For practices recognized under the National Committee for Quality Assurance’s (NCQA) Patient-Centered Medical Home (PCMH) model, understanding and meeting the NCQA PCMH 2025 annual reporting requirements is critical to sustaining recognition.  NCQA continues to refine its NCQA PCMH standards and guidelines , emphasizing team structure, care continuity and data integrity. Here’s what your practice needs to do to stay compliant and ensure a smooth reporting process. This blog is a continuation of our piece back in July 2024, which listed three updates to NCQA PCMH's 2025 annual reporting requirements . What is NCQA PCMH?  The NCQA Patient-Centered Medical Home (PCMH) is a model of care that emphasizes care coordination, patient engagement and continuous quality improvement. The PCMH framework is designed to improve healthcare outcomes by fostering strong patient-provider relationships and enhancing team-based care.  Since its inception, the NCQA PCMH program has evolved to...

Accurate and standardized healthcare data are essential for informed decision-making and compliance. In New York state, the Statewide Planning and Research Cooperative System (SPARCS) plays a critical role in collecting and analyzing patient data. Central to this system is the SPARCS data dictionary, a comprehensive resource that ensures consistency in data reporting across healthcare providers. This blog will explore the SPARCS data dictionary , including:  key components and practical applications;  how it can streamline healthcare operations; and   how understanding it can simplify your submission routines.   We will also cover SPARCS data automation and DataGen’s automated SPARCS data submission tool, UDS (UIS Data System™), and how it can help you achieve 100% accuracy and compliance with minimal effort.  Who should use this SPARCS data dictionary?   Key roles in ambulatory surgery centers (ASCs)  This SPARCS data dictionary is a valuabl...

The end of the CJR model: A look back at its evolution  In October 2024, the final episodes of the Comprehensive Care for Joint Replacement (CJR) model were initiated, with all episodes ending by Dec. 31, 2024. This was the final performance year of CJR, which spanned eight years overall.   CJR began Apr. 1, 2016. It was CMS’ first mandatory bundled payment model. Hospitals were held financially accountable for lower extremity joint replacement (LEJR) episodes of care and were incentivized to improve care coordination for patients across the continuum.    Key insights from CJR: Successes, adjustments and challenges  CJR had numerous ups and downs over the years, as its scope was adjusted over several administrations through the rule-making process. Here are the five main highlights.  1. CJR’s mandatory participation: A changing landscape  When the CJR model was introduced, participation was mandatory for hospitals in 67 metropolitan statistical a...

The Transforming Episode Accountability Model (TEAM) is a mandatory, episode-based alternative payment model developed by the Centers for Medicare and Medicaid services (CMS).    It requires selected acute care hospitals to coordinate care for Medicare beneficiaries undergoing specific surgical procedures, assuming responsibility for the cost and quality of care from surgery through the first 30 days post-discharge.   To prepare for participation in the TEAM model, we’ve put together this blog that hospitals can leverage to ensure model success. If you want a fillable, easy-to-download form, you can access that in our CMS TEAM Model Readiness Checklist. [Access the CMS TEAM Model Readiness Checklist] TEAM readiness checklist breakdown  1. Complete preparation steps: Assess participation status and more  Mandatory participation: Determine if your hospital is located within one of the Core-based Statistical Areas (CBSAs) selected for mandatory participation...

In April, we wrote about the updated New York state Section 1115 Medicaid Redesign Team (MRT) Waiver and how it was a game changer for New York state primary care practices.   Almost a year later, we have updates to share so you can drive meaningful change for your practice — while solving some of the biggest pain points in primary care. Keep reading for key summaries or to check out our complete New York 1115 Medicaid Waiver white paper that includes:    an essential summary of the 1115 Medicaid Waiver;  enhanced payment overview;  anticipated challenges and how to navigate them;  next steps for practices with or without NCQA Patient-Centered Medical Home (PCMH) status; and  how DataGen can help you achieve and retain NCQA PCMH status.  [Access it here] New York 1115 Medicaid Wavier updated summary  Primary care practices in New York state have an unprecedented opportunity to boost their revenue, improve care quality and strength...

Why hospitals and providers should leverage episodes of care data before TEAM begins  As CMS continues to advance value-based care initiatives, including the Transforming Episodes Accountability Model (TEAM) , hospitals and health systems face increasing pressure to adapt to episodic payment models. To help overcome this pressure, opportunity analysis, which includes simulated TEAM episodes of care, provides a low-risk, data-driven way to prepare for these changes in payment policy and care delivery before TEAM’s formal implementation.  In this blog, we’ll explain why integrating simulated episodes of care into your strategic planning can set your organization up for success under the CMS TEAM model. We’ll also cover the basics of episodes of care and how DataGen helps providers nationwide to access bundled payment opportunity analyses to better understand the expected impact of TEAM, reduce risk and drive improvement.  What are simulated TEAM episodes of care? ...

The pursuit of health equity in the United States has become more critical as healthcare disparities continue to affect millions of Americans. Socioeconomic status and access to healthcare services are pivotal in determining health outcomes, leaving underserved populations at a disadvantage. To address these issues, the Centers for Medicare and Medicaid Services (CMS) introduced changes in the Medicare Value-Based Purchasing (VBP) Program to incentivize quality care for all.  In this blog, we provide an update, discuss recent data and analyze the national impact. Read on for our interpretation of the CMS VBP Program and how it aims to advance health equity.   Understanding the Hospital VBP Program  The Hospital VBP Program aims to reward acute care hospitals with incentive payments based on their quality of care. This initiative ties a portion of Medicare payments to performance on quality measures, putting 2.0% of a hospital's base operating IPPS revenue at risk. CM...