Blog

The Need to Incorporate Equity Lens into Patient Care

Healthcare costs are already skyrocketing and creating a challenging crisis for the industry. The disparities in the U.S. healthcare system forge an unnecessary rise in costs that spreads over society, resulting in a financial crisis. The continuing upward trend in costs could lead to an even more significant number of unaffordable bills and deteriorating health...
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Getting you up-to-speed for the all-new Primary Care First Program

Primary Care First (PCF) is an innovative payment model created by the Centers for Medicare and Medicaid Services (CMS) to encourage the high performance and delivery of extraordinary primary care services. PCF members must provide data on specified quality metrics annually, including the quality indicator Advance Care Plan (ACP), which needs reporting from a Qualified...
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Leveraging Data to drive Risk Adjustment Accuracy

Risk adjustment has incentive insurance companies to provide memberships to patients who need it the most by “adjusting” the risk of enrolling chronically ill people along with healthier patients, ensuring that providers are adequately compensated according to each patient’s underlying health patterns, and the care provided. To ensure a mutually beneficial risk adjustment program, payers...
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Healthcare Organizations Call on CMS and HHS to Scrap the New ACO REACH Model

The Centers for Medicare & Medicaid Services (CMS) has stated that the global Direct Contracting Model will be replaced by the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model in 2023. Furthermore, the regional Direct Contracting Model, which has been on hold since March 2021, will be phased out immediately. Based...
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In Terms of Care Delivery and Care Coordination, The ACO REACH Model will benefit both Recipients and Providers

Even though the Social Determinants of Health (SDoH) and health equity have received a great deal of interest from the healthcare industry in the recent years, the Biden administration is overhauling the contentious Direct Contracting Model to include additional conditions aimed at addressing the health equity model of accountable care and assuaging progressive legislators’ worries...
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ACO REACH Model’s Strategic Ramifications in the Healthcare Industry

The Centers for Medicare and Medicaid Services (CMS) Innovation Center is working on replacing its Global and Professional Direct Contracting model (GPDC), which will be phasing out at the end of 2022, with the highly-anticipated Accountable Care Organization Realizing Equity, Access, and Community Health model (ACO REACH), which will take effect on January 1, 2023....
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The Financial Benefits of the Primary Care First Model for Practices

Primary Care First (PCF) intends to increase primary care professionals’ self-governance by providing more operational adaptability and performance-based incentives, allowing them to customize care delivery depending on their specific patient groups and resources. The concept actively encourages providers to invest additional time with patients and offer coordinated, effective care by connecting health outcomes for patients...
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Primary Care First: A Quick Overview

There Are A few Things You Should Be Aware of About Primary Care First Primary Care First (PCF), innovative care delivery and reimbursement paradigm designed by the CMS Innovation Center is a distinct method for improving primary care. PCF criteria and the care delivery model are similar to the Comprehensive Primary Care Plus (CPC+) framework...
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Successfully Implementing AI Solutions for A 100% Encounter Data Reality

As CMS moves towards 100% encounter data in risk adjustment calculations next year, the ability to extract relevant information from clinical records will become paramount. While payers dread this upcoming change in Medicare Advantage and Part D calculations, all is not lost. In this article, we will identify a few key innovations these organizations can...
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Accountable Care: Key Changes in CJR Program for a Smooth Transition towards Performance Year 6

Introduced back in 2016, the Comprehensive Care for Joint Replacement (CJR) program was designed to bundle payments for joint replacement surgeries in acute care hospitals and hold them financially accountable for the episode of care. COVID-19: Something that Caught Everyone off Guard Initially, the CJR program was planned to go for 5 years. However, the...
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