Risk Adjustment in the Medicare ACO Shared Savings Program
|
|
- Cameron Richard
- 8 years ago
- Views:
Transcription
1 Risk Adjustment in the Medicare ACO Shared Savings Program Presented by: John Kautter Presented at: AcademyHealth Conference Baltimore, MD June 23-25, 2013 RTI International is a trade name of Research Triangle Institute.
2 Introduction Role of risk adjustment in the ACO Shared Savings Program CMS-HCC risk scores Risk Adjustment in Historical Benchmark Period Risk Adjustment in Performance Years 2
3 Risk Adjustment: Overview Risk adjustment is a method for adjusting expenditures to account for differences in expected health costs of individuals Adjustment can take into account demographic information (age, sex, eligibility) and health status (diagnoses) Why adjust? To account for changes in severity and case mix over time and to more accurately set ACO performance targets. Recognize ACOs that care for complex patients, and not create incentives for ACOs to avoid these populations. 3
4 CMS-HCC Risk Scores CMS-HCC (Hierarchical Condition Categories) risk scores The CMS-HCC model uses beneficiary demographic characteristics and prior year diagnoses to predict relative Part A and Part B Medicare fee-for-service program payments The CMS-HCC model does not incorporate Medicare Part D costs The CMS-HCC model is prospective, meaning it uses prior year information to predict costs Same risk adjustment model used for Medicare Advantage Separate CMS-HCC models for Aged-disabled community and institutional ESRD New Medicare enrollees (demographic score) 4
5 Demographic Factors Used in CMS-HCC Risk Scores 24 age-sex cells E.g., male age Medicaid dual eligible status By sex and aged vs. disabled entitlement Disabled status Current disabled: Separate age/sex and Medicaid factors Selected diagnoses have different risk weights Currently aged, originally entitled to Medicare by disability Separate factor by sex 5
6 Diagnoses Used in CMS-HCC Risk Scores The diagnoses used to calculate risk scores for fee-for-service (FFS) beneficiaries are from FFS claims Use International Classification of Disease, Version 9, Clinical Modification diagnosis codes (ICD9-CM) Diagnoses from the following settings/providers are used Hospital inpatient Hospital outpatient Physician Clinically-trained non-physician (e.g., clinical psychologist) The CMS-HCC model counts only the most severe manifestation among related conditions 6
7 Hypothetical Illustrative Example of Beneficiary s Individual Risk Score Calculation Beneficiary is male, age 77, with the chronic conditions: congestive heart failure, diabetes with complications, and chronic obstructive pulmonary disease Risk adjustment model coefficients Male age 77 = $5,100 CHF = $3,900 Diabetes w/ comp = $3,300 COPD = $3,700 Beneficiary s predicted expenditures are $16,000 Average expenditures for all beneficiaries are $10,000 Beneficiary s risk score = $16,000 / $10,000 = 1.6 7
8 Risk Adjustment in Historical Benchmark Period The CMS-HCC prospective risk adjustment models will be used to calculate the ACO s assigned beneficiary population s risk scores for the benchmark years, which are used in calculating the historical benchmark. Changes in the ACO s risk score between benchmark years 1 and 3 will be used to trend forward benchmark year 1 expenditures. Similarly, changes in the ACO s risk score between benchmark years 2 and 3 will be used to trend forward benchmark year 2 expenditures. 8
9 Risk Adjustment in Historical Benchmark Period (cont d) BY1 expenditures will be adjusted by the BY1 to BY3 risk ratio (BY3 risk score BY1 risk score). Similarly, BY2 expenditures will be adjusted by the BY2 to BY3 risk ratio (BY3 risk score BY2 risk score). BY1 BY2 BY3 [C] Assigned Beneficiary HCC Risk Scores ESRD Disabled Aged/dual Aged/non dual [D] Risk Ratios to BY3 ESRD Disabled Aged/dual Aged/non dual Risk ratios used to trend historical benchmark expenditures to benchmark year three risk 9
10 Risk Adjustment in Performance Years The benchmark will be annually adjusted for changes in health status and demographic factors during the performance year. Newly assigned beneficiaries vs. continuously assigned beneficiaries 1) Newly assigned beneficiaries in a given year = Beneficiaries assigned to the ACO in that year but not assigned to the ACO in the prior year and not receiving primary care services from the ACO in the prior year. 2) Continuously assigned beneficiaries in a given year = Beneficiaries assigned to the ACO in that year and assigned to the ACO in the prior year or receiving primary care services from the ACO in the prior year. 10
11 How to Determine Final Risk Scores to Use in Adjusting Benchmark For newly assigned beneficiaries, an ACO's CMS-HCC prospective risk scores will be annually updated in each performance year to adjust the historical benchmark for changes in severity and case mix relative to the newly assigned population from the historical benchmark period (BY3). For continuously assigned beneficiaries, patient demographic factors will be used to adjust the benchmark to account for changes between the benchmark period and the performance year, unless the continuously assigned population shows a decline in its CMS- HCC risk scores, in which case health status changes for this population will be adjusted by their CMS-HCC risk scores. 11
12 Example 1 CMS-HCC Risk Score Used for Continuously Assigned Beneficiaries Determine Final Risk Ratio [R5] Step 1 Calculate Risk Ratios Demographic Ratio: HCC Ratio: Weights ESRD % Disabled % Aged/dual % Aged/non dual % Average (dollar weighted) Dollar weighted average risk ratios Historical Benchmark $ x Continously Assigned Person Years [R6] Step 2 Final Adjusted Risk Scores HCC Score: Risk Score to use: Avg Adjusted Score: ESRD Disabled Aged/dual Aged/non dual Because dollar weighted average HCC risk ratio is less than one, use HCC risk [R7] Step 3 Final Risk Ratios Risk Ratio: ESRD ratio for continuously assigned Disabled Aged/dual Aged/non dual Weighted average of PY1 HCC score for newly assigned plus appropriate risk score for continously assigned PY1 average adjusted score / BY3 average HCC score These risk ratios are multiplied by the historical benchmark dollars and added to the National growth increment to produce the ACO s updated benchmark expenditures 12
13 Example 2 Demographic Factors Used for Continuously Assigned Beneficiaries Determine Adjusted Benchmark Continously Assigned [R5] Step 1 Compare Risk Ratios Demographic Ratio: HCC Ratio: Weights ESRD % Disabled % Aged/dual Dollar weighted % Aged/non dual average risk ratios % Average (dollar weighted) Historical Benchmark $ x Continously Assigned Person Years Newly Assigned [R6] Step 2 Final Adjusted Risk Scores PY1 HCC Score: Risk Score to use: Avg Adjusted Score: ESRD Disabled Aged/dual Aged/non dual Because dollar weighted average [R7] Step 3 Benchmark Adjustment Risk Ratio: HCC risk ratio is greater than one, ESRD use demographic ratio for Disabled continuously assigned Aged/dual Aged/non dual Weighted average of PY1 HCC score for newly assigned appropriate risk score for continously assigned PY1 average adjusted score / BY3 average HCC score These risk ratios are multiplied by the historical benchmark dollars and added to the National growth increment to produce the ACO s updated benchmark expenditures 13
14 Incorporated Risk Scores in Adjusted Benchmark Risk ratios are multiplied by the historical benchmark dollars and added to the National growth increment to produce the ACO s updated benchmark expenditures 14
15 Wrap-up Risk Adjustment for the Medicare Shared Saving Program Risk adjustment helps to more accurately establish an ACO s performance target, that is used to measure the ACO s financial performance. Risk adjustment methodology reflects changes in health status of an ACO s assigned beneficiary population over time, both in establishing the historical benchmark and during the performance year. Risk adjustment is performed at the population level, taking into account enrollment status, HCC and demographic factors. 15
Risk Adjustment Models for Medicare Part D Capitation Payments Modeling
Risk Adjustment Models for Medicare Part D Capitation Payments Modeling John Kautter Melvin J. Ingber Gregory C. Pope Sara Freeman RTI International AcademyHealth 2011 RTI International is a trade name
More informationUsing encounter data for risk adjustment in Medicare Advantage. Andy Johnson and Dan Zabinski April 7, 2016
Using encounter data for risk adjustment in Medicare Advantage Andy Johnson and Dan Zabinski April 7, 2016 Presentation outline Medicare Advantage (MA) risk adjustment overview & current use of FFS cost
More informationImproving risk adjustment in the Medicare program
C h a p t e r2 Improving risk adjustment in the Medicare program C H A P T E R 2 Improving risk adjustment in the Medicare program Chapter summary In this chapter Health plans that participate in the
More informationAnalysis of Care Coordination Outcomes /
Analysis of Care Coordination Outcomes / A Comparison of the Mercy Care Plan Population to Nationwide Dual-Eligible Medicare Beneficiaries July 2012 Prepared by: Varnee Murugan Ed Drozd Kevin Dietz Aetna
More informationMeasure Information Form (MIF) #275, adapted for quality measurement in Medicare Accountable Care Organizations
ACO #9 Prevention Quality Indicator (PQI): Ambulatory Sensitive Conditions Admissions for Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Data Source Measure Information Form (MIF)
More informationMedicare Savings and Reductions in Rehospitalizations Associated with Home Health Use
Medicare Savings and Reductions in Rehospitalizations Associated with Home Health Use June 23, 2011 Avalere Health LLC Avalere Health LLC The intersection of business strategy and public policy Table of
More informationIssue Brief. CMS Finalizes Rules for Medicare Shared Savings Program (ACOs) KEY POINTS COMMENT
Issue Brief 4712 Country Club Drive Jefferson City, MO 65109 P.O. Box 60 Jefferson City, MO 65102 573/893-3700 www.mhanet.com FEDERAL ISSUE BRIEF June 5, 2015 KEY POINTS z More than 400 accountable care
More informationThe Value Quadrant of Healthcare Reform. 2008 Pharos Innovations, LLC. All Rights Reserved.
The Value Quadrant of Healthcare Reform ACOs in PPACA Provider Organizations or networked groups Accountable for quality, cost and overall care of defined population of Medicare FFS benes Key metrics to
More informationMethodology for Determining Shared Savings and Losses under the Medicare Shared Savings Program
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Methodology for Determining Shared Savings and Losses under the Medicare Shared Savings Program Overview The Centers for
More informationACO Type Initiatives
If you proposed an ACO initiative, please fill our this Comparison of Elements for Participation in Medicare Shared Savings Program (MSSP) to State SIM ACO Test Proposal From Funding Opportunity Announcement:
More informationRISK SELECTION IN THE MASSACHUSETTS STATE EMPLOYEE HEALTH INSURANCE PROGRAM. Running Title: Risk Selection in Health Insurance. Wei Yu, Ph.D.
RISK SELECTION IN THE MASSACHUSETTS STATE EMPLOYEE HEALTH INSURANCE PROGRAM Running Title: Risk Selection in Health Insurance Wei Yu, Ph.D. 1 Randall P. Ellis, Ph.D. 2 Arlene Ash, Ph.D. 3 1 Health Economics
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile Montana Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization... 6
More informationRisk Adjustment 101: Health-Based Payment Adjustment Methodology
Risk Adjustment 101: Health-Based Payment Adjustment Methodology Presented by: Kim Browning, CHC, PMP, CHRS Executive Vice President, Cognisight, LLC Tara Swenson Attorney, Mintz, Levin, Cohn, Ferris,
More informationMedicare Advantage coding intensity and health risk assessments. Andy Johnson October 8, 2015
Medicare Advantage coding intensity and health risk assessments Andy Johnson October 8, 2015 Presentation outline Health risk assessments (HRAs) Medicare Advantage (MA) risk adjustment Impact of HRAs on
More informationSelection of Medicaid Beneficiaries for Chronic Care Management Programs: Overview and Uses of Predictive Modeling
APRIL 2009 Issue Brief Selection of Medicaid Beneficiaries for Chronic Care Management Programs: Overview and Uses of Predictive Modeling Abstract Effective use of care management techniques may help Medicaid
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile North Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization... 6 Spending...
More informationEvaluation of the CMS-HCC Risk Adjustment Model
The Centers for Medicare & Medicaid Services' Office of Research, Development, and Information (ORDI) strives to make information available to all. Nevertheless, portions of our files including charts,
More informationHome Health Care Today: Higher Acuity Level of Patients Highly skilled Professionals Costeffective Uses of Technology Innovative Care Techniques
Comprehensive EHR Infrastructure Across the Health Care System The goal of the Administration and the Department of Health and Human Services to achieve an infrastructure for interoperable electronic health
More informationACOs may elect Track 2 without completing a prior agreement period under a one-sided model
Financial and Regulatory Parameters for MSSP Risk Tracks in ACO Learning Network Comments and the blue box indicates LN different from ; red text indicates change from and/or LN on Transition to Two-Sided
More informationAccountable Care Fundamentals for Medical Practice Executives
Accountable Care Fundamentals for Medical Practice Executives Nathan Anspach, FACMPE Senior Vice President and Chief Executive Officer John C. Lincoln Accountable Care Organization and John C. Lincoln
More informationHealth Spring Meeting June 2009. Session # 27 TS: Medicare Advantage: Revenue Payments + Part D Accounting
Health Spring Meeting June 2009 Session # 27 TS: Medicare Advantage: Revenue Payments + Part D Accounting Brian M. Collender, FSA, MAAA Judah Z. Rabinowitz, FSA, MAAA, FCA Moderator: Judah Z. Rabinowitz,
More informationRisk Adjustment: Implications for Community Health Centers
Risk Adjustment: Implications for Community Health Centers Todd Gilmer, PhD Division of Health Policy Department of Family and Preventive Medicine University of California, San Diego Overview Program and
More informationGreg Peterson, MPA, PhD candidate Melissa McCarthy, PhD Presentation for 2013 AcademyHealth Annual Research Meeting
Greg Peterson, MPA, PhD candidate Melissa McCarthy, PhD Presentation for 2013 AcademyHealth Annual Research Meeting Medicare Coordinated Care Demonstration (MCCD) Established in Balanced Budget Act of
More informationMedicare Managed Care Manual Chapter 7 Risk Adjustment
Medicare Managed Care Manual Chapter 7 Risk Adjustment Transmittals for Chapter 7 Table of Contents (Rev. 118, 09-19-14) 10 Introduction 20 Purpose of Risk Adjustment 30 Statutory and Regulatory Authority
More informationMedicare Design Part A: Inpatient care, hospice, and some home health care Part B: Physician services + outpatient care Part C ( Medicare Advantage
Medicare Design Part A: Inpatient care, hospice, and some home health care Part B: Physician services + outpatient care Part C ( Medicare Advantage ): Private plan alternative to Parts A and B Part D:
More information2014: Volume 4, Number 3. A publication of the Centers for Medicare & Medicaid Services, Office of Information Products & Data Analytics
2014: Volume 4, Number 3 A publication of the Centers for Medicare & Medicaid Services, Office of Information Products & Data Analytics The HHS-HCC Risk Adjustment Model for Individual and Small Group
More informationCMS National Dry Run: All-Cause Unplanned Readmission Measure for 30 Days Post Discharge from Inpatient Rehabilitation Facilities
CMS National Dry Run: All-Cause Unplanned Readmission Measure for 30 Days Post Discharge from Inpatient Rehabilitation Facilities Special Open Door Forum October 20, 2015 2-3 PM ET RTI International is
More informationThe Medicare Shared Savings Program and the Pioneer Accountable Care Organizations
The Medicare Shared Savings Program and the Accountable Care Organizations Promoting and evaluating accountable care organizations Victoria Boyarsky, FSA, MAAA Rob Parke, FIA, ASA, MAAA Peer reviewed by
More informationMedicare Risk-Adjustment & Correct Coding 101. Rev. 10_31_14. Provider Training
Medicare Risk-Adjustment & Correct Coding 101 Rev. 10_31_14 Provider Training Objectives Medicare Advantage - Overview Risk Adjustment 101 Coding and Medical Record Documentation Requirements Medicare
More informationHOW TO UNDERSTAND YOUR QUALITY AND RESOURCE USE REPORT
HOW TO UNDERSTAND YOUR QUALITY AND RESOURCE USE REPORT CONTENTS A BACKGROUND AND PURPOSE OF THE MID-YEAR QUALITY AND RESOURCE USE REPORTS... 1 B EXHIBITS INCLUDED IN THE MID-YEAR QUALITY AND RESOURCE USE
More informationMA plans available to almost all Medicare beneficiaries
9 Chart 9-1. MA plans available to almost all Medicare beneficiaries CCPs HMO Any Average plan or local Regional Any MA offerings per PPO PPO CCP PFFS plan county 2009 88% 91% 99% 100% 100% 34 2010 91
More informationChart 11-1. Number of dialysis facilities is growing, and share of for-profit and freestanding dialysis providers is increasing
11 0 Chart 11-1. Number of dialysis facilities is growing, and share of for-profit and freestanding dialysis providers is increasing Average annual percent change 2014 2009 2014 2013 2014 Total number
More informationRisk Adjustment ABC s
Medicare Advantage Risk Adjustment and Coding Academy Coding Risk Adjustment Documentation Training Risk Adjustment ABC s What is Risk Adjustment? Risk adjustment is the process by which the Medicare &
More informationCMS Innovation Center Improving Care for Complex Patients
CMS Innovation Center Improving Care for Complex Patients ECRI Institute Dr. Patrick Conway, M.D., MSc CMS Chief Medical Officer and Deputy Administrator for Innovation and Quality Director, Center for
More informationBellin-ThedaCare Healthcare Partners a Pioneer Accountable Care Organization. George Kerwin President/CEO Bellin Health
Bellin-ThedaCare Healthcare Partners a Pioneer Accountable Care Organization George Kerwin President/CEO Bellin Health Objectives Describe the characteristics of Bellin-ThedaCare Healthcare Partners and
More informationMedicare Final Accountable Care Organization (ACO) Regulations Effective January 1, 2012 Median Savings of $470 Million over 4 Years
October 20, 2011 CIT Healthcare, John M. Cousins, SVP Healthcare Intelligence john.cousins@cit.com Tel: 850-668-2907 Cell: 716-867-9965 Medicare Final Accountable Care Organization (ACO) Regulations Effective
More informationFact sheets: Accountable Care Organization (ACO) Investment Model Fact Sheet. Accountable Care Organization (ACO) Investment Model Fact Sheet
Fact sheets: Accountable Care Organization (ACO) Investment Model Fact Sheet Date 2014-10-15 Title Accountable Care Organization (ACO) Investment Model Fact Sheet For Immediate Release Wednesday, October
More informationHDE FREE WEBINAR SERIES: BIDDING, RISK ADJUSTMENT, AND STARS. May 3, 2012
HDE FREE WEBINAR SERIES: BIDDING, RISK ADJUSTMENT, AND STARS May 3, 2012 AGENDA Impact of Star Ratings on 2013 Part C bid Looking ahead: 2014 & beyond How risk scores & QBPs work hand-in-hand to maximize
More informationRisk Adjustment of Medicare Capitation Payments Using the CMS-HCC Model
Risk Adjustment of Medicare Capitation Payments Using the CMS-HCC Model Gregory C. Pope, M.S., John Kautter, Ph.D., Randall P. Ellis, Ph.D., Arlene S. Ash, Ph.D., John Z. Ayanian, M.D., M.P.P., Lisa I.
More informationAccountable Care Organization Final Rule Briefing. November 7, 2011
Accountable Care Organization Final Rule Briefing November 7, 2011 Health Care Reform: Health Care Delivery Reforms GOALS: Controlling Cost Growth Improving Quality/Outcomes Changing Incentives Coordinating
More informationPrescription drugs are a critical component of health care. Because of the role of drugs in treating conditions, it is important that Medicare ensures that its beneficiaries have access to appropriate
More informationGeneva Association 10th Health and Aging Conference Insuring the Health of an Aging Population
Geneva Association 10th Health and Aging Conference Insuring the Health of an Aging Population November 18, 2013 Diana Dennett EVP, Global Issues and Counsel America s Health Insurance Plans (AHIP) America
More informationNational Medicare Readmission. Centers for Medicare and Medicare Services
National Medicare Readmission Findings: Recent Data and Trends Office of Information Products and Data Analytics Office of Information Products and Data Analytics Centers for Medicare and Medicare Services
More informationSession 5 PD, Keys to Succeeding in the Medicare Advantage Market. Moderator/Presenter: Corey N. Berger, FSA, MAAA
Session 5 PD, Keys to Succeeding in the Medicare Advantage Market Moderator/Presenter: Corey N. Berger, FSA, MAAA Presenters: Dylan Ascolese, FSA, MAAA JoAnn Bogolin, ASA, FCA, MAAA Stephen Lawrence Webb,
More informationBrief Research Report: Fountain House and Use of Healthcare Resources
! Brief Research Report: Fountain House and Use of Healthcare Resources Zachary Grinspan, MD MS Department of Healthcare Policy and Research Weill Cornell Medical College, New York, NY June 1, 2015 Fountain
More informationNOTE TO: Medicare Advantage Organizations, Prescription Drug Plan Sponsors, and Other Interested Parties
April 6, 2015 NOTE TO: Medicare Advantage Organizations, Prescription Drug Plan Sponsors, and Other Interested Parties SUBJECT: Announcement of Calendar Year (CY) 2016 Medicare Advantage Capitation Rates
More informationMedicare Physician Group Practice Demonstration
Medicare Physician Group Practice Demonstration Heather Grimsley Medicare Demonstrations Program Group Center for Medicare and Medicaid Innovation Centers for Medicare & Medicaid Services April 2011 PGP
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile Kentucky Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization...
More informationHealth Law Bulletin. provided by: ACOs AND SHARED SAVINGS IN A NUTSHELL Applications to Participate Available Now
Health Law Bulletin provided by: ACOs AND SHARED SAVINGS IN A NUTSHELL Applications to Participate Available Now Earlier this month, the Center for Medicare and Medicaid Services (CMS) published the final
More informationUsing Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare
December 2010 Using Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare CONTENTS Background... 2 Problems with the Shared Savings Model... 2 How
More informationMedicare Shared Savings Program
Medicare Shared Savings Program Eastern Michigan Chapter of HFMA Insurance and Reimbursement Committee April 30, 2015 Presenter: Kenneth B. Lipan, FHFMA Director of Finance: Clinical Integration, Unified
More informationMedicare Shared Savings Program Quality Measure Benchmarks for the 2015 Reporting Year
Medicare Shared Savings Program Quality Measure Benchmarks for the 2015 Reporting Year Release Notes/Summary of Changes (February 2015): Issued correction of 2015 benchmarks for ACO-9 and ACO-10 quality
More informationAccountable Care Organizations (ACO) Proposed Rule Summary March 31, 2011
Accountable Care Organizations (ACO) Proposed Rule Summary March 31, 2011 On March 31, 2011, the Centers for Medicare & Medicaid Services (CMS) released the longawaited proposed rule on Accountable Care
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization... 6 Spending...
More informationJohns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases
Johns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases Epidemiology Over 145 million people ( nearly half the population) - suffer from asthma, depression and other chronic
More informationMedicare Advantage Risk Adjustment Data Validation CMS-HCC Pilot Study. Report to Medicare Advantage Organizations
Medicare Advantage Risk Adjustment Data Validation CMS-HCC Pilot Study Report to Medicare Advantage Organizations JULY 27, 2004 JULY 27, 2004 PAGE 1 Medicare Advantage Risk Adjustment Data Validation CMS-HCC
More informationPhysical and Mental Health Condition Prevalence and Comorbidity among Fee-for-Service Medicare- Medicaid Enrollees
Physical and Mental Health Condition Prevalence and Comorbidity among Fee-for-Service Medicare- Medicaid Enrollees Centers for Medicare & Medicaid Services September, 2014 i Executive Summary Introduction
More informationTexas Association of Community Health Centers www.tachc.org NOVEMBER 15, 2013 9:00 AM WEBINAR
Texas Association of Community Health Centers www.tachc.org NOVEMBER 15, 2013 9:00 AM WEBINAR Coding to Ensure Accurate Health Risk Scoring JAMES L. HOLLY, MD CHIEF EXECUTIVE OFFICER SOUTHEAST TEXAS MEDICAL
More informationMedicare-Medicaid Coordination Office
Increasing Access to Seamless, Quality and Person Centered Care Programs for Dual Eligibles Edo Banach Senior Advisor Medicare Medicaid Coordination Office Centers for Medicare & Medicaid Services March
More informationDEPARTMENT OF HEALTH AND HUMAN SERVICES. Medicare Program; Request for Applications for the Medicare Care Choices Model
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-5512-N] Medicare Program; Request for Applications for the Medicare Care Choices Model AGENCY: Centers for Medicare
More informationPresented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION
Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION At the end of this session, you will be able to: Identify ways RT skills can be utilized for
More informationWhat Would Strengthen Medicaid LTSS?
What Would Strengthen Medicaid LTSS? Melanie Bella Director Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services August 1, 2013 Medicare-Medicaid Coordination Office Section 2602
More informationMedicare accountable care organization (ACO) update
Medicare accountable care organization (ACO) update April 4, 2013 David Glass and Jeff Stensland Today s presentation Background Description of ACO models in Medicare Strengths and weaknesses of ACOs vs.
More informationACOs: Impacting the Past, Present and Future State of Healthcare
ACOs: Impacting the Past, Present and Future State of Healthcare Article By Alan Cudney, RN, CPHQ, PMP, FACHE, Executive Consultant October 2012 What are Accountable Care Organizations? Can they help us
More informationPL 111-148 and Amendments: Impact on Post-Acute Care for Health Care Systems
PL 111-148 and Amendments: Impact on Post-Acute Care for Health Care Systems By Kathleen M. Griffin, PhD. There are three key provisions of the law that will have direct impact on post-acute care needs
More informationDual Eligibles and State Innovations in Care Management
Dual Eligibles and State Innovations in Care Management Ann Kohler, Director of Health Services National Association of State Medicaid Directors American Public Human Services Association Ann.Kohler@aphsa.org
More informationINTRODUCTION. 7 DISCUSSION AND ONGOING RESEARCH.. 29 ACKNOWLEDGEMENTS... 30 ENDNOTES.. 31
May 2010 Working Paper: Using State Hospital Discharge Data to Compare Readmission Rates in Medicare Advantage and Medicare s Traditional Fee-for-Service Program TABLE OF CONTENTS SUMMARY 1 INTRODUCTION.
More informationGold Coast Health IT Resource Center. Accountable Care Organization (ACO)
Gold Coast Health IT Resource Center Accountable Care Organization (ACO) August 27, 2013 Copyright 2013 Gold Coast HIT 1 Agenda Upcoming Webinars ACO s Copyright 2013 Gold Coast HIT 2 Upcoming Webinars
More informationRisk Adjustment/HCC Coding and Documentation
Manual: Policy Title: Reimbursement Policy Risk Adjustment/HCC Coding and Documentation Section: Administrative Subsection: None Date of Origin: 1/2/2013 Policy Number: RPM050 Last Updated: 6/8/2016 Last
More informationQuick Turnaround with Administrative Health Data
Quick Turnaround with Administrative Health Data Katherine Giuriceo, PhD Research and Rapid Cycle Evaluation Group Center for Medicare and Medicaid Innovation, CMS October 2, 2015 1 Overview Center for
More informationThe Medicare Shared Savings Program
The Medicare Shared Savings Program Centers for Medicare & Medicaid Services Jonathan Blum, Deputy Administrator & Director, Center for Medicare May 20, 2011 Overview CMS s vision of its ACO program Summary
More informationAccountable Care Organizations: What Providers Need to Know
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Accountable Care Organizations: FACT SHEET Overview http://www.cms.gov/sharedsavingsprogram On October 20, 2011, the Centers
More informationMedicare Advantage payment areas and risk adjustment
C H A P T E R2 Medicare Advantage payment areas and risk adjustment R E C O M M E N D A T I O N S 2A The Congress should establish payment areas for Medicare Advantage local plans that have the following
More informationA predictive analytics platform powered by non-medical staff reduces cost of care among high-utilizing Medicare fee-for-service beneficiaries
A predictive analytics platform powered by non-medical staff reduces cost of care among high-utilizing Medicare fee-for-service beneficiaries Munevar D 1, Drozd E 1, & Ostrovsky A 2 1 Avalere Health, Inc.
More informationKaiser Permanente Guide to Medicare Basics
Kaiser Permanente Guide to Medicare Basics The National Medicare program, which was created in 1965, has given people peace of mind and the security of knowing they ll have access to health coverage. Medicare
More information2015 Medicare Advantage rates: Perspectives for payors
2015 Medicare Advantage rates: Perspectives for payors On April 7, the Centers for Medicare and Medicaid Services (CMS) released the final 2015 Rate Announcement and Call Letter for Medicare Advantage
More informationThe Critical Importance of Targeting (or It s the targeting, stupid. )
The Critical Importance of Targeting (or It s the targeting, stupid. ) Randall Brown NHPF Targeting High-Cost Medicare Beneficiaries to Improve Care and Reduce Spending: Finding the Bull's-Eye March 9,
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile The National Summary Centers for Medicare & Medicaid Services Introduction... 1 Data Source and General Notes... 2 Types and Ages of Medicare-Medicaid Enrollees...
More informationMedicare Shared Savings ( ACO ) Proposed Rule: Attribution and Payment Provisions. AAMC Teleconference May12, 2011
Medicare Shared Savings ( ACO ) Proposed Rule: Attribution and Payment Provisions AAMC Teleconference May12, 2011 Main Topics Top Issues IME/DGME/DSH & Benchmarks/Performance Year Expenditures Attribution
More informationMedicare Shared Savings Program Quality Measure Benchmarks for the 2014 Reporting Year
Medicare Shared Savings Program Quality Measure Benchmarks for the 2014 Reporting Year Release Notes/Summary of Changes (February 2015): Issued correction of 2014 benchmarks for ACO-9 and ACO-10 quality
More informationMedicare Risk Adjustment Models: DxCG vs. CMS-HCC. Corresponding author: Jing Chen, Ph.D, MBA, Verisk Health, Inc.
Medicare Risk Adjustment Models: DxCG vs. CMS-HCC Jing Chen *, Randall P. Ellis *, Katherine H. Toro * and Arlene S. Ash * * Verisk Health, Inc., Waltham, MA. Department of Economics, Boston University,
More informationJanuary 3, 2012. RE: Comments submitted at http://www.regulations.gov.
January 3, 2012 RE: Comments submitted at http://www.regulations.gov. Marilyn Tavenner, Acting Administrator U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services Attention:
More informationSpecial Needs Plan Model of Care 101
Special Needs Plan Model of Care 101 What is a Special Needs Plan? First of all it s a Medicare MA-PD, typically an HMO Consists of Medicare enrollees who meet special eligibility requirements In our case
More informationNavigating CMS Incentive Programs for Eligible Professionals Why It Matters and What You Need to Know. Dr. Paul Mulhausen, CMO
Navigating CMS Incentive Programs for Eligible Professionals Why It Matters and What You Need to Know Dr. Paul Mulhausen, CMO Objectives Better understand CMS Incentive Programs and payment adjustments
More informationCMS Proposals for Quality Reporting Programs under the 2015 Medicare Physician Fee Schedule Proposed Rule. July 24, 2014
CMS Proposals for Quality Reporting Programs under the 2015 Medicare Physician Fee Schedule Proposed Rule July 24, 2014 Medicare Learning Network This MLN Connects National Provider Call (MLN Connects
More informationPrivate Fee-For-Service -----Provider Questions and Answers
Private Fee-For-Service -----Provider Questions and Answers 1. What qualifications must a health care provider have in order to be eligible to furnish services to Medicare beneficiaries who are enrolled
More informationThe Organization and Performance of Accountable Care Organizations: Early Evidence Thomas D Aunno, Ph.D. Columbia University
The Organization and Performance of Accountable Care Organizations: Early Evidence Thomas D Aunno, Ph.D. Columbia University Innovation in Health Care Delivery Systems McCombs Healthcare Initiative University
More informationHCCs and Star-Ratings: An IPA s Successful Approach to Revenue Integrity. Nancy Hirschl, CCS Victoria McKemy, MHA James Taylor, MD, CPC
HCCs and Star-Ratings: An IPA s Successful Approach to Revenue Integrity Nancy Hirschl, CCS Victoria McKemy, MHA James Taylor, MD, CPC 1 Introduction Agenda HCCs (Hierarchical Condition Categories) Diagnosis
More informationDETAILED SUMMARY--MEDCIARE SHARED SAVINGS/ACCOUNTABLE CARE ORGANIZATION (ACO) PROGRAM
1 DETAILED SUMMARY--MEDCIARE SHARED SAVINGS/ACCOUNTABLE CARE ORGANIZATION (ACO) PROGRAM Definition of ACO General Concept An ACO refers to a group of physician and other healthcare providers and suppliers
More informationMEDICARE. Results from the First Two Years of the Pioneer Accountable Care Organization Model
United States Government Accountability Office Report to the Ranking Member, Committee on Ways and Means, House of Representatives April 2015 MEDICARE Results from the First Two Years of the Pioneer Accountable
More informationProposed changes to 2014 Medicare Advantage payment methodology and the effect on Medicare Advantage organizations and beneficiaries
Proposed changes to 2014 Medicare Advantage payment methodology and the effect on Medicare Advantage organizations and beneficiaries February 26, 2013 GLENN GIESE FSA, MAAA CHRIS CARLSON FSA, MAAA CONSIDERATIONS
More informationGAO MEDICARE ADVANTAGE. Relationship between Benefit Package Designs and Plans Average Beneficiary Health Status. Report to Congressional Requesters
GAO United States Government Accountability Office Report to Congressional Requesters April 2010 MEDICARE ADVANTAGE Relationship between Benefit Package Designs and Plans Average Beneficiary Health Status
More informationDRAFT. Background About Shared Savings Program Design Features: Patient Attribution, Cost Target Calculation, and Payment Calculation and Distribution
Background About Shared Savings Program Design Features: Patient Attribution, Cost Target Calculation, and Payment Calculation and Distribution Excerpted from Draft Narratives Developed in the CT SIM Equity
More informationMedicare Advantage special needs plans
C h a p t e r14 Medicare Advantage special needs plans R E C O M M E N D A T I O N S 14-1 The Congress should permanently reauthorize institutional special needs plans. COMMISSIONER VOTES: YES 16 NO 0
More informationcaresy caresync Chronic Care Management
caresy Chronic Care Management THE PROBLEM Chronic diseases and conditions, including heart disease, diabetes, COPD and obesity, are among the most common, expensive, and preventable health problems in
More informationAnatomy of an ACO. Through the Eyes of a Physician-owned IPA. Genesis Accountable Care Organization
Anatomy of an ACO Through the Eyes of a Physician-owned IPA Genesis: IPA by the Numbers 1,400 Physicians PCPs 500 900 SCPs 700 Practices 400 Square miles in North Texas Genesis: Challenges for Change Pressure
More informationImpact of VA Home Based Primary Care: Access, Quality and Cost National Health Policy Forum
Impact of VA Home Based Primary Care: Access, Quality and Cost National Health Policy Forum Thomas Edes, MD, MS Director, Geriatrics and Extended Care Office of Clinical Operations U.S. Department of Veterans
More informationEARLY INDICATIONS OF CHANGES TO 2014 MAO PAYMENT METHODOLOGY
Early indications of changes to the 2015 medicare advantage payment methodology and the potential effect on medicare advantage organizations and beneficiaries February 6, 2014 GLENN GIESE FSA, MAAA KELLY
More informationNew York Presbyterian Innovations in Health Care Reform at Academic Medical Centers
New York Presbyterian Innovations in Health Care Reform at Academic Medical Centers October 28, 2011 Timothy G Ferris, MD, MPH Mass General Physicians Organization, Medical Director Associate Professor,
More informationSite-neutral payments for select conditions treated in inpatient rehabilitation facilities and skilled nursing facilities
C h a p t e r6 Site-neutral payments for select conditions treated in inpatient rehabilitation facilities and skilled nursing facilities C H A P T E R 6 Site-neutral payments for select conditions treated
More information