Katie Anderson’s Post

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

In a 5-minute review of the 2024 Medicare Physician Fee Schedule (PFS) final rule, TimeDoc Health’s CEO, Brian Esterly, and Vice President of Clinical Strategy, Sarah Cameron, shed light on the implications surrounding reimbursement for RPM services provisioned to FQHCs and RHCs. 📺 Watch the clip: https://hubs.la/Q02bFcdz0 #G0511 #RPM #CCM #TimeDoc #RemotePatientMonitoring

What is the best way to judge a #valuebasedcare model explored by #CMS? If the results don't line up with initial expectations or don't hit all of the targets is it a failure? Could it just be that the metrics for success should be viewed differently or that different lessons should be learned? Those are some the questions that should be considered following an analysis of #Medicare data available from the CPC+ model. While #primarycare spending increased in both tracks, #patient use of the emergency department and #hospital stays decreased. Is that a problem or does it show that #proactivecare may cost a little more upfront, but reduces higher spend from more intensive, reactive services? This would seem to support the argument for more upfront investment to generate down the road benefit. https://lnkd.in/ebxB6Dt7

Care Management is the cornerstone of effective Value-Based Care (VBC) programs, playing a crucial role in improving patient outcomes while controlling healthcare costs. Chronic Care Management (#CCM) stands out as a vital component, providing continuous, comprehensive care for patients with multiple #ChronicConditions. This proactive approach ensures that patients receive the necessary support to manage their health between office visits, reducing hospital admissions and enhancing quality of life. Currently, CCM is integrated into many healthcare practices, particularly those serving Medicare beneficiaries. The Centers for Medicare & Medicaid Services (CMS) recognizes the value of CCM and has incorporated it into several payment models, emphasizing the need for regular, non-face-to-face patient interactions. These interactions, managed by skilled #NurseCareManagers, include medication reviews, care coordination, and personalized care plans, all tailored to meet individual patient needs. The evolution of CCM is evident in its inclusion in new, innovative care models from #CMS. These models incentivize #PrimaryCarePractices to adopt a patient-centric approach, with CCM at the core, focusing on preventive care and chronic disease management. The recent introduction of the Principal Illness Navigation (PIN) services in the 2024 Physician Fee Schedule underlines the commitment to integrating care management into VBC programs. PIN services is designed to support patients with complex health needs and aligns perfectly with the goals of CCM, ensuring comprehensive care across the healthcare continuum. As we move towards a more integrated and patient-centered healthcare system, the role of #CareManagement, particularly CCM, will continue to expand. By fostering collaboration between care managers, physicians, and patients, we can achieve better health outcomes, enhanced patient satisfaction, and more efficient use of healthcare resources. Embracing CCM within VBC models is not just a strategic choice but a necessary step towards sustainable, high-quality healthcare for all. #nurseentrepreneur #valuebasedcare #nurseinnovation

What happens when two major players join forces to enhance patient engagement in #valuebasedcare? The Health Care Transformation Task Force and the National Association of ACOs have teamed up to create a resource presenting recommendations aimed at strengthening #patientengagement in #ACOs, care delivery redesign, and individual care planning. #Healthcare #PatientCare

Navigating the changing landscape of payment models can be complicated for physicians. Partnership with agilon simplifies those complexities because our platform enables a rapid transition to a full-risk value-based care model, which enables physicians to focus on the total quality and cost of care for their Medicare patients. Learn how shifting from the traditional fee-for-service (FFS) model to #ValueBasedCare enhances the delivery of quality care and patient outcomes, as well as key strategies physicians can take to successfully transition to our full-risk, Total Care Model:

When the GPDC model (now ACO REACH) was announced, we believed it was the right accountable care model for the Medicare patient population served by Bloom Healthcare. That has proven to be true. Our model leading results are a direct reflection of the high quality care our dedicated primary care providers and care teams deliver to our patients everyday. They validate Bloom’s clinically differentiated model of care is effective at improving health outcomes (fewer hospitalizations and increasing days at home) and the patient experience, while reducing cost. That’s good for our patients, their families, as well as our senior living and business partners. #primarycare #accountablecare #valuebasedcare #qualityhealthcare #quadrupleaim #seniorliving #healthoutcomes

Join PYA tomorrow (7/31) as we continue our webinar series on the proposed Medicare payment rules for 2025. In Part 2, Valerie Rock, Martie Ross, and Miriam Murray will cover the following topics from the MPFS proposed rule: • 2025 payment rate reduction • Deadline for reporting overpayments • Advanced primary care management payments • Telehealth • Rural health clinics and federally qualified health centers #MPFS #ProposedRule

It's important to understand the guidelines set by the Centers for Medicare & Medicaid Services (CMS) for successful #RemotePatientMonitoring (RPM) implementation. Our latest video breaks down key program requirements to help enhance care quality and health outcomes. https://hubs.li/Q02GXvt60 #HealthTech #ValueBasedCare #HealthcareIT

Capacity (availability of appointments) is a major challenge in primary care. Keep reading below to learn more about how HealthHelper is expanding access to Medicare Annual Wellness Visits with South County Health! CHALLENGE: South County Medical Group (SCMG) recognized the value of providing Medicare Annual Wellness Visits (MAWVs) to their patients, but primary care providers had limited capacity to provide MAWVs to their large Medicare patient population. In response, SCMG developed a Nurse-Led MAWV Program to enhance their capacity. SCMG staff, however, were reticent to schedule appointments with this new program due to the time it required to educate patients on the benefits. SOLUTION: SCMG leveraged its partnership with HealthHelper to proactively identify patient candidates for this program, engage those patients, and schedule appointments with the Nurse-Led MAWV Program. HealthHelper leveraged AI-assisted, bi-directional text messaging and phone calls to engage and educate qualifying patients on the program. HealthHelper’s care coordinators, serving as an extension of the SCMG team, directly scheduled patients for their Nurse-Led MAWV appointments, ensuring strong utilization of the program, more accurate risk coding, and better care gap closure. #primarycare #medicare #populationhealth #AI #patientaccess #healthcarequality #annualwellnessvisits #healthcareIT