We think about Care Coordination and as we define care coordination, that includes, for our teams, nurses and CMAs. They work together to assist also in quality. So, the CMAs help close quality care gaps throughout the year. They schedule annual wellness visits, that's a big emphasis in the first half of the year. If you can already tell, that annual wellness visit is a key component of value-based care because it touches on so many different elements of value. The other role for Care Coordination would be moving with that patient, tracking that patient, outreaching the patient between transitions of care. So, patient is admitted to the hospital, discharged to the skilled nursing facility, then discharged home. Our Care Coordination teams are monitoring that patient as they transition through those different sites of service and ensuring that each transition is as safe as possible. We all know that medication errors, in particular, are a massive problem through transitions of care. So, ensuring that patients know what medications they're taking, or supposed to be taking, and that they can afford those medications. If they can't, then connecting them with the resources to be able to provide those medicines for them.They also perform Chronic Care Management. So, that's identifying. So, we can go back to population health, identifying a group of patients who are either at high risk or rising risk of a complication or with a certain disease state. Identifying those patients, and then on a regular basis, setting up telephonic or even telehealth outreach to those patients, so that between those four office visits a year, that a chronic patient might have with a provider in the office, someone is touching base with them throughout the year. As a clinician, I always think that way. That for an average chronic care patient, I might have an hour or two hours a year of face time with a chronic care patient. Whether that's diabetes, hypertension, the combination of the two. That's really not very much time over the course of the year. And so, when you think about the Care Coordination team being able to touch those patients in between those visits, you really are improving the patient's experience of care. You're extending the provider's reach and ability to impact the patient in between those...
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In this episode of Finding Certainty, Finding Certainty host, Patrick Laing, sits down with Jim Bland, Founder and CEO of Seniors Home Services, to explore how his innovative remote senior care and management solutions are transforming healthcare for seniors and providers alike. Discover how SHS offers a seamless, turn-key approach to Remote Patient Monitoring, Chronic Care Management, and Remote Therapeutic Management, enabling practices to improve patient outcomes and experience, reduce staff workload, and generate substantial new revenue—all with zero out of pocket expense to them. Jim shares his vision for a future where healthcare is more efficient, affordable, accessible, and patient-centered, and explains how SHS is helping practices nationwide embrace this change. For more information on Finding Certainty, Certainty Management, or Certainty Global LLC, visit certaintyteam.com or call (888) 684-3122. To learn more about Seniors Home Services' free health and wellness coaching, go to https://www.remotecaretoday.com/introduction/1292. To learn about the revolutionary brain health program they offer, CereSkills (an app that can help improve memory, balance, and cognition in seniors and is paid for by Medicare), go to https://www.remotecaretoday.com/brainhealth/1292. Thank you for tuning in, and we look forward to sharing this important conversation with you today.
Host Justin Barnes records live at GAHIMSS in Atlanta. Stay tuned for the next few weeks to hear all his guests. This week Justin talks to Greg Fulton, Chronic Care Management & Value-based Care Lead at GLF Strategies, and Mike Mosquito, Comms Chair, GAHIMSS Board & lead Emerging Technology and Innovation at NE GA Health System. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. 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
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Our expert guest on this episode is Brian Esterly, who was appointed CEO of TimeDoc Health in August 2023. Brian brings more than 25 years of healthcare leadership experience to ...
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In this inspiring episode of Leaders in Medical Billing, Chanie Gluck sits down with Josh Fertel, owner of J3RCM, to discuss his remarkable journey into the medical billing industry. Pivoting from 30-years in the car business to founding his own medical billing company at the age of 57, Josh shares how personal challenges and a passion for learning led him to his career change. This episode explores the importance of networking, the role of communication in business success, and the entrepreneurial mindset that drives Josh's success. Tune in to hear his story and gain valuable insights for your business! Timestamps 00:00:00 - Introduction and Host's Background 00:00:32 - Guest Introduction: Josh Fertel 00:00:47 - Josh's Career Transition to Medical Billing 00:01:42 - Overcoming Health Challenges 00:02:23 - Learning Medical Billing During Recovery 00:03:02 - Starting J3RCM and Early Success 00:03:32 - Challenges and Unique Perspective in Medical Billing 00:04:20 - Networking and Client Acquisition 00:05:16 - Building a Knowledgeable Team 00:05:49 - First Major Project: Chronic Care Management 00:06:46 - Launching the Angry Biller Podcast 00:07:01 - Frustrations with Physicians' Business Knowledge 00:08:48 - Enjoyment and Purpose of Podcasting 00:09:47 - Communication as a Key Business Focus 00:11:09 - Managing a Remote Team 00:12:45 - Networking and Learning from Industry Leaders 00:13:05 - Host's Business Journey and Offshoring 00:16:01 - Growth and Networking Strategies 00:17:05 - Client Referrals and Specialties 00:18:22 - Software Preferences and Challenges 00:19:13 - Future Goals and Success Metrics 00:20:04 - Planning for the Future 00:20:20 - Contact Information and Closing Remarks
Welcome to the Paint The Medical Picture Podcast, created and hosted by Sonal Patel, BA, CPMA, CPC, CMC, ICDCM. Thanks to all of you for making this a Top 15 Podcast for 3 Years: https://blog.feedspot.com/medical_billing_and_coding_podcasts/ Sonal's 12th Season starts up and Episode 18 features her Newsworthy updates on the month's fraud, waste, and abuse cases. Trusty Tip features Sonal's compliance recommendations on new HCPCS G-codes for chronic care management. Spark inspires us all to reflect on collaboration based on the inspirational words of Margaret Mead. Thanks to Advanced Coding Services: Website: https://advancedcodingservices.com/ Paint The Medical Picture Podcast now on: Spotify: https://open.spotify.com/show/6hcJAHHrqNLo9UmKtqRP3X Apple Podcasts: https://podcasts.apple.com/us/podcast/paint-the-medical-picture-podcast/id1530442177 Amazon Music: https://music.amazon.com/podcasts/bc6146d7-3d30-4b73-ae7f-d77d6046fe6a/paint-the-medical-picture-podcast Find Paint The Medical Picture Podcast on YouTube: https://www.youtube.com/channel/UCzNUxmYdIU_U8I5hP91Kk7A Find Sonal on LinkedIn: https://www.linkedin.com/in/sonapate/ And checkout the website: https://paintthemedicalpicturepodcast.com/ If you'd like to be a sponsor of the Paint The Medical Picture Podcast series, please contact Sonal directly for pricing: PaintTheMedicalPicturePodcast@gmail.com --- Support this podcast: https://podcasters.spotify.com/pod/show/sonal-patel5/support
In this episode, Dr. Shannon Fox Levine shares her unique path to becoming a pediatrician, starting from a criminology major to her final realization during her third-year clinical rotation. She discusses her practice in Palm Beach, which has a strong focus on mental health and chronic care management. Dr. Levine highlights the collaborative efforts with a local nonprofit for mental health care and the challenges faced, especially regarding payment structures and care coordination codes like G2211. The conversation covers the need for fair payment, advocacy for primary care, and the evolving landscape of pediatric care with an emphasis on chronic disease management.00:00 Introduction and Guest Welcome01:13 Dr. Foxx's Journey to Pediatrics04:24 Residency and Early Career05:34 Building a Comprehensive Pediatric Practice07:29 Mental Health Integration in Pediatrics11:33 Challenges and Innovations in Pediatric Care19:19 Patient Experience and Practice Management28:26 The Future of Pediatrics36:28 The Demands of Pediatric Practice36:45 Challenges in Pediatric Infectious Disease37:25 Shift to Chronic Disease Management39:01 Mental Health Crisis in Pediatrics39:25 Insurance and Access to Care Issues40:55 Obesity and Metabolic Syndrome43:22 Vaccination and Disease Prevention44:44 Advocacy for Fair Payment49:18 National Pediatric Advocacy Efforts52:10 Value-Based Care and Chronic Disease01:07:34 Future of Pediatric CareSupport the Show.
Remembering that healthcare is a privilege and approaching it with a heart makes our community healthier. In this episode, Dr. Arti Masturzo, the Chief Medical Officer at CCS, shares insights into her journey in healthcare, the innovative work being done at CCS, and the impact of value-based care transformation. She discusses the unique services offered by CCS, emphasizing the company's approach to healthcare provider support, personalized patient education, and addressing social determinants of health. Arti also delves into the company's evolution and the importance of continuously adding value to the healthcare ecosystem. Moreover, she reflects on the impact of AI and the privilege of contributing to better healthcare outcomes. Tune in to gain insightful perspectives on healthcare innovation from Dr. Arti's wealth of experience in the industry. Resources: Watch the entire interview here. Connect with and follow Arti on LinkedIn. Follow CCS on LinkedIn and visit their website.
Get ready for an episode that promises to reshape the way you perceive healthcare! In Episode 15 of the Bedrock Way podcast, our host, Dr. Andre Gomez, President and Chief Operating Officer of Bedrock Healthcare At Home, is taking the stage to unveil the NEW MEDICAL SPECIALTY that is set to revolutionize the healthcare landscape.Join us as Dr. Gomez dives deep into the transformation that Bedrock Healthcare At Home is bringing to the forefront. Drawing on his extensive experience as a clinician, Dr. Gomez will shed light on the stark disparities he observed between the collaborative inpatient setting and the fragmented world of outpatient care. This episode is not just an announcement; it's a journey into the heart of healthcare transformation.But that's not all! Dr. Gomez will outline the Top 5 Reasons why this change is not just necessary but imperative for the well-being of patients: Changing Healthcare Landscape: Explore how the traditional healthcare system falls short in addressing the evolving needs of our population and why a shift towards continuous care is crucial. Technological Advancements: Discover how Bedrock Healthcare At Home leverages cutting-edge technology to provide proactive, innovative, and patient-centric care, revolutionizing the way healthcare is delivered. Shifting from Reactive to Proactive Care: Uncover the limitations of reactive healthcare and the profound impact of embracing proactive medical wellness on patient outcomes and overall healthcare efficiency. Value-Based Healthcare: Delve into the flaws of the fee-for-service model and learn how Bedrock Healthcare At Home is prioritizing the quality of care and patient outcomes through a value-based approach. Rebranding Primary Care: Understand the necessity of redefining primary care as CHRONIC CARE MANAGEMENT specialists to meet the ever-evolving needs of patients with chronic conditions.Prepare to be inspired as Dr. Gomez champions the patient journey and announces Bedrock Healthcare At Home's national expansion, bringing their revolutionary medical culture to every corner of the country. This isn't just a podcast episode; it's a declaration of a new era in healthcare.Tune in to Episode 15 of the Bedrock Way podcast and be part of the movement that is reshaping the future of medicine. The time for change is now, and Dr. Gomez is leading the way! Don't miss out on this extraordinary episode – the unveiling of the NEW MEDICAL SPECIALTY awaits you.
On this episode, we had an opportunity to have a conversation with Dr. Kellee Mitchell Farris. Take a listen as she shares her journey of coming back home to serve and the pure love and care that she has for her community. Dr. Kellee Mitchell Farris has been on the staff at Lee County Cooperative Clinic since 2010. However, her time at LCCC dates back to her childhood. Her father, Dr. L.C. Mitchell, moved his family to Marianna in 1976 to be the Dentist at the Clinic. So, Dr. Farris has strong ties not only to the community, but to the Clinic. She has over 25 years of experience in health care and holds a Ph.D. in Public Health. She also has Master Certificates from Johns Hopkins University in Healthcare Data Analytics and in Population Health. Dr. Farris began her career at LCCC as the Depression Care Manager and later became the Quality Improvement Coordinator helping LCCC reach Level 3 PCMH Recognition in 2017. While working in the QI Coordinator role, LCCC was able to be awarded several grants and awards for achievement. Since becoming CEO in 2018, Dr. Farris has led the LCCC in receiving the 2019 Governor's Quality Award and celebrating 50 years of service while having one of the most profitable years to that date. Most notably, Dr. Farris has helped lead the way in the Clinic's recent groundbreaking of a new 20,000 square foot facility. This facility is more than double the size of the current facility and will be the focal point for what Dr. Farris calls the “Lee County Cooperative Clinic Campus”. Dr. Farris has developed a plan for the 16-acre campus to include a women's health clinic, pediatric clinic, a program offering clinical rotations for medical students, and housing a wellness/fitness center. Dr. Farris wants to ensure that the community has direct access to quality primary and specialty care without having to travel outside of Eastern Arkansas. Dr. Farris was named the 2019 Community Leader of the Year by the School of Religious Studies, the 2020 Jack Geiger Vision Award recipient by the Community Health Centers of Arkansas, and in 2022 was named one of 5 finalists for the Best CEO by the Arkansas Times. In 2020, Dr. Farris was appointed to the NACHC Quality Improvement Advisory Board. Being a native of Marianna aids in Dr. Farris being able to work with the culturally diverse population. She is very active in the community. She recently ran for elected office in her district, with plans to run again and continue to advocate for hercommunity. She is a volunteer for the Arkansas Single Parent Scholarship Fund, Rotary, Arkansas Colorectal Cancer Consortium, a member of Delta Sigma Theta Sorority, Inc., is a youth mentor, and volunteers for countless other community projects. Dr. Farris has twochildren, Lawton (12) and Klein (28). Lee County Cooperative Clinic (LCCC) was established by a group of community leaders in 1969 in response to the desperate need for basic health care services for a community struggling with poverty, malnutrition, and insurmountable health care barriers. As the first Federally Qualified Health Center in Arkansas and one of the first in the United Stated, LCCC has provided comprehensive primary and preventative medical and dental care services to the most vulnerable populations. LCCC has grown from one small clinic to a comprehensive primary care delivery system comprised of four clinic sites and a mobile unit that provide medical, dental, and pharmacy services in a three-county area in eastern Arkansas - Lee, Phillips, and St. Francis Counties. LCCC prides itself in offering complementary services (case management, remote patient monitoring, health education, transportation, and Chronic Care Management) to its patients to ensure the “whole” patient is treated. LCCC is continuously looking for programs and strategic partnerships that will help achieve this vision.
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In this episode, we hear from Susa Monacelli, General Manager at Propeller Health. In their own words Propeller Health is a precision digital health company on a mission to uplift every person living with chronic disease so they can take control of their health and live a better life. Topics include: The background to Propeller Health and the ResMed umbrella The original business hypothesis of ResMed and how this has evolved Patient experience using Propeller Health Differentiating propositions to health system, pharma and payers DTx vs. Disease Management 2.0 The future of prescription digital therapeutics Partnerships with health systems vs other routes to patient access Challenges holding the digital health industry back Guest Links and Resources: Connect with Susa Monacelli on LinkedIn Visit Propeller Health Episode PDF Host Links: Connect with Eugene Borukhovich: Twitter | LinkedIn Connect with Chandana Fitzgerald, MD: Twitter | LinkedIn Connect with YourCoach.health: Website | Twitter Check out Shot of Digital Health with Eugene and Jim Joyce: Website | Podcast App HealthXL: Website | Twitter | Join an Event Digital Therapeutics Podcast would not be possible without the support of leading DTx organizations. Thank you to: > Presenting Partner: Amalgam Rx > Contributing Partners and Sponsors: LSI | Bayer G4A | Lindus Health Follow Digital Health Today: Browse Episodes | Twitter | LinkedIn | Facebook | Instagram Follow Health Podcast Network: Browse Shows | LinkedIn | Twitter | Facebook | Instagram
August 11, 2023 Ray, Mark, and Scott discuss 2 questions that came into the Urology Coding and Reimbursement Group (see below for a link to sign up free):Good Evening Our office is looking into Chronic Care Management. We know that CCM requires the patient to have 2 chronic conditions. Most of these patients have prostate cancer and diabetes, and or hypertension. Which brings me to my question our providers will be treating and managing the cancer but as for as the diabetes goes they are not treating this or managing it in any way. Would we still be able to use this in out CCM billing?Hi, What CPT code set would you bill for Excision Scrotal Lesion(s)? (Path Report: Benign). Would you code with 11420-11426 or 11106-11107 or 54060 or something else? NOTE DETAILS: FINDING(s): Numerous scattered superficial skin lesions, In total 20cm skin removed. "We began by marking out the areas of concern with elliptical incisions. There were numerous lesions but they were spread out enough that we decided to do multiple separate incisions. After the lesions were marked the skin was anesthetized with 0.5% Macaine. Incisions were made sharply along the previous marked ellipse. The skin was then carefully dissected sharply from of the underlying dartos tissue. Hemostasis was achieved with bipolar cautery. This was repeated for all lesions."Urology Documentation, Coding, and Billing CertificationFor Urologists and APPs (Click Here for Pricing, More Information, and Registration)Documentation, Coding, and Billing Fellowship - Urology (DCB-FS) For Coders, Billers, and Admins (Click Here for Pricing, More Information, and Registration)Documentation, Coding, and Billing Specialist Certification (DCB-SC)Documentation, Coding, and Billing Master Certification (DCB-MC)Urology Advanced Coding and Reimbursement SeminarClick Here to Register Now Las Vegas, December 1 & 2, 20238 am - 4:30 pm Friday, 8 am - 3:30 pm SaturdayNew Orleans, January 26 & 27, 20248 am - 4:30 pm Friday, 8 am - 3:30 pm SaturdayReserve your spot and save!As a Urology Coding and Reimbursement Podcast listener, you get access to a discount (limited-time offer).Use code: 24UACRS733Get signed up today and get peace of mind knowing you will be prepared for all the upcoming changes.The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/ Join the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.Click Here to Start Your Free Trial of AUACodingToday.com
Chronic diseases are the result of a combination of genetic, physiological, environmental and behavioral factors. They require long-term management and often behavioral changes. Achieving long-lasting effects can be extremely difficult, and digital health solutions have since the beginning been seen as an important factor in assuring success, by providing patients with continuous monitoring and feedback. Omada Health is a US digital behavioral medicine company that uses digital tools and personalized support to help individuals living with prediabetes, diabetes, hypertension, and musculoskeletal issues. It's been present on the market for over a decade, so in this discussion, you will hear the CEO Sean Duffy talk about what exactly does Omada do differently compared to traditional chronic care management providers, we discussed approaches to providing sustainable long-term chronic care management, and touched the topic of the sharp rise in popularity of GLP-1 inhibitors, we've seen in the last year. GLP-1 inhibitors are drugs that are used for treating diabetes but have become a popular weight loss tool for many people. SPONSOR https://magicmind.com/digitalhealth For discount, use the code: digitalhealth20
Current capabilities of remote monitoring, using wearable technology for chronic disease management and future opportunities for practices with Richard Milani, MD, chief clinical transformation officer at Ochsner Health. American Medical Association CXO Todd Unger hosts.
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On today's episode, we spoke with Jon-Michial Carter, CEO and founder of ChartSpan about their proactive, full-service Chronic Care Management (CCM) program. They handle patient enrollment, education, care plans, and prescription refills, allowing healthcare staff to focus more on in-person care. We also discussed how ChartSpan supports community health centers' unique needs, especially for social determinants of health screenings and care gap assists.
The second half of our conversation with Yates Lennon, MD, President of CHESS Health Solutions who discusses the seven pillars of value-based care and the benefit of moving from fee for service to fee for value.At CHESS we often refer to the seven pillars of value-based care. What are these pillars and how does each impact fee-for-value? So, we've tended to use these pillars, if you will, to think about the process. Really, it follows our implementation process in many ways. So, I would start with practice transformation. So, that involves ensuring that physicians, advanced practice providers, office staff from CMA to nurses to even front desk staff, has some awareness of value-based care, understand why it is important, and then are engaged in the process of transforming that practice to a infrastructure that supports the delivery of the value-based care models and success in those models, both clinically, which is ultimately what this is really all about, and financially.From there, you can begin to layer on other services or pillars if you will. These don't necessarily have to happen in this order, but we often start with thinking about quality. Most organizations today have some quality efforts already in place just due to primarily to the fact that CMS and other payors are pushing those. And most people have at least some pay-for-performance type of arrangements, where they're paid for closing quality care gaps. But quality goes beyond just thinking about closing quality care gaps. For our quality team, we're thinking about optimizing the annual wellness visit so that the template within the EMR is just capturing data points and discrete fields. That makes reporting easier back to CMS as well as to the private insurance companies, Medicare Advantage, as well as commercial.We think about Care Coordination and as we define care coordination, that includes, for our teams, nurses and CMAs. They work together to assist also in quality. So, the CMAs help close quality care gaps throughout the year. They schedule annual wellness visits, that's a big emphasis in the first half of the year. If you can already tell, that annual wellness visit is a key component of value-based care because it touches on so many different elements of value. The other role for Care Coordination would be moving with that patient, tracking that patient, outreaching the patient between transitions of care. So, patient is admitted to the hospital, discharged to the skilled nursing facility, then discharged home. Our Care Coordination teams are monitoring that patient as they transition through those different sites of service and ensuring that each transition is as safe as possible. We all know that medication errors, in particular, are a massive problem through transitions of care. So, ensuring that patients know what medications they're taking, or supposed to be taking, and that they can afford those medications. If they can't, then connecting them with the resources to be able to provide those medicines for them.They also perform Chronic Care Management. So, that's identifying. So, we can go back to population health, identifying a group of patients who are either at high risk or rising risk of a complication or with a certain disease state. Identifying those patients, and then on a regular basis, setting up telephonic or even telehealth outreach to those patients, so that between those four office visits a year, that a chronic patient might have with a provider in the office, someone is touching base with them throughout the year. As a clinician, I always think that way. That for an average chronic care patient, I might have an hour or two hours a year of face time with a chronic care patient. Whether that's diabetes, hypertension, the combination of the two. That's really not very much time over the course of the...
Alex Bahram is the co-founder and CEO of JupiterDX, a health data analytics and engagement platform that helps patients suffering from chronic illnesses manage their care and find effective treatments. Using wearables like apple watch and Fitbit to monitor vital signs and activity levels, JupiterDX's app assists patients with energy and symptom management. JupiterDX is currently focused on helping patients with Long COVID.Prior to co-founding JupiterDX, Alex was the sixth employee at SummerBio, a high throughput COVID testing startup. While there, he helped manage their hardware supply chain and helped the company grow to over 100 employees and the largest COVID tester in California.He is currently on hiatus from his studies at Northwestern University to focus on growing JupiterDX. Learn More at JupiterDX
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Monica Salopek of Acadiana Health & Wellness in Lafayette, Louisiana, said that providers are the driving force behind successful implementation of Chronic Care Management (CCM) programs. Her practice launched the CCM program to focus on patients who need more one-on-one attention. They have succeeded with it thanks to the initiative and strong communication skills of providers, with follow-up communications by staff.
Tom joined Engooden Health as President and CEO after two years as a member of the board. Prior to Engooden, for nearly 20 years Tom was CEO of Curaspan, a discharge planning technology company that he co-founded in 1999 and sold in 2016. Before Curaspan, Tom held multiple business development roles at American Hearing Centers, Thermo Electron Corporation, and Specialty Chemicals Business, a division of Monsanto.Learn more at Engooden Health
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In this episode Terry joins Sean to discuss Transitional Care Management and Chronic Care Management and all of the auditing, billing, coding, and compliance information you need to get it right! These are not profit centers, at least how they are structured so be careful and avoid the pitfalls associated with these services! Thank you for making us a Top 25 Podcast: https://blog.feedspot.com/regulatory_compliance_podcasts/ The Compliance Guy has been Nominated in 2 categories (Andy Curry Award and The Business Category) for a People's Choice Award. The voting has now opened and if you would, please vote for The Compliance Guy Podcast in the 2 Categories mentioned above! Simply go to this link: https://lnkd.in/grYHk-8P and register then it will take you to the nominations page for you to vote... Once you click on the "Andy Curry" and "Business" categories and you will find "The Compliance Guy" half way down... Click on it, then submit and you are done!
In this week's episode, the founder and CEO of ThoroughCare talks about the lessons he learned from growing his business from zero to a multi-million dollar business. Daniel also shares his thoughts on value-based care, CCM programs, AI, and how he used content marketing to drive leads and revenue. About ThoroughCare: ThoroughCare is one of the fastest-growing companies according to the Inc. 5000 list. They are a web-based company that has found a way to simplify value-based healthcare with their intuitive software.They have made it easy for providers to manage wellness programs and coordinate patient care for some of Medicare's most profitable programs like: - Chronic Care Management - Remote Patient Monitoring - Annual Wellness Visits - Behavioral Health Integration - Transitional Care Management - Principle Care Management - Care CoordinationLearn more about Previva Health Group:Website: https://previva.com/ LinkedIn: https://www.linkedin.com/company/previva-health-group/Learn more about Daniel Godla:https://www.linkedin.com/in/dgodla
In 2015, the Centers for Medicare & Medicaid Services (CMS) introduced Chronic Care Management (known as CCM) with the intent of improving the care of patients with chronic conditions. CCM offers physicians an opportunity to be compensated for the work that they were doing between office visits including but of course, not limited to calls, education, coordination, and pre-authorizations. In 2020, CMS rolled out Principal Care Management (PCM). What is Chronic Care Management?CMS defines CCM as care coordination services done outside of the regular office visit for patients with two or more chronic conditions that are expected to last at least 12 months or until the death of the patient. In addition, these conditions need to place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.You can bill for CCM when a physician or qualified health care professional directs your staff to spend at least 20 minutes of non-face-to-face clinical time treating the patient per calendar month. CMS distinguishes between complex and non-complex care. The key differences between them are the:Amount of clinical staff service time providedThe Involvement and work of the billing practitionerAnd The extent of care planning performedWondering how much you can increase your revenue by?Currently CMS reimburses $42.00 for providing a minimum of 20 minutes of CCM per patient per month. Provide 60 minutes of CCM per patient per month and your practice will get $117.60. Let's say you have a practice with100 CCM patients you could earn an additional $4,200-$11,760 per month for work you are likely doing anyway.What is Principal Care Management (PCM)?PCM is similar to CCM because both services are intended for patients requiring ongoing clinical monitoring and care coordination. One of the key differences, however, is that PCM only requires patients to have one complex chronic condition. There are 6 criteria for PCM:The condition is expected to last at least three months.The condition places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death.The condition requires the development, monitoring, or revision of a disease-specific care plan.The condition requires frequent adjustments in medication regimens, and/or the management of this condition is unusually complex due to the patient's comorbidities.The condition requires ongoing communication and care coordination between the relevant providers who are involved in the patient's care.The condition requires at least 30 minutes of PCM services per calendar month.To incorporate CCM and/or PCM into your practice, you will need to develop processes for implementation, tracking and billing. Tracking time and then using the appropriate codes is probably the most difficult part. You have to document the name of the staff member, the time spent, what they did specifically and their credentials. If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com. Be sure to join my FB group, The Private Medical Practice Academy.Enroll in my course, How To Start Your Own Practice and get the step-by-step process for opening your doors.Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and every
Are you already managing patients in-between visits but not billing for it? Interested in building CCM services into your workflow and increasing revenue? Join us this week for all things Chronic Care Management!Join other healthcare professionals in the discussion on Facebook Group RevMD.Don't miss an episode, subscribe via Apple PodcastsLeave me a review on Apple PodcastsIf you are looking for a reliable, data-driven, medical biller to help grow your revenue reach out to Info@nationalrevenueconsulting.com or visit us here.
Dr. Sandra Awaida is a clinical pharmacist that has been practicing in the US since 1999. She worked as an attending pharmacist at the Massachusetts General hospital which is a Harvard Medical School teaching hospital in the intensive care unit and internal medicine department where she also served on the pharmacy residency advisory committee, the MGH pharmacy research committee and a writer to the MGH pharmacy newsletter. She joined Novartis Canada working on new product launches, developing medical content and speaking on national meetings. Her passion for clinical pharmacy led her on to teach at several universities in the US and abroad until she found her calling when she founded a private cardiology practice where she incorporated Chronic Care Management, Remote Patient Monitoring or RPM and PGx. She is the founder of PreciGenX, LLC. Since 2008, she has worked to advance the non traditional role of pharmacists in medical practices and is a is a huge advocate of a preventative approach to patient care. She is constantly looking to create value by marrying cutting-edge innovative services with the highest evidence-based medicine to achieve the best outcome for her patients and increase ROI or Return of Investment for physicians. And of course she has been mentoring and coaching others to be able to do the same. Learn more about your ad choices. Visit megaphone.fm/adchoices
Dr. Sandra Awaida is a clinical pharmacist that has been practicing in the US since 1999. She worked as an attending pharmacist at the Massachusetts General hospital which is a Harvard Medical School teaching hospital in the intensive care unit and internal medicine department where she also served on the pharmacy residency advisory committee, the MGH pharmacy research committee and a writer to the MGH pharmacy newsletter. She joined Novartis Canada working on new product launches, developing medical content and speaking on national meetings. Her passion for clinical pharmacy led her on to teach at several universities in the US and abroad until she found her calling when she founded a private cardiology practice where she incorporated Chronic Care Management, Remote Patient Monitoring or RPM and PGx. She is the founder of PreciGenX, LLC. Since 2008, she has worked to advance the non traditional role of pharmacists in medical practices and is a is a huge advocate of a preventative approach to patient care. She is constantly looking to create value by marrying cutting-edge innovative services with the highest evidence-based medicine to achieve the best outcome for her patients and increase ROI or Return of Investment for physicians. And of course she has been mentoring and coaching others to be able to do the same. Learn more about your ad choices. Visit megaphone.fm/adchoices
Dr. Sandra Awaida is a clinical pharmacist that has been practicing in the US since 1999. She worked as an attending pharmacist at the Massachusetts General hospital which is a Harvard Medical School teaching hospital in the intensive care unit and internal medicine department where she also served on the pharmacy residency advisory committee, the MGH pharmacy research committee and a writer to the MGH pharmacy newsletter. She joined Novartis Canada working on new product launches, developing medical content and speaking on national meetings. Her passion for clinical pharmacy led her on to teach at several universities in the US and abroad until she found her calling when she founded a private cardiology practice where she incorporated Chronic Care Management, Remote Patient Monitoring or RPM and PGx. She is the founder of PreciGenX, LLC. Since 2008, she has worked to advance the non traditional role of pharmacists in medical practices and is a is a huge advocate of a preventative approach to patient care. She is constantly looking to create value by marrying cutting-edge innovative services with the highest evidence-based medicine to achieve the best outcome for her patients and increase ROI or Return of Investment for physicians. And of course she has been mentoring and coaching others to be able to do the same. Learn more about your ad choices. Visit megaphone.fm/adchoices
In this episode we continue our conversation with Yates Lennon, MD, President and Chief Transformation Officer of https://www.chesshealthsolutions.com/ (CHESS Health Solutions) who discusses the seven pillars of value-based care and the questions physicians and health systems should be asking themselves when transforming from fee-for-service to fee-for-value. At CHESS we often refer to the seven pillars of value-based care. What are these pillars and how does each impact fee-for-value? So, we've tended to use these pillars, if you will, to think about the process. Really, it follows our implementation process in many ways. So, I would start with practice transformation. So, that involves ensuring that physicians, advanced practice providers, office staff from CMA to nurses to even front desk staff, has some awareness of value-based care, understand why it is important, and then are engaged in the process of transforming that practice to a infrastructure that supports the delivery of the value-based care models and success in those models, both clinically, which is ultimately what this is really all about, and financially. From there, you can begin to layer on other services or pillars if you will. These don't necessarily have to happen in this order, but we often start with thinking about quality. Most organizations today have some quality efforts already in place just due to primarily to the fact that CMS and other payors are pushing those. And most people have at least some pay-for-performance type of arrangements, where they're paid for closing quality care gaps. But quality goes beyond just thinking about closing quality care gaps. For our quality team, we're thinking about optimizing the annual wellness visit so that the template within the EMR is just capturing data points and discrete fields. That makes reporting easier back to CMS as well as to the private insurance companies, Medicare Advantage, as well as commercial. We think about Care Coordination and as we define care coordination, that includes, for our teams, nurses and CMAs. They work together to assist also in quality. So, the CMAs help close quality care gaps throughout the year. They schedule annual wellness visits, that's a big emphasis in the first half of the year. If you can already tell, that annual wellness visit is a key component of value-based care because it touches on so many different elements of value. The other role for Care Coordination would be moving with that patient, tracking that patient, outreaching the patient between transitions of care. So, patient is admitted to the hospital, discharged to the skilled nursing facility, then discharged home. Our Care Coordination teams are monitoring that patient as they transition through those different sites of service and ensuring that each transition is as safe as possible. We all know that medication errors, in particular, are a massive problem through transitions of care. So, ensuring that patients know what medications they're taking, or supposed to be taking, and that they can afford those medications. If they can't, then connecting them with the resources to be able to provide those medicines for them. They also perform Chronic Care Management. So, that's identifying. So, we can go back to population health, identifying a group of patients who are either at high risk or rising risk of a complication or with a certain disease state. Identifying those patients, and then on a regular basis, setting up telephonic or even telehealth outreach to those patients, so that between those four office visits a year, that a chronic patient might have with a provider in the office, someone is touching base with them throughout the year. As a clinician, I always think that way. That for an average chronic care patient, I might have an hour or two hours a year of face time with a chronic care patient. Whether that's diabetes, hypertension, the combination of the two. That's really not...
Let's talk about provider organizations and telehealth. It's just too common a refrain amongst provider organizations who say some combination of: Our patients and/or clinicians don't like telehealth. Telehealth is too expensive for us to do ... unless maybe we should charge facility fees for telehealth visits. Telehealth is risky to invest in because as soon as payers start paying less than 65% of in-person visits, we're gonna drop it anyway. These things are said despite the overwhelming popularity of telehealth in almost any large-scale survey that you'll find. It seems like largely the only entities reporting that patients and clinicians don't like telehealth are provider organizations who haven't adequately invested in telehealth at the systematic/strategic level. Therefore, the only thing their anecdotal evidence about telehealth really seems to show is the negative impact of phoning it in—which is no one wanting to phone in (pun unintentional but, you have to admit, kind of great). All of this is going on with an interesting backdrop, as reported by Chartis Group (and shared by Olivia Webb in her Substack the other day): Health systems see telehealth as a major competitor—82% of health systems surveyed reported that telehealth companies like Teladoc or Amwell are competitors. This is second only to the percentage of surveyed health systems that named other health systems as competitors. John Singer wrote on Twitter the other day, “Any leader who thinks their business is immune to the wild dynamism of our time is unlikely to last long.” So apropos. Love it. I said this on a podcast last December (and you can go back and check the tape if you want to), and I'm even more convinced of it right now: Telehealth is inexorable, and it's already showing its disruptive potential. But let me point out something here. Who is leaning in hard to telehealth? I'm gonna make a broad-stroke statement here—so take it for what it's worth—but let me hypothesize that who is leaning in hard to telehealth and virtual healthcare are telehealth and virtual healthcare companies. Many of them are adding in-person care because billing codes, but their DNA is digital. So, most of the so-called “hybrid” companies out there are digital companies with in-person clinics that they've added—not ye old in-person clinic that added a digital service line. So, I say all this to say I wanted to talk to a traditional sort of provider organization. I wanted to talk to an in-person provider organization who is conceiving of telehealth not as a threat but as a new opportunity to provide ancillary services. One who is going “hybrid” but from the other direction—traditional in-person to digital instead of digital to in-person. Further, I wanted to talk to the CFO of one of these places. I thought the CFO would be the one to get the real scoop from because it's all about the business model, baby. Let me underline the business model point with a quote from a Substack entitled “I wasted $40k on a fantastic startup idea.” And here's the quote: “It had been … a working assumption of mine ... that if you could improve the health of … patients then, you know, [someone] would pay for that.” Yeah. No, they won't. Unless … business model. My guest in this healthcare podcast, Ali Ucar, is the CFO of Care Solutions Group. They provide mobile physician services to seniors. As they expanded their mobile physician service, they also looked at additional ancillary opportunities. Those ancillary opportunities all involve telehealth. Right now, Ali Ucar's company is running two telehealth programs. One of them is basically tele-urgent care. The second one is using telehealth for care transitions including some care coordination. They transition patients back to the home care setting as safely as possible. Let me say that again in business model speak: Discharged patients don't wind up in the ER and/or readmitted within 30 days. So, let's hear about telehealth from the vantage point of a CFO. How do organizations who realize that telehealth is essential for future viability, how do they make it financially viable today? Ali Ucar listed out a stepwise approach to creating a sustainable business model that takes advantage of telehealth. Here's the first thing: Figure out what you're trying to do on behalf of patients … please. For example, what opportunities are you trying to give your team or customers to improve patient care or equity in care? That's where it really should start. The next step, then, is figuring out how you're gonna get paid sustainably. There are two pieces to that. Maybe you can get paid directly, if at all possible. The most common way to do this, which is also the one I like the least because it echoes with the ghosts of paying for volume, is the whole “get yourself a code and bill FFS” for your activities. Maybe there's a value-based or risk-based contract that you can get where you're taking care of a patient population at a certain stage in their care journey. Good luck with that, and I say this as a finger wag to plan sponsors/employers/carriers who, only in a slim majority of cases, offer a way for providers to get paid for the value they create. Please do better. OK … moving along in our ways to get paid list besides trying to figure out how to get paid directly vis-à-vis FFS or in some kind of risk-based way, another thing that you can do is to ascertain how another stakeholder in the care continuum is going to directly benefit from what you're doing. Make them your customer and then bill them. You can figure out the quality programs that they're a part of and how much revenue is at stake, then take a piece of that. Maybe you can charge them to do something because they could get direct reimbursement for what you're doing, and then you take a piece of that. There's a second part to the business model here besides the revenue generation part, and oddly, despite its apparent, I don't know, seeming straightforwardness, it's so often relegated to the world of the afterthought. After constructing the revenue side of the business model, you gotta get operational and figure out how you're going to switch up your workflows and your processes and your roles and responsibilities, your strategy or infrastructure ... ascertain how you're doing business has to change to accommodate the new service offerings. Listen to the shows with Liliana Petrova (EP357) and Christian Milaster (EP320) for many examples of healthcare businesses kind of weirdly disregarding this last part here. If I had to pick one predominant reason why, first of all, telehealth at some provider organizations is getting a bad rap but also why doctors are suffering under the weight of their administrative burden (and other clinicians as well, of course), it's this, right here. If leadership in an organization doesn't stop and pick apart their operational model when their revenue model changes, you get a suboptimal and misaligned operational model. I feel like there's three shelves of books on this topic in most public libraries, so I won't belabor it here. You can learn more at caresolutionsusa.com or by emailing Ali at ali@caresolutionsusa.com. Ali Ucar is CFO of Care Solutions Group with a diverse background in finance, operations, and strategic planning. Ali has been instrumental in designing and implementing programs targeted at reducing costs to insurance companies, hospitals, and nursing homes. Ali played the lead role in the acquisition and integration of a distressed, near-bankrupt mobile physician practice in 2015. The integration included implementation of operating and restructuring initiatives to improve competitive positioning and financial performance. As part of the mobile clinician service and to improve access to care while minimizing the financial impact of the pandemic, Ali launched the statewide telehealth program in 2020. Additionally, to address the needs of a chronically ill and high-risk patient population, Ali has assisted in the launch of the Transitional and Chronic Care Management Programs to assist families and patients with the required coordination of care in the home. Providing this connectivity to a dedicated, single-contact point provided through a registered nurse has been a major factor in reducing hospitalizations, readmissions, and emergency room visits. Ali also has secured contracts with commercial insurance companies for implementation of Chronic Care Management programs as well as program outreach initiatives targeted at engaging and communicating with moderate- to high-risk members. His work also includes project management expertise gained while leading projects with a chain of skilled nursing facilities targeted at managing the needs of discharged patients and for projects initiated by Blue Cross Blue Shield, Ford Motor Company, and multiple start-ups. The development and expansion of Care Solutions Group's comprehensive medical management programs traverse across multiple healthcare systems and settings that include private homes, group homes, independent living communities, assisted living, and skilled nursing facilities. 07:45 How do Care Solutions' telehealth programs do payments? 08:57 EP320 with Christian Milaster and EP357 with Liliana Petrova.09:33 “As you go deeper into it, you're coupling that telehealth with transitional care, chronic care; you can also address … health equity issues in … areas which may be difficult to reach.” 10:02 As a CFO, how is Ali Ucar involved in the telehealth strategy development? 11:26 How have Care Solutions' telehealth programs become sustainable? 13:02 Why would it make financial sense for Care Solutions to continue their telehealth programs? 15:13 EP354 with Shawn Rhodes.18:55 How does the work that Care Solutions' telehealth programs do benefit customers? 21:50 Does Care Solutions have a proactive strategy to building out their telehealth programs? 24:34 How do Care Solutions' telehealth programs add value to provider organizations? 26:33 “It's basically refining your practice. That's the way I look at it.” 27:58 How does Ali Ucar, as a CFO, evaluate the success of his telehealth programs? 30:09 “I think the most frustrating thing from a patient standpoint may be if they don't have those needs addressed quickly.” You can learn more at caresolutionsusa.com or by emailing Ali at ali@caresolutionsusa.com. Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth How do Care Solutions' #telehealth programs do payments? Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth “As you go deeper into it, you're coupling that telehealth with transitional care, chronic care; you can also address … health equity issues in … areas which may be difficult to reach.” Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth As a CFO, how is Ali Ucar involved in the telehealth strategy development? Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth How have Care Solutions' telehealth programs become sustainable? Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth Why would it make financial sense for Care Solutions to continue their telehealth programs? Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth How does the work that Care Solutions' telehealth programs do benefit customers? Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth Does Care Solutions have a proactive strategy to building out their telehealth programs? Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth How do Care Solutions' telehealth programs add value to provider organizations? Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth “It's basically refining your practice. That's the way I look at it.” Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth How does Ali Ucar, as a CFO, evaluate the success of his telehealth programs? Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth “I think the most frustrating thing from a patient standpoint may be if they don't have those needs addressed quickly.” Ali Ucar of Care Solutions discusses #hybridbusinessmodels on our #healthcarepodcast. #healthcare #podcast #digitalhealth
Care Management solutions are one of the most powerful tools for improving Population Health Outcomes, but many organizations aren't sure which solution is the best for them, or have questions about how Chronic Care Management can help them boost clinical and financial outcomes for at-risk populations. Is your organization searching for a Care Management solution proven to improve patient outcomes and engagement while reducing costs? Listen in for a conversation with Cole Naldzin about our Care Management solution, Medical Advantage Powered by Wellbox, to find out the ways Care Management can benefit both patients and organizations alike. For further information, download our free whitepaper outlining the program's effectiveness here. This is the ninth episode in the Medical Advantage Podcast, where each we take time each episode to discuss the ideas and technologies changing healthcare, and the best practices your organization can take to stay productive and profitable. Subscribe wherever you get your podcasts to ensure you never miss an episode. To learn more visit MedicalAdvantage.com.
Stephen Nuckolls grew up listening to his physician father talk about how healthcare could save money for Medicare if it was accountable for outcomes. It was with this intent that he built Coastal Carolina Health Care (CCHC) in 1998, a multi-specialty practice managing 36,000 patients with 60 providers across 16 sites of care in Eastern North Carolina. CCHC serves in both urban and rural communities, with a mission is to promote the health of its patients by providing high quality, compassionate, comprehensive, and personalized health care. It's no surprise that Stephen and his team formed one of the first 27 MSSP ACOs, Coastal Carolina Quality Care. Currently in the 8th year of the Medicare Shared Savings Program (ENHANCED Track), the ACO performs at the highest quality levels nationally and has saved consecutive years. The ACO exemplifies the vision of Stephen's leadership, captured in the ACO's slogan, “Tomorrow's Health Care Delivered Today.” Episode Bookmarks: 05:00 Stephen reflects on the influence of his physician father who championed value-based care early on 05:40 Setting up Coastal Carolina Health Care, PA (CCHC), a multi-specialty group practice, in 1998 to be accountable for cost and quality 06:00 Leveraging ancillary services and electronic health records to prepare for the future state of value-based care 06:45 The passage of the Affordable Care Act in 2010 as an opportunity for Stephen's practice to demonstrate value 07:00 Stephen and his physicians head to Washington, D.C. to collaborate with CMS on the early design of the Medicare Shared Savings Program 07:20 The struggles of balancing FFS and VBC in the early years of Coastal Carolina Quality Care (CCQC) ACO 08:45 “It's not the actual doctor services that are expensive. The real big costs are in hospitalizations.” 09:00 ACO Care Management dropped Hospital Admissions per 1000 by 22% 11:00 Engaging physicians in the early years of the ACO before Shared Savings performance 12:30 Mandatory transition to downside risk in the “Pathways to Success” MSSP final rule and how ACOs should evaluate potential for future success 13:30 Getting comfortable and fully understanding the ACO benchmarking methodology 13:50 “Ultimately we need to have risk in the game, but we need to recognize that different ACOs are in different periods in their transformation.” 14:00 How CCQC ACO is consistently ranked among the top performers nationally in quality measure performance, clinical outcomes, and Shared Savings returns 16:00 How having one practice in the ACO with one electronic health record supported quality outcomes 17:00 Selecting “true north” standardized quality measures that are managed consistently across the entire payer contract portfolio for all patients 17:20 Implementing a successful point-of-care quality measure reporting dashboard 18:00 Developing an equitable physician compensation/incentive structure as a key to success for driving quality 19:00 ACO concerns related to diminishing returns over time due to sustained performance in comparison to the benchmark 21:00 Advantages in specialist integration within the ACO due to multispecialty practice model 23:00 Capital investments required to build an ACO population health management infrastructure 26:00 Efficiencies gained by being a one-TIN/one practice ACO and how Advanced Payment ACO Model funds were used to build a Chronic Care Management program 27:00 Investments in automated dashboards for quality reporting to identify and manage gaps in care 28:00 Annual Wellness Visits (AWVs) as a source of funds for practice transformation in primary care 29:00 Reinvesting funds back into the ACO versus distribution to physicians 29:30 A recent investment in an “extended care” clinic (a higher acuity center with ER physicians, hospitalists, and nurses) 31:00 How the extended care clinic resulted in an ER visit per 1000 rate of 25 for self-i...
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