Shift in location for performance of services, frugality of the consumers, Obamacare credited By Christine Kern, contributing writer
Government expert calls HIT initiatives ‘experiment’ as provider expert coincidently observes ‘we can’t afford to experiment’ By Greg Bengel, contributing writer
At the Senate Finance Committee hearing on health IT, one senator suggests suspending MU for reassessment, while witnesses fear a pause would stop provider momentum By Greg Bengel, contributing writer
A recent study says that pharmaceutical companies will see modest gains offset by discounts and rebates when the health insurance exchanges kick in. By Greg Bengel, contributing writer
This special report covers the uses for Electronic Health Records (EHRs) beyond just collecting, aggregating and reporting on data and demonstrating compliance with Meaningful Use (MU).
Over the past decade, the healthcare system in the United States has been increasingly encumbered by an aging population, the burden of chronic disease, and economic pressures. In response to this confluence of events, federal healthcare reform has stimulated the public and private sectors to bend the cost curve and improve performance.
This white paper examines how the ACO (Accountable Care Organization) model can impact both hospitals and physicians, and highlights several specific points providers should consider and understand.
Many industry leaders championed a free market approach to healthcare during the 12th Annual World Health Care Congress last week. Here are a few key reasons why I don’t think this model is “the fix” our industry so desperately needs.
An Accountable Care Organization (ACO) utilizes a payment and care delivery system that bases payments to providers on quality metrics and seeks to reduce the total cost of care for a certain population of patients. ACOs use a range of payment models and consist of groups of coordinated healthcare providers that provide care to groups of patients. ACOs are accountable to a third-party payer and the group of patients for the appropriateness, quality, and efficiency of the health services they provide.
In 2011, the Department of Health and Human Services (DHHS) set forth initial guidelines for ACOs to be created under the Medicare Shared Savings Program. These guidelines contained all necessary steps required for a physician, health care provider, or hospital to voluntarily participate in ACOs.
The quality measures used to evaluate an ACO's performance as defined by the Center for Medicare and Medicaid Services (CMS) fall into five domains. These domains are patient/caregiver experience, care coordination, patient safety, preventative health, and at-risk population/frail elderly health.
The three stakeholders in an ACO are the providers, payers, and patients. Providers are a network of hospitals, physicians, and other healthcare professionals. The primary payer is the federal government, Medicare, but also includes other payers such as private insurances or employee-purchased insurance. The patient population of an ACO will primarily consist of Medicare beneficiaries, but in larger ACOs can also include those who are homeless and uninsured.
According to a new report, a lack of out-of-network interoperability is the biggest obstacle facing ACOs today. By Katie Wike, contributing writer