Providers
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Variation in skilled nursing facility practice patterns: Opportunities exist for more efficient management
There is significant variation in skilled nursing facility (SNF) average length of stay (ALOS) and readmission rates among Medicare fee-for-service (FFS) beneficiaries admitted to a SNF following an acute inpatient hospital stay.
Shadow bundles: A big opportunity for MSSP and REACH ACOs
New data provided to accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) and ACO Realizing Equity, Access, and Community Health (REACH) models can provide opportunities for managing hospital and specialist referrals, but the limitations of the data should be carefully considered.
Hospital financial results from the FY2022 CMS Medicare cost reports
Hospital margins, occupancy, and Medicaid reimbursement
CMS Making Care Primary Model: Should I participate?
Program summary, opportunities, risks, and key considerations
MSSP minimum savings/(loss) rates: A double-edged sword
For ACOs participating in MSSP, the minimum savings/(loss) rate (MSR/[MLR]) can offer protection against losses.
Interactions between the CIF and the +/- 3% risk score floor and ceiling in ACO REACH
The Coding Intensity Factor (CIF) is intended to establish revenue neutrality in the Realizing Equity, Access, and Community Health (REACH) program and causes all accountable care organizations (ACOs) to pay for increases in program-wide risk scores.
Recent changes to ACO REACH financial benchmark methodology to account for PY 2024 fee schedule changes
As the CMS Innovation Center revises how the ACO REACH Rate Book handles performance-year fee schedules, we provide average impact estimates at a state level and background information regarding the change.
Summary of The U.S. Playbook to Address Social Determinants of Health
While data science techniques offer immense potential for risk managers, (re)insurers need a multidisciplinary approach to tackle challenges and ensure successful implementation.
Commercial reimbursement benchmarking
Commercial payment rates for medical services as percentage of Medicare fee-for-service rates
Price transparency and provider network identification
Improving provider network identification could yield improved interpretation of price transparency data and processing burden.
Medicare Shared Savings Program: ACO financial results for 2021
Over the last decade, ACOs have emerged as a major force in the way healthcare is delivered in this country.
ACO REACH: Leveraging data to reach the underserved and address disparities
Now that CMS requires REACH ACOs to measure and address health equity, providers face a steep learning curve with data analysis.
Provider strategy: Control vs. contracting
Providers are uniquely situated to both direct and/or provide care for those in the healthcare delivery system through establishing their own health plans or contracting with existing payers.
Price transparency: New requirements and considerations for hospitals
This paper provides a summary of the key provisions of the price transparency final rule that apply to hospitals.
MedInsight: Trust your data
We know that your decisions are only as good as your data. And your data is only as good as your platform. You can trust the MedInsight platform to get it right.