The Centers for Medicare and Medicaid Innovation (CMMI) Director Liz Fowler testified before the House Committee on Energy and Commerce Health Subcommittee on CMMI’s work to advance value-based care. CMMI has seen success over the last decade, improving patient health and generating millions in savings. Members of the Alliance for Value-Based Patient Care shared recommendations to further strengthen CMMI and support long-term healthcare transformation, including: ➡️Creating new models to engage more medical specialties ➡️Making it easier for safety net, rural, and small practices to transition to value ➡️Broadening and clearly defining the criteria to expand value-based models ➡️Engaging diverse healthcare stakeholders in model development Read the full letter: https://bit.ly/45n0PZX #ValueBasedCare #CMMI #HealthcareInnovation
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There are valuable reasons that so much of the CMMI models focus on primary care. Possibly the most important reasons are that increased spend in primary care reduces costs across the spectrum of care and improved quality outcomes for patients. When reading about concerns, it is important to know the full story. Check out this article to see the impact of what value-based care (VBC) models are doing for healthcare! https://okt.to/DGmvVz
CMMI And Value-Based Care: Advancing And Safeguarding Primary Care | Health Affairs Forefront
healthaffairs.org
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MBA, APRN, CPHQ | Health System Design Support | Champion for primary care and care transition connections
Team-based, integrated primary care involving behavioral health and care coordination services, continues to be the gold-standard, sought-after redesign model. Prospective, monthly payment contract arrangements, including capitation, can support primary care practices in being able to provide services that aren't typically reimbursable in a fee-for-service, code-justifiable environment. CIMMI model participation as well as state-level Medicaid Alternative Payment Model (APM) piloting is providing much needed data to help us understand how to support primary care in a way that it works for the provider as well as the payer. Four learnings: 1) Payer alignment continues to be worked on and necessary; 2) Prospective payment amounts need to be sufficient to cover services; 3) Technical assistance will be important to help practices with an "on-ramp" for assuming risk associated with prospective payments; and 4) Long-term commitment to the model by CMS will be important in order for practices to be able to feel confident in making the transition. #primarycare, #clinicalqualityimprovement, #carecoordination, #behavioralhealthintegration, #primarycaretransformation, #caretransitions
How Upfront, Predictable Payments Can Improve Primary Care
commonwealthfund.org
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CMS has issued its 2024 Medicare Physician Fee Schedule final rule. Coming in at nearly 3,000 pages, there's a lot to digest. We're here to help practices and providers make sense of key changes, highlighting the top 5 remote care takeaways in our latest blog 👇 . #cms #remotepatientmonitoring #rpm #chroniccaremanagement #ccm #fqhcs #rhcs
2024 Physician Fee Schedule Final Rule: 5 Remote Care Highlights
blog.prevounce.com
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CMS Introduced the Transforming Episode Accountability Model (TEAM) model. The proposed mandatory TEAM model would begin on January 1, 2026, and end on December 31, 2030 and signifies a significant shift towards value-based care and patient-centric models. What exactly is the TEAM model, and why is it generating buzz across the healthcare landscape? 1. Episode-Based Alternative Payment Model: TEAM represents a bold step towards episode-based alternative payment models. It builds upon the successes and lessons learned from previous models like the Bundled Payment for Care Improvement Advanced (BPCI-A) and Comprehensive Care for Joint Replacement (CJR) models. 2. Incentivizing Care Coordination: TEAM aims to incentivize care coordination, improve patient transitions, and reduce avoidable readmissions for beneficiaries undergoing specific procedures. By holding hospitals accountable for the cost and quality of care throughout the episode, TEAM promotes efficiency and quality across the care continuum. 3. Participation and Episodes: Under the proposed model, participation would be mandatory for acute care hospitals within selected core-based statistical areas (CBSAs). Episodes would cover a range of procedures, including lower extremity joint replacement, spinal fusion, and major bowel procedures, starting from hospitalization to 30 days post-discharge. 4. Economic Framework: CMS will establish target prices covering most Medicare Parts A and B spending during episodes. Hospitals will be reimbursed based on their performance compared to these targets, with adjustments for patient risk factors. 5. Participation Tracks: TEAM offers three tracks with varying levels of financial risk and quality performance adjustments, accommodating different hospital types and preferences. 6. Flexibilities and Initiatives: To support care coordination and innovation, CMS proposes flexibilities such as safe harbors for financial arrangements and beneficiary incentives. Additionally, TEAM includes a pioneering Decarbonization and Resilience Initiative, emphasizing climate resilience and sustainability. #CMS Centers for Medicare & Medicaid Services #HealthcareInnovation #ValueBasedCare #TEAMModel #PatientCentricity #HealthcareTransformation
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News from First Report Managed Care: The current Medicare Physician Fee Schedule brought many significant changes to increase access to much needed virtual care management (VCM) services to underserved populations. Learn more about the potential implications of these fee changes from an expert in this interview with Brian Esterly. #FirstReportManagedCare #FRMC #medicarephysicianfeeschedule #medicare #virtualcaremanagement #VCM
Insights on the 2024 Medicare Physician Fee Schedule: Implications and Opportunities for Virtual Care Management Services
hmpgloballearningnetwork.com
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Healthcare is at a crossroads! With an aging population and skyrocketing costs, health plans are under immense pressure to control expenses while maintaining quality inpatient care. Reevaluating payment integrity is essential to ensure timely and accurate payment recommendations. One powerful tool? Diagnosis-related group (DRG) validation! Take a look at my article on how DRG reimbursement helps manage costs and improve payment accuracy. https://lnkd.in/eKhbedka #Healthcare #DRGValidation #PaymentIntegrity #Zelis
The Impact of DRGs on Transforming Payment Accuracy in Healthcare
https://www.zelis.com
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Optimizing Client Outcomes through Staff Augmentation for Case Management, Utilization Management & Social Work | Empowering Clients with Innovative Advisory Solutions
Thank you CMS for a good Monday morning read with my cup of tea 🌞 Introducing the Transforming Episode Accountability Model (TEAM), a proposed initiative aimed at enhancing care quality and reducing costs for Traditional Medicare beneficiaries undergoing surgical procedures. TEAM fosters coordinated, high-quality care, potentially lowering rehospitalization rates and improving recovery times. 🌟Key highlights🌟 🔸TEAM builds upon previous episode-based payment models and targets specific high-expenditure, high-volume surgeries. 🔸Hospitals selected would be accountable for episode quality and cost, ensuring patient referrals to primary care services. 🔸Mandatory implementation begins January 2026, spanning five years with various risk-reward tracks. 🔸Evaluation will gauge impact on care quality, access, utilization, expenditure, and patient experience. 🔸Hospitals required to participate would be based on selected geographic regions, Core-Based Statistical Areas (CBSAs) 🔸TEAM prioritizes health equity, offering flexibilities for underserved hospitals and including a social risk adjustment in pricing methodology. Exciting times ahead as TEAM aims to revolutionize Medicare care delivery! Personally, I feel inspired seeing healthcare shift more towards this value base care approach. Anyone else? Share your thoughts below 💭 Shoutout to Patricia (Patty) Resnik, MJ, MBA, FACHE, RRT, CPHQ, CHC, CHPC for always keeping me in the loop on CMS updates ⚡Link to CMS briefing in comment below⚡ #Medicare #HealthcareInnovation #ValueBasedCare #TEAMInitiative
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"Being Intentional About Reporting Leads to Better Quality" - Sound Physicians Long-Term Care Management (SLTCM) Accountable Care Organization (ACO) As a member of the Mingle Health team working in partnership with SLTCM to report clinical quality measures (CQMs), it has been a rewarding experience! Check out this article from Provider Magazine to hear more from SLTCM on their success and collaboration with Mingle Health. #ValueBasedCare #MSSP #ACO #QualityReporting
Being Intentional About Reporting Leads to Better Quality
providermagazine.com
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On November 2, 2023, the CMS unveiled The 2024 Physician Fee Schedule along with the ultimate guidelines governing #remotecare management. The #cms persists in enhancing the potential of Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) services to both bolster revenue and enhance the overall #patientcare experience. Concurrently, #medicare disclosed two significant modifications poised to significantly advantage Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). These alterations will empower FQHCs and RHCs to adopt a comprehensive approach to patient care, facilitating the delivery of more inclusive and easily accessible #healthcare services to their patient population. Read more about the 2024 RPM and RTM reimbursement changes on our blog: https://lnkd.in/gKPkjAUU #NetrinHealth #Remotepatientmonitoring #Primarycare #Valuebasedcare #FQHC #Ruralhealthcare
Navigating the Medicare Final Rule 2024: RPM and RTM Insights
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Elizabeth Fowler, Sarah Fogler, Claire Schreiber, Brian Waldersen, Genevieve Kehoe, Rachel Roiland, Sacha Wolf, Anna Goldman, and Purva Rawal from the Centers for Medicare & Medicaid Services discuss how the CMS Innovation Center has laid out a comprehensive specialty strategy to test models and innovations that support access to high-quality, integrated specialty care across the patient journey. "The first element of the Innovation Center’s specialty strategy aims to deliver enhanced specialty care data to clinicians, hospitals, and other health care entities across multiple models and programs. This requires a coordinated rollout of multiple data initiatives to support different kinds of providers and/or participants. The framework for data coordination and transparency is based on a survey of Accountable Care Organizations (ACOs) and advanced primary care model participants that asked what additional data would support specialty care engagement." Read the full article here: https://bit.ly/43LvZJN
The CMS Innovation Center’s Strategy To Support Person-Centered, Value-Based Specialty Care: 2024 Update | Health Affairs Forefront
healthaffairs.org
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