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 …

A Guide to Population Health – Part 1: Technology

Since healthcare has moved to value-based reimbursement and downside risk, provider groups and payer organizations have named population health management (PHM) a top priority. Benefits of true PHM include delivering high-quality care while reducing costs and preventing unnecessary admissions for defined patient groups. Such groups may be based on contracts, chronic conditions, event types, or any other commonality. Executing PHM is only possible with complete visibility. Visibility into what’s going on outside the exam room is such a high priority that, “Ninety-three percent of healthcare providers believe population health will have a significant impact on their organization within the next …

Gaining Patient Buy-in for Chronic Care Management

Medicare patients who have two or more chronic conditions account for 93% of total Medicare spending. These patients are found to have higher rates of hospitalizations, pharmacy utilization, and specialist utilization, which increases costs for all stakeholders. Basics of CCMChronic care management (CCM) is a separately billed, non-face-to-face CMS covered service that is designed to be delivered through the primary care setting. To participate in the Medicare program, the patient must have two or more chronic conditions (conditions lasting more than 12 months or until the death of the patient). Physicians are given financial incentives from CMS to talk with …

What it Takes to Make a Sustainable HIE

By definition, health information exchanges (HIEs) allow clinicians and patients to have secure access to patient data across disparate healthcare systems. HIEs still have various obstacles, one being that most state HIEs were formed with grants and funding streams that have started to run their course. We have also seen the HIE vendor market shift from a ‘one throat to choke’ model to a ‘best of breed approach,’ with many HIEs now on their second vendor. In addition, vendors are consolidating in the market with payers or other data warehouse offerings. The moral of the story is that with the …

Machine Learning vs. Deep Learning

Lightbeam is positioned to expand your ability to deliver care in an efficient way using artificial intelligence (AI) insights. In my most recent blog post, I shared what AI is and the use cases for it within the population health management realm. Many companies are beginning to integrate machine learning and deep learning into their offerings and I want to better explain the technology, so you can differentiate product offerings. We live in a data-driven analytic world where providers are trying to figure out the most efficient ways to solve problems and improve care. Artificial intelligence tries to solve problems …