Patient-Centered Analytics for Population Health Management

A new approach to data-driven decision making

Healthcare reform initiatives, driven by government, healthcare providers, and payers, are

shifting the focus of care delivery and payment from individual points of service to the whole
patient and entire populations. This transition from “volume” to “value” (or population health)
requires a mindset change for hospitals, health systems, and other providers. It necessitates an
expanded perspective that encompasses the full spectrum of care for patient populations—from
primary to post-acute services—to improve health and outcomes while reducing costs.

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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!

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

CMMI’s New Enhancing Oncology Model – Deadline Approaching

As the final at-risk period for the Oncology Care Model was closing at the end of June, the Center for Medicare and Medicaid Innovation announced its new Enhancing Oncology Model (EOM). EOM aims to improve the coordination of oncology care, drive practice transformation and reduce Medicare fee-for-service spending through episode-based payment. What is EOM? EOM is a voluntary, five-year model set to begin July 1, 2023. Patients undergoing chemotherapy for the treatment of cancer will trigger six-month episodes of care. Eligible EOM participants include physician group practices with at least one Medicare-enrolled physician or a non-physician practitioner who furnishes evaluation and management services to Medicare beneficiaries receiving chemotherapy for cancer treatment. EOM participants are required to implement eight participant redesign activities to drive care transformation in their practice. Examples include the provision of patient navigation, 24/7 access to an appropriate c

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