January 23, 2020

Recent CMS Rulings Simplify Payments for Transitional Care Management

In recent years, the use of care management services to provide better patient outcomes has gained momentum. Contributing to this momentum is a desire to generate greater transparency around patient behaviors in Post-Acute Care settings. This setting was the first focus area for the creation of care management services.

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Topics: Physician Compensation, Patient Care, Managed Care Organization, CMS

March 12, 2015

3 Strategies to Become an ACO

The early experience with ACOs has not been very good. The cost of implementation has been higher than expected, and population health management has been difficult to achieve. Data released last October showed that out of 220 CMS ACOs, only 52 were able to share savings, and 115 ACOs had no cost savings. The CMS ACO spend was reduced by a paltry 1%.

So why were the results so underwhelming? It was harder to reduce costs than expected. Low hanging fruit did not exist. The outcomes could have been better if they had deployed these three important strategies.

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Topics: Managed Care Organization

December 11, 2014

Challenges of Accountable Care Organizations

As health care evolves from fee-for-service to shared-savings model, accountable care organizations are a key component in driving this evolution. ACOs can be broadly defined as: "a group of health care providers who accept shared accountability for the cost and quality of care delivered to a population of patients." This concept places the financial risk of each patient's care on the group of providers.

There have been many obstacles blocking the success of implementing the ACO model nationwide. At a recent summit, I attended a session about why ACOs have not been successful, and many challenges were discussed, such as:

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Topics: Managed Care Organization

February 03, 2014

HORNE Health Care Blog

“Status quo is not a strategy”

Welcome to our conversation about changing the culture of health care organizations. Each week we will dive deep into the challenges facing health care providers and the big ideas that are solving them. We’ll also monitor trending news to bring you stories that are important to improving the health of medical providers.

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Topics: Managed Care Organization, Hospital Management