Top 5 Ways to Supercharge Your Claims Analysis Capabilities

by Amanda Brown, MHA

Supercharging claims analysis capabilities empowers healthcare organizations to zero in on opportunities to improve care and reduce costs. The most successful organizations typically elevate their performance under value-based contracts by using claims analysis to drive engagement and improvement. Achieving next-level claims analysis status requires a multifaceted approach. To gain the most value from claims analysis, […]

5 Strategies for Strengthening Physician Alignment

by Rudd Kierstead, Principal

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There are signs that hospitals’ interest in employing physicians or owning physician practices may be waning—yet the need to align physicians with hospital strategy is perhaps greater than ever. American Medical Association (AMA) research shows that 33 percent of physicians were employed by hospitals or part of hospital-owned practices in 2016. That’s an increase of […]

MSSP 2017 Performance Year Results and Pathways to Success: Implications for Track 1 ACOs

by Amanda Brown, Manager & Alexandra D'Innocenzo, Senior Associate

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Performance results were recently released for the 5th year of the Medicare Shared Savings Program (MSSP). These results show that a small but growing proportion of ACOs continue to earn shared savings from Medicare, as shown below. This data comes at a pivotal moment for Accountable Care Organizations (ACOs) as they rush to determine how […]

Involved in Value-Based Payment? Meet Quanto

by Amanda Brown, Senior Associate

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Veralon’s health system clients have achieved significant savings using Quanto to identify value-based improvement targets and provide the financial management reports to manage to those targets; client savings have varied from over $1 million to $13 million. Quanto was developed by Veralon and by Health Data Innovations, a leader in healthcare data integration. We partnered to make […]

What Does CVS-Aetna Have in Store for Hospitals?

by Scott Stuecher, Manager, Veralon

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Twelve years after launching the retail health insurgency with the purchase of the start-up MinuteClinic, CVS Health is upping the ante. In the biggest deal of 2017, CVS Health acquired Aetna in December. At this point, all predictions about how this merger will impact hospitals and health systems are conjecture. However, hospital leaders would be […]

ACOs: To Risk, Or Not To Risk?

by Idette Elizondo, Manager; Amanda Brown, Senior Associate;
& Alexandra D'Innocenzo, Associate

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Despite many uncertainties, the shift toward value based payment continues. More Medicare Shared Savings Program (MSSP) ACOs have entered risk-based tracks (Tracks 2, 3, and now Track 1+), to take advantage of MACRA’s[1] 5% bonus to physicians in risk-based payment models. The latest numbers about exactly how many have selected risk for next year will […]

Tackling the IT Challenge in Your CIN

by Molly Johnson, Manager & Alexandra D'Innocenzo, Associate

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Clinically Integrated Networks (CINs) need quality data to understand their patient population and manage provider practice patterns. That makes information technology (“IT”) critical at any stage of CIN development. For CINs with a mix of employed and independent physicians, IT is likely to be a tale of two cities – the employed physicians have solid, […]

Hospital Independence Assessments

by Scott Stuecher, Manager

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Consolidation among healthcare providers has continued at a significant rate over the last decade. In 2005, 45% (2,220) of acute, non-federal community hospitals were independent; by 2015, the figure had fallen to 34% (1,677)[1]. Factors driving this consolidation have been well articulated and thoroughly examined, and include financial distress, competitive pressures, the challenges of success […]

Medicare Shared Savings Program 2015 Results and the Future of ACOs

by Idette Elizondo, Manager & Amanda Brown, Senior Associate

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To date, just under one-third of accountable care organizations (ACOs) have been eligible to share in savings.  This situation is changing somewhat as ACOs gain experience in managing populations of patients for high quality and low cost healthcare. As of 2016, nearly 50 percent of Medicare lives were covered in non-traditional arrangements, including Medicare Advantage […]