Industry Insights

Guidance for Healthcare Providers and Purchasers

Leading healthcare data analytics insights:

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

Submitted by jonpearce on Wed, 2011-03-23 23:26

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

Submitted by jonpearce on Wed, 2011-03-23 22:49

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). 
 

Risk Scoring and the Luck of the Draw

Submitted by jonpearce on Sun, 2011-03-20 17:13

Many recent healthcare initiatives, including the Accountable Care Organizations that are created under health reform, utilize risk adjusters to compensate for the differences in disease status of the members.  These risk adjusters are used to establish payment targets that compare costs incurred by patients in the organization to what the costs “should be” based on those patients’ diagnoses.  The accuracy of the risk adjusters, therefore, is critically important when significant amounts of money are involved.  A small percentage difference between the risk-