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Article

Provider network optimization – Finding value in the details

With a comprehensive picture of provider quality, cost, accessibility, and affiliations, payers and providers themselves can make informed decisions.

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Variation in skilled nursing facility practice patterns: Opportunities exist for more efficient management

There is significant variation in skilled nursing facility (SNF) average length of stay (ALOS) and readmission rates among Medicare fee-for-service (FFS) beneficiaries admitted to a SNF following an acute inpatient hospital stay.

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Shadow bundles: A big opportunity for MSSP and REACH ACOs

New data provided to accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) and ACO Realizing Equity, Access, and Community Health (REACH) models can provide opportunities for managing hospital and specialist referrals, but the limitations of the data should be carefully considered.

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Hospital financial results from the FY2022 CMS Medicare cost reports

Hospital margins, occupancy, and Medicaid reimbursement

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CMS Making Care Primary Model: Should I participate?

Program summary, opportunities, risks, and key considerations

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MSSP minimum savings/(loss) rates: A double-edged sword

For ACOs participating in MSSP, the minimum savings/(loss) rate (MSR/[MLR]) can offer protection against losses.

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Interactions between the CIF and the +/- 3% risk score floor and ceiling in ACO REACH

The Coding Intensity Factor (CIF) is intended to establish revenue neutrality in the Realizing Equity, Access, and Community Health (REACH) program and causes all accountable care organizations (ACOs) to pay for increases in program-wide risk scores.

ARTICLE

Recent changes to ACO REACH financial benchmark methodology to account for PY 2024 fee schedule changes

As the CMS Innovation Center revises how the ACO REACH Rate Book handles performance-year fee schedules, we provide average impact estimates at a state level and background information regarding the change.

Article

Summary of The U.S. Playbook to Address Social Determinants of Health

While data science techniques offer immense potential for risk managers, (re)insurers need a multidisciplinary approach to tackle challenges and ensure successful implementation.

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Commercial reimbursement benchmarking

Commercial payment rates for medical services as percentage of Medicare fee-for-service rates

Read the most recent provider thought leadership.

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