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Alternative payment models: Strategies for success

In this edition of DataGen Insights, we look at how alternative payment model participants can ensure their processes and workflows are optimally set up for success. To help, DataGen listed the top three strategies all providers participating in APMs can employ and created a handy checklist to enable maximum returns and reduce financial risk. Please explore our website to learn more about our  products and services .  Download DataGen Insights today .  We hope you enjoy!

Alternative Payment Models: Mid-year review

Are you up to date with the latest on alternative payment models?  This summer, catch up on all that you might have missed! Check out this list of must-reads from the last few months on APMs like Primary Care First, Kidney Care Choices, and more. Alternative Payment Models (General) Top challenges providers face in alternative payment models [Physician’s Practice] What to expect from CMS’ second decade of APM programs Primary Care First Start the year off right: DataGen answers your Primary Care First questions Three Steps to Successfully Participate in Primary Care First INFOGRAPHIC: 3 Strategies for PCF Success Why you must consider leakage for Primary Care First Kidney Care Choices Crucial rules and deadline guidance for Kidney Care Choices INFOGRAPHIC: 3 Strategies for KCC Success Critical Tools for Kidney Care Choices Success Oncology Care Model Lessons Learned from the Oncology Care Model If you have any questions or would lik

Food is life: Why healthcare facilities must be part of the solution to food insecurity

It’s 5 p.m. on a Tuesday. You’re exhausted and still need to pick something up for dinner. The nearest grocery store is 15 miles away, and the only thing closer is a convenience store with higher prices and fewer healthy options. This is what it can be like to live in a food desert  — one of several contributing factors of food insecurity. Food insecurity and limited or uncertain access to adequate food impacts millions of Americans each year. And the pandemic only compounded access and affordability issues that drive food insecurity like irregular income, unemployment and disability. Add to this heredity’s influence, race and ethnicity and you have a very complex picture of food-related health issues in 21-century America. While most social determinants of health lay outside of healthcare’s circle of influence, they create conditions that erupt inside its circle of treatment. In most cases, the healthcare industry faces acute to downstream effects in the form of improper utiliza

Why it's critical for Primary Care First participants to control and understand leakage

Patients' primary care visits outside of their attributed primary care office, also called “leaked” patient visits, can have unintended consequences for Primary Care First participants. Beginning July 2022, PCF Cohort 1 will face a reduction in population-based payments based on their leakage rate. The payment adjustment will be based on their 2021 claims data and will roll forward quarterly. To calculate your leakage rate, divide the number of qualifying visits and services your attributed beneficiaries have made to care centers outside of your practice (for example, visits to urgent care centers) by the total number of qualifying visits and services your attributed beneficiaries have made. Calculating primary care leakage with claims data alone comes with some unintended challenges. Unfortunately, some circumstances can unfairly and negatively impact a practice’s leakage rate: Nuances classifying care delivered by provider team members: It’s difficult to distinguish

Critical Tools for Kidney Care Choices Success

The Kidney Care Choices Model is welcoming a new cohort of participants in January 2023. KCC is a voluntary model for nephrology practices, nephrology professionals and kidney contracting entities.  KCC provides financial incentives to help providers improve the quality and reduce the cost of care for patients with late-stage chronic kidney disease and end-stage renal disease. The program’s main goals are to delay the progression of CKD to ESRD, effectively manage the transition onto dialysis, support beneficiaries through the transplant process and keep them healthy post-transplant. In addition to announcing Cohort 2, CMS shared more information on the incentive structure and quality measures current and future participants must understand. Successful participation in the program will drive: reduction in total cost of care; comprehensive and coordinated care delivery; and improved access to care. Participants can achieve these benefits through three strategies:

Linking financial strain to medical and social need

The most immediate point of intersection between hospitals and consumer financial risk is the inability of patients to pay their medical bills. This is changing as the role of hospitals in meeting social determinants of health (SDOH) expands. Low incomes and poor health outcomes are linked across multiple conditions and stages of life. The short- and long-term risks of financial security are amplified for providers and patients, given just how close so many in the U.S. are to economic shocks they cannot cover or rebound from: A Federal Reserve survey found that 36% of adults could not pay cash to cover a $400 emergency expense ; even those who could cover the expense might tap savings or a credit card to meet the immediate need (2020). Race-related outcomes are worse: nearly 40% of employed Black or Hispanic adults in the same survey reported that a $400 emergency expense would make it harder to pay other bills, compared to 18% of employed white adults. This can create

Lessons learned from the Oncology Care Model

After a six-year run, the Oncology Care Model is due to sunset in June. Designed to provide better quality, highly coordinated oncology care, OCM offered oncologists the opportunity to improve person-centered care. It also gave participating practices access to new data across the care continuum to support practice transformation. Practices that participated in OCM were required to commit to providing enhanced services to their Medicare patients. These enhanced services, which were well received by cancer patients, became part of the practices’ transformation plans. Practices focused on: better symptom management to reduce emergency department utilization; depression and pain screenings to support psychosocial needs; navigation for high-risk patients; advanced care planning; and end-of-life care. The challenges of implementing the Oncology Care Model Despite the care delivery improvements made under OCM, participating practices faced several challenges that were