OneCare Vermont's ACO providers met most quality targets and earned $5.6 million in shared savings from Medicare in 2018. The ACO scored 100% on Medicare quality measures in the reporting year, earning 82.4% of available points compared to benchmarks. For Medicaid, the ACO was within the ±3% risk corridor, providing $1.5 million more in care than expected. The ACO met quality targets on 85% of measures, exceeding national benchmarks for developmental screening and follow-up after emergency department visits.
The Medicare Advantage Value-Based Insurance Design (VBID) Model team hosted a webinar on Wednesday, March 17, 2021 from 4:00 - 5:00 PM EDT. During this webinar, presenters provided a preview of the Calendar Year 2022 payment design related to the Hospice Benefit Component of the VBID Model. The session also offered attendees an opportunity to ask follow-up questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Due to popular demand, the Comprehensive Primary Care Plus (CPC+) team hosted a repeat of the webinar that was originally held on Thursday, April 21, 2016. During this webinar Model team members provided an overview of the model specifically for health IT vendors.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Quality Payment Program (MACRA) Proposed RuleMick Brown
The Quality Payment Program, established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), began in 2017, known as the transition year. The Program’s main goals are to:
Improve health outcomes.
Spend wisely.
Minimize burden of participation.
Be fair and transparent.
The Quality Payment Program has 2 tracks: (1) The Merit-based Incentive Payment System (MIPS) and (2) Advanced Alternative Payment Models (Advanced APMs).
Because the Quality Payment Program brings significant changes to how clinicians are paid within Medicare, the Centers for Medicare & Medicaid Services (CMS) is continuing to go slow and use stakeholder feedback to find ways to streamline and reduce clinician burden. CMS has engaged more than 100 stakeholder organizations and over 47,000 people since January 1, 2017 to raise awareness, solicit feedback, and help clinicians prepare to participate. Based on stakeholder feedback, CMS established transition year policies from the clinician perspective, such as:
Giving clinicians the option to choose how they’ll participate (also known as Pick Your Pace).
Having a low-volume threshold that exempts many clinicians with a low volume of Medicare
Part B payments or patients.
Allowing flexibilities for clinicians who are considered hospital-based or have limited face-to-
face encounters with patients (referred to as non-patient facing clinicians).
As the Quality Payment Program moves into the second year, CMS wants to ensure that there is meaningful measurement and the opportunity for improved patient outcomes while minimizing burden, improving coordination of care for patients, and supporting a pathway to participation in Advanced APMs.
MACRA, MIPS, & APMs: Considerations for 2018 and BeyondPYA, P.C.
Providing an overview of QPP’s second performance year finalized in the 2018 Centers for Medicare & Medicaid Services’ QPP and Medicare Physician Fee Schedule, this presentation highlights changes from last year’s program requirements, identifies key areas of immediate focus relevant to financial risks and outcomes, and provides insights into 2019 planning.
The Medicare Advantage Value-Based Insurance Design (VBID) Model team hosted a webinar on Wednesday, March 17, 2021 from 4:00 - 5:00 PM EDT. During this webinar, presenters provided a preview of the Calendar Year 2022 payment design related to the Hospice Benefit Component of the VBID Model. The session also offered attendees an opportunity to ask follow-up questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Due to popular demand, the Comprehensive Primary Care Plus (CPC+) team hosted a repeat of the webinar that was originally held on Thursday, April 21, 2016. During this webinar Model team members provided an overview of the model specifically for health IT vendors.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Quality Payment Program (MACRA) Proposed RuleMick Brown
The Quality Payment Program, established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), began in 2017, known as the transition year. The Program’s main goals are to:
Improve health outcomes.
Spend wisely.
Minimize burden of participation.
Be fair and transparent.
The Quality Payment Program has 2 tracks: (1) The Merit-based Incentive Payment System (MIPS) and (2) Advanced Alternative Payment Models (Advanced APMs).
Because the Quality Payment Program brings significant changes to how clinicians are paid within Medicare, the Centers for Medicare & Medicaid Services (CMS) is continuing to go slow and use stakeholder feedback to find ways to streamline and reduce clinician burden. CMS has engaged more than 100 stakeholder organizations and over 47,000 people since January 1, 2017 to raise awareness, solicit feedback, and help clinicians prepare to participate. Based on stakeholder feedback, CMS established transition year policies from the clinician perspective, such as:
Giving clinicians the option to choose how they’ll participate (also known as Pick Your Pace).
Having a low-volume threshold that exempts many clinicians with a low volume of Medicare
Part B payments or patients.
Allowing flexibilities for clinicians who are considered hospital-based or have limited face-to-
face encounters with patients (referred to as non-patient facing clinicians).
As the Quality Payment Program moves into the second year, CMS wants to ensure that there is meaningful measurement and the opportunity for improved patient outcomes while minimizing burden, improving coordination of care for patients, and supporting a pathway to participation in Advanced APMs.
MACRA, MIPS, & APMs: Considerations for 2018 and BeyondPYA, P.C.
Providing an overview of QPP’s second performance year finalized in the 2018 Centers for Medicare & Medicaid Services’ QPP and Medicare Physician Fee Schedule, this presentation highlights changes from last year’s program requirements, identifies key areas of immediate focus relevant to financial risks and outcomes, and provides insights into 2019 planning.
An increasing number of states are expanding managed care. This webinar provides a straightforward overview and history of the Medicaid Managed Care program and how it applies to physicians, practices, and patients.
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum covering benefit enhancements for the 2017 Next Generation Accountable Care Organization Model. The open door forum was held on Tuesday, April 19 from 4:00pm – 5:30pm EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
MIPS APM for ACOs: A Hybrid Reimbursement ModelCitiusTech
CMS announced the Quality Payment Program (QPP) final rule in October 2017, stating how it plans to implement the clinician payment changes to QPP, mandated under the Medicare Access and CHIP Reauthorization (MACRA) act. The implementation of the MACRA act impacts different type of organizations, one such being the Accountable Care Organizations (ACOs). ACOs are evaluated for payments on the basis of quality care and the cost factors associated in achieving their quality goals. Post MACRA implementation, all clinicians will receive payments as per the MIPS (Merit based incentive payments) and Advanced APMs (Advanced alternative payment models). ACO’s can register as APM entities and are eligible to receive payments under Advanced APMs. There is a third category of APM entities which participate in Advanced APMs models but do not meet the threshold of payments and patients set by CMS. Such entities fall into a category that is straddling the line between APM and the MIPS track, called MIPS APM (partially qualifying APM participants). This document discusses about the reporting, scoring and payments for the MIPS APM entities
Sustainable Growth Rate? Goodbye for Good!PYA, P.C.
PYA Staff Consultant Aaron Elias spoke to attendees of the Georgia Healthcare Financial Management Association’s (HFMA) Spring Institute May 6, 2015, on the implications of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
The Medicare Advantage Value-Based Insurance Design (VBID) Model team hosted a webinar on Thursday, January 30, 2020 to provide information and answer questions about the hospice benefit component recently added to the Value Based Insurance Design (VBID) Model. The Centers for Medicare & Medicaid Services announced in January 2019 that beginning in calendar year 2021, the VBID Model will test including the Medicare hospice benefit in Medicare Advantage.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum covering financial methodology for the 2017 Next Generation Accountable Care Organization Model. The open door forum was held on Tuesday, April 5 from 4:00pm – 5:30pm EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Mastering MACRA: A Beginner’s Guide to New Reimbursement ModelsCureMD
MACRA is 2 years of work, signed into law in April 2015
Extends the Children’s Health Insurance Program (CHIP) for two more years
Requires Medicare to move away from SSN based Medicare ID numbers
Includes new funding for development and testing of performance measures
Enables new programs and requirements for data sharing
Establishes new federal advisory groups.
(Click the download button for a high-resolution view)
Quality and Outcome Framework (QOF) is a voluntary annual incentive programme for GPs in England, detailing practice achievement results. The primary objective of QOF is to drive the quality of primary care and reduce variations in the quality of care amongst GPs
The Medicare Aaccess and CHIP Reauthorization Act of 2015 establishes two Quality Payment Programs to transition the U.S. Healthcare System from a Fee-For-Service reimbursement methodology to a Fee-For-Value model. MACRA fundamentally adjusts the Medicare Fee Schedule, forcing healthcare providers to utilize HIT, population health management, and care coordination to receive financial rewards.
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum covering population based payments and all inclusive population based payments for the 2017 Next Generation Accountable Care Organization Model. The open door forum was held on Tuesday, April 26 from 4:00pm – 5:00pm EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Prepping for CCJR: Lessons Learned in Physician Alignment and Bundled PaymentsWellbe
With CMS’ recent announcement of its Comprehensive Care for Joint Replacement (CCJR) payment model and its plan to implement in seventy-five geographic areas, hospitals must be prepared to manage the entire episode of care from the time of surgery through ninety days after discharge. CCJR presents both opportunities and challenges for hospitals. In order to achieve success, organizations must manage their system of care delivery, ensure they are aligned with their physicians and post acute providers, and master the analytics necessary for driving high quality, low cost care.
MedAssets has worked with numerous providers to implement alignment models that bring hospitals and their physicians together, evaluate, identify, and implement changes to the care delivery system to improve quality and decrease cost across the continuum, and employ meaningful analytics for managing an episode of care.
Kevin Lieb, Senior Director for MedAssets’ Physician Alignment Solutions division, will share examples demonstrating how organizations have successfully implemented Episodes of Care. Mr. Lieb will also share examples from both hospital led and specialist led programs and provide lessons learned from these experiences.
This webinar will enable attendees to do the following:
• Identify alignment models within bundled payments and understand their applicability to your organization
• Understand the analytic capabilities necessary for success in a bundled payment environment
• Identify opportunities and strategies for cost reduction and quality improvement
About the Speaker:
Mr. Lieb has more than 20 years of healthcare-related experience focusing on quality improvement, market development and cost reduction initiatives for the hospital provider market. Mr. Lieb has worked for a number of well-known healthcare companies including GE Medical Systems, HCIA and LBA in Denver, Colorado. His responsibilities included healthcare consulting with a focus on process improvement and quality initiatives.
The Center for Medicare and Medicaid Innovation released a Request for Information (RFI) in late 2013 entitled the “Evolution of ACO Initiatives at CMS.” These are the first of two batches of responses received by the Center for Medicare and Medicaid Innovation to the RFI.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Making CJR Work for You: A Roadmap for Successful Implementation of Medicare ...Wellbe
This presentation will describe a structured approach to successfully launching a program for the Comprehensive Care for Joint Replacement (CJR) Model. Based on years of experience with bundled programs, this roadmap provides the basis for developing a targeted plan for your organization as the April 1, 2016 deadline for CJR rapidly approaches.
Key topics to be addressed include:
• Overview of CJR rules and program requirements
• CJR implications for your organization
• Bundle evaluation – financial and clinical issues
• Gainsharing considerations with program collaborators
• Designing an effective post-acute care network
• Using analytics to develop and monitor your program
• Key “must-dos” for an April 1, 2016 launch
Learning Objectives:
1. Describe the rules and requirements of CJR
2. Assess the key success drivers in bundle performance
3. Evaluate where and why organizations fail in bundles
4. Develop strategies and tactics to create a post-acute partnership
5. Illustrate risk stratification factors in bundle design
About the Speaker:
Sheldon Hamburger is an Alternative Payment Model advisor for hospitals and healthcare firms nationally. With a focus on program implementation, he brings extensive knowledge and experience gained from more than 25 years of healthcare financial consulting, technology design and development, and sales & marketing strategy for Fortune 1000 clients. He is a frequently sought-after speaker and writer on regulatory and technology trends affecting hospital operations, provider reimbursement issues, BPCI / CJR, programs and regulations, medical expense strategies and payer-provider dynamics. Residing in Raleigh, he is an active member of HIMSS, HFMA, & ACHE. He earned his B.S.E. in Computer Engineering from the University of Michigan.
Healthcare Consumerism and Cost: Dispelling the Myth of Price TransparencyHealth Catalyst
The world of healthcare costs is confusing and messy for both patients and providers. Many providers don’t fully understand their costs and therefore struggle to meet the increasing pressure for greater price transparency for consumers. With price transparency rules finalized and implementation looming, many providers are racing against the clock to adapt business practices to meet regulations and communicate the implications to consumers. And each organization’s financial health depends on transparency, as uncertainty about costs keeps many patients from seeking care.
Deb Gordon, seasoned healthcare executive and author of the book, “The Health Care Consumer’s Manifesto: How to Get the Most for Your Money,” and Pat Rocap, Director of Cost Management Services at Health Catalyst, examine the relationship between cost and pricing as the path to transparency for consumers. Deb and Pat provide expert analysis and practical advice to help you become a savvier provider and consumer when it comes to healthcare pricing and spending.
- The implications of federal price transparency regulations.
- The connection between healthcare costing and pricing.
- How to start your organization’s journey to understand costs and why it matters.
- Why price transparency is important to both patients and providers.
The Evolving Role of the Compliance Officer in the Age of Accountable CarePYA, P.C.
Much has been written about new competencies physicians must develop in the face of payment and delivery system reform. But providers are not the only ones seeing their roles change. Compliance officers, who serve as organizations’ internal police officers, will have many new challenges. PYA Principal Martie Ross presented a national Health Care Compliance Association (HCCA) webinar entitled “The Evolving Role of the Compliance Officer In the Age of Accountable Care.”
The Center for Medicare & Medicaid Services hosted a webinar on Thursday, April 14, 2016. During this webinar staff provided an overview of the model. A repeat of the webinar was held on Tuesday, April 19.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Physician Payment Reforms: The Future of MIPS and APMs – Value-Based Payments...Epstein Becker Green
Epstein Becker Green Webinar with Attorney Lesley Yeung - Value-Based Payments Crash Course Webinar Series - May 16, 2016.
Topics include:
* An overview of the physician payment reforms included in the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”)
* A summary of the Merit-Based Incentive Payment System (“MIPS”) and Alternative Payment Models (“APMs”) Proposed Rule (publication is expected in the spring of 2016)
* Opportunities for provider engagement with the Centers for Medicare & Medicaid Services to shape physician payment reform efforts
http://www.ebglaw.com/events/physician-payment-reforms-the-future-of-mips-and-apms-value-based-payments-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Delivering Care Under the MACRA Final Rule: Implementation Considerations and...Epstein Becker Green
Presented November 18, 2016, by Mark Lutes, Robert F. Atlas, and Lesley R. Yeung of Epstein Becker Green and EBG Advisors.
http://www.ebglaw.com
http://www.ebgadvisors.com
An increasing number of states are expanding managed care. This webinar provides a straightforward overview and history of the Medicaid Managed Care program and how it applies to physicians, practices, and patients.
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum covering benefit enhancements for the 2017 Next Generation Accountable Care Organization Model. The open door forum was held on Tuesday, April 19 from 4:00pm – 5:30pm EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
MIPS APM for ACOs: A Hybrid Reimbursement ModelCitiusTech
CMS announced the Quality Payment Program (QPP) final rule in October 2017, stating how it plans to implement the clinician payment changes to QPP, mandated under the Medicare Access and CHIP Reauthorization (MACRA) act. The implementation of the MACRA act impacts different type of organizations, one such being the Accountable Care Organizations (ACOs). ACOs are evaluated for payments on the basis of quality care and the cost factors associated in achieving their quality goals. Post MACRA implementation, all clinicians will receive payments as per the MIPS (Merit based incentive payments) and Advanced APMs (Advanced alternative payment models). ACO’s can register as APM entities and are eligible to receive payments under Advanced APMs. There is a third category of APM entities which participate in Advanced APMs models but do not meet the threshold of payments and patients set by CMS. Such entities fall into a category that is straddling the line between APM and the MIPS track, called MIPS APM (partially qualifying APM participants). This document discusses about the reporting, scoring and payments for the MIPS APM entities
Sustainable Growth Rate? Goodbye for Good!PYA, P.C.
PYA Staff Consultant Aaron Elias spoke to attendees of the Georgia Healthcare Financial Management Association’s (HFMA) Spring Institute May 6, 2015, on the implications of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
The Medicare Advantage Value-Based Insurance Design (VBID) Model team hosted a webinar on Thursday, January 30, 2020 to provide information and answer questions about the hospice benefit component recently added to the Value Based Insurance Design (VBID) Model. The Centers for Medicare & Medicaid Services announced in January 2019 that beginning in calendar year 2021, the VBID Model will test including the Medicare hospice benefit in Medicare Advantage.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum covering financial methodology for the 2017 Next Generation Accountable Care Organization Model. The open door forum was held on Tuesday, April 5 from 4:00pm – 5:30pm EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Mastering MACRA: A Beginner’s Guide to New Reimbursement ModelsCureMD
MACRA is 2 years of work, signed into law in April 2015
Extends the Children’s Health Insurance Program (CHIP) for two more years
Requires Medicare to move away from SSN based Medicare ID numbers
Includes new funding for development and testing of performance measures
Enables new programs and requirements for data sharing
Establishes new federal advisory groups.
(Click the download button for a high-resolution view)
Quality and Outcome Framework (QOF) is a voluntary annual incentive programme for GPs in England, detailing practice achievement results. The primary objective of QOF is to drive the quality of primary care and reduce variations in the quality of care amongst GPs
The Medicare Aaccess and CHIP Reauthorization Act of 2015 establishes two Quality Payment Programs to transition the U.S. Healthcare System from a Fee-For-Service reimbursement methodology to a Fee-For-Value model. MACRA fundamentally adjusts the Medicare Fee Schedule, forcing healthcare providers to utilize HIT, population health management, and care coordination to receive financial rewards.
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum covering population based payments and all inclusive population based payments for the 2017 Next Generation Accountable Care Organization Model. The open door forum was held on Tuesday, April 26 from 4:00pm – 5:00pm EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Prepping for CCJR: Lessons Learned in Physician Alignment and Bundled PaymentsWellbe
With CMS’ recent announcement of its Comprehensive Care for Joint Replacement (CCJR) payment model and its plan to implement in seventy-five geographic areas, hospitals must be prepared to manage the entire episode of care from the time of surgery through ninety days after discharge. CCJR presents both opportunities and challenges for hospitals. In order to achieve success, organizations must manage their system of care delivery, ensure they are aligned with their physicians and post acute providers, and master the analytics necessary for driving high quality, low cost care.
MedAssets has worked with numerous providers to implement alignment models that bring hospitals and their physicians together, evaluate, identify, and implement changes to the care delivery system to improve quality and decrease cost across the continuum, and employ meaningful analytics for managing an episode of care.
Kevin Lieb, Senior Director for MedAssets’ Physician Alignment Solutions division, will share examples demonstrating how organizations have successfully implemented Episodes of Care. Mr. Lieb will also share examples from both hospital led and specialist led programs and provide lessons learned from these experiences.
This webinar will enable attendees to do the following:
• Identify alignment models within bundled payments and understand their applicability to your organization
• Understand the analytic capabilities necessary for success in a bundled payment environment
• Identify opportunities and strategies for cost reduction and quality improvement
About the Speaker:
Mr. Lieb has more than 20 years of healthcare-related experience focusing on quality improvement, market development and cost reduction initiatives for the hospital provider market. Mr. Lieb has worked for a number of well-known healthcare companies including GE Medical Systems, HCIA and LBA in Denver, Colorado. His responsibilities included healthcare consulting with a focus on process improvement and quality initiatives.
The Center for Medicare and Medicaid Innovation released a Request for Information (RFI) in late 2013 entitled the “Evolution of ACO Initiatives at CMS.” These are the first of two batches of responses received by the Center for Medicare and Medicaid Innovation to the RFI.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Making CJR Work for You: A Roadmap for Successful Implementation of Medicare ...Wellbe
This presentation will describe a structured approach to successfully launching a program for the Comprehensive Care for Joint Replacement (CJR) Model. Based on years of experience with bundled programs, this roadmap provides the basis for developing a targeted plan for your organization as the April 1, 2016 deadline for CJR rapidly approaches.
Key topics to be addressed include:
• Overview of CJR rules and program requirements
• CJR implications for your organization
• Bundle evaluation – financial and clinical issues
• Gainsharing considerations with program collaborators
• Designing an effective post-acute care network
• Using analytics to develop and monitor your program
• Key “must-dos” for an April 1, 2016 launch
Learning Objectives:
1. Describe the rules and requirements of CJR
2. Assess the key success drivers in bundle performance
3. Evaluate where and why organizations fail in bundles
4. Develop strategies and tactics to create a post-acute partnership
5. Illustrate risk stratification factors in bundle design
About the Speaker:
Sheldon Hamburger is an Alternative Payment Model advisor for hospitals and healthcare firms nationally. With a focus on program implementation, he brings extensive knowledge and experience gained from more than 25 years of healthcare financial consulting, technology design and development, and sales & marketing strategy for Fortune 1000 clients. He is a frequently sought-after speaker and writer on regulatory and technology trends affecting hospital operations, provider reimbursement issues, BPCI / CJR, programs and regulations, medical expense strategies and payer-provider dynamics. Residing in Raleigh, he is an active member of HIMSS, HFMA, & ACHE. He earned his B.S.E. in Computer Engineering from the University of Michigan.
Healthcare Consumerism and Cost: Dispelling the Myth of Price TransparencyHealth Catalyst
The world of healthcare costs is confusing and messy for both patients and providers. Many providers don’t fully understand their costs and therefore struggle to meet the increasing pressure for greater price transparency for consumers. With price transparency rules finalized and implementation looming, many providers are racing against the clock to adapt business practices to meet regulations and communicate the implications to consumers. And each organization’s financial health depends on transparency, as uncertainty about costs keeps many patients from seeking care.
Deb Gordon, seasoned healthcare executive and author of the book, “The Health Care Consumer’s Manifesto: How to Get the Most for Your Money,” and Pat Rocap, Director of Cost Management Services at Health Catalyst, examine the relationship between cost and pricing as the path to transparency for consumers. Deb and Pat provide expert analysis and practical advice to help you become a savvier provider and consumer when it comes to healthcare pricing and spending.
- The implications of federal price transparency regulations.
- The connection between healthcare costing and pricing.
- How to start your organization’s journey to understand costs and why it matters.
- Why price transparency is important to both patients and providers.
The Evolving Role of the Compliance Officer in the Age of Accountable CarePYA, P.C.
Much has been written about new competencies physicians must develop in the face of payment and delivery system reform. But providers are not the only ones seeing their roles change. Compliance officers, who serve as organizations’ internal police officers, will have many new challenges. PYA Principal Martie Ross presented a national Health Care Compliance Association (HCCA) webinar entitled “The Evolving Role of the Compliance Officer In the Age of Accountable Care.”
The Center for Medicare & Medicaid Services hosted a webinar on Thursday, April 14, 2016. During this webinar staff provided an overview of the model. A repeat of the webinar was held on Tuesday, April 19.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Physician Payment Reforms: The Future of MIPS and APMs – Value-Based Payments...Epstein Becker Green
Epstein Becker Green Webinar with Attorney Lesley Yeung - Value-Based Payments Crash Course Webinar Series - May 16, 2016.
Topics include:
* An overview of the physician payment reforms included in the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”)
* A summary of the Merit-Based Incentive Payment System (“MIPS”) and Alternative Payment Models (“APMs”) Proposed Rule (publication is expected in the spring of 2016)
* Opportunities for provider engagement with the Centers for Medicare & Medicaid Services to shape physician payment reform efforts
http://www.ebglaw.com/events/physician-payment-reforms-the-future-of-mips-and-apms-value-based-payments-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Delivering Care Under the MACRA Final Rule: Implementation Considerations and...Epstein Becker Green
Presented November 18, 2016, by Mark Lutes, Robert F. Atlas, and Lesley R. Yeung of Epstein Becker Green and EBG Advisors.
http://www.ebglaw.com
http://www.ebgadvisors.com
Home Healthcare companies are staring down the barrel of Value Based Purchasing; the newest changes in healthcare. Value Based Purchasing will have an immediate and significant impact on claims from here on out. If you are not familiar with VBP now it is time to start doing your homework because VBP is here to stay. The physician world is not the only place where the emphasis is moving from fee-for-service to a quality of care reimbursement model.
The CMS Innovation Center hosted a special webinar featuring Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, on Monday, November 10, 2014 from 10:30am – 11:30 am ET. Dr. Conway will provided an update about the work of the CMS Innovation Center and the models being tested to improve better care for patients, better health for our communities, and lower costs through improvement for our health care system. Opportunities for questions were provided.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Value-Based Purchasing: Four Need-to-Know Domains for 2018Health Catalyst
Health systems that meet the 2018 Hospital Value-Based Purchasing Program measures stand to benefit from CMS’s $1.9 billion incentive pool. Under the 2018 regulations, CMS continues to emphasize quality. To reduce the risk of penalty and vie for bonuses, it’s increasingly critical that organizations leverage data to build skills and processes that meet more demanding reimbursement measures.
To thrive under value-based payment, healthcare systems must understand CMS’s four quality domains, and their associated measures, for 2018:
Clinical Care
Patient- and Caregiver-Centered Experience of Care/Care Coordination
Efficiency and Cost Reduction
Safety
The Medicare Access and CHIP Reauthorization Act (MACRA) overhauls the payment system for Medicare providers. It’s a complex program that requires careful study so physicians can make the best choice for how they want to report. This choice ultimately impacts reimbursement and the potential bonuses or penalties associated with each reporting option.
This FAQ covers both tracks of the new rule, the Merit-based Incentive Payment System (MIPS), and the Advanced Alternative Payment Model (APM), with a background review and a comprehensive list of questions and answers.
It’s a practical guide complete with next steps for strategic and tactical planning.
The Next Revolution in Healthcare: Why the New MSSP Revisions Matter Now More...Health Catalyst
Now more than ever, we are entering a period of rapid change catalyzed by the power of data. On December 21, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a final rule for the Medicare Shared Savings Program (MSSP), strengthening the financial incentives for ACOs to drive improved outcomes. The health systems that embrace data to achieve financial success will grow while the rest will struggle to compete. View this webinar for a discussion on how to prepare.
The US healthcare system didn’t develop overnight, rather, it is the culmination of a series of revolutions within wealthy parts of the world. In this webinar, we explore the high points of history that have led us to our current challenges. While care has steadily improved over time, the cost of that care has risen at a much more dramatic rate. CMS created the MSSP to help mitigate the growth of these costs while providing better care for individuals and populations. On a larger scale, the program serves to shift the healthcare industry towards fee-for-value.
Despite general frustration related to legislative involvement, history has proven that regulatory changes precede attitudinal changes and the MSSP (combined with accurate, timely data) may be just the piece of legislation to help make value-based care a reality. By viewing this webinar you will learn:
- How the US healthcare industry reached its current state.
- Why financial imperatives drive cultural change in our economic model.
- Ways that the MSSP can help your organization achieve financial success.
- Ideas for how to utilize data to develop better healthcare delivery systems.
Dr. Will Caldwell is a strong proponent of the use of data analytics to promote good health and save lives. His area of expertise rests in technology-enabled health care delivery models and value-based care platforms. We hope that you will view this webinar and learn from his 17-years of work as a data-informed clinician.
In follow-up to the March 10, 2015 announcement of the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted a repeat of the first open door forum in a series focusing on various aspects of the Model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Accountable Care Organization Final Rule may be a 700-page mammoth, but fear not! This presentation will provide you with the highlights you need to know about the Final Rule, including details on the ACO contract with CMS; information on ACOs and FQHCs, Rural Health Centers and Hospitals; required processes and patient-centered criteria; quality and reporting highlights; application details; and more!
In follow-up to the March 10, 2015 announcement of the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted the first in a series of open door forums focusing on various aspects of the Model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Chronic diseases such as cancer, stroke, cardiovascular disease, arthritis and diabetes are the leading causes of death and disability in the United States and throughout the world. Statistics show that more than 40% of U.S adults suffer from chronic diseases making the diseases responsible for about 23% of all hospitalizations in the U.S. Statistics show that cancer and heart disease account for more than 50% of all deaths among elderly people.
This webinar focuses on the new financial policies featured in the ACO REACH webinar. For more information on the financial methodology for the ACO REACH Model that will be transitioned from the Global and Professional Direct Contracting (GPDC) Model, please refer to prior released financial webinars available on the GPDC Model webpage.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Bumpy Road Ahead New Challenges Facing PracticesCureMD
Insurance mergers, shift to alternative payment models, Meaningful Use stage 2, preventing data breaches, pressure to consolidate – welcome to 2016.
Your patience is not the only thing at stake when these changes kick in. Your hard earned money will become harder to collect and worse to retain. While we cannot wish these changes away, we can help you fight them.
USS Value Based—Navigating Old Obstacles in the New WorldPYA, P.C.
A proud supporter of the American Health Lawyers Association (AHLA), PYA joined legal counselors, compliance officers, government representatives, and other attendees October 4-6, at the 2017 Fraud and Compliance Institute, held at the Renaissance Harborplace Hotel, Baltimore, MD. PYA Principal Carol Carden co-presented “USS Value Based—Navigating Old Obstacles in the New World,” with Robert G. Homchick, a partner with Davis Wright Tremaine. The presentation explored: alternative payment models, value-based payments under program waivers, fraud and abuse laws, and IRS rules, as well as valuation and commercial reasonableness of value-based payments.
Similar to 2018 ACO Quality and Financial Results by Payer (20)
8 years later, Vermont's 100 digital coverage still incomplete.
This is an Emergency Broadband Action Plan (EBAP). It was prepared by the Vermont Department of Public Service in response to the COVID-19 pandemic.1 The internet has become the highway to essential everyday services. It is also key to a vibrant economy. And now the COVID-19 pandemic has forced this new clarity about the internet: it can keep people safe during a public health emergency. On March 25, 2020, Governor Scott issued an executive order directing Vermonters to stay home and stay safe. The EBAP seeks to ensure that all Vermonters have access to the internet at home when a public emergency requires that we shelter in place, whether during the ongoing COVID-19 pandemic, or during a natural disaster such as Tropical Storm Irene. Today, 23% of the state -- comprising 69,899 business and residential locations -- presently does not have access to broadband at 25/3 Mbps – the service speed that defines “broadband” under federal law.2 At this time, nobody knows when the public health threat of the COVID-19 virus will be suppressed, if not defeated. It is unclear when a vaccine will become available, or whether we will face yet new waves of contagion and mass illness that will force more sheltering at home and again shut down the public square and our economy. What we do know is that universal broadband access can provide the flexibility to meet this uncertainty with confidence that no one will be left behind for want of access to the internet.
#GreenMountainRepublicans #VermontUniversalRecyclingLaws #VermontCompostingLaws
It’s the law – and if you throw food scraps in the trash after July 1, you’re breaking it.
"That's because, as of July 1, 2020, the last phase of Act 148 will become law, which bans the last sector of food scraps from landfills -- the ones from your kitchen's garbage pail -- in favor of mandatory composting.
Vermont passed the law in 2012 and has been phasing in various parts ever since, the last of which passed into law on July 1, 2017 and required transfer stations and waste haulers to accept food scraps separate from trash. It also required places likes restaurants or other businesses that produced at least 18 tons per year (1/3 ton/week) to separate out their food waste to be composted at any certified facility within 20 miles."
Vermont's Universal Recycling Law Timeline:
https://dec.vermont.gov/waste-management/solid/universal-recycling
Vermont's Composting guidelines for Wild Animal areas.
https://www.vermont.gov/
From 2010—the first full year after the official end of the Great Recession—to 2018, Vermont’s economy, as measured by gross state product, grew at less than one-third the rate of the country’s overall. Vermont’s annual growth rate, after adjusting for inflation, averaged 0.7 percent per year, compared with 2.3 percent for the U.S. That was also slower than Vermont’s own annual growth rate during the previous recovery (2002-07), which was 1.8 percent. From 2017 to 2018 Vermont’s real GSP grew by 1.2 percent.
Vermont's State of Vermont Human Resources Dashboard Information, just wait until you see how much you are paying people for #50 Vermont WORST GDP ranking, and no wonder Vermont is dying FAST! Be prepared for these Salaries are very TOP HEAVY and in the Private Sector for this kind of lousy performance their would be downsizing BIG TIME.
Another reason why Vermonters need #TaxRelief #TaxReform
No wonder Vermont is failing and dying so fast.
#1 to #4 Vermont MOST TAXED State in the Country
#4 Vermont Welfare State in the Country, Median
State of Vermont's Payroll Data, in #50 Vermont WORST GDP State, #49 Vermont WORST Business Start-Up State.
Vermont's Actual Human Resources Payroll
https://humanresources.vermont.gov/data/workforce-dashboard?fbclid=IwAR3rwt9k4Y59E_SsbtCeYkxgqMD3C-4GNYDnkXU2bHdyQsFuqHfuaVAIYck
State/Congressional Officers 500 signatures
Office of the Secretary of State State Senate 100 signatures
Senatorial District Clerks State Representative 50 signatures
Representative District Clerks County Office (Probate Judge, Assistant Judges (Side Judges), State’s Attorney, Sheriff, High Bailiff) 100 signatures
County Clerk
https://www.sec.state.vt.us/elections/candidates.aspx
The Advanced Small Modular Reactors with Renewlogy Reverse Engineering Plastics proposals for #50 Vermont Smallest Carbon Footprint State in the country creating JOBS while generating REAL VERMONT ENERGY INDEPENDENCE.
The Plastic Life Cycle Tired of paying Tax Schemes, request Renewlogy to be placed on the ballots throughout Vermont. One of several solutions Green Mountain Republicans suggested for Tax Relief, Tax Reform, Business Reform getting away from nepotism driving the State of Vermont DEAD LAST #50 Vermont Welfare State Model.
Renewlogy www.renewlogy.com is one solution reverse engineering TONS of plastics throughout 14 Counties, throughout Vermont Cities that would create jobs while generating heating fuels without "Carbon Taxes Schemes", "Carbon Pricing Schemes","Carbon Pollution fees", "Cap N Trade Schemes", "Stealth Carbon Taxes Schemes", "Without banning Plastics Schemes".
Vermont Tax Payers should request this solution on all ballots throughout all communities throughout Vermont. The Plastic Life Cycle explaining the process: http://renewlogy.com/?fbclid=IwAR13pfO4zqRmU4qbcXIevnO6qYB_Uw2Qf3eiXQ8KV53hBsbyYx5WpaJEOgI
#ESGJRConsultingInc #Software #Cisco #Network #Engineering #RenewlogySolution #ReverseEngineeringPlastics #GreenMountainRepublicans
This Report was prepared pursuant to a contract with Allegheny Science & Technology Corporation with funding from the U.S. Department of Energy (“DOE”), Office of Nuclear Energy, under Small Modular Reactor Report, MSA No. DOE0638-1022-11, Prime Contract No. DE-NE0000638.
This Report does not represent the views of DOE, and no official endorsement should be inferred. Additionally, this Report is not intended to provide legal advice, and readers are encouraged to consult with an attorney familiar with the applicable federal and state requirements prior to entering into any agreements for the purchase of power.
The authors of this Report are Seth Kirshenberg and Hilary Jackler at Kutak Rock LLP and Brian Oakley and Wil Goldenberg at Scully Capital Services, Inc. The authors gratefully acknowledge the assistance of federal government officials working to support the small modular reactor program and the development of nuclear power. DOE provided the resources for this Report and invaluable leadership, guidance, and input.
In particular, the authors appreciate the leadership, support, guidance, and input from Matt Bowen, Associate Deputy Assistant Secretary, Office of Nuclear Energy, and Tim Beville, Program Manager, Small Modular Reactors Program at DOE. Additionally, the authors appreciate the input and guidance from the Western Area Power Administration, the Utah Associated Municipal Power Systems, NuScale Power LLC, and the many other governmental entities and individuals that reviewed and provided input and technical guidance on the drafts of this Report.
https://www.energy.gov/sites/prod/files/2017/02/f34/Purchasing%20Power%20Produced%20by%20Small%20Modular%20Reactors%20-%20Federal%20Agency%20Options%20-%20Final%201-27-17.pdf
Here is a link to Vermont's Superfund Clean up Sites, the EPA actually deletes sites after a while?
Vermont's EPA Superfund Sites:
https://www.epa.gov/vt/list-superfund-npl-sites-vermont
Superfund Clean up Grants:
https://tools.niehs.nih.gov/srp/programs/index.cfm
Timely Announcements
Click here for the results for the May 14, 2019 Barre Town Municipal Vote and the BUUSD Vote.
http://www.barretown.org/
If you would like to be considered for appointment to one of the Town’s Boards, Commissions, and Committees,please prepare a brief letter of interest, or fill out the application in your April Barre Town Newsletter, and either mail to the Town Manager’s Office, PO Box 116, Websterville VT 05678 or drop off at the Municipal Building at 149 Websterville Rd. You can refer to this list of questions as a guide (opens in Word) for your letter. The deadline is Fri May 24, by noon.
Vermont Ranks #49, slowly dying due to Democrat/Progressive Socialist Super Majority destroying the State by claiming low unemployment. Vermonters leaving for far better states to live without taxing everything.
Here are some financial reporting links to help you see the Financial status of the State of Vermont.
https://auditor.vermont.gov/about-us/strategic-plans-and-performance-reports
The State Budget Links:
https://auditor.vermont.gov/about-us/budget
Building a Wall around the Welfare State, Instead of the Country July 23, 2013 No. 723
John McClaughry: Vermont's Welfare cornucopia
https://vtdigger.org/2013/08/19/mcclaughry-vermonts-welfare-cornucopia/
VT Digger:
https://vtdigger.org/2013/08/19/mcclaughry-vermonts-welfare-cornucopia/
This report provides information on policies to reduce greenhouse gas (GHG) emissions in Vermont.1 It considers both carbon pricing policies, such as carbon taxes or cap-and-trade programs, and nonpricing policies, such as electric vehicle (EV) and energy efficiency incentives, weatherization programs and investments in low-carbon agriculture. This study aims to inform the policy dialogue but is not intended to address the complete universe of policy options. The key findings are presented below.
Seven Days Opioid Deaths Rise in Vermont Article:
https://www.sevendaysvt.com/OffMessage/archives/2019/02/14/opioid-deaths-rise-in-vermont-but-plummet-in-chittenden-county
Act 46 Barre City and Barre Town,
Gilbert for U.S. Senate 2018 www.gilbertforsenate.us Education Reform, Upgrading Vermont's Digital Infrastructure, Home School Options for Parents that do not support local Public School Academic Standards, The New LGBTQ Standards, Cutting Schools Budgets due to smaller student populations.
History of Vermont Politics in Education Reform across all 14 Counties www.greenmountainrepublicans.org
High-Tech Business Research Models supporting Economic Prosperity designing leading edge Technologies www.esgjrconsultinginc.com Fidelity Investments President of Technology Award Earner Roth IRA/Roth IRA Rollover Business Models.
141 Main St.
Montpelier, VT 05602
1-800-834-7890
www.disabilityrightsvt.org
As a Veteran with slight disability www.esgjrconsultinginc.com or the History of Politics in Vermont, some of which is not very supportive with people with disabilities at www.greenmountainrepublicans.org or Gilbert for U.S. Senate 2018 at www.gilbertforsenate.us
Vermont experienced some serious violations of Ethics, Public Trust, Economic Hardships, Education Costs with needed School Consolidation for 21st Century STEM, High-Tech Start-Up Eco-Systems www.gilbertforsenate.us better access to information with accurate statistics at www.greenmountainrepublicans.org or President of Technology Award Earning Roth IRA/Roth IRA Rollover Business Models in order to grow good paying jobs with benefits. People are leaving Vermont due to an outdated, out of touch Socialist Democrat/Progressive Super Majority Destroying the Affordability of Vermont causing issues with all 3 E's. I love E, Economics, Education, Ethics.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
4. 4
Overview: Measuring Performance
How do we measure performance of the APM and Vermont’s ACO?
• ACO contractual performance of payers vs. APM agreement
performance
• Finance/quality outcomes available on an annual basis
• Trend analysis not available until there is comparable data at two points
in time
• Two points in time:
• Quality performance - 2018 is the first year of the agreement, 2019
data are not final until 2020
• Financial performance – 2017 is the reference population; however,
2018 is the first year of the agreement
• Comparability: Extent to which data are comparable depend on
stability of…
• Measures
• Populations
• Another early indicator of ACO performance is the reallocation of
resources
6. 6
Paid thru 2017
Paid thru 2016
$0
$100
$200
$300
$400
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Total
Allowed
Claims
(millions)
Incurred Month (2016)
Overview: Data Timing
Source:VHCURES
Allowed amounts are for primary payments from commercial, Medicaid, Medicare
7. 7
Overview: Payer Program Comparisons
While working toward payer alignment is a
primary objective, not all payer programs are
equivalent in terms of fiscal and quality
requirements:
1. Medicare
2. Medicaid
3. Commercial
8. 8
Overview: Payer Program Comparison
2018 Fiscal Components
Payer Program Risk Arrangement Corridor FPP FPP Recon Attribution
Medicare ACO
Initiative
2-side, 5% risk corridor,
80% share (100% also an
option), truncation for
outliers (top 1%)
95% - 105% Yes Yes NextGen Methodology
Medicaid NextGen
ACO
2-side, 3% risk corridor,
100% share, no
truncation for outliers
97% - 103% Yes No NextGen Methodology BUT
PCP only & larger set of claims
than Medicare based on
Blueprint & DVHA’s 2016
Medicaid Shared Savings E&M
codes
BCBS QHP 2-side, 6% risk corridor,
50% share, no truncation
for outliers
94% - 106% No NA PCP only
9. 9
Overview: Payer Program Comparison
2018 Quality Metrics
Similarities can be seen in the quality framework for the Medicaid and
the BCBCVT models. Primarily due to the VMNG 2017 experience and
ability to closely align quality metrics with those the State is
responsible for through the Agreement.
Differences across payers are primarily seen in the Medicare quality
measure set.
10. 10
Measure
Vermont All-
Payer ACO Model
2018 Vermont
Medicaid Next
Gen
2018 Medicare
Next Gen
2018 BCBSVT
Next Gen
% of Medicaid adolescents with well-care visits X X X
Initiation of alcohol and other drug dependence treatment X X
X*
Engagement of alcohol and other drug dependence treatment X X
30-day follow-up after discharge from emergency department for mental health X X X
30-day follow-up after discharge from emergency department for alcohol or other drug
dependence
X X X
Screening for clinical depression and follow-up plan (ACO-18) X X X X
Tobacco use assessment and cessation intervention (ACO-17) X X X
Hypertension: Controlling high blood pressure
X**
X
X
X
Diabetes Mellitus: HbA1c poor control X X
All-Cause unplanned admissions for patients with multiple chronic conditions X
Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience surveys*** X X X X
All-cause readmissions (HEDIS measure for commercial plans) X
Risk-standardized, all-condition readmission (ACO-8) X
Skilled nursing facility 30-day all-cause readmission (ACO-35) X
All-cause unplanned admissions for patients with Diabetes (ACO-36) X
All-cause unplanned admissions for patients with Heart Failure (ACO-37) X
Falls: Screening for future fall risk (ACO-13) X
Influenza immunization (ACO-14) X
Pneumonia vaccination status for older adults (ACO-15) X
Body mass index screening and follow-up (ACO-16) X
Colorectal cancer screening (ACO-19) X
Breast cancer screening (ACO-20) X
Statin therapy for prevention and treatment of Cardiovascular Disease (ACO-42) X
Depression remission at 12 months (ACO-40) X
Diabetes: Eye exam (ACO-41) X
Ischemic Vascular Disease: Use of aspirin or another antithrombotic (ACO-30) X
Developmental screening in the first 3 years of life X X
Follow-up after hospitalization for mental Illness (7-Day Rate) X X
Timeliness of prenatal care
Acute ambulatory care-sensitive condition composite X
Medication reconciliation post-discharge (ACO-12) X
Use of imaging studies for low back pain (ACO-44) X
*BCBSVT Next Gen treats these measures as a single composite measure; All-Payer ACO Model and Vermont Medicaid Next Gen treat them as two separate measures.
**All-Payer ACO Model and Medicare Next Gen treat these measures as a single composite. Medicaid Next Gen and BCBSVT Next Gen treat them as separate measures.
***Surveys vary by program. All-Payer ACO Model includes ACO CAHPS Survey composite of Timely Care, Appointments, and Information for ACO-attributed Medicare beneficiaries. Vermont Medicaid Next Gen includes multiple CAHPS PCMH
composites for ACO-attributed Medicaid beneficiaries. Medicare Next Gen includes multiple ACO CAHPS composites for ACO-attributed Medicare beneficiaries. BCBSVT Next Gen includes care coordination composite and tobacco cessation
question from CAHPS PCMH for ACO-attributed BCBSVT members.
11. 11
Today’s Results Presentation…
• ACO-Payer performance in 2018 based on
contractual obligations.
• Today is not an evaluation of the All-Payer
Model.
• GMCB annual reports on finance and quality
• External evaluator hired by CMMI
13. 13
Medicare: Financial Results
0
50
100
150
200
250
300
350
400
2018
TCOC Advanced Shared Savings Shared Savings
In 2018, OneCare Vermont Accountable Care
Organization, LLC earned $5.6 million
in shared savings and received an
additional $7.7 million in money designated
for population health investments through its
Vermont Modified Next Generation ACO
participation agreement as part of the
Vermont All-Payer ACO Model with Centers
for Medicare and Medicaid Services (CMS).
The All-Payer Model Agreement earmarked
approximately $7.7 million to continue
Vermont’s Blueprint for Health program
and support the Support And Services at
Home (SASH) and Community Health
Team (CHT) programs in 2018. Though it
received a large portion of those earmarked
funds up front, OneCare remained
responsible for that money as part of the risk
it assumed under its agreement with CMS.
OneCare will distribute the remaining $5.6
million of shared savings to its network using
a previously outlined methodology.
14. 14
Medicare: Quality Results
Background: Quality measurement alignment was done prior to the start of
the 2019 performance year. Per Agreement language; Measures for 2019
will be different from 2018 in an effort to better align with other ACO-
payer programs in operation.
As outlined in the Vermont All-Payer ACO Model Agreement, CMS and
the State of Vermont are expected to identify a quality strategy for the
Vermont Medicare ACO Initiative for Performance Years 2-5, beginning in
January 2019. The specific language in the Agreement states that:
CMS, in collaboration with Vermont, shall design and launch the Vermont
Medicare ACO Initiative to begin on January 1, 2019, and its performance
period will align with Performance Years 2 through 5 of this Agreement.
CMS shall require Vermont ACOs participating in the Initiative (VMA
ACOs) to accept beneficiary alignment methodology, ACO quality measures,
payment mechanisms, and risk arrangements for the overall quality and cost
of medical care furnished to Medicare FFS beneficiaries aligned to the ACO.
The GMCB may propose modifications to the Initiative to better align the
Initiative with ACO programs operated by Vermont Medicaid, Vermont
Commercial Plans, and participating Vermont Self-Insured Plans. CMS may
accept such proposals at its sole discretion.1
1 Vermont All-Payer Accountable Care Organization Model Agreement, section 8.
16. 16
Medicare: 2018 Quality Results
Earned Score: 100%
• 2018 was a reporting-only year, as is standard practice for
year 1 of program implementation
Score Based on Benchmarks from Reporting Year: 82.4%
• 29 measures (2pt maximum each = 58pts)
• 9 measures (18pts) with no benchmark or score available
• Total of 40 points available
32.95 𝑒𝑎𝑟𝑛𝑒𝑑 𝑝𝑜𝑖𝑛𝑡𝑠
40 𝑝𝑜𝑠𝑠𝑖𝑏𝑙𝑒 𝑝𝑜𝑖𝑛𝑡𝑠
= 82.4%
18. Vermont Medicaid Next Generation ACO
Program: 2018 Performance
Department of Vermont Health Access
November 20, 2019
19. The VMNG program is reinforced by DVHA’s
priorities
• Medicaid as predictable and reliable payer partner
• A focus on continual, incremental programmaticand
performance improvements
• Opportunities to align with other payer programs;
opportunities to be an innovative leader
01
Value-Based
Payments
02
Information
Technology
Projects
03
Performance
1
9
20. VMNG ACO Contract Term
2
0
• The original contract was a one-year agreement (2017) with four
optional one-year extensions.
• DVHA and OneCare triggered one-year extensions for each2018
and 2019, and are in the process of negotiating a third one-year
extension for 2020. The parties will have the option of one
additional one-year extension thereafter.
• Rates are renegotiated annually and reconciliation may occur more
frequently.
22. Result 1: DVHA and OneCare made
incremental program improvements
2
2
• DVHA and OneCare continued program operations andidentified
opportunities for incremental improvement.
• Expansion of prior authorization waiver to all providers in the
Vermont Medicaid network.
• Further decreasing administrative burden for providers; relying
on their clinical expertise when caring for patients.
23. Result 2: The program continues to grow
2
3
• Additional providers and communities have joined the ACO network to
participate in the program for the 2019 and 2020 performance years.
• In 2020, DVHA and OneCare are planning to modify the attribution
methodology, which would further increase the number of Vermonters
connected to the All-Payer ACO Model.
2017 Performance
Year
2018 Performance
Year
2019 Performance
Year
2020 Performance
Year
Health Service
Areas
4 10 13 14
Provider
Entities
Hospitals, FQHCs, Independent Practices, Home Health Providers, SNFs, DAs, SSAs
Unique
Medicaid
Providers
~2,000 ~3,400 ~4,300 ~5,000
Attributed
Medicaid
Members
~29,000 ~42,000 ~79,000
~86,000
+ Geographically
Attributed
Members
24. The VMNG has taken an incremental approach
to changes in attribution
2017
• Consistent with
the Medicare
NextGeneration
ACO beneficiary
alignment
methodology.
2018
• Altered the
VMNG
attribution
methodologyto
consider only
primary care
specialties as
eligible to
attribute.
2019
• Further refined
the Medicaid
definition of
attribution-
eligible primary
care specialties;
increased look-
back period to
2.5 years;
introduced
geographic
attributionpilot
in St. Johnsbury
HSA.
2020
• Exploring
statewide
implementation
of the
geographic
attribution
approach.
2
4
25. Result 3: ACO providers and Medicaid shared
financial accountability for health care in 2018
2
5
• DVHA and the ACO agreed on the price of health care upfront, and
the ACO provided approximately $1.5 million in care above the
expected price. Financial performance was within the ±3% risk
corridor, which means that OneCare Vermont and its members paid
this amount to DVHA.
26. DVHA and OneCare set an agreed-upon price for
each VMNG contract year
100%
Total
Price
±3% Risk
Corridor
>103%: DVHA bears full
accountability for financial
performance in excess ofthe
corridor.
This allows providers to
change the way they deliver
care without facing
catastrophic losses.
100%-103%: ACO network
bears full accountability for
financial performance within
the corridor.
This creates incentives to
moderate costs and keep
them close to the agreed-
upon price.
97%-100%: ACO network
entitled to retain difference
between actual performance
and 100%.
This creates an incentive to be
efficient with resources within
the corridor.
<97%: The difference
between actual performance
and 97% is returned toDVHA.
This creates an incentive to
spend money on care and to
invest in providers and the
community.
27. 103% of Price (Upper Limit of RiskCorridor)
100% of Price
97% of Price (Lower Limit of RiskCorridor)
$52,659,844
$67,254,681
$26,970,978
$49,882,552
$2,365,825
$1,538,376
$-
$20,000,000
$10,000,000
$30,000,000
$60,000,000
$50,000,000
$40,000,000
$70,000,000
$80,000,000
$90,000,000
$110,000,000
$100,000,000
$120,000,000
$130,000,000
Paid Prospectively
2017
Paid FFS Portion allocated for FFS payments but not paid
2018
Paid FFS over agreed upon price
±3% Risk
Corridor
±3% Risk
Corridor
Vermont Medicaid Next Generation ACO Program:
2017 & 2018 FinancialPerformance
28. Result 4: The ACO met most of its quality
targets
28
• The ACO’s quality score was 85% on 10 pre-selectedmeasures.
• OneCare’s performance exceeded the national 75th percentile on
measures relating to developmental screening in the first three years
of life and 30-day follow-up after discharge from Emergency
Departments for mental health, alcohol, and other drug abuse or
dependence.
• Examining quality results over time will be important in order to
understand the effect of changing provider payment on quality of
care.
29. Overview of VMNG Quality Performance, 2018
29
Measure Description NQF # Numerator Denominator Rate
Quality Compass 2018
Benchmarks (CY 2017)
National Medicaid Percentiles
Points
awarded
25th 50th 75th 90th
30 Day Follow-Up after Discharge from the EDfor
Alcohol and Other DrugDependence
2605 72 247 29.15% 10.07 16.26 24.48 32.15 2
30 Day Follow-Up after Discharge from the EDfor
Mental Health
2605 282 345 81.74% 45.58 52.79 66.25 74.47 2
Adolescent Well Care Visits N/A 4903 8693 56.40% 45.74 54.57 61.99 66.80 1.5
All Cause Unplanned Admissions for Patientswith
Multiple ChronicConditions*
CMS
ACO
#38
11 1078 1.02% N/A N/A N/A N/A 2
Developmental Screening in the First 3 Years ofLife‡ 1448 1861 3140 59.27% 17.80 39.80 53.90 N/A 2
Diabetes Mellitus: HemoglobinA1c Poor Control
(>9%)*
0059 122 366 33.33% 46.96 38.20 33.09 29.68 1.5
Hypertension: Controlling High BloodPressure 0018 223 349 63.90% 49.27 58.68 65.75 71.04 1.5
Initiation of Alcohol and Other DrugDependence
Treatment
0004 494 1271 38.87% 38.62 42.22 46.40 50.20 1
Engagementof Alcohol and Other Drug Dependence
Treatment
0004 206 1271 16.21% 9.11 13.69 17.74 21.40 1.5
Screening for Clinical Depression and Follow-UpPlan 418 142 327 43.43% N/A N/A N/A N/A 2
Total PointsEarned 17
Key: Performance Compared to National Benchmarks
Equal to and below 25th percentile (0 points)
Above 25th percentile (1 point)
Above 50th percentile (1.5 points)
Above 75th percentile (2 points)
Above 90th percentile (2 points)
* denotes measures for which a lower rate indicates higherperformance
‡ denotes measure with multi-state benchmarks: 26 states reporting (FFY2016)
30. Result 5: The ACO expanded implementation of
the Advanced Community Care Coordination
(A3C) model to all participating communities
30
• OneCare distributed approximately $2.7 million in A3C payments to
65 community partner organizations (including primary care
practices, Designated Mental Health Agencies, Area Agencies on
Aging, and Visiting NurseAssociations).
• Key performance indicators showed incremental increases in care
team activity in OneCare’s care coordination software, Care
Navigator.
• OneCare trained nearly 700 community care team members in care
coordination skills and core competencies, including the use of Care
Navigator.
• Care Coordination Core Teams were active in all ten participating
communities, tasked with expanding upon best practices, sharing
learnings, and implementing team-based care quality improvement
projects using Care Navigator.
31. VMNG Opportunities
31
• Reviewing and modifying DVHA’s requirements for prior
authorizations and service limitations
• Restructuring utilization reporting to better understand patterns over
time
32. Blue Cross & OneCare 2018 Performance
Green Mountain Care Board Meeting
November 20, 2019
33. ▪ Program term overview
▪ Population demographics
▪ Quality results
▪ Clinical results
▪ Financial results
▪ Overall ACO value review
and summary
2 2
Introduction
34. Our vision
33
Together we can build a
transformed health care
system in which every
Vermonter has health
care coverage, and
receives timely, effective,
affordable care.
35. Program term overview
35
▪ Covering attributed Qualified Health Plan lives with
relationship with a OneCare Participating Primary Care
Provider.
▪ 50/50 Shared Risk/Shared Savings Financial Arrangement
within 6% of Expected Medical Spend based on GMCB QHP
approved rates.
▪ Quality metrics aligned with the All Payer Model
▪ Performance on Quality impacting ACO value based
incentive fund amounting to 0.5% of total cost of care
▪ Collaboration requirements on quality, care coordination
and analytics activity
38. 7
▪ Steady Primary Care
Engagement
▪ Decreased Emergency
Department and Inpatient Use
Clinical results
38
39. Financials Results
Calendar year 2017
▪ Included a minimum savings rate of
2.45%, making the target $481.11
▪ One-sided arrangement with no
downside risk
Calendar year 2018
▪ No minimum savings rate, making
the target equal to expected
▪ Two-sided arrangement
▪ GMCB reduced
utilization trend
from 2% to 1%,
which reduced the
expected spend.
39
40. Review of early indicators
Bright spots—what’s working
▪ Early indicators of positive
impact based on
utilization and quality
metrics
▪ ACO performance
consistent or better than
non ACO QHP population
▪ Jointly developed
programs and analytics
targeting readmissions
outreach and gaps in care
What will impede progress
▪ Disregard for small
numbers and change in
demographics in year-
over-year comparison
▪ GMCB-approved QHP
premiums directly affect
ACO target and ability to
achieve savings
40
41. Measuring clinical programs in the future
41
▪ Use condition-specific measurements, not broad-based population
metrics
• Example: maintaining healthy BMI, ED visit linked to asthma event, adherence
to medication
▪ Use a comprehensive clinical health assessment
• Patient satisfaction and engagement data
• Health confidence measure, a way to gauge member empowerment
▪ Connect clinical measurements to financial impact
▪ Evaluate annually (or more frequently when appropriate) current
measures, the need for new programs, new measurements and
appropriateness of benchmarks
▪ Learn from others—track national programs related to evolving research
on social determinates of health and outcome metrics
42. • Moving to risk contracting
after four years of shared
savings
• Collaborating on clinical
opportunities—more than a
payment program
• Expanding analytics
capabilities through shared
expertise
• Developing long term goals
and process for improvement
• Aligning quality and processes
with Medicaid Program
1
1
11
All-payer model
achievements
43. • Data mapping and managing
claims and clinical data sharing
• Expanding the Provider
Network for Blue Cross
Agreement
• Complexity with Fixed
Prospective Payment
• Expansion of risk model while
ensuring access and stability of
the health care system
• Aligning premium setting with
ACO expected spend target
12
All-payer model challenges
44. • Impact of programs
will develop over time
• Programs will take
three to five years to
mature
• Adopt continual
assessment and
improvement strategy
1
3
13
Success cannot be
measured in one year
45. Did we impact total cost of care?
Did member and client satisfaction
increase?
Did provider satisfaction increase?
Did we close gaps in care?
Did transitions in care lead to
reduced inpatient stays?
Did member health improve year
over year?
Did we support Vermont’s overall
population health goals?
1414
Understanding the value
the all-payer model