The last three years have forced health systems to realign services; first, to address the demands of COVID-19 and later to meet pent-up demand for care, all while addressing community health needs, competitive positioning and right-sizing of services. With the pandemic as a catalyst, today's healthcare market is increasingly influenced by new business models aimed at delivering superior healthcare experiences. Healthcare is seeing a rapid shift to consumer-centric care models — fundamentally changing how healthcare systems compete for market share and revenue.  Is your health system constantly asking: Are there service lines that we should add or remove? Are there physician groups that we should align with? Are there hospitals with which we should align? Should we add a new facility or program based on the shift of procedures to outpatient? Strategic planning is vital for revenue growth. But what do you need to know to get there? To truly understand and move your market position, ...

New trends and change agents are increasingly challenging health systems’ volume and revenue growth. To compete and stay relevant, they must take a more balanced approach to their near-, mid-and long-term growth. DataGen and Sg2 recently joined forces to host  Optimizing strategic planning for revenue growth: DataGen and Sg2 resources. This webinar featured customers' experiences using Sg2's suite of analytical tools and how, when partnered with DataGen's customized customer service and training, these tools helped their organization optimize its strategic planning for enhanced revenue growth.  We broke down five common questions asked during the session. 1.       What disruptors are you keeping an eye on?  We are keeping an eye on four major disruptors: Retail clinics, big tech/digital, VC-backed medical groups and payers as providers.  2.       What downstream effects have these disruptors had on inpatient...

Z codes that document patients' non-medical needs are rarely used and often misunderstood. Yet they’re vital to address social determinants of health, which are responsible for 80% of a person's health outcomes. New developments make it easier to incorporate Z codes into an organization’s health equity strategy. These include patient e-screening, leveraging an enhanced Community Health Needs Assessment, use of robust social risk intelligence data and new efficiencies that capture insights from these sources and make them actionable. By using a combination of "push and pull" strategies, health systems can start these efforts now. But first, a brief introduction to Z codes and why they're important. What are Z codes and why are they important? Z codes are a subset of ICD-10-CM diagnostic codes to document a person's SDOH, defined by Healthy People 2030 as "the conditions in the environments where people are born, live, learn, work, play, worship and age th...

CMS recently made several major announcements about the Bundled Payments for Care Improvement Advanced Model.  The model, which was due to expire at the end of 2023 (Model Year 6), will be extended for an additional two years through Dec. 31, 2025.  New applications will be accepted in 2023 for the two-year extension. Participants still active in Model Year 6 can continue without reapplying by signing an amended and restated participation agreement for Model Year 7.  New methodological changes will be implemented for Model Year 6, which starts on Jan. 1, 2023. Methodological changes include that: the CMS Discount Factor for medical clinical episodes will be reduced from 3% to 2%;  the Peer Group Trend Factor Adjustment cap for all clinical episodes will be reduced from 10% to 5%; the Major Joint Replacement of the Upper Extremity clinical episode category will become a multi-setting episode category by allowing episodes to be triggered when the procedure is performed...

The good news: The Medicare Shared Savings Program (MSSP) has reported a fifth consecutive year of savings while delivering high-quality care for Medicare beneficiaries in accountable care organizations (ACOs). The tricky news: With participation dropping since performance year 2018, ACOs will need places to pivot as success becomes more dependent on risk progression, benchmarking and equity goals. The 2021 MSSP results CMS reported the following highlights from the 2021 MSSP performance year : 99% of participants met the quality targets required for shared savings; 58% earned shared savings; ACOs outperformed non-MSSP providers in metrics related to diabetes, blood pressure, select cancers, fall risk, flu vaccination, tobacco screening and smoking cessation, and screening/remission for depression. ACOs with specific characteristics saved more than their counterparts. This includes ACOs labeled low revenue and those dominated by primary care providers. For example, low-revenue ACOs sa...

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 ...

Not owning a vehicle in New York City has negligible impact on a person’s health. Not owning one in a rural area — or even a booming metropolis like Nashville that lacks a diversified public transportation system — can be life-threatening. This tale of two cities suggests that transportation, perhaps more than any other social determinant of health, illustrates the link between ZIP code, disparities and health outcomes. The importance of transportation Missing medical appointments due to lack of transportation is a stark example of how SDOH can directly impact health outcomes. The ability to get where and when you need to is also connected to other social determinants of health domains such as finance, food and housing. However, one study found that transportation is found in fewer SDOH assessment tools (66%) than any other metric besides social and community context (61%) and physical activity (33%). Addressing transportation inequality begins with knowing how it impacts populations ...