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Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success
Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success
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A laser focus on population health interventions and processes can generate immediate revenue streams for fledgling accountable care organizations that support the hard work of creating a sustainable ACO business model.

This population health priority has proven a lucrative strategy for Caravan Health, whose 23 ACO clients saved more than $26 million across approximately 250,000 covered lives in 2016 under the Medicare Shared Savings Program (MSSP).

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success examines Caravan Health's population health-focused approach for ACOs and its potential for positioning ACOs for success under MSSP and MACRA's Merit-based Incentive Payment System (MIPS).

In this 25-page resource, Tim Gronniger, senior vice president of development and strategy, Caravan Health, shares lessons his organization has learned from helping clients manage more than a million patient lives under Medicare. Gronniger outlines the core population health revenue opportunities available to ACOs while they wait up to several years for the value-based model's anticipated shared savings to accrue.

Caravan Health has found that population health revenue not only offsets the cost of ACO infrastructure and clinical transformation but can also dramatically boost key quality and clinical metrics.

Averaging net savings of nearly $1.1 million per MSSP ACO, Caravan Health's ACO clients also achieved higher than average quality scores and quality reporting scores in 2016, according to recently released data from the Centers for Medicare and Medicaid Services (CMS).

Gronniger covers the following concepts in this special report:

  • Overview of Caravan Health ACO activity and achievements;
  • Primer on MACRA and Quality Payment Program, including MIPS uncertainties that favor a population health focus;
  • Rationale for and financial advantages of ACO population health activity;
  • Common missteps of newly formed ACOs;
  • Positioning population health in an ACO revenue strategy;
  • Projection of revenue potential from recently created Medicare billing codes, including Chronic Care Management;
  • Impact of trained population health staff on Medicare wellness and prevention screening levels;
  • Advantages of ACO dashboards, roadmaps and scorecards in overall accountable care planning;
  • Non-financial benefits of ACO participation, include impact on physician and practice rankings;
  • Guidelines for ACO team planning, training and engagement;
  • Reaction to recent Medicare Payment Advisory Commission (MedPAC) recommendation to eliminate MIPS;
and much more.

Table of Contents

  • Generating Population Health Revenue: ACO Best Practices for Medicare Shared Savings and MIPS Success
    • MACRA Round-Up
    • 6 Benefits of ACO Participation
    • 4 Mistakes Hospitals Make in ACOs
    • Population Health Revenue Opportunities
    • Prevention Results from Trained Population Health Nurses
    • Identifying Population Health Priorities
    • ACO Planning Roadmap
    • Performance Scorecard
    • Case Study: Benefits of Hospital ACO Participation
    • Non-Financial Benefits of ACO Participation
    • ACO Participation and MIPS Scores
    • MedPAC and MIPS Future
    • Additional Benefits of ACO Participation
    • ACO Lessons from MIPS and MSSP Participation
  • Q&A: Ask the Expert
    • Rationale for Tapping Medicare Billing Codes
    • Engaging Medicare Beneficiaries in Annual Wellness Visits
    • Physician Pain Points Under MIPS
    • Sharing ACO Physician Practice Data
  • Glossary
  • For More Information
  • About the Contributor
Publication Date: March 2018
Number of Pages: 25
ISBN 10: 1-943542-84-8 (Print version); 1-943542-85-6 (PDF version)
ISBN 13: 978-1-943542-84-0 (Print version); 978-1-943542-85-7 (PDF version)
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