Debbie Ahl’s Post

MSSP or ACO REACH? Deciding to join, or start, a Value-Based Care (VBC) contract is the right decision to be prepared for 2030, when CMS plans to have all Medicare and most Medicaid patients in a VBC arrangement. But which model is the right one for your organization? For a more in-depth comparison of Medicare Shared Savings Program (MSSP) and ACO Realizing Equity, Access, and Community Health (ACO REACH) models, check out this blog: https://okt.to/AfTiYC #valuebasedcare

Succeeding in at-risk alternative payment models requires cost transparency awareness at the point of specialist care initiation and subsequent post acute care management. That knowledge translates to narrower spend variations in episode-of-care delivery within patient populations matched by disease severity. BPCI can prove to be a significant first step engagement in at risk contacting prior to the proposed CMS mandatory episodes and value-based referrals impacting specialist group practices in the coming years.

Medicare Advantage is an ideal opportunity to implement new value-based care initiatives. Take care coordination, for example. Encouraging or even incentivizing collaboration among different healthcare providers along a member's continuum of care ensures members receive the right care at the right place at the right time which leads to better health outcomes and efficiency. Although challenges such as communication barriers, lack of patient engagement, rural and underserved populations and fragmented care still exist, Synergy 3C looks to be your partner in identifying and solving for these challenges to transform your VBC offering. Reference: Becker's Payer Issues. (2024, May 20). 10 key questions facing Medicare Advantage. https://lnkd.in/gu_v57iK

Happy to be part of work from the National Association of ACOs and AHCA/NCAL on policy changes needed to increase participation by long-term care providers in value-based care arrangements. We came together last year to organize roundtables to test ideas and develop recommendations that are included in a paper we're making public today. Our recommendations include: Alignment - Because ACOs are historically centered around primary care, the method that Medicare uses to assign accountability to providers doesn't work well for post-acute care. There are ways to make that better. Financial Benchmarks - Institutionalized patients are inherently sicker and more costly. Therefore, how we set financial spending targets, which is based on patients' historic spending, needs to better account for these patients. Quality Measurement - Here too, special considerations need to be made for different provider types because what is used in Medicare ACO programs is designed for traditional physician office settings. Data Access - Accountable care relies on providers receiving timely, actionable data on their patients in order to identify care needs and effectively intervene. Here too are ways to make the process better for post-acute care providers. Nested bundles - Improvements can be made to pay for episodic care by better leveraging relationships ACOs have today with their post-acute provider networks. Read the full paper here: https://lnkd.in/evxZBzvc https://lnkd.in/eaVeu6-d

🚨 Last week, Centers for Medicare & Medicaid Services released the proposed 2025 Medicare Physician Fee Schedule (PFS) with key changes to MSSP! READ: https://lnkd.in/exGxdp-s ▶️Highlights: • Addressing anomalous billing • Creating a higher risk track • Easing beneficiary notifications ▶️Key MSSP changes: • Removing anomalous billings • Adding Health Equity Benchmark Adjustment (HEBA) • New primary care service codes • Aligning quality measures • New “prepaid shared savings” option AaNeel’s #healthcaretechnology solutions can help you navigate these changes seamlessly, improving operational efficiency and care quality. Visit www.aaneel.com for more information. #Healthcare #Medicare #CMS #MSSP #HealthcareInnovation #HealthEquity #MedicalBilling #DigitalHealth #AaNeel

MSSP or ACO REACH? Deciding to join, or start, a Value-Based Care (VBC) contract is the right decision to be prepared for 2030, when CMS plans to have all Medicare and most Medicaid patients in a VBC arrangement. But which model is the right one for your organization? For a more in-depth comparison of Medicare Shared Savings Program (MSSP) and ACO Realizing Equity, Access, and Community Health (ACO REACH) models, check out my blog: https://okt.to/Bfn8bl

Important opportunities to weigh in on the future of health in Maryland!

The concept of Accountable Care Organizations (ACOs) may not be new, but it is evolving and gaining traction. The Centers for Medicare & Medicaid Services (CMS) continues to test and evaluate new versions of these models to provide phyisician practices a variety of ACO-based options to support their specific needs. Whether you're new to ACOs or need a refresher on the viability of joining an ACO, check out CareAllies' latest blog by Corey Redding, VP of Value Based Programs, to gain insights into its advantages and learn how CareAllies can help you navigate their ever-changing landscape: https://bit.ly/4dwlAp7 #AccountableCareOrganizations #ACO #Healthcare

🥳 I’ll join in this week’s birthday celebrations for Medicare, but I’m looking forward to Medicare’s "Medicare birthday" (it's 65th). On July 30, 1965, President Lyndon B. Johnson signed into law the bill that would create Medicare and Medicaid. Americans 65 and older gained at least a basic level of healthcare coverage. And now we (patients, providers and payors) can’t imagine life without these vital programs. So much has changed over 59 years, but the next six years will be transformative. On Medicare’s 65th birthday (2030), the goal is to have every patient in the kind of accountable care relationship that Wellvana facilitates — whether through an Accountable Care Organization for Original Medicare or Medicare Advantage for patients with private plans. We worked with our partners at the Healthcare Leadership Council (HLC) and AdventHealth to pull together recommendations to help the U.S. reach this goal. I hope you’ll take a look. We look forward to Medicare’s big 6-5. It’s really just around the corner.  https://lnkd.in/eQB55hbs #valuebasedcare #medicare #medicareadvantage #medicaid #patientcare

Centers for Medicare & Medicaid Services will introduce the ACO Primary Care Flex Model in 2025, aiming to enhance primary care for Medicare beneficiaries. It targets low-revenue ACOs, offering financial incentives and flexible payment models.   This initiative seeks to promote innovative, person-centered care, improve health outcomes, and increase ACO participation in the MSSP.   Despite declining interest in MSSP due to policy changes and the pandemic, CMS hopes the ACO PC Flex Model will revitalize participation, especially among primary care providers in underserved areas.   The application process opens in May 2024, signaling CMS's commitment to advancing health equity and transforming accountable care relationships with a focus on primary care providers.   Our RCM team can support ACOs participating in the new Primary Care Flex Model by optimizing revenue cycles, facilitating financial management, and ensuring compliance. This enables ACOs to focus on delivering innovative, person-centered primary care to Medicare beneficiaries effectively.   We are the One!   #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner Xtelligent Healthcare