A recent report from Frost & Sullivan assesses the approaching HIX deadline and the concerns surrounding implementation By Greg Bengel, contributing writer
A forecast from a risk mitigation and response solution company identifies seven trends that need to addressed as we enter 2014 By John Oncea, editor, Health IT Outcomes
By 2020, accountable care organizations (ACOs) are expected to provide care for at least 105 million patients, up from 23 million in December 2015. With ACOs assuming more responsibility for the quality and cost of care, this rapid patient growth is driving the need for new, more intelligent clinical decision support tools at the point of care. These tools can help ACOs deliver consistent, evidence-based care so patients can return to health safely and quickly.
Movement within the nation’s healthcare system has been swift and broad-‐based since the October 2011 Centers for Medicare & Medicaid Services (CMS) Shared Savings Final Rule.
This paper examines the impact of the 5010 and ICD-10 initiatives from a strategic standpoint. The objective is to ensure compliance with federal regulations, while considering synergies around MU, business intelligence (BI) and business performance management (BPM) and resource maximization.
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
