OIG Series Blog 4: Managing Hospitalizations

We are continuing our review of the Office of Inspector General (OIG) study on the seven strategies that 20 high-performing accountable care organizations (ACOs) used to generate impactful results. Today we are discussing strategy four: managing hospitalizations. The largest portion of fee-for-service Medicare spending is hospitalizations, and proper management can lead to expedited treatment that reduces admissions before they occur and helps prevent readmissions later. In this post, we will cover the challenges and fundamental steps they used that offer the perfect blueprint for other ACOs to follow suit. The Challenge of Incentive Joanne M. Chiedi, the Acting Inspector General …

Part 2 of Our Breakdown of the CMS Primary Cares Initiatives: Direct Contracting

The Centers for Medicare & Medicaid Services (CMS) Primary Cares Initiative announced in April 2019 was two-part. We have already covered the Primary Care First (PCF) payment model options; now, we are moving into another group of value-based models that organizations can choose from called Direct Contracting (DC). These voluntary payment structures allow providers to take on risk while operating under value-based care principles to cut costs and increase the quality of care. Plus, Direct Contracting offers enhanced flexibility for providers to help their patients beyond their immediate medical needs. Direct Contracting Objectives As Primary Care First’s foundation was the …

OIG Series Blog 3: Managing Beneficiaries with Costly or Complex Care Needs

As a former bedside ICU nurse, I have witnessed numerous patients who reached a breaking point in their condition management. Whether their worsening was related to overlooked social determinants or the neglect of their treatment, I am a witness to the impact of proper care coordination when it comes to managing the highest-risk beneficiaries. Careful coordination not only positively affects patients but results in tremendous reductions in spending from the value-based care perspective. Today, we are continuing our advisor analysis of the latest Office of Inspector General (OIG) report about 20 high-performing accountable care organizations (ACOs) who each earned well-deserved …

Part 1 of Our Breakdown of the CMS Primary Cares Initiatives: Primary Care First

Announced in April of 2019, the Centers for Medicare & Medicaid Services (CMS) revealed two new paths of payment options for primary care and other providers pursuing risk-based agreements: Primary Care First (PCF) and Direct Contracting (DC). As with any new CMS guideline, there is much to unpack. This week, we are discussing Primary Care First and the options primary care providers (PCPs) have based on their patients. Primary Care First “Primary Care First reflects a regionally-based, multi-payer approach to care delivery and payment. Primary Care First fosters practitioner independence by increasing flexibility for primary care, providing participating practitioners with …

OIG Series Strategy 2: Engaging Beneficiaries

Our second installment of the seven-part blog series covers best practices on engaging patients to take actionable steps for their health. For new readers, my colleagues and I are breaking down the main strategies covered in the Office of Inspector General’s (OIG) latest report on transitioning to value-based care. Part one unpacked the methodology behind engaging physicians in value-based care measures, and how withholding this step can make or break results. While physician participation is vital, convincing patients to act on information is the real objective of any campaign. Today, we are talking about the two key strategies that helped …

Mastering Pathways to Success with Lumina Health Partners’ Daniel Marino

Recently, I co-hosted a webinar with Lightbeam Senior Advisor, Maha Salah-Ud-Din, discussing the top three strategies to maximize results for organizations in The Centers for Medicare & Medicaid Services (CMS) Pathways to Success program. There is an undeniable sense of urgency with this topic; by 2028, Medicare spending is projected to exceed $1.5 trillion if the healthcare system does not change course and shift to value-based care. We in the healthcare space are observing telling signals from Medicare to suggest there will be more value-based care payment structures to choose from in the future, and potentially new commercial payers. As …

OIG Series Strategy 1: Working with Physicians

We recently kicked off a blog series discussing the seven key strategies that 20 high performing ACOs utilized to elevate quality scores and achieve shared savings. These success stories were chronicled in the latest study from the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (DHHS). As a physician with over 30 years of experience and a first-hand witness to ground-up clinical transformations, I can say with certainty that involving physicians from start to finish is fundamental. Having physicians on board while working towards sustained high quality scores and cost-effective utilization practices is the …

Artificial Intelligence in Healthcare

Three major buzzwords in healthcare information technology are artificial intelligence (AI), machine learning, and deep learning. Since significant noise surrounds these topics, we decided to address what AI actually is and how we use it at Lightbeam within our strategies. The Differences Between AI and Machine Learning I want to start by defining what AI is not: AI is not a doctor. AI is not merely a set of rules. Instead, AI is the development of computer systems to aid or enhance a set of tasks that normally require human intelligence. Examples include visual perception, speech recognition, decision-making, and translation …

7 Key Cost Reduction and Quality Improvement Strategies: A Series About the Latest OIG Study

In July of this year, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (DHHS) released a new study chronicling 20 high performing accountable care organizations (ACOs). Their efforts produced notable successes, each achieving a quality score of 90 or above and coming in less than their benchmark of spending within their second, third, or fourth performance year. This study, entitled “ACOs’ Strategies for Transitioning to Value-Based Care: Lessons from the Medicare Shared Savings Program,” offers compelling understandings on how ACOs can stretch their funding further while expanding the quality of care they provide. …

Reduce Physician Burnout by Becoming a “Dot Connecting” Organization

Earlier this month, I hosted a webinar about combating physician burnout by shifting to value-based culture. Although burnout is common in many professions, the negative impact of physician burnout is substantial. Burnout often links to low job satisfaction, a decline in patient outcomes, and an overall decline in healthcare delivery. Recognizing the causes of burnout and implementing the right solutions improves both medical professionals’ outlook and how they tend to their patients. The Main Causes of Physician Burnout The first step is finding the root of burnout. According to the 2019 Medscape National Physician Burnout, Depression & Suicide Report, the …