Despite the uncertainty and new demands that two-plus years of the pandemic have created, now is the time for hospitals to create a purposeful strategy to address social determinants of health (SDOH). COVID-19 repositioned the importance of telehealth and outcome disparities. At their intersection is “digital,” the competency that determines whether people can actually use the tech tools that healthcare stakeholders have built for them. While digital needs are secondary to having somewhere to live and enough to eat, digital tools are how people often access needed resources and are a primary point of intersection between providers and the populations they serve — patients and the broader community. This blog details why digital competency is a distinct and important metric that can help hospitals calculate social risk to make better business decisions and create better outcomes. Digital competency: Definition, dimensions and risk Digital competency is one of six social determinants of...

Innovation that benefits only the privileged is not progress. While accountable care organizations helped show that a focus on value was missing from healthcare, new ACO priorities reflect that equity has been missing, too — for providers as well as patients. In its recent Strategy Refresh , the Center for Medicare and Medicaid Innovation noted that its “Medicare-focused models have limited reach to Medicaid beneficiaries and safety net providers.” CMMI’s new ACO model and planned improvements to existing ones are designed to help more providers reap the benefits of value-based care. If it’s broke, fix it The objectives of accountable care are clear: higher quality at lower costs, involving less waste and a better experience for all. Those outcomes have not fully arrived. CMMI reports that “only six out of more than 50 models launched have generated statistically significant savings to Medicare and to taxpayers” since 2011. The reasons are many but include the need for a new standa...

Earlier this month CMS unveiled that the Kidney Care Choices Model will welcome Cohort 2 in January 2023. CMS also provided guidance around payment mechanisms, policies and quality measures. New participants submitted applications earlier this month. KCC is built upon the successes of the Comprehensive End-Stage Renal Disease Model. CMS offers several structures for participation in KCC: Comprehensive Kidney Care Contracting Options : This includes the CKCC Graduated Option, the CKCC Professional Option and the CKCC Global Option for kidney contracting entities. Participation in CKCC is open to Kidney Contracting Entities consisting of nephrologists, nephrology practices and transplant providers. KCEs can also include dialysis facilities and other providers and suppliers. Kidney Care First: A payment structure for individual nephrology practices and nephrology professionals only. To ensure that new and current participants succeed, DataGen has compiled some of the top questions re...

Primary Care First (PCF) participants need to pay attention There is a renewed emphasis on advancing primary care. Primary care serves as the front door to the overall healthcare system, and early and accurate diagnosis can lead to fewer hospital admissions – a metric that has become especially important during the pandemic. With the January 2022 launch of Primary Care First Cohort 2, it is important to review what steps healthcare organizations should take to ensure the best outcomes. To be successful, PCF participants must pay special attention to three aspects: tracking the beneficiary population, obtaining physician buy-in, and ensuring timely access to performance metrics. 1. Tracking Beneficiary Population Tracking patients participating in the PCF program is necessary to build patient navigation processes and monitor care outcomes. However, this can be challenging for many providers as internal EMR solutions do not provide complete data across the entire continuum of care f...

Can ACO REACH help CMS and providers achieve the unmet goals of prior alternative payment models? If so, a stronger focus on equity, provider leadership, accountability through risk and evaluation may make the difference. Announced Feb. 24, ACO REACH — Accountable Care Organization Realizing Equity, Access, and Community Health — is CMS' newest voluntary APM. Robust resources and capabilities will be needed to navigate its requirements. As highlighted in a recent CMS webinar , ACO REACH is the first APM to launch following a Strategy Refresh by the Center for Medicare and Medicaid Innovation. ACO REACH aligns with the CMMI objective of driving accountable care to improve cost and quality and will replace the current Global and Professional Direct Contacting program, effective Jan. 1, 2023. CMMI encourages current GPDC participants and new entrants to apply, noting that selection criteria and performance monitoring will be more stringent. This blog highlights key differences bet...

Download our white paper, Using Social Risk Scores to Predict Unnecessary Healthcare Utilization .  All forward-thinking hospitals understand the role of social risk in providing effective, equitable and efficient care. In many ways, hospital objectives align with those of social risk assessment. Both help to distinguish acute from long-term needs, identify underlying contributors to poor outcomes and, wherever possible, help minimize or completely prevent more serious interventions. Six social risk factors and their drivers Social risk is a measure of vulnerability as defined by specific social determinants of health (SDOH) . DataGen uses the following six SDOH categories. Social Determinants of Health Category Defined by Individual risk drivers Community risk influencers Digital Access, affordability and literacy Competency Resources Finance Strength, resources and r...

CMS has introduced more than 50 innovative care delivery models designed to drive health system transformation over the last decade. Only six of those produced significant savings; of those, only four met the requirements to be expanded. As the second 10-year period of the program gets underway, which includes $10 billion in new funding, CMS’ Center for Medicare and Medicaid Innovation is considering numerous changes to improve the overall success of these programs and, in turn, drive overall gains in care outcomes and health equity. When evaluating what has worked in the past and what changes are needed moving forward, it is important to review what success looks like for Alternative Payment Model programs.  CMMI relies on three benchmarks to measure levels of success The gold standard: improving quality of care while simultaneously reducing expenditures. Improving quality of care without impacting expenditures. Reducing expenditures without impacting quality of ...