Accountable Care Organizations and use of Telehealth/Telemedicine?

LampOnLink: Early Cost savings from Banner Telehealth Pilot

Health Data Management (in the above link) reported cost savings from use of Telehealth that resulted in decreases in readmissions and health care expenses. The ONC’s Federal Health Information Technology Strategic Strategy 2011-2015 described the use of innovation to enhance care, improve population health and decrease per capita costs of health care. Objective II defined chances to Enhance Care, Improve Population Health, and Reduce Healthcare Costs through using Health IT.

This very same technology could be used in an Accountable Care Organization (ACO) to enhance care and minimize expenses. Systems, like telehealth, have actually been executed in particular ACOs. Remote monitoring, mobile health (mHealth), and the medical house have the prospective to positively influence patient lives.

The light bulb has been turned ON. Health care is migrating from a disease management system to a “National Prevention and Health Promotion Method” that avoids adverse health conditions where possible, expects and replies to threats and emergency situations and determines at-risk populations. To me, this strategy represents the objectives for ACOs.

Lowering spend for ACO populations is key to health change and total expense reductions in Medicare spending. According to the Banner Health Telehealth pilot, results were remarkable. By having a strong support group for clients, clinicians had the ability to “gather and analyze objective and subjective health details to identify early stages of deterioration” and to prevent aggravating health conditions. Banner health reported registering its 500th patient into their program.

An Accountable Care Organization has a minimum of 5,000 patients with care coordinators accountable for monitoring client condition. Their beneficiaries lie throughout a geographic location and the ACO might gain considerable cost decreases with positive patient care chances using Telehealth.

Several years back, I was asked to be a panelist on a Bloomberg webinar on Telehealth. The concern at the time was easy, “Is telehealth a sensible option to in person patient care?” I thought it then, and I believe it now, when made use of in appropriate circumstances. To find out more on Telemedicine and its Telehealth subpart, read this post about the World Health Company and Telemedicine Opportunities.

Health care & Innovation

Interested in a Masters degree in Health Informatics?


I was asked to take part in a video (above) about the University of South Florida Morsani College of Medication’s graduate program for Health Informatics. Since it is an online program, there were students from throughout the country in addition to Florida. I was able to finish the program in a little over a year.

If you’re interested in discovering more about Health Informatics examine out the curriculum on the USF web site.

Health care & Technology

Pioneer Accountable Care Organizations exhibited smaller Medicare expense

BinocularsLink: JAMA

In 2012, CMS launched the Leader Accountable Care Organization model and the Medicare Shared Cost savings Program. The Pioneer ACO design is a more ambitious test of population health management that targets experienced companies. This design is an attempt to check practicality of Accountable Care organizations and their ability to lower spending and enhance the quality of care supplied to recipients.

A research study reported in the May 4, 2015 edition of JAMA evaluated Medicare spending, usage and CAHPS domain scores for Leader ACOs in 2012 or 2013. The goal of the research study was to assess spending and usage between recipients aligned with Leader ACOs and other FFS recipients.

The study was “based upon the work of evaluation professionals for the Assessment of CMMI Accountable Care Organization Initiative performed under Agreement HHSM-500-2011-00019i/ HHSM-500-T0002 with the Centers for Medicare & & Medicaid Services (CMS). CMS provided access to the information to the examination specialists to perform analyses under the guidance of Drs Nyweide, Lee, and Cuerdon. In conjunction with the specialists, Drs Nyweide, Lee, and Cuerdon created the research study and assisted with interpretation of the data.”

Information was gotten from CMS’ Chronic Conditions Data Storage facility. The CMS Chronic Conditions Data Stockroom (CCW) provides researchers with Medicare and Medicaid beneficiary, claims, and assessment information linked by beneficiary throughout the continuum of care. The following graph is an example of Medicare Chronic Conditions by Medicare Condition Code for 2013.


To learn more about Accountable Care Organizations and the policies that support them see the ACO Survival Guide shop. ACO Quality Checklist coming soon!

Health care & Innovation

Is Fee-for-Service dead?

GraphPie2Link: CMS Lays Out Vision for Medical professional Quality Reporting Programs.

“With passage of H.R. 2 [SGR repeal and Medicare service provider payment modernization], key components of these medical professional programs will work as the foundation for the Merit-based Incentive Payment System.”

“The Strategic Vision describes in concrete terms how we will certainly advance the goals and objectives for quality enhancement described in the CMS Quality Method through these quality measurement and reporting programs.”

The Medicare Sustainable Development Rate (SGR) is a method to manage spending by Medicare on physician services. CMS’ Quality Approach looks for to enhance health results using medical quality improvement and health care transformation, including payment reform. The vision streamlines existing quality programs to lower healthcare professionals’ burden, acknowledging constraints of existing doctor quality reporting program requirements and regulative processes.



As revealed in January, 2015 by HHS, the relocate to move from a simply fee-for-service (FFS) payment system to alternative payment approaches, like Accountable Care reimbursement models, benefit service providers based upon the quality and expense of care provided to Medicare recipients. HHS revealed the goal of “tying 30 % of payments to quality and value through alternative payment models by 2016 and 50 % by 2018 under alternative methods for payment reimbursement developed by the Affordable Care Act.

One aspect of the concern associated with quality reporting involves the collection of information from disparate sources in order to report and keep track of quality efficiency. This is exactly what I might think about the next step in technology use; motion from information caught in an EHR to analysis of scientific, functional and monetary data collected from numerous sources. Data collection may build up in an information storage facility or an application made use of for data evaluation. Keeping an eye on efficiency and quality metrics provide the chance for continuous enhancement in client care and minimized costs.

As an example, Accountable Care Organizations (ACOs) have actually shown their ability to reduce Medicare expenses in the short time of their existence. Since September, 2014, overall net savings to Medicare had to do with $ 484 million in shared savings.

Healthcare & Innovation

Moving from fee-for-service to Accountable Care

BrickWallLink: Michigan’s Fee-for-Value Medical professional Reward Program Minimizes Spending and Improves Quality in Medical care – The Commonwealth Fund.

With the recent statement from HHS concerning “Better, More intelligent, Healthier”and its objectives and timeline for moving Medicare reimbursements from volume to value, Michigan’s Fee-for-Value effort is reported to have actually decreased spending and enhanced quality of medical care. This is a big step to break-down the brick wall in between fee-for-service and value-based liable care compensation designs.

The short article sources that overall spending by practices lowered $ 4 per member, monthly in the 2nd year, although spending increased in the first year. Adult savings were achieved through expense decreases in outpatient facility use.

Released by the Commonwealth Fund at the above link, the research study utilized BCBS of Michigan’s utilization and spending data and compared pre- and post- intervention efficiency between those who took part in the Reward Program and those who did not. Information depended on HEDIS procedure measures for preventive and evidence-based care.

This study demonstrates that the move from fee-for-service to a value-based reward program has the possibility to reduce expenses while keeping top quality patient care.

Healthcare & Technology

Accountable Care Organizations (“ACOs”) face Complex Regulatory Challenges

Megaphone1Link: News release

The Accountable Care (ACO) Survival Guide Shop now contains a 3-hour training program with a Concern and Answer Quiz to assist ACO Professionals and their partners better understand the difficult challenges of CMS regulations. The training is separated into 3 parts: Eligibility and Application Requirements, Benchmark and Performance targets, and understanding the calculations for option of a Shared Cost savings and Losses risk design. For more information check out the ACO Survival Guide Store.


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CMS Innovation Center hard at work?

DrawingPin1_BlueSEC. 3021 of the Affordable Care Act established the Center for Medicare and Medicaid Innovation (CMI) within CMS. The function of the CME is to establish presentation tasks (i.e. tests) of ingenious payment and service models that improve the quality, coordination and effectiveness of services and minimize expenses.

CMS might speak with Federal companies or external parties with its dedication to open door forums. The kinds of models to be checked by CMI might consist of:

a) Promoting broad payment and practice reform for medical care.

b) Promoting ingenious shipment designs through risk-based detailed or income payments with groups of carriers or services/suppliers.

In basic, these models need to put on geriatric clients with numerous chronic conditions that would benefit from services that include care coordination between providers and suppliers. These designs may likewise support care coordination for patients with high risk of hospitalization. The design might support a chronic condition windows registry and house tele-health innovation.

Other features of models initiated by CMI may include payment variations to physicians based upon appropriateness of services, using medication services explained in section 935 of the general public Health Service Act, and making use of community-based health groups to support small-practice medical houses.

Added aspects consist of factor to consider for tracking and upgrading patient care based on the requirements and choices of patients. In summary, objectives of the CMI include enhanced quality of care and decreased spending. Other specifics of the CMI program might be discovered on CMI’s internet site.

As I am reading the objectives of CMI, I can not assist however question the influence successful tests may have on future healthcare policies. In current months, we have seen the following significant updates to Accountable Care (ACO) policies. The following information was obtained from the CMS web site at



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