Single Tracks Blog Archive

Risk Adjustments for Individuals and Groups


A new report was recently released by CMS that measures the accuracy of the risk adjustment models that CMS utilizes for Medicare Advantage plans, the Physician Group Practice demonstration and others, and is expected to be used for Accountable Care Organizations (ACOs). This report provides some interesting insights into the effectiveness of risk adjusters.

Maintaining Financial Technology Skills

How to prepare for your next employer while your current employer is using outdated technology
Several years ago I worked on projects for four different clients that involved evaluating a change in the payment methodology of a major payer.  This change had a major impact on revenue, and required analysis of historical data to estimate its effects.

Data Integration in ACOs

The Healthcare IT Guy's recent blog about the analytical systems that ACOs will require does an excellent job of framing the issue of the IT needs of ACOs and other similar organizations.  We would like to highlight several points from this article.

First, these systems will require data integration capabilities of a type not typically seen in hospitals.  Hospital systems typically integrate data though the HL7 stan

You've signed up to become an ACO. CMS sent you the data. Now what?

As has occurred in most demonstration programs in the past, CMS is expected to send ACO applicants the historical data for the members that will be attributed to the ACO's primary care physicians.  But what should you do with that data?  Time to crank up Excel and go to work? 

Analytics can't be an afterthought for ACOs.  It can't be something that's loaded onto the overworked hospital accountant who's already preparing the financial justification for the new linear accelerator and reconciling last year's Blue Cross payments.  It can't be done in spreadsheets.  It's too important to be rele

The "Other" Medicare Pilot Program

Everyone involved in healthcare knows about ACOs.  Every healthcare publication contains at least one article about them.  Every seminar has a session describing them.  They're on every consultant's lips.  Google "ACO" and you'll find dozens of references to them (along with "ant colony optimization" and the American Cornhole Organization, which presumably have nothing to do with health reform). 

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