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The New Payment Model and Redesign: Improving Care Delivery

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In October 2015, a new era in health care for all providers across the nation began.The Centers for Medicare & Medicaid Services (CMS) changed the way it pays health care providers for services provided to people receiving Medicare and Medicaid.

Instead of only paying for the number of services an organization provides, CMS also pays providers incentives for delivering high-quality services, thus, rewarding providers for delivering services of higher quality and higher value.

This week, CMS announced 121 new participants in Medicare Accountable Care Organization (ACO) initiatives designed to improve the care patients receive. ACOs now represent 49 states and the District of Columbia.

With all of the new payment models and systems, there are now: 

  • A total of 477 ACOs across all models
  • 64 ACOs are in a risk-bearing track
  • Nearly 8.9 million beneficiaries served

In the new era of healthcare, post-acute care leaders must align their clinical and operational systems to meet the demands of reimbursement goals and healthcare reform.

Post-Acute Care: A Model Delivery System

How ready is your organization in this new era of payment and care delivery?  Start by asking your leadership team the following:

  1. What are our established formal partnerships with acute care organizations; physicians; other post-acute care organizations; commercial insurance carriers; conveners; BPCI program; ACOs; MSSP; PACE; episodic initiators and MCOs?
  2. How has our organization aligned our data per the 48 bundles; ALOS; discharge to community ratios; readmission rates per disease state and overall; customer satisfaction, and more?
  3. What measures have we taken to assess our organization’s readiness for increased demand on clinical competency; clinical capacity; financial risk models; operational flexibility and specialty program development?
  4. What is our targeted reimbursement and revenue cycle management strategy?

Now, more than ever, it is vital to have your team focused on care delivery and quality performance in the complex reimbursement environment.

Resources:

Innovation.CMS.gov

Value Based Purchasing; CMS.gov

 

Lisa-Thomson

 

Lisa Thomson

Chief Marketing and Strategy Officer

Pathway Health