Podcasts about medicare shared savings

Are you ready to climb the mountain and reach new heights for a transformative future? In the “race to value”, the mountain climber must not be intimidated by the steep terrain of a broken healthcare system. Instead we must look within ourselves, while also finding inspiration from others, to keep climbing! The ultimate summit of value transformation is what drives us, but the climb itself is what matters.  If you are looking for inspiration in your value journey, look no further than our guest this week, Debbie Welle-Powell. Debbie is a healthcare thought leader, educator, national speaker, and content expert in delivery systems, clinical models of care, population health, and digital care. She is also an avid mountain climber, having attempted three of the Seven Summits while also reaching the summit of all 58 of Colorado's 14,000 peaks. She has also climbed Mt. Rainer in in Washington and Grand Teton in Wyoming and, she has climbed peaks in Bolivia, Mexico, France, Argentina, and Mt. McKinley in Alaska.  In this podcast, you will learn how taking the path least travelled is when you learn the most about yourself and why value transformation is a most noble journey to undertake in healthcare. As the former Chief Population Health Officer at Essentia Health – an integrated delivery system with 14 hospitals, and 1,500 provider health system spanning the states of Minnesota, North Dakota, and Wisconsin – Debbie Welle-Powell designed, built, and operationalized Essentia's $2.5 billion dollar transition from a primarily fee-for-service model of care to one that focused on value.  She oversaw risk-based contracting with payers and care delivery transformation, resulting in forty-five percent of the system's fee-for-service revenue tied to financial and clinical performance which produced record earnings on shared savings. Debbie's exceptional experience and background in multi-state, large integrated delivery systems, coupled with industry involvement and insights into emerging opportunities, trends, and challenges, have been valuable to health systems and purchasers seeking to grow, diversity, and promote expertise in the development and implementation of data-driven strategies and solutions in population health and value-based care. Episode Bookmarks: 01:30 Introduction to Debbie Welle-Powell, a nationally-recognized leader in value-based care transformation. 03:30 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:00 The grim statistics of American healthcare and the moral and economic imperative to reform it! 05:00 Recent article from Don Berwick about the excess profiteering and greed in healthcare: “Salve Lucrum: The Existential Threat of Greed in US Health Care” 06:30 Debbie discusses the current state of the healthcare industry and how she spent her career moving healthcare delivery to full-risk and globally capitated payments. 07:30 A leadership commitment to test models of care that address the moral imperative for improved outcomes. 08:30 Reflections on Dr. Berwick's article and the need to expand the conversation by focusing on solutions. 11:00 The Innovation Center Strategy Refresh is a stake in the ground for 100% of Medicare beneficiaries to be in an accountable care relationship. 12:00 The need for innovation in specialty care and new risk models that improve health equity. 13:00 “Medicare is a laboratory for change.” (e.g. alignment of quality measures, multi-payer approaches to improvement, expansion of access in rural areas) 13:45 Two-thirds of those in Medicare Shared Savings contracts are now taking risk. 14:00 Balancing the need to move fast while not being too aggressive (“people are exhausted!”) 15:00 In the last year, hospitals have seen their operating costs increase upwards of 10%, and their bottom lines are now hemorrhaging to the tune of billions of dollars.

In this episode, we continue our conversation with Jennifer Houlihan, Vice President of Value-based Care and Population Health for Atrium Health Wake Forest Baptist, about the need for value-based care in rural population health.Jennifer what are some of the rural focused value-based strategies that you're currently employing?That is actually been a focus for us many years. So working with CHESS evolving our Medicare Shared Savings, Medicare Advantage, scaling that now to our Medicaid population, we have been building what I would say is a foundation of value based capabilities that almost from day one we also scaled immediately in our rural communities. So some of those include working closely with our providers and to promote Annual Wellness Visits and that's such an important piece of the work that we do to close care gaps, address those social drivers of health and really proactively identify the patients that we need to care manage, So working with our rural providers to build out a process that works well for their clinics and making sure the patients, through those e-consult virtual visits and proactively scheduling them in, are able to get to their medical home in a timely manner to do that. So that that's something we've really focused on with our rural providers and that's where some of the wrap around transportation and other services come into play. Access is such a critical piece of that. Transitions of care would be another one. We have put RN resources in the ED; we work very closely with our hospitalist program, and part of that is development of the hospitalist to home program so that that allows patients to be maybe be discharged early home but putting in additional supports with our care management team; our community health worker team; social work; as well as some remote patient monitoring to help them be successful and hopefully not get readmitted. And then other supports that kind of play more of a behind the scenes role include some of our robust analytics. So doing some risk stratification work, which again, just really helps us understand the population from who has high social needs? Where is there polypharmacy? Do we have patients who have multiple chronic conditions? Allowing us to understand who's seeing their primary care provider, who needs to be scheduled in and create a more proactive approach and I do think that's very important in rural because again we might have more scarcity of resources. So really trying to be proactive and sort of leverage some of these other access ways to provide a medical home support becomes even more key. And the analytics also allows us to know our patients, know all of the care gaps that we need to address, but then also evaluate whether what we're doing is working and sort of shift that around. And so knowing where we may have provider gaps working with our family medicine internal medicine departments, making sure we can scale resources where we can from that perspective also is something we've worked on.Jennifer is it sometimes difficult to think in entire population segments concerning outcomes? You're looking at vast groups. Do you find that to be a challenge in terms of moving the needle in public health?In our region we have about 250,000 unique patients and it is a lot of data. We're getting data from the EMR on multiple clinical indicators with our payer partners. We're collecting now social driver information. I think that's where having such a strong analytics platform is so important. Risk segmentation becomes really important, so if we know patients are well, they're seeing their physician every year, they're taking their medications, they're controlled within their chronic disease, then there's a pathway for that. But if there are patients that we know are at risk for a readmission or are not adherent to their medication and seem to not be managing well then that's where we think...

HealthLynked Corp's Michael Dent and George O'Leary tell Proactive that its subsidiary ACO Health Partners LLC will receive $2.4 million in Medicare Shared Savings from the Centers for Medicare & Medicaid Services (CMS). The company said the money represents a 213% increase over the $768,000 in shared savings that ACO Health Partners received the previous year. HealthLynked purchased ACO Health Partners in May 2020 and since has seen substantial increases in both shared savings and the number of attributed Medicare lives.

Dr. Farzad Mostashari’s extensive resume doesn’t fully convey the true value he brings to reimagining healthcare. He’s the former National Coordinator for Health IT at the Department of Health and Human Services, served as assistant commissioner at the New York City Department of Health, was an Epidemic Intelligence Service officer at the CDC, a fellow at The Brookings Institution and a resident at Mass General Hospital. Yet, with all that experience, he says living through the Iranian revolution before moving to the U.S. at age 14 is what fuels his ability to see things differently.As he told Keith Figlioli, “seeing an actual revolution does something for your sense that things can change; that you can be looking at one reality one day, and a different reality the next day.”In this episode of Healthcare is Hard, Farzad talks about how he’s never been totally comfortable inside – or even leading – the grand institutions he’s been part of, and at some level, has always felt like an outsider. He describes his ability to see the insider and outsider perspective, his natural disposition to see things differently, and how this trait led him to found Aledade.Most of the industry looked at the Medicare Shared Savings program in the Affordable Care Act and assumed that hospitals needed to be at the center of creating and sharing in savings. But after noticing the law didn’t require a hospital, Farzad began building a network of primary care doctors who could treat people upstream, reduce hospitalization and lower costs.Seven years later, Aledade has assembled 800 practices in 35 states and has $12.5 billion in annual medical spend under management. It’s helping independent physician practices deliver better care, reduce overall costs and preserve their autonomy in communities all across America.Farzad brings his outsider mentality and inclination to see things differently to his conversation with Keith Figlioli on this episode of Healthcare is Hard. They cover a number of topics including:Dis-economies of scale. Farzad talks about how healthcare is one of the few industries where organizations tend to lose money as they get bigger, and how it all maps back to fee-for-service. The main driver of consolidation in healthcare has been the need to build leverage at the negotiating table. But he says if you change the rules of game – including what’s being valued, rewarded, and compensated – you actually see that the small guys do better.Independent vs. Institutions. Farzad sees this as a proxy battle. He says if you’re betting fee-for-service will be the future of healthcare, bet on consolidating health systems. But if you’re betting on value, bet on the independents.Trust in policy makers. As someone who has lived on both the public and private sides of healthcare, Farzad sees that many people in the private sector are highly skeptical of healthcare policy makers. But in his experience, smart policy makers are motivated by evidence and doing the right thing to help improve care and lower cost. He says leaders in the private sector who understand this are in a better position to navigate the potential regulatory risk impacting their business.A decade of vision driving real value. It’s taken a long time to build much of the infrastructure that started under Farzad’s leadership at ONC almost ten years ago. And now, the combination of new incentives with data-driven capabilities the industry has talked about for a long time are very real. These elements have already created billions of dollars in value that couldn’t exist before, and that impact will continue to multiply.To hear Farzad and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.

This episode features guest Aneesh Chopra, the first Chief Technology Officer of the United States and more currently, the co-founder and president of CareJourney. Hosts Gary Austin and Ken Kleinberg sit down with Aneesh to discuss smarter choices the industry can make to move more quickly towards value based care, specifically direct contracting and third party apps.Aneesh first gives some background on his company CareJourney. He explains that CareJourney is, in many ways, the private sector implementation of his passion of serving in government around open data, open APIs and payment reform. His primary mission is to make sure we use all these open resources to help patients, through the organizations they trust, make smarter decisions throughout the healthcare delivery system.Gary asks Aneesh to overview direct contracting as well as what's to win here for providers. Aneesh says direct contracting is ripping the band-aid off the move to value-based care. Direct contracting is Medicare Advantage-like, but without the insurance company and without the consumer changing their actual insurance benefits. They retain all their Medicare benefits, but they have their capitated dollar. They can bring their resources to a primary care group and integrated delivery network to help them better manage their care without taking away any of their rights to see any doctor they wish. This model is a leapfrog from training wheels to full downside capitated risk. Aneesh explains that remote patient monitoring could be a category. CMS explicitly invites applicants who have proposals who can reduce the cost burden and improve quality for high needs patients, especially those who have historically fragmented care. The model allows for these entrants to drive the process and bring along a physician network that may help administer some of the services. Aneesh thinks it is traditional doctors and networks applying from Medicare Shared Savings to direct contracting.Gary asks Ken how interoperability plays into these arrangements. Ken says risk is about what you know and what you can control. The more you know, the better you can control that risk. Interoperability can bring in all kinds of data about that patient, traditional clinical data, social determinants of health and claims data. We can pull information from many different sources and understand our population in ways we've never been able to before. That gives you the power to control risk and do a better jobGary asks Aneesh what he thinks of the “patient gets everything from everyone, on demand, delivered anywhere model.” Is it good for the marketplace? Aneesh says it's great for the marketplace. It builds the healthcare data sharing infrastructure on a foundation of “must share.” One of the challenges we've had for the last 20 years is that we've built all these data sharing networks and policies that try to square a complicated circle. We are saying we want all of the information flowing where it's needed, but we have to honor the HIPPA minimum data necessary provisions. So, the broader the network, the broader the use cases, the weaker the signal because by definition, someone is on the network to do something that is only entitled to a minimum amount of data. If I have to join a network where I've got to meet the lowest common denominator, I'm not going to get the information I need nor am I going to help make better decisions for people because limited information, limited affect. What we need is a mechanism to right size the information sharing to the legal frameworks under which those information sharing provisions exist. The consumer's right to access health information by being bedrock as a foundational right in HIPPA. Now technically materializing through these two rules is a smarter method of sharing data because no matter what I am entitled to my full medical record and if I choose to share it with my primary care doctor, that's my choice and that's my right. Gary asks Aneesh how to get payers moving along. Aneesh suggests that instead of just working to meet the letter of the rule, payers should ask themselves what they are doing to meet the spirit of the rule and how that benefits the strategic plans of their organizations. His overarching message is shift from defense to offense. How can the investments you're making advance the goals you have? What apps are you putting in the hands of your consumers? Are you working to get those apps connected to every single EHR in your network? Ken agrees with Aneesh on the compliance. He says these organizations often ask themselves what is their bigger fear? Is it financial penalty? Losing some business? Will we do the best by just giving the minimum possible? In the end, what you're really trying to do is meet the business objectives, which is increase your brand and gain loyalty. You do that by providing information in a format that's more usable. That's where a lot of these technologies can play a role. That's where we get into these apps. You have the potential to give people information in a format that's usable to them. Gary moves the conversation to third-party health apps. Aneesh views CommonHealth and Apple Health as infrastructure. He notes there is a hypothetical fear that Google, Amazon, or Apple are going to swoop in and take over healthcare, but he does not believe that is the case. Aneesh says if anything, Google, Microsoft, and Amazon are going to be infrastructure partners to existing players in healthcare or these new direct contracting entities who are managing risk, building clinically integrated networks and engaging patients.Gary asks Ken what he thinks of third-party apps. Ken agrees with Aneesh in that trust starts with primary care physicians. Primary care physicians are likely going to go with apps that work with the EHRs and the portals that they are already familiar with. With regulations coming up, some consumer-type apps may surface that tend to do a better job than what might have been offered to the physician and their EHR vendor. As community pressure builds, the physician may go back to their EHR vendor and ask why they can't support this. That can drive some advance here. Gary asks Aneesh if this is an opportunity for payers to engage their members more deeply. Aneesh explains that high need patients suffer from terrible care fragmentation. It's so obvious that the plan can do a better job here. The decision support to go from fragmentation to coordination is best done by an entity that is trusted by the consumer to do that coordination. You want to trust an app that can be connected to a portal, get the updated feeds and have other context about my healthcare needs. Gary asks Ken for his closing remarks. Ken says this really has been a long journey, measured in decades. He is optimistic that things are getting better. Interoperability in the past decade or two has been like the wild west. Now, he thinks we are aiming with FHIR, projects like Da Vinci and USCDI to be much more practical. That's going to benefit everyone.Aneesh shares in Ken's optimism. We don't have the luxury of waiting decades for this chapter to have success. So, while it does take decades, we must move faster and make smarter decisions to comply with the rules, embrace value-based care and better engage consumers. These things will help accelerate that timeline. Let's do it smarter, together.  

The Centers for Medicare & Medicaid Services (CMS) has released its proposed changes to the Medicare Shared Savings program. Reporting this developing story during this edition of Monitor Mondays will be healthcare attorney Knicole Emanuel, who will discuss how the proposed changes are likely to impact Medicare providers.The broadcast rundown also will include:TPE: Targeted Probe and Educate Audits continue to generate confusion and concern. Returning to report on this developing story is healthcare attorney Andrew Wachler who has a follow-up to his reporting last Monday on Monitor Monday.Death by Cyber, Part II: RACmonitor investigative reporter and New York attorney Edward Roche reports on how healthcare IT enables pharmacy benefit managers to keep drug prices high.Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility.Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics.Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment.

While shared savings could be several years in the future for fledgling accountable care organizations, there are shortcuts for physician practices in ACOs to generate population health revenue immediately, explains Tim Gronniger, senior vice president of development and strategy for Caravan Health. In this HealthSounds episode, Gronniger outlines the rationale for using three Medicare billing codes--the annual wellness visit (AWV), chronic care management and advanced care planning--to create revenue that offsets ACO infrastructure costs.

Wednesday's, September 7th 2016 broadcast of Pophealth Week Fred Goldstein, Douglas Goldstein and Gregg Masters weigh in on population health, precision medicine and ACOs including the perhaps definitive fall from grace of Theranos founder Elizabeth Holmes. Other issues we cover is Sharecare acquisition of Healthways (a transaction few saw coming), the Cancer Moonshot, and CMS's release of results of ACOs participating in the Medicare Shared Savings program. For a summary view via Ashish Jha, MD one take see: 'ACOs Winners and Losers: A Quick Take' . Mentions of Health 2.0 Fall Conference, Florida Association of ACOs (FLAACO) and Frost and Sullivan's Award to Validic as defacto standard of interoperability in the digital health. 

On the Wednesday, February 5th, 2014 episode at 12 Noon Pacific/3PM Eastern time we kick off our 2014 coverage with an ACO Roundtable with three industry veterans who will dig into the headlines and discuss the meaning of the data. For a context piece on the episode, see: 'More than Half of ACOs "Save Money' Only 1/4 Bonus Providers' on ACO Watch.   Following a rather robust conversation on twitter centered around the recently published 'start up costs for ACOs' published by the National Association of ACOs (NAACOs), we decided it was a good time to dig beyond the headlines and try to make sense of the growth and dispersion of ACOs both nationally and regionally. On the broadcast is Fred Goldstein, Jim Hansen and David Crais. Join us!  

To avoid missing other opportunities inherent in the ACO model, payors and providers shouldn't get hung up waiting for CMS's rule for Medicare accountable care organizations, advises Greg Mertz, senior project director with the Healthcare Strategy Group. In this podcast, Mertz has advice for both providers and payors on how to maximize participation in an ACO. Mertz will provide a critical analysis of CMS's anticipated final rule on Medicare Shared Savings and how it will impact commercial ACOs during a 45-minute webinar on April 21, 2011, "Analyzing CMS's Medicare Shared Savings Final Rule: Implementation Advice for ACOs," sponsored by the Healthcare Intelligence Network.