What are the financial risks in TEAM?  Hospitals are preparing for the launch of the Centers for Medicare and Medicaid Services’ (CMS) Transforming Episode Accountability Model (TEAM) in 2026.   To help you understand both the opportunities and financial risks for participants, DataGen put together a comprehensive white paper, CMS Transforming Episodes Accountability Model Financial Risk Guide.   [Access it Now for Key Updates]  Keep reading for highlights of what’s inside.   Exploring the goals and structure of CMS TEAM Model  CMS TEAM Model is designed to enhance care quality and cost-efficiency. It aims to revolutionize how hospitals manage patient care over 30-day episodes for specific surgical procedures by holding them accountable for the quality and cost of care delivered.   As seen on CMS’ Transforming Episode Accountability Model overview fact sheet , this model not only seeks to improve patient outcomes, but encourages hos...

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), has finalized a mandatory six-year model called the Increasing Organ Transplant Access (IOTA) Model .   This model,  finalized by the Biden-Harris administration,  is designed to address critical challenges in the nation’s kidney transplant system and significantly improve access to kidney transplants.  IOTA Model background  CMS has implemented various initiatives to improve care for patients living with kidney disease and address access to kidney transplantation. The IOTA Model builds on these efforts, enhancing organ availability and providing better education for patients, their families and caregivers.   The model aligns with previous CMS initiatives like the ESRD Treatment Choices (ETC) Model, launched in 2021, which emphasizes the use of home dialysis and increased access to kidney transplantation to improve the quality of...

Are you a primary care practice that’s considering joining the Making Care Primary model? If so, you may have concerns about the experience needed to participate in a value-based care model. In this blog post, we’ll explore whether VBC experience is a requirement to apply for MCP and what benefits you can expect from the program, regardless of your experience level. Is value-based care experience required for MCP? Primary care providers don’t need VBC experience to apply for MCP. However, since MCP is a multi-state initiative , you do need to be located in one of the following states: Colorado; Massachusetts; Minnesota; New Jersey; New Mexico; New York; North Carolina; or Washington. Note, in New York only upstate counties are included under the model. See Appendix D in the Making Care Primary Request for Applications for more information.  Is there an advantage for practices with little to no VBC experience? One of the key benefits of the model is that primary care providers who...

The Making Care Primary model presents a unique new opportunity for practices to deliver advanced primary care over 10.5 years. As a primary care provider, you may be wondering whether you should take on the risk and how you’ll manage the program requirements, especially if you’ve never participated in a value-based care model before. In this blog, we’ll cover four noteworthy model benefits you may not have considered. These model design elements aim to reduce historic participation barriers and provide an on-ramp for primary care practices to transition to value-based care.   Benefit #1: New structure that encourages participation Unlike other alternative payment models, MCP aims to reduce financial exposure and some of the upfront infrastructure challenges for primary care practices with no or limited value-based care experience. CMS created these flexibilities to encourage more primary care clinicians to participate, especially small, independent, rural and safety net organizat...

Many CMS value-based care models seek to improve care coordination and reduce Medicare fee-for-service spending through episode-based payment and practice transformation. The agency’s new Enhancing Oncology Model applies these objectives to cancer care. There are many good reasons for any oncology practice to join EOM and improve the delivery of cancer care to its patients. But value-based care also raises the stakes. Participation alone doesn't guarantee success. Using analytics helps providers “trust but verify” ─ to not simply believe they are improving care quality and reducing costs, but know where they stand through tangible metrics. This blog post explores three best practices that help ingrain analytics in EOM practice, redesign and performance. How to anchor analytics for EOM performance 1. Estimate episode target prices for financial analyses Financial realities dictate whether practices join EOM, under what risk arrangement and if it's for the long term. Participati...

As healthcare professionals continue to navigate the COVID-19 pandemic, it's important to understand how it has impacted healthcare trends. “Trends in Sepsis and Pneumonia During COVID-19: Lessons From BPCIA,” a recent research article published in The American Journal of Managed Care, explores how COVID-19 has impacted sepsis and pneumonia care and costs. Coauthored by Alyssa Dahl, DataGen’s senior director of advanced analytics, and John Kalamaras, DataGen’s director of business intelligence analytics, along with experts from the Association of American Medical Colleges, the article explores the changes in cost and utilization for sepsis and pneumonia in non-COVID-19 episodes before and during the pandemic, and during the pandemic for patients with and without COVID-19. The analysis used claims data from eight teaching hospitals participating in sepsis and pneumonia episodes in the Bundled Payments for Care Improvement Advanced model. BPCIA is a Medicare value-based care bundle...

CMS has issued its first evaluation report for Primary Care First . The report offers a window into: key attributes of advanced primary care practices; strategies for lowering costs and reducing hospitalizations; and new strategies that signal practice transformation. Future PCF program evaluations will include which practice implementations worked and how they improved quality. In the meantime, even if your medical group is not a PCF participant, you can glean insight into what CMS is looking for as it evolves its Alternative Payment Models and how practices committed to value-based care are prioritizing and evolving their practice transformation strategies. First, some background on PCF. PCF: Focus areas, risk models and payments PCF is designed to improve care quality and patient experience, increase access to advanced primary care services and reduce expenditures. PCF builds upon CMS’s Comprehensive Primary Care Initiative (CPC Classic) and Comprehensive Primary Care Plus by adding...

The Centers for Medicare and Medicaid Services Innovation Center recently announced approved applicants for the new Enhancing Oncology Model. If your facility has been selected by CMS, are you still weighing your options during the current baseline evaluation period?  Two deciding factors may include the program data that CMS provides and whether EOM is enough of an improvement over the prior Oncology Care Model to make your investment worthwhile. Another factor to consider: Will you have the resources in place to conduct a baseline evaluation before EOM’s program start on July 1, 2023? How EOM differs from OCM EOM aims to improve the coordination of oncology care, drive practice transformation and reduce Medicare fee-for-service spending through episode-based payment. It includes three major updates: Fewer cancer types. Compared with OCM’s 21, EOM will be limited to seven common cancer types: breast, prostate, lung, small intestine/colorectal, multiple myeloma, lymphoma and chroni...

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...