Month: April 2016

CMS launches largest ever multi-payer initiative to improve primary care in America.

The Centers for Medicare & Medicaid Services (CMS) today announced its largest-ever initiative to transform and improve how primary care is delivered and paid for in America. The effort, the Comprehensive Primary Care Plus (CPC+) model, will be implemented in up to 20 regions and can accommodate up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians and the 25 million people they serve. The initiative is designed to provide doctors the freedom to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care.


Population Health Has Providers Exploring New Approaches to System –

Expanding and integrating high-value post-acute care networks is an important step in the population health transition, cited by 95 percent of executives as a key area of focus over the next three years. But 94 percent of respondents believe creating these networks is the greatest challenge their systems will face over the same timeframe.

To Identify Patients for Care Management Interventions, Look Beyond Big Data

 5% of patients incur nearly 50% of United States’ health care costs, and there is growing evidence that investing resources in these individuals can improve care while decreasing costs. In kind, provider organizations are increasingly adopting high-risk care management, a strategy that relies on coordinated outpatient care to reduce costly emergency department (ED) visits and inpatient admissions. However, complex care management programs are costly in themselves, so it is important to select patients who are not only high risk but are also most likely to benefit from such programs. We now have a wealth of clinical and financial data coupled with an expanding list of analytical solutions to facilitate these choices. However, to best identify the right patients for targeted population health interventions, we need to consider other data sources as well, particularly provider insights and patient-reported data.

Less than 3% of Americans…..

According to a new study, less than 3% of Americans have a healthy lifestyle or even meet the measurable characteristics that can reduce a person’s risk for heart disease, according to a published research article in the journal Mayo Clinic Proceedings.

Projections on Remote Patient Monitoring

By the year 2020, just 5 short years, Berg Insight projects 36.1 million patients will be being monitored annually from their home.  This will generate over $28 billion in annual revenues.  This is way up from the 2015 number of 4.9 million patients resulting in a compound annual growth rate (CAGR) of 48.9%.

Milestones on the Path to Population Health

In order to better shape the path toward population health two objectives are being proposed:  (1)  Providing a direct connection between the patients who would most benefit from health care and supportive services to the appropriate clinical and community resources; and (2) by developing strategies to address diseases with high quality-of-life (morbidity) burdens, not just those with high mortality burdens.  If implemented, these strategies would address determinations such as education, poverty, and exposure to trauma.

Healthcare News

According to research issued by Excellus BlueCross BlueShield, ten common conditions represent more than 2 million annual visits to hospital emergency rooms statewide resulting in an estimated $1.3 billion cost.  And the astonishing fact is 9 out of the 10 of them could have been avoided or treated elsewhere.

The Birmingham Medical News reports, “P

The Birmingham Medical News reports, “Providers paid on MPFS will have to choose one of two paths – either Alternative Payment Models (APM’s) or the Merit-based Incentive Payment System (MIPS). APM’s offer a 5% incentive program. This approach is more likely to be used with accountable care organizations (APOs), bundled payments and other models that have the advanced technology resources and strong data and analytics to manage risk.”

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