Risk Adjustments and the ABCs of HCCs

Today on the blog, we are discussing two central questions that directly determine how providers receive their operating revenue: What is risk adjustment? What is hierarchical condition category (HCC) coding? Risk adjustment alters the cost of healthcare coverage based on a patient’s health status. The payments are adjusted according to the patient’s age, disability, financial status, and diagnoses. Hierarchical condition category (HCC) codes leverage ICD-10 codes to document those health statuses. Each chronic condition is assigned a payment value on the care of a patient with that condition. When providers document HCC codes, it allows payers to calculate their risk-adjustment …

Questions to Ask GPRO Reporting Partners

Accountable Care Organizations (ACOs) know that when the calendar turns to January, it is time to prepare for quality measure reporting in the new year. For those still transitioning to the shared savings program, the Group Practice Reporting Option (GPRO) is a Centers for Medicare & Medicaid Services (CMS) reporting process to measure quality scores for the previous performance year to obtain eligibility for shared savings and other incentives. But for the performance year (PY) 2019, the process goes by a new name for reporting: the CMS Web Interface. The PY 2019 quality data submission period for ACOs started on …

Our 2020 Predictions at Lightbeam Health Solutions

We predict that 2020 will be a positive year for healthcare, especially in value-based care initiatives. To close out 2019, members of the Lightbeam Health Solutions team are sharing their predictions for innovations in the coming year!  “2020 is the year of the primary care physician. Organizations are realizing the need to restructure antiquated care models built on fee-for-service care to better engage and support doctors, which will dramatically improve the quality of life and patient outcomes.” – Josh Patten, Vice President of Advisory Services “I am hoping that in 2020, we continue to expand telehealth resources and technology so …

The Vitality of HIEs

Health information exchanges (HIEs) allow clinicians and patients to have secure access to electronic patient data across counties, states, and regions. In 2019, there are still many obstacles. Many are now on their second HIE vendor, and vendors are consolidating in the market with payers or other data warehouse offerings. The shift from fee-for-service to value-based care means that HIEs must quickly establish themselves as self-sustaining organizations with genuine business value. HIE vendors must also prove able to deliver efficient exchanges in a timely, cost-effective, and standards-based way. The Ideal HIE Adoption must be supported by an HIE vendor who …

Tried and True Areas of Focus for 2020

Throughout my 22 years in the healthcare technology space, including the last seven in value-based care, I have found that there are a few core strategies that can be deployed to better engage and manage high-risk or high-cost patient cohorts. Focusing care initiatives around these patient groups create impactful outcomes that are clinical and financial in nature. All successful population health endeavors begin with identifying groups of patients where there appear to be opportunities to intervene with care in a way that would close care gaps, reduce unnecessary utilization, help patients better manage a condition or benefit from a preventative …

Seasonal Depression Awareness Month

Seasonal Depression Awareness Month has begun, and in light of the colder, grayer weather, it is an important topic to discuss. According to Johns Hopkins, seasonal depression, or “seasonal affective disorder,” affects approximately 10-20% of the entire population this time of year. Lightbeam’s Clinical Transformation Advisor, Jessica Scruton, will join me again on the Population Health Podcast for our second care transformation-focused episode next week, but we wanted to begin the discussion today on the blog to ensure that everyone has the information they need to maintain strong mental health this winter. The Science Behind Seasonal Depression The Mayo Clinic attributes three main causes to the development of seasonal …

3 C’s to Jumpstart Value-Based Care Programs

Success when it comes to value-based care initiatives does not occur by chance. It takes commitment to engage patients to take advantage of preventative services, capture the attention of providers, and reduce costs. Implementing this kind of care requires cultural alignment, shared risk and rewards, the right infrastructure, and the right resources to deliver.  So, where do we start? Besides having an excellent team, our clients’ value-based care success often involves three “C” qualities throughout the implementation and deployment of their initiatives: communication, coordination, and common goals.  Communication  We have discussed the importance of being on the same page and maintaining …

OIG Series 7: Utilizing Technology to Share Patient Information

Today, we conclude the series on the study by the Office of Inspector General: “ACOs’ Strategies for Transitioning to Value-Based Care: Lessons From the Medicare Shared Savings Program.” Each installment covered a different strategy that 20 high-performing Accountable Care Organizations (ACOs) implemented to attain success. To bring things to a close, we are discussing how the use of technology to share patient information led to enhanced communication, cooperation, and savings.   Access to shared clinical and financial claims data provides a baseline for a patient’s cost and utilization numbers. Knowing where a patient stands in terms of their medical history and emergency service …

Diabetes Awareness Month

November is Diabetes Awareness Month. I had the pleasure of hosting Lightbeam’s Clinical Transformation Advisor, Jessica Scruton, on an episode of the Population Health Podcast discussing this chronic condition. Her experience as a nurse and witnessing diabetes mismanagement stirs a desire to educate patients on essential health topics whenever she can. Be sure to listen to the episode to hear more tips and firsthand experiences from Jessica on diabetes management. Types of Diabetes There are four different types of diabetes: type 1 (or juvenile diabetes), type 2 (or adult onset diabetes), gestational diabetes, and prediabetes. Each is slightly different, but …

OIG Series 6: Addressing Behavioral Needs and Social Determinants of Health

Value-based care practices are not afraid to stray from convention if it means patients have better access to care and avoid emergencies. The above and beyond mentality that accountable care organizations (ACOs) center on is finding the reason for noncompliance in their beneficiaries. Often, behavioral health and social determinants of health (SDoH) are to blame for an inability to attend regular appointments before a hospital admittance occurs. The sixth Office of Inspector General (OIG) study strategy is confronting the behavioral needs and social determinants that prevent patients from receiving proper courses of treatment. The 20 high-performing ACOs achieved significant positive outcomes by …