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 …

AI, and Then What?

The last time we discussed artificial intelligence (AI) and machine learning, we covered the basics of what they are, what they are not, and how useful they are when applied to the healthcare industry. Today we are discussing the human side of AI’s capabilities; how the insights gathered from these analytics allow care plans and patient interventions to take shape for physician and care team action. AI and machine learning allow healthcare providers to better tailor care and maximize the impact of their in-person visits with patients. These focused interventions give providers the ability to continuously survey data and generate insights that can be crafted into care pathways, empowering care managers and helping them understand an intervention’s success.   The Importance of Machine Learning  AI and machine …

OIG Series 5: Coordinating Skilled Nursing and Home Healthcare

The innovation of receiving care in the home allows otherwise unable patients to receive the medical attention they need. In the recent Office of Inspector General (OIG) study, the fifth strategy that 20 high-performing ACOs used to achieve their outstanding clinical and financial results is to work closely with skilled nursing facilities (SNFs) and home health agencies (HHAs). Their practices have raised the quality of care in SNFs and HHAs, too, with simple organizational practices. The Challenges of SNFs and HHAs Joanne M. Chiedi, the Acting Inspector General of the Department of Health and Human Services, defined three primary challenges when …

Integrating Breast Cancer Detection with Value-Based Care: An Interview with Lightbeam’s Jessica Scruton

Breast Cancer Awareness Month is well underway, and today we are discussing the integration of preventative measures with value-based care strategies to proactively treat patients and maintain cost-conscious practices. Our in-house Clinical Transformation Advisor, Jessica Scruton, BSN, RN, CCM, took the time to discuss both of these topics in honor of this initiative. Jessica has been in the healthcare space for over 20 years, and before joining Lightbeam, she served as a Senior Director of Clinical Advisory at her previous healthcare company. During her time as a nurse, she served in the intensive care unit (ICU), where she realized she …

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 …