Cooperating for better care.

Medicare Shared Savings Program

Tag Archives

N.Y.-Presbyterian creating population-health division

November 4, 2015by Robert Whitcomb in Uncategorized tagged , , , ,

cornell

New York-Presbyterian Healthcare System’s Weill Cornell campus, on the East River.

New York-Presbyterian Healthcare System  is creating a population-health division in part to aid the system’s planning for the huge healthcare changes underway and accelerating.

The population-health division will be within the delivery network, with a leadership team of two physicians at the top to “enable its continue success under its new model of integrated care,”  the system said.

New York-Presbyterian, which is linked with the Cornell and Columbia medical schools, has been moving in the population-health direction for some time. Initiatives have included its 13 patient-centered medical homes in its ambulatory-care network and a joint venture with the two medical schools to start a Medicare Shared Savings Program Accountable Care Organization earlier this year.

Now, apparently, the system has reached critical mass to have a  formal population-health unit.

The division will, among other things, boost its ability to analyze claims data and improve care-management skills. Officials are also looking into such things as boosting partnerships with retail health clinics and dramatically increasing the use of telemedicine.

The system thinks that three to five years will be needed to get the new population-health program up to  full speed.

 

Fee-for-value leader Dr. Beauregard joins CMG

October 10, 2015by Robert Whitcomb in Uncategorized tagged , , , , , , , , , , , , , , ,

 

George Beauregard, D.O., has joined Cambridge Management Group (CMG) as a senior adviser. Dr. Beauregard has been a leader in moving hospitals and physicians into the new world of fee-for-value care.

He has 20 years of experience in private practice in internal medicine and vast experience with pay for performance; performance- and risk-based contracts involving commercial and Medicare payers; EMR/HIT implementation, and Accountable Care Organization and Bundled Payment development.

In his recent role as senior vice president and chief clinical officer for the PinnacleHealth System, based in Harrisburg, Pa., he worked closely with the clinical and administrative leadership to help PinnacleHealth achieve enterprise- wide success in successful CMS Accountable Care and Bundled Payment initiatives; quality and performance improvement; clinical integration, and HIT optimization. This helped lead CMS to welcome RiverHealth ACO, of which PinnacleHealth is a founding member, into the 2014 Medicare Shared Savings Program.

Prior to joining PinnacleHealth, in September 2012, Dr. Beauregard was president and chief medical officer of Southcoast Physicians Network, in Massachusetts.  His leadership helped gain Southcoast admission into the 2013 Medicare Shared Savings Program.

Before that, he was co-founder, in 1996, of Primary Care LLC, the largest independent community-based primary-care-physician network in eastern Massachusetts. Dr. Beauregard guided a merger of that entity with Tufts Medical Center in 2005 to form the New England Quality Care Alliance (NEQCA), where he then served as chairman of the board for four years. He also was trustee of Tufts Medical Center Physicians Organization Inc.

George Beauregard is a graduate of the University of New England College of Osteopathic Medicine. He has been awarded Diplomate Certificates by the American Board of Internal Medicine and the National Board of Osteopathic Medical Examiners.

 

The routes of 2 ACOs to improve care, control costs

June 26, 2015by Robert Whitcomb in Uncategorized tagged , , , , ,

 

Two Accountable Care Organizations (ACOs) discussed strategies to boost engagement with patients  in order to improve healthcare delivery and outcomes while more rigorously controlling costs.

One is Mercy Clinic ACO, in Des Moines, Iowa, which in 2012 became a Medicare Shared Savings Program (MSSP) participant. The ACO has provider participants throughout Iowa and focuses on primary care,  community resources, patient advisers and health coaches, who are registered nurses.

Mercy also uses  patient advisers to find out what it can do to offer better  service to patients and the broader community, as the imperative of improving population health becomes more pressing.

The Triad Healthcare Network, in Greensboro, N.C., is is also an MSSP ACO participant. Its initial patient-engagement efforts focused on care management for high healthcare users.But that only represented  5 percent to 10 percent of its patient population.

So it reached out  via telephone to “under-utilizers” — patients with chronic illness who haven’t had an appointment in  months. The idea, of course, is to more closely monitor their condition and care to prevent their illnesses from becoming more dangerously (and expensively) serious.

 

 

 

Experts applaud ‘Next Generation’ ACO’s

March 12, 2015by Robert Whitcomb in Uncategorized tagged , , , , , , , , ,

 

applause

Experts applauded the Centers for Medicare & Medicaid Services’ “Next Generation” Accountable Care Organization (ACO) plan, which asks participants to take on more financial risk in return for more  potential reward. The aim is to move away from fee for service to capitation as payers push healthcare industry toward a value-based reimbursement system.

“It’s a real effort to move away from shared savings or limited risk models. On both counts it’s an important step,” said Mark McClellan, M.D., a former CMS administrator,  told FierceHealthcare.

Larry Kocot,  a visiting fellow in the economic-studies program at the Brookings Institution, agreed. “I do think CMS should be credited for thinking creatively to extend the model to meet the needs of providers no matter what stage they are at within the ACO program,” he told the news service.

Farzad Mostashari, M.D., former national coordinator for health- information technology, told Clinical Psychiatry News Digital Network that the new model will likely suggest how CMS will structure other ACO’s.  “This is directionally, absolutely where the Medicare Shared Savings Program (MSSP) is headed.”

“We are hopeful the changes they proposed and the comments received that they will make the MSSP program more accessible and more friendly to a number of providers,” said Kocot, who also served as a senior administrator of CMS.

FierceHealthcare reported that Kocot said he’d like the CMS to establish a ”fourth track that would lead to full capitation. He recommends tracks that reflect a continuum of ACOs that may begin with little risk and end with the full capitation model.”

Southern hospitals doing best with MSSP

January 23, 2015by Robert Whitcomb in Uncategorized tagged , ,

 

Some early evidence reported in HealthAffairs indicated that geography, not size, is the key factor in success among Accountable Care Organizations of  participating in the Medicare Shared Savings Program.

In any event, of course, there will have to be more changes in the program for it to fulfill its creators’ hopes for hospitals across America

Fierce Healthcare summarized: ”The size of the ACO didn’t necessarily determine its likelihood of producing savings, as large ACOs ‘generally did not have an advantage in financial performance compared to smaller ACOs,’ according to the article.”

ACOs in the South outperformed  other regions’, and those in expensive areas were particularly successful in producing savings. The HealthAffairs study reported that “the way medicine is practiced (or at least has been practiced) in a region is important to the ACO’s ability to generate shared savings under current benchmarking methodology.”

”Financial performance, though, is only one part of ACOs’ overall mission, and the first HealthAffairs analysis notes that the savings produced by MSSP ACOs is not necessarily related to how they were able to improve the quality of care. ”

 

 

Read more

Page 2 of 212

Contact Info

info@cmg625.com

(617) 230-4965

Wellesley, Mass