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
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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
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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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Three years ago, Centers for Medicare & Medicaid Services Innovation Center set a goal of having all traditional Medicare beneficiaries and the majority of Medicaid beneficiaries in accountable care by 2030. Read this promising progress report in Health Affairs from Liz F. and her colleagues. ✅Integrated care empowers patients to be active in decision-making about their health ✅When care is coordinated, primary care providers and specialists can share insights and treatment plans, which reduces fragmentation and improves health outcomes ✅ CMMI will continue to update condition-specific models to target areas where patients experience gaps in high-value care. Prioritizing condition-specific models will allow specialists to take a more principal role in patient’s care and focus on their specific needs. It's been a privilege to support patients in CMMI's Kidney Care Choices model with the Patient Activation Measure (PAM). Shifts in care like this are a huge win for patients and providers alike. https://lnkd.in/etCG3Edn
The CMS Innovation Center’s Strategy To Support Person-Centered, Value-Based Specialty Care: 2024 Update | Health Affairs Forefront
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Frequently Asked Questions Around Medicare's Chronic Care Management Program #chroniccaremanagement #CCM #ChronicCare #carevitality #caremanagement #carecoordination #cpt99490 #cpt99439 #cpt99487 #cpt99489 #cptcode99491
Frequently Asked Questions about Medicare Chronic Care Management (CCM)
https://carevitality.com
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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
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Full Stack Software Engineer | EMT | Prevention Navigation, Scalable Web Applications, Agile Development, JavaScript
𝐅𝐥𝐨𝐫𝐢𝐝𝐚: 𝐀𝐧𝐚𝐥𝐲𝐬𝐢𝐬 𝐨𝐟 𝐭𝐡𝐞 𝐂𝐨𝐫𝐫𝐞𝐥𝐚𝐭𝐢𝐨𝐧 𝐁𝐞𝐭𝐰𝐞𝐞𝐧 𝐇𝐨𝐬𝐩𝐢𝐭𝐚𝐥𝐢𝐳𝐚𝐭𝐢𝐨𝐧, 𝐑𝐞𝐚𝐝𝐦𝐢𝐬𝐬𝐢𝐨𝐧 𝐏𝐚𝐭𝐭𝐞𝐫𝐧𝐬, 𝐚𝐧𝐝 𝐀𝐯𝐞𝐫𝐚𝐠𝐞 𝐑𝐢𝐬𝐤 𝐒𝐜𝐨𝐫𝐞𝐬 𝐻𝑜𝑤 𝑑𝑜𝑒𝑠 𝑡ℎ𝑒 𝑅𝑒𝑎𝑑𝑚𝑖𝑠𝑠𝑖𝑜𝑛 𝑟𝑎𝑡𝑒 𝑝𝑒𝑟 𝐼𝑛𝑝𝑎𝑡𝑖𝑒𝑛𝑡 𝑠𝑒𝑟𝑣𝑖𝑐𝑒 𝑤𝑖𝑡ℎ 𝑎𝑡 𝑙𝑒𝑎𝑠𝑡 𝑜𝑛𝑒 𝑐𝑜𝑣𝑒𝑟𝑒𝑑 𝑠𝑡𝑎𝑦 𝑐𝑜𝑟𝑟𝑒𝑙𝑎𝑡𝑒 𝑤𝑖𝑡ℎ 𝑡ℎ𝑒 𝐴𝑣𝑒𝑟𝑎𝑔𝑒 𝑅𝑖𝑠𝑘 𝑆𝑐𝑜𝑟𝑒? The scatter plot is based on the 2022 Medicare Geographic Variation file [3]. Before we continue, allow me to show my gratitude to mimilabs [1] for the great resources and inspiration from the FFS vs MA: County-level Wind Map LinkedIn post [2]. 𝐂𝐨𝐫𝐫𝐞𝐥𝐚𝐭𝐢𝐨𝐧 𝐀𝐧𝐚𝐥𝐲𝐬𝐢𝐬: Analyzing the readmission rate per inpatient service with at least one covered stay in relation to the average risk score can provide valuable insights into patient care. Typically, a higher average risk score indicates patients with more severe or complex health conditions. If a strong correlation exists, it would suggest that higher-risk patients are more likely to be readmitted, emphasizing the need for targeted interventions to manage these high-risk populations effectively. 𝐂𝐚𝐬𝐞 𝐒𝐭𝐮𝐝𝐲: 𝐅𝐋-𝐌𝐢𝐚𝐦𝐢 𝐃𝐚𝐝𝐞 𝐚𝐧𝐝 𝐃𝐮𝐚𝐥 𝐄𝐥𝐢𝐠𝐢𝐛𝐢𝐥𝐢𝐭𝐲 In FL-Miami Dade, the correlation between high average risk scores and dual (Medicare and Medicaid) eligibility suggests that socioeconomic factors significantly impact readmission rates. Dual eligibility often indicates lower-income patients who may face additional barriers to accessing post-discharge care, leading to higher readmission rates. Understanding this correlation can help tailor healthcare interventions to address both medical and socioeconomic needs. See the chart below and further analysis here: https://lnkd.in/e4APDZBG 𝐂𝐨𝐧𝐜𝐥𝐮𝐬𝐢𝐨𝐧: Analyzing the correlation between readmission rates and average risk scores, along with the impact of dual eligibility and regional differences, provides crucial insights into patient care dynamics. By understanding these factors, healthcare providers can develop targeted strategies to reduce readmissions, improve patient outcomes, and navigate the financial implications of federal penalties. 𝐐𝐮𝐞𝐬𝐭𝐢𝐨𝐧 𝐟𝐨𝐫 𝐞𝐯𝐞𝐫𝐲𝐨𝐧𝐞: - Did you know that in 2023, Forbes Advisor ranked Florida 22nd out of 50 states for healthcare and 41st overall in health system performance? - Have you checked your state's position in healthcare? [1] https://www.mimilabs.ai/ [2] FFS vs MA: County-level Wind Map [3] https://lnkd.in/ebZn2B-m [4] https://lnkd.in/ew3sX9E7 [5] https://lnkd.in/epHqBGwZ #floridahealth #readmissions #riskscore #mimilabs #medicareeligibility #readmissionspenalties
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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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