How HCCs Play into the Role of Population Risk Adjustment

By now, almost all healthcare providers have been affected by the shift to value-based care and are either working with or are aware of hierarchical condition category (HCC) coding. It is practically impossible to participate in Medicare and not be subject to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Consumer Assessment …Read More

How to Achieve a Return on an EHR

In the past decade, many large-scale EHR implementations have led to drops in revenue and operating income, and reductions in physician productivity have been one factor in these declines. Faced with negative ROI on a sizable investment, many organizations have responded by attempting to rebuild productivity through targeted initiatives. Common efforts include provider training, EHR …Read More

New MSSP Rule: Leveraging Analytics Best Practices to Measure and Predict ACO Performance

The Centers for Medicare & Medicaid Services (CMS) published its Medicare Shared Savings Program (MSSP) final rule in December 2018, and the final rule overhauls the MSSP and takes a new approach to transitioning providers to performance-based risk arrangements under accountable care models. A National Association of ACOs survey released in May 2018 indicated that 71 percent of the …Read More

Why Clinically Integrated Networks are Essential on the Journey to Value-Based Care

The implementation and use of clinically integrated networks (CIN) continues to be an essential strategy in the journey to value-based care. The healthcare delivery system continues to become more and more complex, with new technologies, ongoing changes in the competitive landscape with mergers, acquisitions, and partnerships, and challenging payer contracts that are heading to real …Read More

The Benefits of Pursuing a Clinical Integration Strategy

Clinical integration emerged as a healthcare-delivery strategy in the late 1990s, when the Federal Trade Commission and the Department of Justice put forth guidelines to ensure that healthcare systems, hospitals, and physicians that were affiliated in larger structures could do so in ways that would serve the public interest and not be anti-competitive. The primary …Read More

Securing Tertiary and Quaternary Service Lines: The Case for Community Care Integration

Financial challenges again rank No. 1 on the list of hospital CEOs’ top concerns, according to the American College of Healthcare Executives’ annual survey of top issues confronting hospitals. In addition, Moody’s recently confirmed its negative outlook for nonprofit hospitals, citing weak volume, reimbursement constriction, and increased numbers of Medicare patients. Financial issues are especially …Read More