Four Ways RCM Must Transform for the Shift to Value-Based RCM

healthcare informatics

It is likely that 2018 will be remembered as the year that value-based care became a financial reality for most U.S. medical practices. Those participating in MIPS (the Merit-based Incentive Payment System) received their first round of results and a view of the impact on future reimbursement rates.

Specialists taking part in advanced alternative payment models (APMs) such as the Oncology Care Model (OCM) program were also provided performance reports from CMS, in some cases accompanied by unexpected claw back demands. Finally, commercial payers such as UnitedHealthcare and Aetna promoted research and forecasts attesting to the increasing influence of value-based contracts in the reimbursement mix.

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46 RCM tips from 2018

Hospital CFO Report

Tip #9: Parag Shah, president of practice solutions at Integra Connect, a provider of technologies and services for value-based specialty care, advised specialty medical practices to focus on performance optimization and risk management to ensure their revenue cycles meet new value-based care requirements.

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Charles Saunders, MD: Biosimilars in Specialty Pharmacy

the center for biosimilars

How are you seeing biosimilars impact the world of specialty pharmacy?

I think that the promise of biosimilars to bring down the cost of drugs is certainly out there based on the experience that we’ve had with generics. I’m not sure that we’re really seeing the impact as great, though, because the prices of the biosimilars are not that much lower than the other drugs–so, maybe 25% to 35% reduction.

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6 recent RCM tips

Hospital CFO Report

Here are six expert revenue cycle management tips, published by Becker's Hospital Review after Nov. 21.

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5. Parag Shah, president of practice solutions at Integra Connect, a provider of technologies and services for value-based specialty careadvised specialty medical practices to focus on performance optimization and risk management to ensure their revenue cycles meet new value-based care requirements.

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Common Factors Among Successful Practices in the OCM

AJMC - Managed Markets Network

Practices participating in the Oncology Care Model have now received performance results for 2 periods, and many practices were surprised that they didn’t perform as well as expected. In general, some of the practices have found it difficult to predict success in the model, but there have been positive results from the OCM.

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The Oncology Care Model Performance Period 2 Results: Practices Are Making Some Progress, But Major Challenges Remain

When launched in 2016, the Oncology Care Model (OCM) represented one of the most advanced efforts yet to migrate health care delivery from fee-for-service to fee-for-value. Practices representing nearly 3000 oncologists signed on to participate. Since then, much has been written about potential strengths and weaknesses of the model. New to the discussion is a wave of data. Practices received the results of their first performance period in February 2018 and the second performance period at the end of August 2018. This has afforded them the opportunity to identify strengths and areas for improvement, both based on what the data tells them and how it changes across performance periods. This article draws on the aggregated data and experiences of a large segment of community OCM participants to highlight the primary challenges that arose once practices were confronted with the Centers for Medicare & Medicaid Service’s assessment of their performance. In addition, the article highlights high-impact interventions that oncology practices are undertaking to further improve both care quality and cost.

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RCM tip of the day: Align revenue cycle with new value-based care requirements

Hospital CFO Report

Specialty medical practices should focus on performance optimization and risk management to ensure their revenue cycles meet new value-based care requirements, advised Parag Shah, president of practice solutions at Integra Connect, a provider of technologies and services for value-based specialty care.

He recommended practices first focus on optimizing their performance based on value instead of collections based on the number of patients seen.

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Two urology practices select Integra Connect to replace EHRs

health data management - The Resource for Healthcare IT Leaders

The Urology Group, with 15 sites serving parts of Ohio and Kentucky, and the Michigan Institute Urology, with 22 sites in southeast Michigan, both are replacing legacy electronic health record systems and selecting the same vendor—Integra Connect.

Some 39 physicians at The Urology Group recently went live on the EHR as the organization prepares for the shift to value-based care. “We have long seen the need for a new wave of innovation among urology EHRs to better equip practices like ours for the changes in our specialty in general and with the shift to value-based care in particular,” says Gary Kirsh, MD, the group’s president.

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