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Care Providers & Care Coordination

hotspotting

Hotspotting, Superutilizers, and Avoiding “RTM Traps”

Be wary of falling into an RTM Trap when working with superutilizers. RTM can be especially pronounced in this group of patients.

15472823 - doctor talking to her male senior patient at office

WSJ Article on MD Referrals & Leakage: Beware of Premature Conclusions

The question we should be asking is “How can we best align the interests of patients, physicians and hospital systems in referral decisions?”

The answer sometimes might be to make a referral outside of the hospital system — but let’s not jump to premature conclusions.

acn14

ACO Lessons Learned: Revisiting the Timing of Downside Risk

The editor and publisher of Accountable Care News have been generous in allowing me to republish my article from the November 2014 issue.

Click here to download a .pdf copy of the article. It’s in-depth — about 2,000 words.

Here’s the article in a nutshell:

One of the most critical aspects of the Medicare Shared Savings Program (MSSP) ACO has been around the timing and certainty of requiring mandatory downside financial risk for physician and hospital participants. Provider protests cajoled CMS […]

ILACO

BCBSIL Refuses to Negotiate Jointly With “Affiliated” Providers. Now What?

Tensions between health plans and care providers have taken an fascinating turn in Chicago. Blue Cross Blue Shield of Illinois (BCBSIL) is refusing to allow care providers “affiliated” through a clinical integration agreement to negotiate contracts jointly.

The ramifications for future network contracts are significant and could play out very differently in other health care markets.

Background

In February 2014 Advocate Health Care and Silver Cross Hospital announced a clinical integration affiliation agreement. Advocate is the state’s largest hospital network and Silver Cross […]

Are Hospital Business Models on a Burning Platform? Not Yet, But It’s Inevitable.

From reading recent headlines, one might easily get the impression that hospitals are resistant — or at least ambivalent — in their pursuit and adoption of accountable care initiatives.

Are Hospitals Dragging their Feet on Accountable Care?

Commonwealth Fund: “only 13 percent of hospital respondents reported participating in an ACO or planning to participate within a year”

KPMG Survey: “(only) 27 percent of [health system] respondents said current business models were either not very or not at all sustainable over the next five […]

Physicians Shouldn’t Wait for Big Data: “Small Data” Can Jumpstart Your Care Management Program

by David C. Kibbe MD, MBA and Vince Kuraitis JD, MBA

Everywhere we turn these days it seems “Big Data” is being touted as a solution for physicians and physician groups who want to participate in Accountable Care Organizations, (ACOs) and/or accountable care-like contracts with payers. We disagree, and think the accumulated experience about what works and what doesn’t work for care management suggests that a “Small Data” approach might be good enough for many medical groups, while being more immediately […]

Hospitals…Thinking About Getting Into Health Insurance? 6 Reasons To Lie Down Until the Urge Goes Away.

Greg Masters reports on a recent Kaiser Health News article: Hospitals Look to Become Insurers, As Well as Providers of Care”.

This is the dumbest idea I’ve heard since “I’m going to invest all my money in Facebook’s IPO and get rich!”

Here are six reasons why:

The ACO Antitrust Police — Nothing to Do

One of the biggest concerns about ACOs has been their potential to enable market consolidation— that by uniting health care providers the ACO gains market clout and ability to charge higher prices.

While this is a legitimate concern about ACOs, so far it’s not playing out.

Why?

 

Leavitt ACO Report: Overstating or Understating Accountable Care Activity?

Accountable Care Organizations (ACOs) have been likened to

a unicorn — a fantastic creature that is vested with mythical powers. But no one has actually seen one.

a camel — a horse designed by a committee, one that already has its nose in the tent

With this background, you can begin to appreciate the difficulty of conducting an accurate census of ACO animals in the wilderness.  Yet, this is exactly the task undertaken in the excellent Leavitt Partners report measuring ACO activity in the US.

As I […]

Six Quick First Impressions of the CMS Bundled Payments for Care Improvement Initiative (BPCII)

This afternoon CMS announced the Bundled Payments for Care Improvement Initiative (BPCII). For details, start reading here.

Here are six quick first impressions:

1. It’s very creative and innovative. CMS has demonstrated out-of-the-box thinking and leaves a lot of room for applicants to propose their own approaches. Expect to have to read the materials 2-3 times to wrap your thinking around it.

Unlike the Medicare Shared Savings ACO rule, the BPCII is flexible.  Anticipate some innovative and non-traditional proposals from diverse applicants. Unlike […]