Podcasts about medicare shared savings program

Casey Korba, Director of Policy at Aledade, walks us through regulations that were announced along with the 2025 CMS Medicare Physician Fee Schedule, including updates to the Medicare Shared Savings Program. Casey and our host Sean Cavanaugh, who is the former Director of the Center for Medicare, explain policy changes that will support value-based care, including changes to payments for some preventive care services and a new health equity benchmarking adjustment. While there is bipartisan support for CMS's goal of moving towards value-based care, they also explore ongoing challenges like the rebasing process and benchmarking standards.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Jeff Byers is joined by Frank McStay of Duke Margolis Institute for Health Policy to discuss the results of a recent CMS report that explores the impacts of the Medicare Shared Savings Program (MSSP) in 2023 and beyond. Health Affairs's Research and Justice For All podcast returns for its second season, focusing on drivers of health.Bookmark Health Affairs Forefront to keep an eye out for future articles from guest Frank McStay and colleagues. Related Articles:PRESS RELEASE: Medicare Shared Savings Program Continues to Deliver Meaningful Savings and High-Quality Health CareBuilding On CMS's Accountable Care Vision To Improve Care For Medicare Beneficiaries (Health Affairs Forefront)Do Teams Work Better Than Solo Providers? Spoiler Alert: Yes (A Health Podyssey) Subscribe to UnitedHealthcare's Community & State newsletter.

Today we hear Advocate Health's Don Calcagno, Senior Vice President and Chief Population Health Officer for Value Operations and Terry Williams, Senior Vice President and Chief Population Health Officer for Partnerships and Strategy who provide insight into Advocate's participation in the Medicare Shared Savings Program and share with CHESS President and host, Dr. Yates Lennon, the successes that have been achieved along with some of the lessons learned.Well, Don, Terry, thank you for joining us on the Move to Value podcast today. Glad to have you. If you don't mind, Don, we will let you start and just take a few minutes to tell our audience a little bit about yourself. And then Terry, you go next and the role you play at Advocate Health.DC: All right, thanks Dr. Lennon. My name is Don Calcagno, I'm currently the Senior Vice President, Chief Population Health Officer for Value Operations for Advocate Health. I also serve as President of Advocate Physician Partners, which is a large, sophisticated, clinically integrated network in the Chicagoland area. Personally, I'm a lab tech by training, completed my schooling in 1992. I have an MBA as well from Northwestern Kellogg and I've been with Advocate for quite some time in various roles from lab tech to others. But I've been a vice President, Operations, Senior Vice President on OPS and I've been either the President or a Senior Vice President of Population Health at Advocate, Advocate Aurora Health since about 2015. So thanks for having me Dr. Lennon. Look forward to the conversation.Glad to have you. Look forward to it. Terry?TW: Hi, I'm Terry Williams, Chief Population Health Officer with focus on partnerships and strategy for Advocate Health. And in terms of background, I was Chief Strategy Officer at a couple of health systems for about a decade as well as started Population Health at one of them that we'll talk about a little later today and I'm also responsible for looking at how we can tie together the academic enterprise and some of the innovations that are happening there into what we're actually doing in population health. So, to give you one example, there was something called the EFI Electronic Frailty Index that was developed in the School of Medicine. It's the single best indicator we have found for predicting future utilization. And so, we use that to we think really do some unique work in our population health work by incorporating that measure.Yeah, familiar with the EFI and I think you just opened the door for a couple more podcasts right there in that one, one statement. So well, one of the things we wanted to do today with you all is to talk a little bit about the MSSP program and Advocate's participation in that. I know we look forward to hearing about some of the successes as well as the challenges that you all have and are facing. It's interesting the program now is what, 11-12 years old and NAACOS just recently at their fall conference released some stats and I'll read some of those to you. So since 2012, ACO's have saved Medicare 21 1/2 billion dollars in gross savings and 8.3 billion in net savings. So that's since the beginning of the program. For '22, It was the sixth straight year that ACO's delivered net savings to Medicare. 84% of ACO's in 2022 saved Medicare money and almost 60% of them were in two-sided risk arrangements. So when you think about where this program started and when it started, it sounds like success right, we're moving in the right direction. With that...

In this episode, our guest is Dr. Patrick Carroll, a member of the Hims & Hers board and is Chief Medical Officer. Dr. Carroll oversees all matters pertaining to provision of care, clinical outcomes, patient safety, healthcare information systems and strategic initiatives and programs to enhance the Hims & Hers care model. In addition, Dr. Carroll is instrumental in managing relationships with health systems and collaborating with the executive team in the development of new clinical programs.Prior to joining Hims & Hers in June of 2019 Dr. Carroll was the Group Vice President and Chief Medical Officer of Walgreens. Over his 5 year tenure he oversaw retail clinics, healthcare strategy, health system collaborations, quality programs as well as the development of the Walgreens Neighborhood Health Destination initiative. Prior to joining Walgreen's in May 2014, Dr. Carroll served as the Chief Medical Officer of Integrated Care Partners, Hartford HealthCare's clinical integration organization. He was also the Medical Director for Hartford HealthCare's Medicare Shared Savings Program which currently has over 20,000 patients in a Medicare/CMS shared-risk pilot program. He played a key role in leading the Hartford HealthCare's efforts in the transition to value-based care in a time of a rapidly changing healthcare landscape.From 2010–2012, Dr. Carroll served as the Chief Medical Officer for the Granite Medical Group in Quincy, Massachusetts. Granite Medical Group is a 40-provider Multi-specialty/Primary Care Group which is part of Atrius Health, a 1000 Medical Provider Group. Dr. Carroll received his bachelor's degree from the College of the Holy Cross and his medical degree from Dartmouth Medical School. He completed his residency training at Middlesex Hospital in family practice, where he served as Chief Resident.Dr. Carroll is Board Certified in Family Practice and in Adolescent Medicine.Topics to discuss -- Career Background: Dr. Carroll's experience at Walgreens and his journey to being Chief Medical Officer of Hims & Hers. Additionally, he can share insights from his decades of experience in private practice and how that showed him many of the challenges of the traditional system. Overview of Hims & Hers + growth of telemedicine:  Providing a high-level description of Hims & Hers, plus the company's mission and vision to reshape the healthcare system and expand access to high-quality care. Additionally, he can share a brief description of how consumers access care through the Hims & Hers platform. Discussing Hims & Hers' journey as a company, including its recent growth -- especially since the pandemic -- and expansion from ED and hair loss, to primary care, mental health, dermatology and other services. Discussing how the pandemic accelerated telehealth adoption more broadly and why both asynchronous and synchronous telehealth modalities can provide people with a safe, trusted and a convenient way to get care. How Hims & Hers builds trust and ensures patient safetySharing some high-level points about Hims & Hers' homegrown EHR and how the company ensures care quality. The future of medicine + Hims & Hers' focus on personalized treatments Discussing Pat's view on why the healthcare system is at a critical inflection point where patients are looking for new front doors to care for a wide variety of conditions. Discussing, at a high level, how Hims & Hers is focusing on personalized healthcare treatments. How telehealth companies like Hims & Hers can integrate with the traditional healthcare system -- and why that's great for patient experience, continuity of care and ultimately better outcomes.Dr. Carroll can share how providers on the Hims & Hers platform can support a wide variety of conditions, but when care is needed that is not supported, Hims & Hers has partnerships with many well-known, high-quality health systems (e.g. Privia, Ochsner, ChristianaCare, Carbon Health, etc.) Guest - Dr. Patrick Carroll is a member of the Hims & Hers board and is Chief Medical OfficerHost - Hillary Blackburn, PharmD, MBAwww.hillaryblackburn.com https://www.linkedin.com/in/hillary-blackburn-67a92421/  @talktoyourpharmacist for Instagram and Facebook @HillBlackburn Twitter ★ Support this podcast on Patreon ★

As the healthcare industry moves towards achieving CMS's goal of having every Medicare beneficiary in an ACO or ACO-like model by 2030, we must focus on patients in institutional settings. For long-term care patients, better care and better health means ensuring patients receive advanced care planning and regular wellness visits. And it also requires providers and facilities to work together in preventing avoidable hospitalizations and unnecessary SNF and hospice utilization. Unfortunately, the needs of geriatric patients in an institutional setting are often overlooked as compared to other populations in the vast environment that falls within the influence of value-based care. LTC ACO -- the first ACO in the country focused specifically on the special needs of Medicare beneficiaries residing in long-term care facilities -- is changing that narrative. The mission of LTC ACO is to dramatically improve the quality and cost of healthcare delivered to these Medicare beneficiaries, rewarding participating providers for achieving these outcomes. Using this approach, it is their vision to revolutionize the way healthcare is provided to Medicare beneficiaries residing in long-term care facilities. Joining us this week in the Race to Value is Jason Feuerman, the President and Chief Executive Officer of LTC ACO. In addition to leading one of the only ACOs that is dedicated exclusively to management of long-term care facility residents, Jason supports managed care and strategic value-based initiatives for Genesis HealthCare, the biggest post-acute care operator in the country. In this episode, you will learn about LTC ACO implemented a program in the traditional Medicare population that mirrors Institutional Special Needs Plans (I-SNPs). He discusses how the ACO engages and incentivizes providers and facilities and has operationalized a data infrastructure to drive care interventions. They have woken up an entire ecosystem with their approach to value-based care and have generated well over $40M in Shared Savings throughout their lifespan. By focusing on improving care outcomes and engaging providers, they have become the industry-leading exemplar for improving patient outcomes in long-term care!   Episode Bookmarks: 01:30 Introduction to Jason Feuerman and LTC ACO, the first ACO focused specifically on the special needs of Medicare Beneficiaries residing in long-term care facilities. 03:00 LTC ACO was launched by Genesis Healthcare, the biggest post-acute care operator in the country, with significant experience in MA risk and bundled payment models. 06:00 Lessons Learned from MA: How Institutional Special Needs Plans (I-SNPs)provided an operational thesis for LTC ACO in the Medicare Shared Savings Program. 07:00 By improving quality and driving down unnecessary costs, LTC ACO returns the Shared Savings earned to LTC facilities and the physicians who support them. 08:00 “Waking up the ecosystem” by providing outcomes data to long-term care providers. 10:00 Achieving capital efficiency in a model where there is no downside risk. 12:00 How capital requirements for delegated Medicare Advantage differ from the MSSP model. 13:00 Less than 15% of residents in long-term care facilities are in a MA plan. (Limited business opportunities in Medicare Advantage) 15:30 Applying the same tenets of I-SNPs to a Medicare ACO (e.g. aligning providers and providing rewards with surpluses) 16:00 “Waking up an Ecosystem”:  Most LTC providers do not know what happens to their patients once they leave the long-term care institutional setting. 17:00 How data can be used to inform long-term care providers how their patients are doing across the continuum. 18:30 The use of AI for population-based predictive analytics to identify potential health risk (see recent Press Release regarding ClosedLoop AI partnership) 19:00 “Long-term care providers gravitate towards population health data and how they can contribute to bending the cost curve....

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...

How can primary care physicians retain their independence in planning for future success in value-based care?  A medical practice must have access to capital to optimize physician workflow and improve patient experience; however, if it chooses the wrong partner, physicians will lose autonomy and compromise their own personal wellbeing.  Privia Health is a technology-driven, national physician enablement company that is on a mission to enable doctors and their teams to focus on keeping people healthy. Their goal is to transform healthcare by enabling physicians, and they want to build the largest primary care-centric ambulatory delivery system in the country. With a healthcare provider partner base of over 3,500 providers managing 3.9 million patients across eight states and the District of Columbia, they are well on their way. And their results in value-based care are superlative, as recently demonstrated by their most recent 2021 Performance Year in the Medicare Shared Savings Program yielding $99.9 million in savings. Joining us in the Race to Value this week is Shawn Morris, the Chief Executive Officer of Privia Health. Shawn is a seasoned industry leader focused on building a platform that can transform the healthcare delivery experience for physicians and patients. He is driving initiatives to meet providers where they are on the transition to value, by building strategic partnerships with physicians, health plans, health systems, and employers to better align reimbursements to quality, affordability, patient satisfaction and provider wellbeing. In this podcast interview, you will hear from one of the leading voices in value transformation discussing such topics as risk-based contract progression, the importance of workflow optimization in supporting provider wellbeing, technology enablement based on the tenets of automation and consumer-centric innovation, effective governance and management of physician-led risk-bearing entities, bridging FFS to value through a multipayer contract portfolio, and the national movement to value-based care transformation. Episode Bookmarks: 01:30 Register today for the “Population Health Equity: The North Star for Value” Virtual Event (December 1, 2022) 03:00 Privia Health -- a technology-driven, national physician enablement company leading in value-based care transformation. 04:00 Introduction to Shawn Morris, Chief Executive Officer – Privia Health 06:30 Privia Health has expanded its healthcare provider partner base to over 3,500 providers managing 3.9 million patients across eight states and the District of Columbia. 08:30 “Our goal is to transform healthcare by enabling physicians. We want to build the largest primary care-centric ambulatory delivery system in the country.” 09:00 Shawn describes the value-based care contract portfolio held by Privia's physician partners. 10:00 Average practice size of a Privia Health practice is 5 clinicians. 11:00 “If you are not focused on both patient experience and provider wellbeing, you cannot achieve success in value-based care.” 11:30 The importance of understanding medical risk to run a success physician practice. 13:00 The five key elements of the Privia Platform to optimize value-based care performance. 15:00 Shawn describes the opportunity for value transformation in a physician practice landscape that is unsophisticated in managing risk. 17:00 Building hubs of transformation within states, starting with Single TIN anchor groups that are enabled by a technology and MSO wraparound capabilities. 18:00 Creating enablement for physicians by embedding insights directly into a unified EMR workflow. 19:00 The challenges of an un-optimized EMR workflow when physicians are forced to click in and out of disparate information systems. 20:00 Enabling provider access through relationship-based care and a purpose-built platform (“digital front door”) built around the tenets of consumerism.

The accountable care organizations (ACO) model is one of the greatest tools in the value-based care toolbox, with ACOs in the Medicare Shared Savings Program producing savings five years in a row. Sam Starbuck, VP and GM at Privia Quality Network, shares how physician engagement, patient access, and data transparency are all key to savings and quality improvements.

Season 4 of the ACO show kicks off with the return of Travis Broome @Travis_Broome and Ahmed Haque @aehaque on 2021 results in the Medicare Shared Savings Program, why more primary care lowers the total cost of taking care of patients, and some changes coming to the MSSP program for 2023.

In this episode we talk to Melissa Pollock, M.Div., CHC, director of ACO Compliance and Regulatory Affairs for https://www.chesshealthsolutions.com/ (CHESS Health Solutions). She shares with us her expertise on the current CMS payment models, as well as the history and what she sees in the future. Transcript: Melissa would you provide some background on their precursors leading up to what we now know as value based care? Sure! as most people probably know in the 1960s Congress you know began passing legislation to create the Centers for Medicare and Medicaid Services which you know provided Medicare for older populations, provided Medicaid for you know lower income populations, but we all know that that's all based on a fee model right? So you go and see your provider your provider sees you they bill based on the services that they provided you and then you're reimbursed they're reimbursed based on those services. So that's you know kind of the initiation of CMS as we know it Centers for Medicare and Medicaid Services. In the 1970s and 80s we saw the proliferation of the health maintenance organizations preferred provider organizations where people were trying to better control cost and quality through narrow networks. So in the 1980s to 2000s you really saw capitation become more popular. Capitation models being a perspective amount of money given to providers to take care of a population of patients and then this kind of led to the idea the advent of value based care through the idea of the triple aim the triple aim being better care for individuals better health for populations but at a lower cost for the for the patient and for this health care system. And so that became the foundation of value based care, this idea of the triple aim. And so in 2010 Congress passed the Affordable Care Act and allotted $10 billion to give to CMS and they created the Innovation Center. And the Innovation Center is basically there how are we going to fix the healthcare system? What can we do to try to stem the tide of rising costs and how can we create better care and better equity of care for patient populations? And that's really what the Innovation Center was poised to do and that kind of started value based care. CHESS has been in value for quite some time. Can you explain the timeline of the different CMS payment models using the CHESS journey as a guide? Yes, happy to do that. So CHESS really was founded out of the organization of Cornerstone Healthcare back in 2012 I think is when we started. And we realized, cornerstone healthcare at that time in in high point NC was making the move to value. The leadership of the organization saw that you know value based care is going to be the wave of the future and we need to go ahead and make that transition, align up our insurance contracts in a way that we know we can be successful in value based care. So in 2012 CMMI which is the Center for Medicare and Medicaid Services their Innovation Center created the Pioneer ACO or accountable care organization and this was the beginning of a total cost of care model for value based care. We joined actually in I think it was midway through the year of 2012 when they created the Medicare Shared Savings Program and so we participated as Cornerstone Healthcare in 2012 in the Medicare Shared Savings Program and I believe did see savings within the first year or two. So that was kind of the first foray for CHESS. And we realized we're really good at doing this we've been able to generate savings with this group of providers, what if we became an organization that was able to provide this to other healthcare systems in the state of North Carolina? You know could we use what we've learned in these years leading up to our transition to value based care to implement this at other places at other hospitals and would this be something that people would be interested in other healthcare systems would be interested in? And so CHESS was created kind of...

The Physician Organization of Michigan Accountable Care Organization (P.O.M. ACO) is a statewide ACO in the Medicare Shared Savings Program that has saved the Medicare Trust Fund more than $199 Million to-date. It is a physician-led partnership in operation since 2013 that supports more than 5,000 providers serving approximately 60,000 Medicare beneficiaries.  P.O.M. ACO aligned with the University of Michigan Health System, whose Faculty Group Practice participated in a Medicare demonstration project that paved the way for ACOs under federal health care reform years ago.  This is an outstanding Accountable Care Organization led by Dr. Tim Peterson and Kendall Cislo who are featured in this week's episode of the Race to Value. In this interview, you will learn how P.O.M. ACO has been successful by enabling localized solutions, in partnership with their provider network and beneficiary population, to improve care outcomes.  We discuss how the ACO engages their beneficiaries through committee and Board participation, how primary care providers and specialists work together to build “localized” population health programs, and how care management interventions can provide meaningful outcomes in both rural and urban settings.  This is an important interview for ACO leaders to listen to who are looking to establish improved relationships with both providers and patients to drive more effective care management interventions in caring for seniors and underserved populations. Episode Bookmarks:  02:00 Physician Organization of Michigan Accountable Care Organization (P.O.M. ACO) --  a statewide ACO that has saved more than $199 Million 02:40 Introduction to Dr. Tim Peterson (Population Health Executive for Michigan Medicine and ACO Executive and Chairman for P.O.M. ACO) and Kendall Cislo (Chief Operating Officer at P.O.M. ACO) 05:30 How ACO success has been determined by collaboration between a faculty academic practice and groups of independent physicians 10:00 Dr. Peterson discusses some of the unique public health and chronic disease challenges facing urban and rural Michiganders and how medical management programs of P.O.M. ACO meets patient needs 12:00 “Part of our ACO success has been the enablement of local solutions to address local problems.” 12:45 Recent study on patient perceptions of ACOs: Only 7 percent of 55- to 64-year-olds and 4 percent of those over 65 reported ever hearing about value-based care! 13:40 How beneficiary engagement and “the voice of the beneficiary” impact quality improvement and the Triple Aim 15:30 Why the economics of value-based payment shouldn't matter to patients (focus on quality care and out-of-pocket burden most important) 17:30 Utilizing a beneficiary engagement advisory committee as a key strategy for performance success 21:40 “The goal of our ACO is not to build a centralized infrastructure – it is instead to build localized solutions with our network of providers.” 24:30 Engaging patients to raise awareness of high cost (low value) specialists in the area 25:40 Partnering with dialysis centers to more effectively engage patients with kidney disease 28:30 “The key message to remember in healthcare is that we do everything for the patient.  What would you do for a patient if it was your Mom.” 31:20 Engaging physicians to more effectively collaborate with them in population health and quality improvement strategies 34:30 Collaborative conversations to improve risk adjustment coding documentation to more adequately reflect burden of illness in the patient population 38:00 Building local market capabilities for pharmacy integration in rural primary care practices 40:30 Annual Wellness Visits as opportunities to address what is most important in a patient's life and how that has transformed the ACO 44:30 The importance of clinical integration in improving care coordination and why specialist participation in an ACO is a performance adva...

In this healthcare podcast, we're gonna talk about the realities of setting up a clinically integrated network, otherwise known as a CIN. If only the whole process was unicorns and rainbows, but—as you likely suspected—it's not. Setting up a clinically integrated network is hard work, but the payoff for patients and clinicians alike can be worth fighting for. First of all, what is a clinically integrated network? It is a kind of ACO (accountable care organization). It is a legal entity that is a form of an ACO. So, every CIN is an ACO. But not all—in fact, most—ACOs are not CINs.  CINs enable coordinated care. Everybody in the network gets together to figure out how to enable clinicians to (for reals) follow their patients through multiple care settings and plan for an entire care journey. It can really help the patients navigate our crazy healthcare industry by giving them a trusted team that plots out a proactive path toward better healthcare outcomes and then make sure the patient stays on that path. It can be a really beautiful thing. Listen to EP349 with Lisa Trumble for real-world examples of the patient outcomes and experience a CIN can generate. All this for the patient while, at the same time, the total cost of care for Medicare patients goes down, I've heard, about 10% on average; but it can be more, as Lisa Trumble also talks about in episode 349 as aforementioned.  Alright … as we all know in healthcare, what's best for the patient doesn't, in so many cases, mean higher reimbursements. Sadly. So, what financial advantages does going through the time and trouble to create a CIN bring? There are basically four financial opportunities that can be realized with a CIN. I learned some of this from my guest today, Shawn Rhodes, who called strategically managing these four possible financial incentives “a delicate balance”; and as I get into some of them, you will see why. CIN Financial Opportunity #1: Similar to an ACO, if you're a CIN (because you are an ACO), you can participate in the Medicare Shared Savings Program, otherwise known as MSSP. The Medicare Shared Savings Program (MSSP) is the way that ACOs get paid a little something extra if they achieve savings goals for Medicare. The provider shares in the savings. Get it? And CINs are generally well equipped to realize these shared savings goals because to obtain the quality that you have to to pull off the shared savings, being clinically integrated really helps. CIN Financial Opportunity #2: Getting a gang of providers (doctors) together, you can do collective bargaining. So, back to basics with this one. You get a bunch of docs together in a region, then you all go to the big BUCAH plan—meaning the Blue Cross, the Cigna, the Aetna, Anthem, Humana—you go to them together and make your contracting demands, as opposed to each little doc practice going in all by yourself and trying to negotiate David and Goliath style. Now, what the payer might want from your collective crew there, the payer might insist on some kind of value-based agreement. Even if it's an FFS (fee-for-service) contract chassis, they'll attach some kind of quality or outcome component. So again, being organized in a CIN is a bonus either way. CIN Financial Opportunity #3: Your CIN can try to do direct contracting with local employers. Check out EP350 with Katy Talento for more on direct contracting. Actually, Lisa Trumble also mentions this in EP349.   CIN Financial Opportunity #4: Lastly, you can work with local hospitals' quality and efficiency programs. From a hospital financial perspective, they might be interested in the care that happens after an inpatient stay. If the outpatient care at an integrated skilled nursing facility, for example, is good, then the hospital could, for example, reduce readmissions. Now, caveat: I asked (maybe grilled is a better word) our guest in this episode, Shawn Rhodes, about this whole “prevent a readmission” business. Because on one hand, oh wow, you get a couple points back from having lower readmissions—which you can game all day long, by the way. Listen to the show with Dr. Rishi Wadhera (EP326) for more on how to not get dinged for readmissions even if you effectively have readmissions.   So, said another way, the crafty, albeit dubious, power move here if you're a hospital to maximize revenue is to let patients come back to the hospital after discharge but just don't call it a readmission. Call it, I don't know, observational. Then bill fee for service for the whole thing and get the reducing readmission financial incentives. At this point in the time-space continuum, everybody knows this stuff. This is not some kind of secret that I'm spilling here. Anyway, I bring this up because don't forget what I just said: The #4 CIN financial opportunity that Shawn Rhodes had mentioned is hooking up with a local hospital as part of their quality and efficiency program and the hospital looking to the CIN to reduce readmissions. Given the open secret on hospitals and readmissions, my Spidey sense just got really curious. So, when I pressed on this point, Shawn didn't talk about the CIN sharing any financial gains from the reducing readmission incentive program like I might have expected. Instead, he mentioned that having lower readmissions is a way for hospitals to get some negotiating leverage with payers. The next time your hospital's payer contract comes up, you can point to lower readmissions and then demand higher FFS fees. You also might be able to improve throughput of profitable service lines by reducing the number of patients who turn back up after their earlier procedure—which is another way, again, to increase FFS revenues, since the more patients you put through, the more revenue. This is why I like talking to people with a touchstone to the real world. You find out what the actual deal is. Now, I say all this to say that if patients get better care and their care journey is non-fragmented, it's a win-win. And CINs, like most ACOs, have been shown to trim the cost of care with great patient feedback. That's amazing. Just a quick spoiler here, but the seven parameters that Shawn Rhodes and I discuss in this episode which are essential for anyone who is looking to stand up a CIN or basically achieve success—and, I would guess, almost any value-based model—you gotta have an infrastructure that takes into account the following seven things: Patient-first and agile culture Interoperability Patient-centered processes Actionable information (not just data) Clinical integration Strategic planning and alignment of all stakeholders in the CIN Strong leadership My guest in this episode, Shawn Rhodes, has worked in performance and quality improvement for many years. He has worked at a CIN in Bowling Green, Kentucky; and he has overseen multiple value-based programs. Shawn currently serves as regional VP at Caravan Health. You can learn more at caravanhealth.com or connect with Shawn on LinkedIn.   Shawn Rhodes serves as regional vice president at Caravan Health, a services and technology company that helps hospitals and physicians who care for underserved population succeed in value-based care. Shawn collaborates with clients to develop tailored population health strategies and support their efforts to deliver the highest-quality, patient-focused care at the lowest cost. Prior to Caravan Health, Shawn served as the director of clinical integration for a clinically integrated network, Med Center Health Partners, where he oversaw value-based agreements (commercial, Medicare Advantage, Medicaid, BPCI, and employer health plans) with various payers along with ACO activities and quality improvement initiatives within the network. Before his work in value-based care, Shawn served as director of education and organizational development at Baptist Health Hardin, focusing on leadership development and cultural change through Studer Group initiatives. The early part of Shawn's career was spent in industrial equipment design and progressed into the automotive manufacturing industry working with Toyota and Honda on quality and process improvement. He then transitioned to the healthcare industry where he worked for eight years as a consultant specializing in coaching and mentoring hospitals to achieve improved quality, efficiency, and financial performance through process improvement, LEAN techniques, and reengineering. Shawn has a bachelor's degree in mechanical engineering and a master's degree in business administration from Western Kentucky University. He resides in Bowling Green, Kentucky. 08:08 What are the seven parameters to consider when standing up a CIN? 08:25 “Culture trumps strategy.” 09:10 “Communication and education are key components to starting that … process.” 09:26 “How do you get the information to the right person at the right time and the right place?” 09:36 What does interoperability need to look like in a CIN? 10:29 How do organizations communicate with the patient in a CIN? 11:07 Can a clinically integrated network work if it's not patient-centric? 11:37 EP332 with Tony DiGioia, MD.11:49 What's a must-have for a clinically integrated network to be successful? 13:41 “What does that data mean?” 15:34 EP315 with Bob Matthews.15:52 “You really need a go-to person.” 18:57 “The thing with team-based care is, you also have to have team-based accountability.” 20:54 “You've got to build some infrastructure around what you want to do.” 24:37 “Alignment is not an easy task by any means.” 25:15 “There has to be a group decision-making process.” 25:34 EP343 with David Carmouche, MD.25:41 EP341 with Gary Campbell.26:18 How do you define leadership? 27:49 “Start small, get some successes, and it will build as you go.” You can learn more at caravanhealth.com or connect with Shawn on LinkedIn.   Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork What are the seven parameters to consider when standing up a CIN? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “Culture trumps strategy.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “Communication and education are key components to starting that … process.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “How do you get the information to the right person at the right time and the right place?” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork What does interoperability need to look like in a CIN? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork How do organizations communicate with the patient in a CIN? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork Can a clinically integrated network work if it's not patient-centric? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork What's a must-have for a clinically integrated network to be successful? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “What does that data mean?” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “You really need a go-to person.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “The thing with team-based care is, you also have to have team-based accountability.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “You've got to build some infrastructure around what you want to do.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “Alignment is not an easy task by any means.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “There has to be a group decision-making process.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork How do you define leadership? Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork “Start small, get some successes, and it will build as you go.” Shawn Rhodes, regional VP at @CaravanHealth, discusses #CINs on our #healthcarepodcast. #healthcare #podcast #clinicallyintegratednetwork   Recent past interviews: Click a guest's name for their latest RHV episode! Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333)

The Medicare program has placed considerable emphasis on creating accountable care organizations (ACOs), which are groups of health care providers that together take responsibility for providing necessary care and can reap financial rewards if they do so at lower than projected costs.While the American Hospital Association reports that 56 percent of community hospitals participate in an ACO, ACOs have developed more slowly in rural than in urban areas.Observing that not all health care providers can afford the infrastructure cost necessary to make an ACO work, the Center for Medicare and Medicaid Innovation developed the ACO Investment Model (AIM) which supports physicians, clinicians, and smaller hospitals in their formation of ACOs.The AIM Program evaluation has some interesting lessons for those seeking to promote accountable care.Matthew Trombley from Abt Associates joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss how to support ACO creation in less populated areas.Trombley and coauthors published a paper in the January 2022 issue of Health Affairs examining outcomes following implementation of the Medicare Shared Savings Program in 41 rural ACO investment model facilities. They found significant savings net of program costs but also rapid exits from the program once providers were exposed to downside financial risks.If you enjoy this interview, order the January 2022 Health Affairs issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

CMS uses the Medicare Shared Savings Program to encourage providers to enter into accountable care organizations, in which they take on greater responsibility for reducing low-value care and high healthcare spending. Gary Stuck, DO, chief medical officer at Advocate Aurora Health, shares how Advocate Aurora Health has leveraged the ACO model to achieve strong cost savings and high-quality performance in the Medicare Shared Savings Program.

Participants in the ACO will receive millions of dollars in shared savings this year. That's thanks to excellent performance in the Medicare Shared Savings Program. The ACO's chief operating officer, Shannon Banks, provides the details. Also, Ross Feller, MD, is generating savings of his own by moving hand surgery out of the operating room. We learn how.

Josh (@DrJIsrael) and Brian (@chiglinsky) are joined by Travis Broome (@Travis_Broome), the Senior Vice President of Policy and Economics at Aledade. They discuss the challenges in measuring success in the Medicare Shared Savings Program and what it takes to turn a bill on capitol hill into law

On this sixth episode of Health Care by the Numbers, our host Todd Searls is joined by co-host Louise Yinug for a discussion with Mara McDermott, Vice President at McDermott+ Consulting. Mara is a longtime friend to Caravan Health who has spoken about rural health and Medicare policy issues at our annual Accountable Care Symposium and webinars. She helps us understand what federal officials are thinking and what’s coming next on Capitol Hill and at CMS for delivery system reform, physician reimbursement, and value-based payment. Only a few months into the new Congress and the new Administration, the podcast digs into understanding the new landscape in Washington, including the new leaders, new policies, and new approach to value-based payment. The discussion covers the future of the Medicare Shared Savings Program and other alternative payment models and how Washington will employ delivery system reform to lead the country out of the COVID-19 pandemic. https://twitter.com/hashtag/HCBTNPod https://twitter.com/SearlsT https://twitter.com/MaraMcDermott 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/

Dr. Eric S. Weaver is nationally recognized for his work in primary care transformation and value-based care. He is the Executive Director of the Accountable Care Learning Collaborative, a nonprofit organization established by former HHS Secretary Mike Leavitt and former CMS Administrator Dr. Mark McClellan to accelerate the value-based care readiness of healthcare organizations. Eric has an extensive executive leadership track record with physician-led ACOs and risk-bearing entities. He previously held the role of corporate vice president for Innovista Health Solutions, a population health management services organization, and oversaw enterprise capital investment strategy and technology adoption. Eric was also the President, and CEO of Austin, Texas-based Integrated ACO – one of the most successful physician-led Accountable Care Organizations in the Medicare Shared Savings Program before its acquisition by Evolent Health. Eric is a committed health care executive with Fellow designations from the American College of Healthcare Executives, the Medical Group Management Association and the Health Information and Management Systems Society. He received his Master of Healthcare Administration degree from Texas State University and his Doctor of Healthcare Administration degree from the Medical University of South Carolina. He was the recipient of the ACHE Robert S. Hudgens Award for Young Healthcare Executive of the Year and the Modern Healthcare “Up & Comers” Award in 2016. In addition, he was named to Becker's Hospital Review list of “Rising Stars: 25 Healthcare Leaders Under 40” in 2015, and awarded the Young Alumni Rising Award from Texas State University. In addition to his work as a healthcare executive, Eric serves on various Boards such as the Texas State Development Foundation, the Dell Medical School Society for Health & Business, and the Half Helen Foundation. In his free time, he enjoys spending time outdoors and traveling with his wife and daughter. Here in Episode #110 Eric starts our show with a leadership mindset that centers us around fostering strong relationships. Eric walks us through his career path going from the administration, and into blazing a path for value-based care. He also gives us a current state report of the state of value-based care. Eric shares a dark moment story around using leadership setbacks to gain career focus. He tells us why taking smart career risks will pay-off over time. He also highlights how to use your WHY, to build great teams. Eric shares how the ACLC continues to build strong partners throughout the pandemic. He gives us his personal AHA connected with improvement opportunities for healthcare. He shares thoughts on how quality people will drive healthcare transformations. He ties in connections between innovation, entrepreneurship, and value-based care. And gives us his best career advice. • Connect with Dr. Eric on LinkedIn • Learn more about the ACLC • Check out Eric's Podcast • Access the Healthcare QualityCast LinkedIn Group • Leaves Us a Rating • Earn Your Lean Six Sigma for Healthcare Certification • Request a Corporate Demo of our online QI Academy

MaineHealth ACO Chief Medical Officer Rob Chamberlin, MD, joins Julie and Mike to explore financial and quality results just in from the 2019 performance year of the Medicare Shared Savings Program. Plus, Maine Behavioral Healthcare’s Mary Jean Mork discusses an innovative partnership between psychiatry and primary care. 

Insurance carriers have begun publicizing their 2021 Medicare Advantage plans, as seniors can start enrolling in the plans October 15. According to a recent announcement from the Centers for Medicare & Medicaid Services (CMS), carriers are including more supplemental benefits with each plan year cycle to address social determinants of health and chronic conditions, and to enable beneficiaries to age at home. Tyler Overstreet Cromer at ATI Advisory is a leading expert on supplemental benefits that began in 2019 after the CMS changed some of the rules surrounding plan development. In this episode of the Home Leadership Series, Doug Robertson and Tyler chat about the supplemental benefit changes and what they mean for home care. Tyler gained more than a decade of experience in federal health policy and budget at the Office of Management and Budget (OMB). She now advises ATI clients on innovative financing and delivery models. Most recently, Tyler served as a senior executive at the OMB providing oversight and expertise for budget development and execution across the U.S. Department of Health & Human Services. She is particularly interested in payment policy and healthcare delivery system reform and in providing insights to ATI clients from her years of experience shaping federal policy on these topics. Tyler was in on the ground floor of many of the reforms to traditional Medicare, having led efforts at the OMB related to the Center for Medicare & Medicaid Innovation since its inception until her arrival at ATI. Tyler also worked on the initial design and regulations implementing the Medicare Shared Savings Program. She has provided oversight of and guidance for various other health programs and agencies, including the Older Americans Act programs administered by the Administration for Community Living, federal policy related to electronic medical records, and the administrative budget of the CMS.

At President Trump’s direction, and building on its recent historic efforts to help the U.S. healthcare system manage the 2019 Novel Coronavirus (COVID-19) pandemic, the Centers for Medicare & Medicaid Services today issued another round of sweeping regulatory waivers and rule changes to deliver expanded care to the nation’s seniors and provide flexibility to the healthcare system as America reopens. These changes include making it easier for Medicare and Medicaid beneficiaries to get tested for COVID-19 and continuing CMS’s efforts to further expand beneficiaries’ access to telehealth services. CMS is taking action to ensure states and localities have the flexibilities they need to ramp up diagnostic testing and access to medical care, key precursors to ensuring a phased, safe, and gradual reopening of America. Today’s actions are informed by requests from healthcare providers as well as by the Coronavirus Aid, Relief, and Economic Security Act, or CARES Act. CMS’s goals during the pandemic are to 1) expand the healthcare workforce by removing barriers for physicians, nurses, and other clinicians to be readily hired from the local community or other states; 2) ensure that local hospitals and health systems have the capacity to handle COVID-19 patients through temporary expansion sites (also known as the CMS Hospital Without Walls initiative); 3) increase access to telehealth for Medicare patients so they can get care from their physicians and other clinicians while staying safely at home; 4) expand at-home and community-based testing to minimize transmission of COVID-19 among Medicare and Medicaid beneficiaries; and 5) put patients over paperwork by giving providers, healthcare facilities, Medicare Advantage and Part D plans, and states temporary relief from many reporting and audit requirements so they can focus on patient care. “I’m very encouraged that the sacrifices of the American people during the pandemic are working. The war is far from over, but in various areas of the country the tide is turning in our favor,” said CMS Administrator Seema Verma. “Building on what was already extraordinary, unprecedented relief for the American healthcare system, CMS is seeking to capitalize on our gains by helping to safely reopen the American healthcare system in accord with President Trump's guidelines.” Made possible by President Trump’s recent emergency declaration and emergency rule making, many of CMS’s temporary changes will apply immediately for the duration of the Public Health Emergency declaration. They build on an unprecedented array of temporary regulatory waivers and new rules CMS announced March 30 and April 10. Providers and states do not need to apply for the blanket waivers announced today and can begin using the flexibilities immediately. CMS also is requiring nursing homes to inform residents, their families, and representatives of COVID-19 outbreaks in their facilities. New rules to support and expand COVID-19 diagnostic testing for Medicare and Medicaid beneficiaries “Testing is vital, and CMS’s changes will make getting tested easier and more accessible for Medicare and Medicaid beneficiaries,” Verma said. Under the new waivers and rule changes, Medicare will no longer require an order from the treating physician or other practitioner for beneficiaries to get COVID-19 tests and certain laboratory tests required as part of a COVID-19 diagnosis. During the Public Health Emergency, COVID-19 tests may be covered when ordered by any healthcare professional authorized to do so under state law. To help ensure that Medicare beneficiaries have broad access to testing related to COVID-19, a written practitioner’s order is no longer required for the COVID-19 test for Medicare payment purposes. Pharmacists can work with a physician or other practitioner to provide assessment and specimen collection services, and the physician or other practitioner can bill Medicare for the services. Pharmacists also can perform certain COVID-19 tests if they are enrolled in Medicare as a laboratory, in accordance with a pharmacist’s scope of practice and state law. With these changes, beneficiaries can get tested at “parking lot” test sites operated by pharmacies and other entities consistent with state requirements. Such point-of-care sites are a key component in expanding COVID-19 testing capacity. CMS will pay hospitals and practitioners to assess beneficiaries and collect laboratory samples for COVID-19 testing, and make separate payment when that is the only service the patient receives. This builds on previous action to pay laboratories for technicians to collect samples for COVID-19 testing from homebound beneficiaries and those in certain non-hospital settings, and encourages broader testing by hospitals and physician practices. To help facilitate expanded testing and reopen the country, CMS is announcing that Medicare and Medicaid are covering certain serology (antibody) tests, which may aid in determining whether a person may have developed an immune response and may not be at immediate risk for COVID-19 reinfection. Medicare and Medicaid will cover laboratory processing of certain FDA-authorized tests that beneficiaries self-collect at home. Additional highlights of the waivers and rule changes announced today: Increase Hospital Capacity - CMS Hospitals Without Walls Under its Hospitals Without Walls initiative. CMS has taken multiple steps to allow hospitals to provide services in other healthcare facilities and sites that aren’t part of the existing hospital, and to set up temporary expansion sites to help address patient needs. Previously, hospitals were required to provide services within their existing departments.   CMS is giving providers flexibility during the pandemic to increase the number of beds for COVID-19 patients while receiving stable, predictable Medicare payments. For example, teaching hospitals can increase the number of temporary beds without facing reduced payments for indirect medical education. In addition, inpatient psychiatric facilities and inpatient rehabilitation facilities can admit more patients to alleviate pressure on acute-care hospital bed capacity without facing reduced teaching status payments. Similarly, hospital systems that include rural health clinics can increase their bed capacity without affecting the rural health clinic’s payments.   CMS is excepting certain requirements to enable freestanding inpatient rehabilitation facilities to accept patients from acute-care hospitals experiencing a surge, even if the patients do not require rehabilitation care. This makes use of available beds in freestanding inpatient rehabilitation facilities and helps acute-care hospitals to make room for COVID-19 patients.   CMS is highlighting flexibilities that allow payment for outpatient hospital services -- such as wound care, drug administration, and behavioral health services -- that are delivered in temporary expansion locations, including parking lot tents, converted hotels, or patients’ homes (when they’re temporarily designated as part of a hospital).   Under current law, most provider-based hospital outpatient departments that relocate off-campus are paid at lower rates under the Physician Fee Schedule, rather than the Outpatient Prospective Payment System (OPPS). CMS will allow certain provider-based hospital outpatient departments that relocate off-campus to obtain a temporary exception and continue to be paid under the OPPS. Importantly, hospitals may also relocate outpatient departments to more than one off-campus location, or partially relocate off-campus while still furnishing care at the original site.   Long-term acute-care hospitals can now accept any acute-care hospital patients and be paid at a higher Medicare payment rate, as mandated by the CARES Act. This will make better use during the pandemic of available beds and staffing in long-term acute-care hospitals.   Healthcare Workforce Augmentation: To bolster the U.S. healthcare workforce amid the pandemic, CMS continues to remove barriers for hiring and retaining physicians, nurses, and other healthcare professionals to keep staffing levels high at hospitals, health clinics, and other facilities. CMS also is cutting red tape so that health professionals can concentrate on the highest-level work they’re licensed for. Since beneficiaries may need in-home services during the COVID-19 pandemic, nurse practitioners, clinical nurse specialists, and physician assistants can now provide home health services, as mandated by the CARES Act. These practitioners can now (1) order home health services; (2) establish and periodically review a plan of care for home health patients; and (3) certify and re-certify that the patient is eligible for home health services. Previously, Medicare and Medicaid home health beneficiaries could only receive home health services with the certification of a physician. These changes are effective for both Medicare and Medicaid.   CMS will not reduce Medicare payments for teaching hospitals that shift their residents to other hospitals to meet COVID-related needs, or penalize hospitals without teaching programs that accept these residents. This change removes barriers so teaching hospitals can lend available medical staff support to other hospitals.   CMS is allowing physical and occupational therapists to delegate maintenance therapy services to physical and occupational therapy assistants in outpatient settings. This frees up physical and occupational therapists to perform other important services and improve beneficiary access.     Consistent with a change made for hospitals, CMS is waiving a requirement for ambulatory surgery centers to periodically reappraise medical staff privileges during the COVID-19 emergency declaration. This will allow physicians and other practitioners whose privileges are expiring to continue taking care of patients.   Put Patients Over Paperwork/Decrease Administrative Burden CMS continues to ease federal rules and institute new flexibilities to ensure that states and localities can focus on caring for patients during the pandemic and that care is not delayed due to administrative red tape.   CMS is allowing payment for certain partial hospitalization services – that is, individual psychotherapy, patient education, and group psychotherapy – that are delivered in temporary expansion locations, including patients’ homes.   CMS is temporarily allowing Community Mental Health Centers to offer partial hospitalization and other mental health services to clients in the safety of their homes. Previously, clients had to travel to a clinic to get these intensive services. Now, Community Mental Health Centers can furnish certain therapy and counseling services in a client’s home to ensure access to necessary services and maintain continuity of care.    CMS will not enforce certain clinical criteria in local coverage determinations that limit access to therapeutic continuous glucose monitors for beneficiaries with diabetes. As a result, clinicians will have greater flexibility to allow more of their diabetic patients to monitor their glucose and adjust insulin doses at home.   Further Expand Telehealth in Medicare: CMS directed a historic expansion of telehealth services so that doctors and other providers can deliver a wider range of care to Medicare beneficiaries in their homes. Beneficiaries thus don’t have to travel to a healthcare facility and risk exposure to COVID-19.   For the duration of the COVID-19 emergency, CMS is waiving limitations on the types of clinical practitioners that can furnish Medicare telehealth services. Prior to this change, only doctors, nurse practitioners, physician assistants, and certain others could deliver telehealth services. Now, other practitioners are able to provide telehealth services, including physical therapists, occupational therapists, and speech language pathologists.   Hospitals may bill for services furnished remotely by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is at home when the home is serving as a temporary provider based department of the hospital. Examples of such services include counseling and educational service as well as therapy services. This change expands the types of healthcare providers that can provide using telehealth technology.    Hospitals may bill as the originating site for telehealth services furnished by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is located at home.    CMS previously announced that Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. Now, CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.   Until now, CMS only added new services to the list of Medicare services that may be furnished via telehealth using its rulemaking process. CMS is changing its process during the emergency, and will add new telehealth services on a sub-regulatory basis, considering requests by practitioners now learning to use telehealth as broadly as possible. This will speed up the process of adding services.   As mandated by the CARES Act, CMS is paying for Medicare telehealth services provided by rural health clinics and federally qualified health clinics. Previously, these clinics could not be paid to provide telehealth expertise as “distant sites.” Now, Medicare beneficiaries located in rural and other medically underserved areas will have more options to access care from their home without having to travel   Since some Medicare beneficiaries don’t have access to interactive audio-video technology that is required for Medicare telehealth services, or choose not to use it even if offered by their practitioner, CMS is waiving the video requirement for certain telephone evaluation and management services, and adding them to the list of Medicare telehealth services. As a result, Medicare beneficiaries will be able to use an audio-only telephone to get these services. In addition, CMS is making changes to the Medicare Shared Savings Program to give the 517 accountable care organizations (ACOs) serving more than 11 million beneficiaries greater financial stability and predictability during the COVID-19 pandemic. ACOs are groups of doctors, hospitals, and other healthcare providers, that come together voluntarily to give coordinated high-quality care to their Medicare patients. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds both in delivering high-quality care and spending healthcare dollars more wisely, it may share in any savings it achieves for the Medicare program. Because the impact of the pandemic varies across the country, CMS is making adjustments to the financial methodology to account for COVID-19 costs so that ACOs will be treated equitably regardless of the extent to which their patient populations are affected by the pandemic. CMS is also forgoing the annual application cycle for 2021 and giving ACOs whose participation is set to end this year the option to extend for another year. ACOs that are required to increase their financial risk over the course of their current agreement period in the program will have the option to maintain their current risk level for next year, instead of being advanced automatically to the next risk level. CMS is permitting states operating a Basic Health Program to submit revised BHP Blueprints for temporary changes tied to the COVID-19 public health emergency that are not restrictive and could be effective retroactive to the first day of the COVID-19 public health emergency declaration. Previously, revised BHP Blueprints could only be submitted prospectively. CMS sets and enforces essential quality and safety standards for the nation’s healthcare system. It is also the nation’s largest health insurer, serving more than 140 million Americans through Medicare, Medicaid, the Children’s Health Insurance Program, and federal Health Insurance Exchanges. For additional background information on the waivers and rule changes, go to: https://www.cms.gov/newsroom/fact-sheets/additional-backgroundsweeping-regulatory-changes-help-us-healthcare-system-address-covid-19-patient For more information on the COVID-19 waivers and guidance, and the Interim Final Rule, please go to the CMS COVID-19 flexibilities webpage: https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers.  These actions, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov.  For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.

Value-based care has been a big prerogative of CMS for the last decade, and it's not going away, Brian Kern, a lawyer with Frier Levitt, told Amy Ellis, director of quality and value-based care at Northwest Medical Specialties. The government programs, such as the Bundled Payments for Care Improvement, Medicare Shared Savings Program, and Oncology Care Model, are important because practices learn from them and hopefully take these similar models to private payers, which transform healthcare. Through these value-based care programs, data analytics is crucial to help physicians understand cost, improve outcomes, and increase patient satisfaction.

Julie and Mike discuss the ACO's future with the Medicare Shared Savings Program and impact on providers. Dr. Rob Merrill reveals how he hit all the ACO quality targets in 2018 and Dr. Dave Johnson reports on his medical mission to rural India. 

Listen NowMedicare's Fee for Service Alternative Payment Models (APMs), a creation of 2015 MACRA legislation, currently 12 in number with participation largely voluntary, requires Medicare providers to assume financial risk, based on historical spending and quality measurement performance, beyond a "nominal amount."  The flagship APM is the ACA's Medicare Shared Savings Program, more commonly termed Accountable Care Organizations (ACOs).  Though in its 8th year, the ACO program, that currently provides care to over 10 million assigned Medicare beneficiaries, has not produced meaningful savings (estimates are 1 to 2% annually).  Nor have other APMs, largely bundled payment arrangements, produced substantial savings.  The Medicare Advantage program (with one-third of Medicare beneficiaries), defined as administrative pricing, does not formally score savings.  Over the past few years per capita Medicare spending has been limited, however, program growth or beneficiary enrollment (via the aging baby boomer population) is causing Medicare spending, in sum, to increase substantially.  In addition, the soon-to-be-published annual Medicare Trustee's report will show the program will become insolvent within the next few years. During this 26 minute discussion, Mr. Miller provides an overall assessment of APM performance to date.  He moreover discusses the shortcomings in APM design or the barriers APM providers face in improving care, e.g., as ostensibly Fee for Service APMs are not reimburse for valuable non-medical services such as social service supports and ways to improve these models.  We conclude the discussion with his views on the ACA-created PTAC (the Physician-Focused Payment Model Technical Advisory Committee), that has reviewed to date over 30 submitted APM proposals, none of which have been chosen by Secretary Azar for testing as a Medicare demonstration.    Mr. Harold D. Miller is the President and CEO of the Center for Healthcare Quality and Payment Reform.  In this role he has worked in more than 40 states and metropolitan regions to help physicians, hospitals, employers, health plans, and government agencies design and implement payment and delivery system reforms.  He is also currently one of eleven members of the PTAC.  He also serves as Adjunct Professor of Public Policy and Management at Carnegie Mellon University.  Mr. Miller has written a number of widely-used papers and reports on health care payment and delivery reform.  He has assisted numerous professional organizations in developing alternative payment models designed to support better care for patients at lower cost.  From 2008 to 2013, Mr Miller served as the President and CEO of the Network for Regional Healthcare Improvement (NRHI), the national association of Regional Health Improvement collaboratives.  He served as a member of the Board of Directors of the National Quality Forum from 2009 to 2015.  From 2006 to 2010, Mr. Miller served as the Strategic Initiatives Consultant to the Pittsburgh Regional Health Initiative (PRHI).  In 2007, he served as the Facilitator for the Minnesota Health Care Transformation Task Force.  In previous positions, Mr. Miller served as the Director of the Pennsylvania Governors Office of Policy Development, Associate Dean of the Heinz School of Public Policy and Management at Carnegie Mellon University, Executive Director of the Pennsylvania Economy League - Western Division, Director of the Southwestern Pennsylvania Growth Alliance and President of the Allegheny Conference on Community Development.For information on the Center for Healthcare Quality and Payment Reform, go to: http://www.chqpr.org/ For information on the PTAC, go to: https://aspe.hhs.gov/ptac-physician-focused-payment-model-technical-advisory-committeePer my mention of Dr. Robert Berenson's recent (February) essay concerning improving the Medicare Fee for Service schedule, go to: https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05411 This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

The Issue. The Centers for Medicare & Medicaid Services issued a final rule that sets a new direction for the Medicare Shared Savings Program, including wholesale changes to the “track” model previously used for accountable care organizations. Why It’s Important. The final rule dramatically changes the current ACO framework, and providers who participate must understand the differences from the previous rule. Increased risk has been added to the program, meaning providers should ensure they are fully informed of the program’s new structure.

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.

CMS’ accountable care organization program, the Medicare Shared Savings Program, could potentially be undergoing some big changes. During the recent fall 2018 meeting of the National Association of ACOs, the proposed changes were top of mind. Attendees were most concerned about how the faster timeline to taking on risk would impact participation, but were pleased with changes to the benchmark and risk adjustment. In this episode of Managed Care Cast, stakeholders at accountable care organizations (ACOs) and policy experts discuss the proposed changes and what impact they believe they will have on ACO participation. Read more about the stories in this podcast: CMS Plans to Overhaul MSSP Program to Force More Risk on ACOs: https://www.ajmc.com/newsroom/cms-plans-to-overhaul-mssp-program-to-force-more-risk-on-acos Proposed Rule for Medicare ACOs Includes Notable Changes for Rural Providers: https://www.ajmc.com/contributor/caravan-health/2018/09/proposed-rule-for-medicare-acos-includes-notable-changes-for-rural-providers CMS Proposal Is a Start for Making Risk More Appealing to ACOs: https://www.ajmc.com/contributor/travis-broome/2018/08/cms-proposal-is-a-start-for-making-risk-more-appealing-to-acos MSSP Proposal Better Measures Risk With Changes to the Benchmark Methodology: https://www.ajmc.com/contributor/travis-broome/2018/09/mssp-proposal-better-measures-risk-with-changes-to-the-benchmark-methodology MSSP Changes Present Opportunities, but Likely to Decrease Number of ACOs, NAACOS Says: https://www.ajmc.com/newsroom/mssp-changes-present-opportunities-but-likely-to-decrease-number-of-acos-naacos-says Physician ACOs Associated With Growing MSSP Savings Over 3 Years: https://www.ajmc.com/newsroom/physician-acos-associated-with-growing-mssp-savings-over-3-years

The Centers for Medicare & Medicaid Services (“CMS”) recently proposed a major redesign of its Medicare Shared Savings Program (“MSSP”) under a new plan it calls “Pathways to Success.” In this Part II of the two-part series on the proposed MSSP changes, Steve Pine discusses changes to ACO benchmarking, beneficiary notifications, and EHR certifications. He also summarizes CMS’ request for information on methods to facilitate care coordination and modify Medicare fraud and abuse waivers. Presenters: Steven G. Pine Download Presentation Materials    

The Centers for Medicare & Medicaid Services (“CMS”) recently proposed a major redesign of its Medicare Shared Savings Program (“MSSP”) under a new plan it calls “Pathways to Success.” In this Part I of a two-part series on the proposed MSSP changes, Limo Cherian discusses the structural changes included in the proposal and how these changes would affect current risk-sharing models. Presenters: Limo T. Cherian Download Presentation Materials

Accountable care organizations are incentivized to reduce spending and improve quality of care. One way they have tried to do achieve these goals is by establishing control over a patient’s full continuum of care by minimizing the care patients receive from other providers outside of the ACO, including specialists. Michael Barnett, MD, and J. Michael McWilliams, MD, PhD, have a paper in the May issue of The American Journal of Managed Care® on leakage of specialty care among ACOs and the changes in specialty care leakage and use associated with the Medicare Shared Savings Program. Read the paper: http://www.ajmc.com/journals/issue/2018/2018-vol24-n5/changes-in-specialty-care-use-and-leakage-in-medicare-accountable-care-organizations

The problem we’ll be addressing in this episode - which is of critical national significance - is the unsustainable burden of healthcare costs.  We’ll cover two major issues: (1) tactics employers can take to avoid unnecessary healthcare costs; and (2) an approach to understanding and addressing a long-standing challenge in healthcare delivery - post acute care.You should listen to this interview if:You're not overly concerned about these issues, or don’t feel knowledgeable enough to be concerned.  Your provider group is engaged in an Accountable Care Organization, Medicare Shared Savings Program, Medicare Advantage or Bundled Payment Program; or if you’re an employer or payer.You have a family member that may one day end up hospitalized or in a nursing home.Our guest this week, Josh Luke, is a nationally recognized expert in the post-acute care space, and on healthcare cost strategies in general.  He spent 15 years as a hospital CEO and a senior nursing home administrator - so he has deep knowledge and an insider's perspective.Since leaving those roles, his mission has been to assist patients and their families in navigating the opaque archipelago of post-acute care; and to assist individuals & employers in learning how to manage the overwhelming costs of medical care.   Josh is a self-described “truth teller”.  As you’ll hear in this interview, Dr. Luke does not hold back - and with good reason.  He’s got some well defined and thoughtful perspectives, as well as bold practical solutions on how the system needs to change to provide care that is safer, less costly and more dignified.One example is Josh’s program, ‘Discharge with Dignity’ - an initiative to assure that patients being discharged from hospitals are given a reasonable option to return to their home, instead of being corralled into avoidable, unnecessarily lengthy, and costly post-acute care facility stays.  His protocol is being used across the country to train physicians and other providers.Another example - Josh will discuss the main points of his most recently published book, ‘Health-Wealth: 9 Steps to Financial Recovery’.  He’ll share the specific tactics that employers can take to reduce unnecessary costs and optimize their healthcare spend.  From the employee or individual’s perspective, Josh will introduce us all to his “3 P’s” of becoming an “Engaged Healthcare Consumer” (EHC).  If you're still wondering what all of this has to do with 'dignity', here’s what I garnered from listening to Josh.  Healthcare with dignity includes: (1) making what we do in healthcare - including prices - transparent, and easily understandable to patients, families & employers; (2) giving patients real choices that take into account their preferences (keep in mind that the AARP has repeatedly documented that over 97% of people want to go home after a hospitalization, and not to a nursing home); and (3) considering the quality, safety & cost factors first, rather than the business imperatives; or more bluntly put, being patient-centered rather than profit-centered.Dr. Josh Luke's honesty and openness is refreshing and much needed.  He sheds a revealing light and a helpful set of approaches to issues that have been hidden and confusing for decades.  He is clearly purpose-driven and passionate; his perspectives are born of wisdom and backed by data; and his recommendations are forward-thinking, consumer-oriented, value-based and practical.If you still have some doubts as to the importance of this topic, I'll leave you with some stats to consider:The Medicare Trust Fund is expected to go bust by 2029 - that’s only 10 years from now - important for those of us who are expecting Medicare to pay our healthcare bills.About 25% of the total costs of Medicare (which make up half of all medical expenditures in the U.S.) are spent on what is termed ‘post acute care’ - nursing homes, inpatient rehabilitation facilities, long term acute care hospitals, home health and hospice care.  It’s predicted that Millenials (currently 20 to 40 year olds) - who make up the largest employee demographic in the country - will spend over 50% of their lifetime earnings on healthcare.As always, I hope you get as much out of this interview as I have.Zeev 

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care news included Senate confirming Alex Azar as the new HHS Secretary; a report found that healthcare prices rose in 2016; the accountable care organization movement continued to expand. Read more about the stories in this podcast: Senate Confirms Alex Azar as HHS Secretary: www.ajmc.com/newsroom/senate-confirms-alex-azar-as-hhs-secretary Kentucky Medicaid Recipients Sue HHS Over Work Requirements: www.ajmc.com/newsroom/kentucky-medicaid-recipients-sue-hhs-over-work-requirements Americans Used Less Care in 2016 but Healthcare Costs Still Soared, Report Says: www.ajmc.com/newsroom/americans-used-less-care-in-2016-but-healthcare-costs-still-soared-report-says 561 ACOs Participating in Medicare Shared Savings Program in 2018: www.ajmc.com/focus-of-the-week/561-acos-participating-in-medicare-shared-savings-program-in-2018 ODYSSEY Outcomes Results for Sanofi's Praluent to Lead Off ACC Meeting: www.ajmc.com/focus-of-the-week/odyssey-outcomes-results-for-sanofis-praluent-to-lead-off-acc-meeting Patients Prefer End-of-Life Care in Their Location of Choice: www.ajmc.com/newsroom/patients-prefer-endoflife-care-in-their-location-of-choice Implementing the Merit-Based Incentive Payment System for Improved Population Health: www.ajmc.com/webcast/mips

December 12th on This Week in Accountable Care at 5PM PT/8PM ET our featured guest is Julian Malinak, President of Canvas Medical (follow @CanvasMedical).  Topics include: Evolution of ACO benchmarking methodologies including the major issues with benchmarkingCenter for Medicare and Medicaid Services (CMS) vision for how different ACO models (i.e., Next Generation ACOs, and various Medicare Shared Savings Program tracks) fit togetherDay-to-day life at CMS: how issues are prioritized, interaction with model participants, what type of feedback to CMS tends to be most effectiveRole of EMR and population health platforms for ACO success More About Julian: Canvas offers a completely different type of EMR for independent primary care practices focused on usability, clinical quality, and success in value-based payment models. Prior to Canvas, Julian was Technical Advisor for Financial Policy at the Center for Medicare & Medicaid Innovation (CMMI). At CMS, Julian led teams designing and implementing the financial methodologies for ACO models in the CMS Innovation Center while advising CMS leadership on the Medicare Shared Savings Program, MACRA, primary care medical home models, and more. Prior to CMS, Julian was a consultant in the healthcare practice at McKinsey & Company. He received his BA and MPH from Yale University. Join co-hosts Andre Berger, MD and Alex Foxman, MD!

December 12th on This Week in Accountable Care at 5PM PT/8PM ET our featured guest is Julian Malinak, President of Canvas Medical (follow @CanvasMedical).  Topics include: Evolution of ACO benchmarking methodologies including the major issues with benchmarkingCenter for Medicare and Medicaid Services (CMS) vision for how different ACO models (i.e., Next Generation ACOs, and various Medicare Shared Savings Program tracks) fit togetherDay-to-day life at CMS: how issues are prioritized, interaction with model participants, what type of feedback to CMS tends to be most effectiveRole of EMR and population health platforms for ACO success More About Julian: Canvas offers a completely different type of EMR for independent primary care practices focused on usability, clinical quality, and success in value-based payment models. Prior to Canvas, Julian was Technical Advisor for Financial Policy at the Center for Medicare & Medicaid Innovation (CMMI). At CMS, Julian led teams designing and implementing the financial methodologies for ACO models in the CMS Innovation Center while advising CMS leadership on the Medicare Shared Savings Program, MACRA, primary care medical home models, and more. Prior to CMS, Julian was a consultant in the healthcare practice at McKinsey & Company. He received his BA and MPH from Yale University. Join co-hosts Andre Berger, MD and Alex Foxman, MD!

Today we are talking about the Medicare Shared Savings Program. On the show I provide a short overview of the MSSP, we discuss the mandatory compliance plan elements, other regulatory requirements that are important for ACO compliance officers to be aware of and monitor, I talk about the waivers available in the MSSP, and I share my Top 10 Compliance Risks for MSSP ACOs.  This is an episode that I think will be helpful for anyone working with the MSSP, not just compliance officers. Whether you are responsible for quality, care coordination, analytics, governance, or you are the ACO Medical Director or Executive Director, understanding the compliance framework for ACOs, and the risks associated with participating in the MSSP, will help you be a better leader. And if you aren’t familiar with the MSSP compliance requirements, and are looking to find out more, this episode is also for you. Remember to subscribe to the show! Disclaimer: On this podcast I speak only for myself and what I share are the opinions of me alone. My guests also speak for themselves only and do not represent the opinions of their firms or organizations. All content provided on this podcast is for information purposes only. Neither I or my guests make any representations as to the accuracy or completeness of any information on the podcast or in the show notes. This podcast should not be used in any legal capacity whatsoever. Please consult a qualified attorney before taking any action that could have legal implications to you or your business.

Date: September 27, 2012 Featuring: Elliott Fisher, MD, MPH, Director, Center for Population Health, Dartmouth Institute for Health Policy and Clinical Practice Palmer “Pal” Evans, MD, former Senior Vice President & Chief Medical Officer, Tucson Medical Center (TMC) John Friend, Vice President Business Development & Associate General Counsel, TMC Healthcare; Executive Director, Arizona Connected Care, LLC One of the best-kept secrets about US health care this election season is the degree to which change and transformation are coming, no matter what happens in November. You won’t hear “global payment” or Medicare Shared Savings Program mentioned as often as “individual mandate” in the current political debate, but ask anyone leading a health care organization today which issue keeps them up at night, and it’s definitely payment reform. In general terms, the entire system is shifting from paying for volume – lots of procedures – to paying for value, or how well patients are cared for over time and across the continuum. Accountable care organizations (ACOs) are one critical new reflection of this migration, and they’re being encouraged by public and private payers alike. What do we know about the more than 200 ACOs that have formed in the US thus far? It’s still early in the process, but some smart people are keeping a close eye on ACOs, and we’re going to be talking with a few of them on WIHI. As Director of Population Health and Policy at the Dartmouth Institute for Health Policy and Clinical Practice, Dr. Elliott Fisher is leading a major study of the factors enabling ACOs to get up and running and to successfully implement new forms of care delivery. WIHI host Madge Kaplan welcomes Dr. Fisher to the show to share what he and his team of evaluators have learned thus far. He’ll be joined by leaders from Tucson Medical Center, one of the nation’s earliest adopters of the ACO concept. Dr. Palmer “Pal” Evans and John Friend from Arizona Connected Care both say that one of the biggest hurdles for newly forming ACOs is to let go of the notion that hospitals can and should run the show. That’s not where the future is headed, both say, and they’re learning this in spades in Arizona. They’re also learning how to build will and buy-in from mostly independent physicians, a situation that’s typical of most US hospitals.There are plenty of uncertainties ahead, but Elliott Fisher, Pal Evans, and John Friend agree that ACOs or something similar are likely to be a feature of reform for the forseeable future. They share their perspectives and answer questions on WIHI. For some background on Tucson Medical Center’s entrance into the ACO experiment, please take a look at these Commonwealth Fund case studies published earlier this year.   

Interview with J. Michael McWilliams, MD, PhD, author of Changes in Postacute Care in the Medicare Shared Savings Program, and Carrie H. Colla, PhD, author of Moving Forward With Accountable Care Organizations: Some Answers, More Questions

At the 3rd Annual Meeting of the Florida Association of ACOs (@FLAACOS), Fred Goldstein, MS co-host Health Innovation Media chats with FLAACOs Presidentand conference curator extraordinaire Nicole Bradberry. Learn about the role of FLAACOs supporting the development of core competencies to success in the Medicare Shared Savings Program and an overview of the Association's annual gathering. For more information, check out the Florida Association of ACOs here. Produced by Gregg Masters, MPH for Health Innovation Media.  

At the 3rd Annual Meeting of the Florida Association of ACOs (@FLAACOS), Fred Goldstein, MS co-host Health Innovation Media chats with Fahad Rahman, Vice President, Business Development, Salient ACO. Learn about Salient ACO role and successes in the analytics support for participating ACOS in the Medicare Shared Savings Program. For more information, check out the Florida Association of ACOs here. Produced by Gregg Masters, MPH for Health Innovation Media.  

At the 3rd Annual Meeting of the Florida Association of ACOs (@FLAACOS), Fred Goldstein, MS co-host Health Innovation Media chats with David Pierce, Diretor of Operations, PRM Analytics, Milliman Health. We learn more about Universal American successes in the Medicare Shared Savings Program. For more information, check out the Florida Association of ACOs here. Produced by Gregg Masters, MPH for Health Innovation Media.  

At the 3rd Annual Meeting of the Florida Association of ACOs (@FLAACOS), Fred Goldstein, MS co-host Health Innovation Media chats with Mike Barrett, Sr. VP Southeast Universal American/Collaborative Health Systems We learn more about Universal American successes in the Medicare Shared Savings Program. For more information, check out the Florida Association of ACOs here. Produced by Gregg Masters, MPH for Health Innovation Media.  

Listen NowAs a follow up to my April 1st conversation with Jim Gera concerning bundled payments, during this podcast Dr. Richard Morel discusses Medicare's other major payment reform program, Accountable Care Organizations (ACOs), or WESTMED Medical Group's three year experience as a Track 1 ACO.   The Medicare ACO program is a creation of the 2010 Accountable Care Act and participation in the program began in 2012.   Currently, there are 434 ACOs (over 90 percent participating in the "no risk" Track 1) caring for approximately 7.5 million Medicare beneficiaries.  The program to date has been a mixed success.  After two performance years (2013 and 2014) only 25 percent of participants have been successful, i.e., have earned shared savings.  (Performance year three or 2015 performance will be made known this September.)  CMS is currently in the process of revising how the agency calculates an ACO's reset financial benchmark.  It is anticipated these changes will improve program performance, or improve both provider interest in participating (or continuing to participate) in the program and participant success in earning shared savings.   During this 21-minute conversation Dr. Morel provides an overview of WESTMED, explains the organization's interest in becoming a Medicare Shared Savings Program or ACO participant in 2013, WESTMED's experience under their first three year agreement, what explained their success, challenges they've found with the program, how the program could be improved and their expectations now as a second agreement period Track 1 ACO.Dr. Richard Morel is the Co-Medical Director of WESTMED Medical Group in Yonkers, New York.  Prior to joining WESTMED in 2008 Dr. Morel was in private practice affiliated with Columbia-Presbyterian Riverdale Hospital for 12 years.  Dr. Morel is board certified in internal medicine.  He received his medical degree from Columbia University College of Physicians and Surgeons, did his postgraduate training at Columbia-Presbyterian Medical Center and  received his masters of medical management from Carnegie Mellon.  He is a fellow of the American College of Physicians and a member of the American College of Physician Executives.  For information regarding WESTMED go to: http://www.westmedgroup.com/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

At the 2nd Annual Florida Association of ACOs meeting we caught up with Hymin Zucker, MD, Chief Medical Officer at Triple Aim Development Group. Dr. Zucker, a practicing internal medicine physician for more than twenty years, is one of the nation’s leading authorities and innovators on physician protocols, providing quality experiences to patient care while reducing unnecessary costs.  Dr. Zucker recently served as the founding Chief Medical Officer for a 32,000 Medicare Beneficiary physician-owned, and funded ACO in Florida.   This ACO had greater than 100 participating primary care and 95 specialty physicians, and was a top performing ACO earning a Medicare Shared Savings Program payment in 2013 of $33 Million.  In this interview PopHealth Week co-host and co-founder Fred Goldstein learns more about the man, the mission and the company.

Listen NowHealth care payment is solidly moving, or moving once again, toward pay for value or value-based contracting.  This means a health care provider's reimbursement is incented or tied to a predetermined (typically annual) financial amount and/or is based on attaining certain quality care metrics.   The Medicare Shared Savings Program and private sector "accountable care organizations" are both endeavoring to lower health care cost growth and improve quality and patient outcomes via these value or performance-based contracts.  During this 21-minute discussion Dr. David Muhlestein describes the various types of pay for value contract arrangements including use of quality metrics, what types of providers sign these contracts, what have the results been to date, the keys to success or what are the challenges in succeeding under these agreements and potential downsides for providers and/or patients .   David Muhlestein is the Senior Director of Research and Development at Leavitt Partners (LP).  He directs LP's study of pay for value and accountable care contracting through LP's Center for Accountable Care Intelligence and leads the firms' quantitative evaluation of health care markets. He is an expert in using policy analysis, predictive modeling and applied analytics to understand the evolving health care landscape.  His insights have been quoted by publications including The Wall Street Journal, The Seattle Times and Modern Healthcare.  David earned his Ph.D. at Ohio State University and his JD at Ohio State's Moritz College of Law.   For information regarding Leavitt Partners' related work see: http://leavittpartners.com/solutions/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Interview with Tom Rhoads, CEO Parata Systems Tom & I discuss a five step success program for Independent Pharmacy. Number 1: Review your patient data, and identify your chronic medication users, those taking three or more prescription meds a month. Based on trends we see nationally, and across Parata's pharmacy customers, about 10 percent of your multiple medication patients represent about 50 percent of your revenue. Get a plan together now to help them remain more adherent, and thus healthier. If you do that, your chances of losing them to a competing provider – whether a hospital, chain or other outlet – will be greatly diminished. (And if you don't have a solution, contact Parata and ask to learn about Parata PASS and the Companion PASS business training program I mentioned earlier.) Number 2: Conduct some research to find out if hospitals in your area have launched either accountable care organizations or patient centered medical homes. (CMS.gov, the Medicare website, is a good place to start. Search for Medicare Shared Savings Program, Advance Payment Initiative or Pioneer ACO Model.)  Number 3: Identify employer partners for your business. Talk to their HR and health insurance resources about their interest in collaborating to manage medication adherence for their chronic patients. Number 4: Reach out to your Medicare Advantage insurers, and begin a dialogue about the opportunity for your pharmacy to help them bring down the cost of care for the three disease states targeted by CMS: hypertension, diabetes and dyslipidemia. Number 5: Research the institutionalized group quarters (a U.S. Census term) in your area to understand the density of independent living, correctional facilities, group homes, hospice  and other providers of residential care. Most of these organizations are challenged to assist with medication management effectively, and would welcome a strong pharmacy partner. Our company's tagline is Parata Puts You Out in Front.  I hope what I've shared with you today reflects that we as a company are striving to live up to our vision to collaborate closely with customers, understand and respond to their needs and define our success by our ability to help pharmacies meet their service and growth goals. We invite you to visit www.parata.com to take advantage of the webinars, insights and programs offered on a continuing basis in support of our vision. See omnystudio.com/listener for privacy information.

Matt Brow, U.S. Oncology’s top public policy official, breaks down the details of the Medicare Shared Savings Program—the federal government’s final rule on making the accountable care organization model part of Medicare. Brow is the Vice President of Communications in Government and Relations & Public Policy for McKesson Specialty Care Solutions, the parent company of U.S. Oncology.

This is a rebroadcast of the live feed from Thursday, October 20th 2011 conference call  to discuss the release of the final rule on ACOs, the Medicare Shared Savings Program and related activities. For complete press release, click here. Also for two superb background pieces, read Dr. Berwick contextual intro, here, and Kaiser Health News summary, here. The call, absent our commentary and intermittent technical challenges, will be rebroadcast via a phone number to be added shortly as well. Now the fun really starts!! Enjoy!