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.

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 margins, occupancy, and Medicaid reimbursement

Program summary, opportunities, risks, and key considerations

For ACOs participating in MSSP, the minimum savings/(loss) rate (MSR/[MLR]) can offer protection against losses.

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.

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.

While data science techniques offer immense potential for risk managers, (re)insurers need a multidisciplinary approach to tackle challenges and ensure successful implementation.

Commercial payment rates for medical services as percentage of Medicare fee-for-service rates

Improving provider network identification could yield improved interpretation of price transparency data and processing burden.

Over the last decade, ACOs have emerged as a major force in the way healthcare is delivered in this country.

Now that CMS requires REACH ACOs to measure and address health equity, providers face a steep learning curve with data analysis.

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.

This paper provides a summary of the key provisions of the price transparency final rule that apply to hospitals.

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