The document provides questions and answers about the proposed Medicare Shared Savings Program and Accountable Care Organizations (ACOs). It addresses concerns about limiting beneficiary care, risk-bearing requirements for ACOs, data sharing with ACOs, and ensuring various types of providers can participate, including small physician practices and rural providers. Key points addressed include that beneficiary participation in ACOs is voluntary, strong protections and monitoring are in place to prevent limiting care, risk is intensified to better meet program goals, and options aim to facilitate diverse ACO models tailored to local needs.
Attorney Michael James spoke to Michigan Association of CPAs yesterday on his presentation "Accountable Care Organizations 2.0". The presentation addressed the hundreds of pages of recently proposed regulations related to ACOs that represent the most dramatic overhaul of the Medicare Shared Savings Program since its inception. Other insights in the presentation:
- Current Regulatory Environment for Integrated Models
- How Environment Evolves Under Proposed Regulations
- Various Requirements Needed for ACOs
- Potential Risks Under Current ACO Models
To learn more, contact attorney Michael James at mjames@fraserlawfirm.com or 517-377-0823. Michael James is a senior attorney at Fraser Trebilcock, providing representation and counseling related to all facets of business enterprise and health care matters.
NOTE: Information contained in this presentation is only current as of the blog publish date. For updated information, refer to the Fraser Trebilcock Health Care Reform blog: fraserlawfirm.com
Accountable Care Organizations: 4 Physician BenefitsGreenway Health
Why would physicians join an Accountable Care Oragnization (ACO)? This informative slide presentation gives a brief overview of ACOs, their benefits, and four reasons physicians may have for joining one.
The Healthcare Quality Coalition wrote to CMS Administrator Berwick to provide feedback on the proposed Medicare Shared Savings Program and ACO regulations. The coalition supports the goals of improved care coordination and reduced costs through alternative payment models like ACOs. However, the letter outlines several concerns with the proposed rule, including that it requires reporting on too many quality measures in year one, does not adequately account for patient acuity, and may not provide sufficient incentives for high-quality organizations to participate. The coalition urges CMS to address these issues in the final rule.
Learn some simple truths about how ACO's operate and function. Adapted from http://www.insight-txcin.org/post/why-accountable-care-organizations-succeed
The document discusses Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program. It explains that ACOs are groups of doctors, hospitals, and other health care providers that come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of ACOs is to ensure patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. The document provides details on ACO legal structures, governance, operations, payment models, and audits to ensure compliance with program rules.
Information related to the impact of healthcare reform (Affordable Care Act) for 2014 and beyond. It takes an in-depth look at the ACA and its specific impact on California physicians. It further discusses opportunities presented as a result of the ACA and examples of how physicians and their practices can participate in these opportunities.
- Duke University study found that patient satisfaction scores were more closely aligned with lower hospital readmission rates within 30 days than traditional clinical performance measures. This suggests hospitals should focus on improving patient-staff interactions, especially at discharge.
- The Supreme Court will rule on a case challenging Medicaid cuts in California. The outcome could impact Medicaid providers and beneficiaries nationwide if it allows states to arbitrarily reduce Medicaid benefits.
- The final rules for Accountable Care Organizations (ACOs) under Medicare were released. ACOs aim to improve care coordination and quality while reducing costs by allowing providers and hospitals to share savings if quality targets are met. However, patients still have freedom to choose outside providers.
Attorney Michael James spoke to Michigan Association of CPAs yesterday on his presentation "Accountable Care Organizations 2.0". The presentation addressed the hundreds of pages of recently proposed regulations related to ACOs that represent the most dramatic overhaul of the Medicare Shared Savings Program since its inception. Other insights in the presentation:
- Current Regulatory Environment for Integrated Models
- How Environment Evolves Under Proposed Regulations
- Various Requirements Needed for ACOs
- Potential Risks Under Current ACO Models
To learn more, contact attorney Michael James at mjames@fraserlawfirm.com or 517-377-0823. Michael James is a senior attorney at Fraser Trebilcock, providing representation and counseling related to all facets of business enterprise and health care matters.
NOTE: Information contained in this presentation is only current as of the blog publish date. For updated information, refer to the Fraser Trebilcock Health Care Reform blog: fraserlawfirm.com
Accountable Care Organizations: 4 Physician BenefitsGreenway Health
Why would physicians join an Accountable Care Oragnization (ACO)? This informative slide presentation gives a brief overview of ACOs, their benefits, and four reasons physicians may have for joining one.
The Healthcare Quality Coalition wrote to CMS Administrator Berwick to provide feedback on the proposed Medicare Shared Savings Program and ACO regulations. The coalition supports the goals of improved care coordination and reduced costs through alternative payment models like ACOs. However, the letter outlines several concerns with the proposed rule, including that it requires reporting on too many quality measures in year one, does not adequately account for patient acuity, and may not provide sufficient incentives for high-quality organizations to participate. The coalition urges CMS to address these issues in the final rule.
Learn some simple truths about how ACO's operate and function. Adapted from http://www.insight-txcin.org/post/why-accountable-care-organizations-succeed
The document discusses Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program. It explains that ACOs are groups of doctors, hospitals, and other health care providers that come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of ACOs is to ensure patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. The document provides details on ACO legal structures, governance, operations, payment models, and audits to ensure compliance with program rules.
Information related to the impact of healthcare reform (Affordable Care Act) for 2014 and beyond. It takes an in-depth look at the ACA and its specific impact on California physicians. It further discusses opportunities presented as a result of the ACA and examples of how physicians and their practices can participate in these opportunities.
- Duke University study found that patient satisfaction scores were more closely aligned with lower hospital readmission rates within 30 days than traditional clinical performance measures. This suggests hospitals should focus on improving patient-staff interactions, especially at discharge.
- The Supreme Court will rule on a case challenging Medicaid cuts in California. The outcome could impact Medicaid providers and beneficiaries nationwide if it allows states to arbitrarily reduce Medicaid benefits.
- The final rules for Accountable Care Organizations (ACOs) under Medicare were released. ACOs aim to improve care coordination and quality while reducing costs by allowing providers and hospitals to share savings if quality targets are met. However, patients still have freedom to choose outside providers.
The document discusses CMS's Chronic Care Management program, which pays providers to coordinate care for Medicare patients with multiple chronic conditions. Key points:
- The CCM program pays providers $42 per patient per month to perform 20 minutes of care management and coordination activities outside of office visits.
- To qualify for CCM, patients must have Medicare fee-for-service and two or more chronic conditions expected to last over a year.
- Eligible providers must obtain patient consent and provide 24/7 access, care management, care coordination, and electronic care plans shared with other providers.
- The program aims to improve outcomes and lower costs for patients with multiple chronic conditions by encouraging coordinated chronic care management between visits
Drug Medi-Cal's ODS Waiver: Is Your Organization Ready for the Next Steps?Epstein Becker Green
Webinar presented by Kathryn F. Edgerton (Partner, Nelson Hardiman) and attorney Kevin J. Malone (Epstein Becker Green).
Part of a "first Thursdays" fall webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
More info: https://www.ebglaw.com/events/one-in-three-californians-is-a-medi-cal-beneficiary-is-your-organization-ready-for-the-next-steps-in-drug-medi-cals-ods-waiver/
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.
Analysis of the medicare three day inpatient hospital stay rule...Philip McCarley
This document analyzes the Medicare three day inpatient hospital stay rule for determining eligibility for post-hospital care in skilled nursing facilities. It discusses two options - maintaining the status quo or passing legislation to amend the rule. The background provided discusses the history and impact of the rule, including confusion caused by increased use of observation status. Stakeholders impacted include Medicare beneficiaries, hospitals, skilled nursing facilities, and government agencies.
Provider Credentialing Services: Provider Credentialing Services is the process of review and verification of the information of a health care provider who is interested in participating with a managed care organization (MCO).
What is MIPS and How it Affects My Practice?
For additional information on MIPS, you can visit: https://bit.ly/2I6TUxq, or contact us at 888-357-3226/ info@medicalbillersandcoders.com with your questions.
Click Here For More Information: https://bit.ly/3k7QS9P
Get a Free Quote: https://bit.ly/30DFr2z
#texasmedicalbillingandcodingservices #medicalbillingauditing #medicare #medicalbillingandcoding #MBC #MIPS #medicalbillingguideline #mipsaffectsmypractice
The Advance Payment ACO Model provides upfront and monthly payments to Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program. This is intended to help providers coordinate care and generate savings for Medicare more quickly. Eligible ACOs include physician groups and those in rural areas with limited access to capital. Participation in the Advance Payment Model and Shared Savings Program is voluntary for providers and Medicare beneficiaries can continue seeing any provider they choose. Payments to ACOs include a fixed upfront amount, a variable amount based on the number of beneficiaries, and monthly stipends of varying amounts depending on the ACO size. The goal is to incentivize high quality care delivery at a lower cost to Medicare.
This document describes a proposed health care delivery program called HealthShare 2000+. The key points are:
1. HealthShare 2000+ aims to provide affordable, equitable, and accessible health care to members, especially the poor, through a group trust model without insurance, premiums, deductibles, or other limitations.
2. It would organize health care providers and facilities into categories and grades of service. Members would select service units that would be directly paid to providers through electronic funds transfer from the group trusts.
3. The program claims to eliminate wasteful administrative and billing costs compared to insurance, ensuring 100% of member contributions go directly to health care. It also aims to reduce costs and improve care through preventative
The document provides an overview and agenda for a presentation on Accountable Care Organizations (ACOs) and the Next Generation ACO model. It discusses the background and objectives of ACOs, the purpose and components of the Next Generation ACO model, comparisons between traditional and Next Generation ACOs, financial timelines and calculations, risk arrangements, payment mechanisms, and conceptual diagrams. Contact information is provided for follow up.
1) Accountable care organizations (ACOs) are groups of healthcare providers that coordinate care for patients and are accountable for the quality and costs of that care.
2) The core principles of ACOs are that they are provider-led, have payments linked to quality and cost improvements, and use performance metrics to support care improvements.
3) Compared to earlier HMOs, ACOs focus not just on costs but also on quality of care and patient satisfaction, aiming to achieve the "Triple Aim" of better care, lower costs, and improved health.
Medicaid Authorities, Health Plans, and Healthcare Delivery Systems are quickly approaching the tipping point in understanding that we cannot improve quality and bend the cost curve without addressing the healthcare needs of persons with a serious mental illness and the mental health and substance use needs of all Americans - Dale Jarvis
The document discusses the Centers for Medicare & Medicaid Services (CMS) and its role in regulating skilled nursing facilities (SNF). CMS oversees 100 million people through Medicare and Medicaid and works to improve healthcare quality while reducing costs. It regulates SNFs to increase provider performance and the quality of care delivered. Regulating SNFs gives consumers advantages like more accountability and quality standards, while giving providers incentives to improve care. CMS regulation of SNFs affects consumer choice in the healthcare marketplace.
Champion A cure To Combat Health coverage (CATCH) is a proposed non-profit organization that aims to address the lack of adequate insurance coverage for ABA therapy treatments for children with autism. CATCH plans to develop a healthcare discount membership plan that will negotiate discounted rates with providers for treatments. The organization will recruit up to 100 initial members and measure success based on the number of participating providers offering discounted ABA therapy rates. The long-term goals include seeking grants, expanding covered services, and collaborating with additional provider types like home health agencies.
Provider Credentialing Services: Provider Credentialing Services is the process of review and verification of the information of a health care provider who is interested in participating with a managed care organization (MCO).
Health insurance claim | Health Care DomainH2kInfosys
H2K Infosys provides online IT training and placement services worldwide. It acknowledges proprietary rights of trademarks and product names mentioned in training materials for learning purposes only. Students shall not use or sell such materials for private gain or to third parties. H2K does not guarantee or take responsibility for products and projects discussed in training.
Meritage ACO developed a care transitions program with three elements: care transitions coaching, complex care management, and care coordination between care settings. The program aims to reduce preventable hospital readmissions, which cost the healthcare system an estimated $25 billion per year. Care transitions coaches visit patients before discharge to educate them and plan for their needs. Complex care management involves using tools like the Coleman Care Transitions Intervention and motivational interviewing. Care coordinators help with non-clinical needs. The program seeks to shift clinicians' thinking to a team-based approach focused on continuous care between settings and patient care goals.
United Health Group Measures of Quality, Affordability, Accessibility and Usa...finance3
This document discusses measures of quality, affordability, accessibility, and usability in healthcare as promoted by UnitedHealth Group. It provides numerous statistics on clinical quality reports sent to physicians, accredited health plans, individuals with access to specialized care networks, annual healthcare spending represented, prescription drug savings, and uninsured eligible for new benefits programs. Overall, the document aims to showcase UnitedHealth Group's efforts in science-based decision making, cost-effective relationships, consumer-driven products, and organized services to improve the healthcare system.
A low cost alternative to meeting rising healthcare cost. Addresses the root causes of accelerating health care cost and solves the issue of rising healthcare cost.
The document discusses the healthcare administration industry. Key responsibilities include maintaining member profiles, processing enrollment applications and verifying eligibility. Prompt service and efficient processing are important for developing the industry. As administrators, organizations should process healthcare enrollment and claims without financial risk or compromising data accuracy. Third party administrators play a prominent role in administering or outsourcing certain responsibilities like claims processing and premium collection. The industry depends on healthcare professionals providing services to benefit patients.
This memorandum from the EPA summarizes the environmental risk assessment of the insecticide clothianidin. The EPA has concerns about risks to aquatic invertebrates, terrestrial invertebrates, birds, and mammals from the proposed uses of clothianidin as a seed treatment for cotton and mustard. Additional data is needed to further evaluate risks to bees and the environmental fate of clothianidin. Key risks include acute and chronic effects to freshwater and marine invertebrates. Addressing these risks through label language requiring efficient seed incorporation could help mitigate some environmental impacts.
USCIS can take several administrative actions to provide relief to certain immigrants in the absence of comprehensive immigration reform:
1) Reinterpret prior guidance to allow those with Temporary Protected Status who entered without inspection to adjust status, helping thousands gain lawful permanent residence.
2) Expand the discretionary granting of "parole-in-place" to create a basis for adjustment of status for those otherwise inadmissible, such as certain military dependents.
3) Lessen the "extreme hardship" standard for those seeking a waiver of inadmissibility, encouraging more family-based petitions without risk of removal.
The document discusses CMS's Chronic Care Management program, which pays providers to coordinate care for Medicare patients with multiple chronic conditions. Key points:
- The CCM program pays providers $42 per patient per month to perform 20 minutes of care management and coordination activities outside of office visits.
- To qualify for CCM, patients must have Medicare fee-for-service and two or more chronic conditions expected to last over a year.
- Eligible providers must obtain patient consent and provide 24/7 access, care management, care coordination, and electronic care plans shared with other providers.
- The program aims to improve outcomes and lower costs for patients with multiple chronic conditions by encouraging coordinated chronic care management between visits
Drug Medi-Cal's ODS Waiver: Is Your Organization Ready for the Next Steps?Epstein Becker Green
Webinar presented by Kathryn F. Edgerton (Partner, Nelson Hardiman) and attorney Kevin J. Malone (Epstein Becker Green).
Part of a "first Thursdays" fall webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
More info: https://www.ebglaw.com/events/one-in-three-californians-is-a-medi-cal-beneficiary-is-your-organization-ready-for-the-next-steps-in-drug-medi-cals-ods-waiver/
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.
Analysis of the medicare three day inpatient hospital stay rule...Philip McCarley
This document analyzes the Medicare three day inpatient hospital stay rule for determining eligibility for post-hospital care in skilled nursing facilities. It discusses two options - maintaining the status quo or passing legislation to amend the rule. The background provided discusses the history and impact of the rule, including confusion caused by increased use of observation status. Stakeholders impacted include Medicare beneficiaries, hospitals, skilled nursing facilities, and government agencies.
Provider Credentialing Services: Provider Credentialing Services is the process of review and verification of the information of a health care provider who is interested in participating with a managed care organization (MCO).
What is MIPS and How it Affects My Practice?
For additional information on MIPS, you can visit: https://bit.ly/2I6TUxq, or contact us at 888-357-3226/ info@medicalbillersandcoders.com with your questions.
Click Here For More Information: https://bit.ly/3k7QS9P
Get a Free Quote: https://bit.ly/30DFr2z
#texasmedicalbillingandcodingservices #medicalbillingauditing #medicare #medicalbillingandcoding #MBC #MIPS #medicalbillingguideline #mipsaffectsmypractice
The Advance Payment ACO Model provides upfront and monthly payments to Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program. This is intended to help providers coordinate care and generate savings for Medicare more quickly. Eligible ACOs include physician groups and those in rural areas with limited access to capital. Participation in the Advance Payment Model and Shared Savings Program is voluntary for providers and Medicare beneficiaries can continue seeing any provider they choose. Payments to ACOs include a fixed upfront amount, a variable amount based on the number of beneficiaries, and monthly stipends of varying amounts depending on the ACO size. The goal is to incentivize high quality care delivery at a lower cost to Medicare.
This document describes a proposed health care delivery program called HealthShare 2000+. The key points are:
1. HealthShare 2000+ aims to provide affordable, equitable, and accessible health care to members, especially the poor, through a group trust model without insurance, premiums, deductibles, or other limitations.
2. It would organize health care providers and facilities into categories and grades of service. Members would select service units that would be directly paid to providers through electronic funds transfer from the group trusts.
3. The program claims to eliminate wasteful administrative and billing costs compared to insurance, ensuring 100% of member contributions go directly to health care. It also aims to reduce costs and improve care through preventative
The document provides an overview and agenda for a presentation on Accountable Care Organizations (ACOs) and the Next Generation ACO model. It discusses the background and objectives of ACOs, the purpose and components of the Next Generation ACO model, comparisons between traditional and Next Generation ACOs, financial timelines and calculations, risk arrangements, payment mechanisms, and conceptual diagrams. Contact information is provided for follow up.
1) Accountable care organizations (ACOs) are groups of healthcare providers that coordinate care for patients and are accountable for the quality and costs of that care.
2) The core principles of ACOs are that they are provider-led, have payments linked to quality and cost improvements, and use performance metrics to support care improvements.
3) Compared to earlier HMOs, ACOs focus not just on costs but also on quality of care and patient satisfaction, aiming to achieve the "Triple Aim" of better care, lower costs, and improved health.
Medicaid Authorities, Health Plans, and Healthcare Delivery Systems are quickly approaching the tipping point in understanding that we cannot improve quality and bend the cost curve without addressing the healthcare needs of persons with a serious mental illness and the mental health and substance use needs of all Americans - Dale Jarvis
The document discusses the Centers for Medicare & Medicaid Services (CMS) and its role in regulating skilled nursing facilities (SNF). CMS oversees 100 million people through Medicare and Medicaid and works to improve healthcare quality while reducing costs. It regulates SNFs to increase provider performance and the quality of care delivered. Regulating SNFs gives consumers advantages like more accountability and quality standards, while giving providers incentives to improve care. CMS regulation of SNFs affects consumer choice in the healthcare marketplace.
Champion A cure To Combat Health coverage (CATCH) is a proposed non-profit organization that aims to address the lack of adequate insurance coverage for ABA therapy treatments for children with autism. CATCH plans to develop a healthcare discount membership plan that will negotiate discounted rates with providers for treatments. The organization will recruit up to 100 initial members and measure success based on the number of participating providers offering discounted ABA therapy rates. The long-term goals include seeking grants, expanding covered services, and collaborating with additional provider types like home health agencies.
Provider Credentialing Services: Provider Credentialing Services is the process of review and verification of the information of a health care provider who is interested in participating with a managed care organization (MCO).
Health insurance claim | Health Care DomainH2kInfosys
H2K Infosys provides online IT training and placement services worldwide. It acknowledges proprietary rights of trademarks and product names mentioned in training materials for learning purposes only. Students shall not use or sell such materials for private gain or to third parties. H2K does not guarantee or take responsibility for products and projects discussed in training.
Meritage ACO developed a care transitions program with three elements: care transitions coaching, complex care management, and care coordination between care settings. The program aims to reduce preventable hospital readmissions, which cost the healthcare system an estimated $25 billion per year. Care transitions coaches visit patients before discharge to educate them and plan for their needs. Complex care management involves using tools like the Coleman Care Transitions Intervention and motivational interviewing. Care coordinators help with non-clinical needs. The program seeks to shift clinicians' thinking to a team-based approach focused on continuous care between settings and patient care goals.
United Health Group Measures of Quality, Affordability, Accessibility and Usa...finance3
This document discusses measures of quality, affordability, accessibility, and usability in healthcare as promoted by UnitedHealth Group. It provides numerous statistics on clinical quality reports sent to physicians, accredited health plans, individuals with access to specialized care networks, annual healthcare spending represented, prescription drug savings, and uninsured eligible for new benefits programs. Overall, the document aims to showcase UnitedHealth Group's efforts in science-based decision making, cost-effective relationships, consumer-driven products, and organized services to improve the healthcare system.
A low cost alternative to meeting rising healthcare cost. Addresses the root causes of accelerating health care cost and solves the issue of rising healthcare cost.
The document discusses the healthcare administration industry. Key responsibilities include maintaining member profiles, processing enrollment applications and verifying eligibility. Prompt service and efficient processing are important for developing the industry. As administrators, organizations should process healthcare enrollment and claims without financial risk or compromising data accuracy. Third party administrators play a prominent role in administering or outsourcing certain responsibilities like claims processing and premium collection. The industry depends on healthcare professionals providing services to benefit patients.
This memorandum from the EPA summarizes the environmental risk assessment of the insecticide clothianidin. The EPA has concerns about risks to aquatic invertebrates, terrestrial invertebrates, birds, and mammals from the proposed uses of clothianidin as a seed treatment for cotton and mustard. Additional data is needed to further evaluate risks to bees and the environmental fate of clothianidin. Key risks include acute and chronic effects to freshwater and marine invertebrates. Addressing these risks through label language requiring efficient seed incorporation could help mitigate some environmental impacts.
USCIS can take several administrative actions to provide relief to certain immigrants in the absence of comprehensive immigration reform:
1) Reinterpret prior guidance to allow those with Temporary Protected Status who entered without inspection to adjust status, helping thousands gain lawful permanent residence.
2) Expand the discretionary granting of "parole-in-place" to create a basis for adjustment of status for those otherwise inadmissible, such as certain military dependents.
3) Lessen the "extreme hardship" standard for those seeking a waiver of inadmissibility, encouraging more family-based petitions without risk of removal.
This legal memorandum analyzes potential liabilities if units of the California State Park System close or reduce services due to budget cuts. It identifies several areas of potential liability, including for dangerous conditions of public property, nuisance, lack of contractual obligations, and more. It provides an overview of general legal principles and risks, noting that a case-by-case analysis would be required for specific park units or situations. The memorandum concludes that completely closing parks could increase liability risks due to lack of monitoring and maintenance, while partial closures or service reductions may still pose liability issues.
Leaked Salesforce Email - Brandon Olson - Shane Johnson MemoLeaker
Shane Johnson emails Brandon Olson to check on the status of any action plans and reminds him that the SalesForce report is due by the 15th. Shane also mentions that they have received a new project from Foursquare.
1) The long-running morning radio show "Coop and Tobin Show" on WPDH-FM is undergoing a change after John Tobin left due to contract negotiations.
2) Meanwhile, the morning show "The Electric Morning Show" on WBPM-FM, hosted by Jack Hammer and Andre Kane, continues to entertain listeners with comedy, music and prizes.
3) The two morning shows aim to keep listeners engaged with humor and chemistry between the hosts, though they differ in style, with Hammer and Kane known to push boundaries more.
This document provides information for media studies students on professional practice and skills required by media industries. It discusses the importance of finding a placement, developing key skills like critical analysis and teamwork, and the challenges of securing employment in media fields. Industry wants graduates with a creative and flexible approach who can meet deadlines. While media graduates have relatively high employment rates, many find jobs in retail and catering instead of media. The document provides resources on skills standards and gaining experience to help students pursue media careers.
The evaluation of production files and playbacks will take place by May 26th. Students must submit production files by today which include an updated proposal, research, planning documents, scripts, and information about the audience and market. Playbacks will be reviewed next week with the supervisor and second marker. The evaluation will involve submitting a 2000-2500 word individual report by May 26th explaining and justifying the program style and content. The report should review the program's strengths, weaknesses, and learning points relating the experience to real world contexts and practices.
The document provides information about Carbonium, a company that specializes in carbon finance and the carbon market. It discusses Carbonium's role in developing carbon credit projects under the Clean Development Mechanism and Joint Implementation, as well as trading carbon credits. Carbonium has a global presence with offices in several countries and regions involved in project origination, development, brokerage, and downstream carbon trading activities. The company utilizes its expertise in assessing and financing small-scale renewable energy and biogas carbon credit projects.
Two radio DJs, Andre and Jack, are hosting a new TV show called After Hours that is filmed in a Cornwall TV studio. The show features live music and celebrity interviews in a relaxed bar setting. It is produced by Bill Diamond, a puppeteer and TV producer, who built the Cornwall studio himself. Future shows will include guests from TV shows like Warriors and Deadliest Catch. Tickets for tapings of After Hours can be requested by email.
Copyright protects original creative works and provides exclusive rights to the creator. The 1988 Copyright, Designs and Patents Act is the key legislation and grants copyright automatically to original literary, dramatic, musical or artistic works. Copyright covers the physical work as well as rights to copy, distribute, perform or adapt the work. These rights are typically held for 70 years after the creator's death. Exceptions allow limited use without permission for review, private study or incidental inclusion. Proper permissions and rights clearance is needed to legally use copyrighted material.
1) The document discusses how radio is augmenting itself with visual elements like pictures and videos to engage new, younger audiences accustomed to visual media.
2) It provides examples of how the BBC has incorporated visual elements into radio programs to increase listenership and discovery on platforms like YouTube.
3) Radio executives acknowledge that to remain relevant, radio will need to provide content in a more visually engaging format that appeals to younger audiences who may not consider traditional radio an important medium.
Study: The Future of VR, AR and Self-Driving CarsLinkedIn
We asked LinkedIn members worldwide about their levels of interest in the latest wave of technology: whether they’re using wearables, and whether they intend to buy self-driving cars and VR headsets as they become available. We asked them too about their attitudes to technology and to the growing role of Artificial Intelligence (AI) in the devices that they use. The answers were fascinating – and in many cases, surprising.
This SlideShare explores the full results of this study, including detailed market-by-market breakdowns of intention levels for each technology – and how attitudes change with age, location and seniority level. If you’re marketing a tech brand – or planning to use VR and wearables to reach a professional audience – then these are insights you won’t want to miss.
What is an Accountable Care Organizations (ACO) How does an ACOs .pdfwasemanivytreenrco51
What is an Accountable Care Organizations (ACO)? How does an ACO\'s economics work to
manage costs and quality?
Solution
Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care
providers, who come together voluntarily to give coordinated high quality care to their Medicare
patients.
An accountable care organization (ACO) is a healthcare organization characterized by a payment
and care delivery model that seeks to tie provider reimbursements to quality metrics and
reductions in the total cost of care for an assigned population of patients. A group of coordinated
health care providers forms an ACO, which then provides care to a group of patients. The ACO
may use a range of payment models (capitation, fee-for-service with asymmetric or symmetric
shared savings, etc.). The ACO is accountable to the patients and the third-party payer for the
quality, appropriateness and efficiency of the health care provided. According to the Centers for
Medicare and Medicaid Services (CMS), an ACO is \"an organization of health care providers
that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who
are enrolled in the traditional fee-for-service program who are assigned to it.
Design and Structure
There is no single organizational model for developing an ACO. ACOs may be formed and
organized by health systems using employed and contracted physicians, by integrated delivery
systems, by physician groups (either primary care or multispecialty) or through joint ventures or
contractual relationships among providers. Regardless of the organizational structure, an ACO
must be physician-led and physician-driven. Physician leadership is critical because an ACO is
primarily a vehicle for clinical integration, not financial or risk integration. Only physicians are
able to develop, monitor and adjust clinical care protocols that can more efficiently use resources
based on documented effectiveness.
Qualifying ACOs will be assigned a pool of patients whose care the ACO will be responsible for
managing in a cost-effective and clinically appropriate manner. The ACO will need to develop
internal mechanisms for monitoring and managing costs and quality that cut across traditional
reporting lines and result in a higher degree of clinical interdependence than is typical in a less-
integrated medical community.
The PPACA states that any of the following groups of providers of services and suppliers that
have established a mechanism for shared governance are eligible to participate, in accordance
with regulations to be developed by the Secretary of Health and Human Services (HHS):
ACOs Under Health Reform
Section 3022 of PPACA requires HHS to establish a shared savings program under which
qualifying ACOs may be eligible for incentive payments. The criteria in the statute, which will
need to be further defined by regulation, include:
ACOs will be required to measure and report their progress to HHS, includ.
The document discusses Accountable Care Organizations (ACOs) created by the Affordable Care Act. ACOs allow groups of doctors, hospitals, and other providers to share responsibility for the cost and quality of care received by their patients. If ACOs meet quality benchmarks and reduce costs, they receive a share of the savings from insurers. The document outlines key features of ACOs such as local accountability, shared savings based on quality and cost measures, and a minimum of a 3-year contract period with Medicare.
The document provides information about Accountable Care Organizations (ACOs) and the Medicare Shared Savings Program proposed by CMS. It explains that ACOs allow groups of healthcare providers to coordinate care for Medicare patients, with the goals of improving quality of care and reducing costs. Providers can form or join ACOs to participate in the program. ACOs will be evaluated on quality measures and their ability to lower healthcare spending compared to spending benchmarks. ACOs that meet quality standards and reduce costs below their benchmark can earn a share of the savings, with larger rewards available to ACOs that take on two-sided risk models involving potential loss sharing as well.
How to Manage Population Health Effectively in Accountable Care OrganizationsPhytel
The Affordable Care Act authorized a Medicare shared-savings program for accountable care organizations, and private payers are also contracting with ACOs. To succeed, ACOs must learn how to manage population health effectively.
HMOs and PPOs in USA (Healthcare Management Functions)Abdu Naf'an
The document provides an overview of HMOs and PPOs in the US healthcare system. It defines HMOs as organizations that combine health insurance and healthcare delivery, requiring members to use providers in the HMO network. PPOs allow members to use out-of-network providers but with higher costs. The document then discusses key differences between the two models such as network size, cost structures, claims processes and more. It analyzes trends in HMOs and PPOs and concludes there is no single better option, as preferences depend on individual health needs and priorities around affordability versus flexibility of choice.
ReadingsHealth Care Reform and Future PossibilitiesIntroduct.docxsodhi3
Readings
Health Care Reform and Future Possibilities
Introduction
Health care has undergone episodes of major change since the introduction of Medicare in the 1960s. All of these have resulted in fundamental changes in how health care providers were paid for services to Medicare patients and were swiftly followed by matching changes from independent insurance companies. The latest, and some might say the biggest, change since diagnosis-related groups (DRGs) were introduced in 1983 is the signing into law of the Patient Protection and Affordable Care Act (PPACA), on March 23, 2010. This law proposes to change the delivery of health care services by changing how providers are paid and what they are paid for. This module explores some of the key elements of PPACA and how health care providers are planning their changes in delivery processes and systems in response.
Major Elements of PPACA
The most significant elements of the PPACA legislation are scheduled to take place over several years. Congress still has the ability to modify some of these elements, so we will examine them with that in mind.
June 2010
Adults with pre-existing conditions were eligible to join a temporary high-risk insurance pool run by the federal government. This will be replaced by a health care exchange in 2014, which will provide access to insurance at affordable rates. Applicants must have a pre-existing health care condition and have been uninsured in the six months prior to application. Premiums will be set at rates for the general population rather than the high-risk premiums charged by insurance companies. Out-of-pocket costs will be limited to $5,950 for individuals and $11,900 for families.
July 2010
The government established the National Prevention, Health Promotion, and Public Health Council, with the Surgeon General to act as chair of the council. This council will oversee the implementation of many of the PPACA elements and will disseminate recommendations to the health care community at large in regard to best practices in prevention and health promotion. As of fall 2010, little had yet been heard from this entity. However, the National Committee on Quality Assurance, which is a private entity dedicated to improving the quality of health care services, is providing best practices and quality measures for health care providers, especially hospitals.
September 2010
Insurance companies can no longer apply lifetime dollar limits on essential benefits for patients. In addition, children may be covered under their parents' insurance plan until they turn 26 years of age. This includes children not living at home, not listed as dependents on their parents' tax returns, not students, and children who are married. Further, no patients under 19 years of age with pre-existing conditions can be excluded from health care benefits based on the pre-existing conditions, and there can be no deductibles or copayments required for provision of preventive care measures and medic ...
Impact on Health Reform on Device Development and FundingUBMCanon
The document discusses the impact of US healthcare reform on medical device development and funding. It summarizes that healthcare reform through the Affordable Care Act and other policies is driving major changes in health insurance purchasing and moving payments from fee-for-service to bundled payments and accountable care organizations. This shift to alternative payment models will require device manufacturers to understand how provider reimbursement is changing to ensure their devices provide value within the new systems.
Accountable Care Organizations and The Medicare Shared Savings ProgramPhytel
Population Health Management, Enabled by Information Technology, Will Be Critical To Success. In 2012, the Centers for Medicare and Medicaid Services (CMS) will launch a shared-savings program with accountable care organizations (ACOs). ACOs that meet specified quality goals will be able to split with CMS any savings that surpass a minimum level. The challenge facing ACOs is choosing the right information technologies so they can track the health status of and the care provided to every one of their patients to produce significant savings or meet the quality benchmarks of CMS
Disaster Contact a disaster preparedness person at either a loca.docxlynettearnold46882
Disaster
Contact a disaster preparedness person at either a local hospital, or local city or county emergency services agency. NORTHEAST OHIO
1. Blackout 2003
2. Chardon Highschool shooting 2012
3. Great blizzard 1978
Interview your contact, asking the following questions:
1) "What do you consider to be the top three disasters for which you prepare?"
2) "What would you say are your top three lessons learned about managing a disaster?"
What Would the Best Future for Health Care Look Like?
Introduction
The one thing the debate over reforming health care taught us all is that there are as many opinions as there are interested groups, and all of them differ in meaningful ways. To look at the views on improving the systems of care delivery, it is important to note where they have points of agreement and where they differ. They are all driven by the values and principles of the constituencies and what they hope to achieve from changes in the delivery system. This module will explore points of agreement and differences between important groups that will influence the direction health care will go in the next decade.
Patients
It is an interesting point that all constituencies, in their public statements, emphasize that a strong health care system should focus on getting the best outcomes for patients. What would that be, from the perspective of patients? Typically, patients relate that they want top quality in their care and the latest technology, along with immediate and unrestricted access to care, at the lowest possible cost. This triad has become the stumbling block of change initiatives, since to date, no one has figured out how to deliver all three. However, when patients' views are explored and probed, some interesting facts emerge. When patients say they want top quality care, in general, they tend to define that as achieving a cure or return to health. They certainly do not want to leave the system feeling worse than when they came in. Patients have been heavily lobbied in the media by pharmaceutical and medical technology companies to convince them that the latest (and most expensive) technology will deliver the desired outcomes. However, very little real research on the true effectiveness of treatments and technology makes its way to most patients, and patients in general do not shop for their medical care as carefully as they would if they were purchasing new cars, for example. The language of research and medicine is difficult for patients to understand and is frequently not well-explained by providers.
So, the nuances of top quality care in terms of being able to deliver a cure or return to health are not well understood by the constituency with the most at risk. What patients do understand is whether they feel better or see improvement in their health and whether care was rendered without errors and in a compassionate way. The best health care system, from a patient's point of view, is one that can consistently deliver the good.
Trends From The Trenches : Adapting to Affordable Care Act: Provider and Heal...Andrea Simon
As the Affordable Care Act is implemented and healthcare expenditures continue to rise, providers and payers need to explore how to best set themselves up to succeed in an evolving marketplace. In this 5th webinar, Margaret Davino will discuss how the relationships between hospitals, physicians and other providers are changing and what structures are being used for providers and payers to work together, including accountable care organizations (ACOs). Margaret will also describe the different models of collaboration between hospitals and physicians, how these affect reimbursement, and what to expect in the future.
How Physicians Can Prepare for the Financial Impact of MACRAHealth Catalyst
If all goes according to plan, the first performance period for the new Medicare Access and Chip Reauthorization Act (MACRA) is just around the calendar corner. It’s a complicated reimbursement structure with multiple tracks that are guaranteed to reward with bonuses or inflict pain through penalties in CMS’s new zero sum game. To the physicians and practices that adopt this new program early and position themselves for the best fiscal outcomes, go the spoils. But for many smaller practices and those that consistently underperform, the outlook may be glum regardless. Here are some highlights of the new program and the financial impact it will have on clinicians and practices.
US Health Care System Week 5 For this assignment, you wishandicollingwood
US Health Care System:
Week 5
For this assignment, you will generate, designate, Organize, investigate and, present a Manage Care Control Cost Plan: Under traditional indemnity insurance, the money follows the patient. Patients select health care providers and visit them as they choose. Providers then bill the private insurer or public payer and are reimbursed on a fee-for-service or per case basis
Manage Care Control Cost Plan: Chapters 9 & 10
Objective
:
Managed health care as it has developed in the USA, and the current backlash against it, must be viewed in the context of the traditional US health care system.
This system of employer-based, indemnity insurance and fee-for-service health care conditioned both providers ‘and patients ‘expectations of unlimited resources and unrestrained choice.
Not surprisingly, the constraints and controls imposed by managed care have resulted in outrage by doctors and their patients (and by doctors through their patients).
ASSIGNMENT GUIDELINES (10%):
For this assignment, you will generate, designate, Organize, investigate and, present a Manage Care Control Cost Plan: Under traditional indemnity insurance, the money follows the patient. Patients select health care providers and visit them as they choose. Providers then bill the private insurer or public payer and are reimbursed on a fee-for-service or per case basis.
Most indemnity plans attempt to limit demand through financial barriers to the patient, such as deductibles and co-insurance, rather than constraints on the provider. Many also require the patient to pay the provider directly and seek reimbursement from the insurer, often with payments less than charges.
Due to growing popular discontent with managed care organizations, many critics believe that the system will not continue in its current state. No one, however, expects managed care to disappear completely and indemnity plans to rise to their former prominence. Changes are expected to occur as managed care programs begin competing among themselves. Cost and efficiency will no longer be the main selling point; quality of services will take precedence. One researcher has suggested that along with new systems of managed care and continuing systems of indemnity plans, health care providers may even organize and offer services directly to employers, thus eliminating the middlemen. This development would be beneficial to all involved: employers would pay less; providers would be better compensated; and clients would receive better care
The paper will be 4-5 pages long. More information and due date will provide in the Fifth Week assignments link.
EACH PAPER SHOULD INCLUDE THE FOLLOWING:
1.
Introduction (30%)
Provide a short-lived outline of the meaning (not a description) of Chapter 9 and 10 and articles you read, in your own words. Types and classifications of managed care models.
2.
Manage Care Control Cost Plan:
(50%)
a.
Cost savings
‘‘Structural changes centere ...
The document provides an overview of accountable care organizations (ACOs) including:
1) ACOs aim to tie provider reimbursements to quality and reduce total cost of care for assigned patients.
2) Key stakeholders include providers, payers (primarily Medicare), and patients (primarily Medicare beneficiaries).
3) The concept of ACOs originated in 2006 but builds on prior models. Successful implementation remains challenging.
4) The Patient Protection and Affordable Care Act supports the development of ACOs and other innovative models.
Advertising AssignmentPick a global product brand and co.docxstandfordabbot
Advertising Assignment
Pick a global product / brand and country of interest to you (Do not choose South
Korea). In a 2-page report (double space), compare and contrast how that offering is
advertised in the USA and the foreign market. Please provide your thoughts pro and
con and any questions you have about the differences in marketing practice, as well as
any suggestions / recommendations for potentially doing things better. Source material
for this assignment can be obtained from an internet search and published journal
articles. Please provide a bibliographic list of your references at the back of your paper.
MLA Format.
Please reply to
William Polanco- Rowland–
Please note minimum of 200 words. Please cite one scholarly source. In-text citation should be included.
The cost of healthcare and the associated dollar signs connected to it has kept a certain number of patients away from seeing a doctor when needed. The creation of Managed Care Organizations exists to deal with the exorbitant prices associated with seeing a healthcare provider and actually decreasing costs while increasing the level of care (Nikitas et al, 2020). The common thread is the network of providers that exists within each network that agrees to provide care for the policy holders for an agreed price. Among the Managed Care Organizations are three plans known as Health Maintenance Organization (HMO’s), Preferred Provider Organization(PPO’s), and Point-Of-Service Plan (POS). The structure of HMO’s exists as a network of hospitals, doctors and providers that usually only pay for care in the network visits. These have lower premiums the insured must use a provider within the network that is their Primary Care Physician (PCP). In addition, referrals must be obtained from the PCPs for visits to specialists within the network (healthy.kaiserpermanente.org, 2022) Membership is generally required in the form of employment or one who lives in the area of coverage. With an associated higher cost is the PPO’s. They will allow for visits to in or out of network providers as well as cost of fee coverage for visiting those out of network providers, generally covered by the increased monthly premiums and out of pocket costs (healthy.kaiserpermanente.org, 2022). The third plan being mentioned here is the Point-Of-Service Plan (POS). This is considered a hybrid of plans which allows for the insured to make decisions to see who they want as a provider without first obtaining prior approval. With regard to a plan that works best for the consumer, the HMO plan is one where the nurse within the system is most connected to the providers and the case files allowing for a seamless connection with provider to facility. The other two plans have steps between each provider and information can be lost in the shuffle. The position of nurses working within the healthcare system allows them an opportunity to help keep health costs down via means of self aud.
Patient Resource: Medicare Observation Versus Admit DaysTerri Embry RN BS
This resource provides information a patient, their advocate or a health care professional can use to learn about this topic. Hyperlinks are embedded to allow for self guided research and is encouraged.
Accountable Care Organizations (ACOs) are organizations of health care providers who provide care to a group of patients. Created in an attempt to decrease the cost of service delivery and increase efficiency, value and profit, these organizations are new territory for the CPA professional. This presentation was given to the Michigan Association of Certified Public Accountants at their Healthcare Conference on April 23, 2013.
Read the scenario that you will use for the Individual Projects in ea.pdfashokarians
Read the scenario that you will use for the Individual Projects in each week of the course. The
Centers for Medicare and Medicaid Services (CMS) has taken on a more visible role in health
care delivery. Many changes have transpired to improve patient safety along with the
implementation of additional quality metrics, and these changes impact reimbursement rates
Likewise, the Patient Protection and Affordable Care Act has changed the reimbursement fee
structure of Medicare and Medicaid reimbursement for health care services. Other legislation
including the HITECH Act and the Medicare Authorization and CHIP Reactivation Act of 2015
(MACRA) all impact how healthcare organizations receive reimbursement and demonstrate use
of data to improve quality and delivery of patient care Mr. Magone, CEO of Healing Hands
Hospital, has asked you to join the \"Future of Healing Hands Task Force, and your first
assignment is to work with the Hospital Chief Financial Officer, Mr. Johnson, and provide a
summary of the current regulations regarding Medicare reimbursement including how MACR
impact reimbursement if/when Healing Hands coordinates delivery of services by affiliating with
physician practices For this assignment, write a 2-3 page report that you will deliver to Mr.
Magone on how the new CMS initiatives and regulations impact the organization\'s revenue
structure. In your presentation, address the following questions: Why did CMS become more
involved in the reimbursement component of health care? How does CMS\'s involvement impact
the reimbursement model for Healing Hands Hospital and other health care organizations If
CMS reimbursement regulations for Medicare and Medicaid change, does it follow that other
insurance providers change heir policies on reimbursement? What tools can be implemented to
ensure organizations such as Healing Hands Hospital and physician practices are meeting the
policies and procedures set forth by CMS? Identify 3 tools from the CMS Web site that are
helpful in meeting the requirements for Medicare reimbursement set forth by CMS
Solution
Part-a & part-b:
The physician’s work, practice expense, and malpractice, RVU values, CMS (centers for
Medicare and Medicaid services) is required to control overall expenditures in health care
organization. Therefore, CMS become highly involved in the reimbursement component of
health care to patients as per their \"insurance packages\". The CMS\' involvement in “budget
Neutrality” & the reimbursement model at Healing Hand hospital & other health care
organizations is mainly for physician RVU based payments from Medicare & Medicare that can
control its physician costs by adjusting physician payment rates based on “previous periods in a
calendar year” as per federal acts and regulations. The Medicare is going to control physicians
costs according to “medical procedures and medical visits of their record” in a Jan- 1 ending Dec
31. Conversion Factor is main basis to control the physician costs ac.
Accountable Care Organizations and Physician Joint Ventures .docxAMMY30
Accountable Care Organizations and Physician Joint Ventures
Jeffrey P. Harrison
Chapter 9
“I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient.”
—from The Hippocratic Oath (modern version)
Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale.
1
Learning Objectives
Demonstrate an understanding of the interparty relationships associated with healthcare joint ventures and accountable care organizations.
Understand some of the dynamics and controversies surrounding the concept of accountable care organizations as an alternative approach to the current marketplace.
Demonstrate a basic understanding of the patient-centered medical home with attention to how it supports network-based delivery systems.
Master the concept of physician–hospital alignment and health system integration including consumer, provider, and regulatory developments.
Assess the emerging role of medical groups and hospital-owned group practices across the continuum of healthcare services.
Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale.
2
Key Terms and Concepts
Accountable care organization (ACO)
Clinical integration
Equity-based joint venture
Hospitalist model
Integrated physician model
Medical foundation
Patient-centered medical home (PCMH)
Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale.
3
Introduction
A positive relationship between hospitals and physicians is important to the success of the US healthcare system, because hospitals and physicians can be both collaborators and competitors.
Many hospitals and healthcare systems have moved to various models of physician integration through which hospitals hope to capture market share and physicians seek financial security.
After the Affordable Care Act (ACA) was passed in 2010, physician–hospital alignment became driven by another factor: cost control and quality outcomes in the accountable care era (Reiboldt 2013).
Physicians work in a wide range of settings and serve in leadership positions that have significant responsibility for quality of care.
Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale.
4
Clinical Integration
What Is It?
Coordination of patient care between hospitals and physicians across the healthcare continuum— e.g., an accountable care organization (ACO).
Provides an opportunity to coordinate services through centralized scheduling, electronic health records, clinical pathways, management of chronic diseases, and innovative quality improvement programs.
Clinical integration is necessary to delivering high-quality, affordable care in the current environment (Jacquin 2014).
Clinical.
1) The payment models in healthcare are shifting from fee-for-service to value-based models that tie reimbursement to quality outcomes and cost savings. This transition is being driven by rising healthcare costs, the Affordable Care Act, and commercial insurers.
2) Providers now need to accelerate preparations for managing clinical and financial risk through value-based contracts. This requires changes to business models, physician alignment, and supporting patients through the transition.
3) For organizations to succeed under value-based contracts, they must define population health strategies, implement coordinated care delivery models, and carefully sequence clinical and financial transformations to capture savings while maintaining stability.
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To implement a CRM for real estate, set clear goals, choose a CRM with key real estate features, and customize it to your needs. Migrate your data, train your team, and use automation to save time. Monitor performance, ensure data security, and use the CRM to enhance marketing. Regularly check its effectiveness to improve your business.
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How to Start Up a Company: A Step-by-Step Guide Starting a company is an exciting adventure that combines creativity, strategy, and hard work. It can seem overwhelming at first, but with the right guidance, anyone can transform a great idea into a successful business. Let's dive into how to start up a company, from the initial spark of an idea to securing funding and launching your startup.
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How to Implement a Strategy: Transform Your Strategy with BSC Designer's Comp...Aleksey Savkin
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Unveiling the Dynamic Personalities, Key Dates, and Horoscope Insights: Gemin...my Pandit
Explore the fascinating world of the Gemini Zodiac Sign. Discover the unique personality traits, key dates, and horoscope insights of Gemini individuals. Learn how their sociable, communicative nature and boundless curiosity make them the dynamic explorers of the zodiac. Dive into the duality of the Gemini sign and understand their intellectual and adventurous spirit.
[To download this presentation, visit:
https://www.oeconsulting.com.sg/training-presentations]
This PowerPoint compilation offers a comprehensive overview of 20 leading innovation management frameworks and methodologies, selected for their broad applicability across various industries and organizational contexts. These frameworks are valuable resources for a wide range of users, including business professionals, educators, and consultants.
Each framework is presented with visually engaging diagrams and templates, ensuring the content is both informative and appealing. While this compilation is thorough, please note that the slides are intended as supplementary resources and may not be sufficient for standalone instructional purposes.
This compilation is ideal for anyone looking to enhance their understanding of innovation management and drive meaningful change within their organization. Whether you aim to improve product development processes, enhance customer experiences, or drive digital transformation, these frameworks offer valuable insights and tools to help you achieve your goals.
INCLUDED FRAMEWORKS/MODELS:
1. Stanford’s Design Thinking
2. IDEO’s Human-Centered Design
3. Strategyzer’s Business Model Innovation
4. Lean Startup Methodology
5. Agile Innovation Framework
6. Doblin’s Ten Types of Innovation
7. McKinsey’s Three Horizons of Growth
8. Customer Journey Map
9. Christensen’s Disruptive Innovation Theory
10. Blue Ocean Strategy
11. Strategyn’s Jobs-To-Be-Done (JTBD) Framework with Job Map
12. Design Sprint Framework
13. The Double Diamond
14. Lean Six Sigma DMAIC
15. TRIZ Problem-Solving Framework
16. Edward de Bono’s Six Thinking Hats
17. Stage-Gate Model
18. Toyota’s Six Steps of Kaizen
19. Microsoft’s Digital Transformation Framework
20. Design for Six Sigma (DFSS)
To download this presentation, visit:
https://www.oeconsulting.com.sg/training-presentations
Innovation Management Frameworks: Your Guide to Creativity & Innovation
Acospin
1. INTERNAL USE ONLY
CMS Sensitive or Controversial
Questions and Answers
Regarding the Medicare Shared Savings Program (Shared Savings Program)
Notice of Proposed Rule Making (NPRM) Release
March 31, 2011
What is an ACO?
Under the proposed rule, an ACO refers to a group of providers and suppliers of services (e.g.,
hospitals, physicians, and others involved in patient care) that will work together to coordinate
care for the patients they serve with Original Medicare. The goal of an ACO is to deliver
seamless, high quality care for Medicare beneficiaries, instead of the fragmented care that has so
often been part of fee-for-service health care. The ACO would be a patient-centered
organization where the patient and providers are true partners in care decisions.
The Affordable Care Act specifies that an ACO may include the following types of groups of
providers and suppliers of Medicare-covered services:
ACO professionals (i.e., physicians and hospitals meeting the statutory definition) in
group practice arrangements,
Networks of individual practices of ACO professionals,
Partnerships or joint ventures arrangements between hospitals and ACO
professionals, or
Hospitals employing ACO professionals.
Other Medicare providers and suppliers as determined by the Secretary
In the proposed rule, the Secretary has made clear that certain critical access hospitals are
eligible to participate in the Shared Savings Program.
What do these rules mean for people with Medicare?
Any patient who has multiple doctors probably understands the frustration of fragmented and
disconnected care: lost or unavailable medical charts, duplicated medical procedures, or having
to share the same information over and over with different doctors. Accountable Care
Organizations are designed to lift this burden from patients, while improving the partnership
between patients and doctors in making health care decisions. People with Medicare will have
better control over their health care, and their doctors can provide better care because they will
have better information about their patients’ medical history and can communicate with a
patient’s other doctors.
2. 2
Medicare beneficiaries whose doctors participate in an ACO will still have a full choice of
providers and can still choose to see doctors outside of the ACO. Patients choosing to receive
care from providers participating in ACOs will have access to information about how well their
doctors, hospitals, or other caregivers are meeting quality standards.
If You Like What You Have, You Can’t Keep It
If a beneficiary’s physician joins an ACO, that beneficiary must either become part of the
ACO or find a new physician. The President has said “if you like what you have, you can
keep it.” This doesn’t seem to be the case in the ACO rule. Why is the President forcing
beneficiaries who want to keep what they have to change physicians?
Patient and provider participation in an ACO is purely voluntary. Patients in an ACO maintain
complete freedom of choice to select their Medicare providers. We have proposed that providers
participating in an ACO notify the beneficiary that the provider participates in an ACO. The
beneficiary may then choose to receive services from that provider or seek care from another
provider that is not part of the ACO.
Improving coordination and communication among physicians and other providers and suppliers
will help improve the care Medicare beneficiaries receive.
Limiting Care for Beneficiaries / Sharing Risk
Your proposal would require all ACOs to bear risk – much like an HMO or managed care
organization. Isn’t the easiest way for an at-risk ACO to make a profit or to avoid having
to repay money to CMS by limiting beneficiaries’ access to care? How do you propose to
monitor and prevent an ACO from limiting care?
ACOs that skimp on care will not qualify for bonuses. Under the proposed rules, to share in
savings, ACOs would meet quality standards in five key areas:
Patient/caregiver experience of care
Care coordination
Patient safety
Preventive health
At-risk population/frail elderly health.
The proposed rules also include strong protections to ensure patients do not have their care
choices limited by an ACO. CMS has proposed a vigorous monitoring plan that includes
analyzing claims and specific financial and quality data. We plan to generate quarterly and
annual aggregated reports, visit some ACOs on site, and perform beneficiary surveys to make
sure that ACOs are not stinting on care and are not avoiding at risk beneficiaries.
The Affordable Care Act contemplated a “Shared Savings Program” where ACOs would
not have to accept risk. Yet your proposal requires that all ACOs accept risk either from
the beginning or in the third year of their 3-year agreement. Haven’t you essentially
rewritten the law without involving Congress?
3. 3
No, we propose to intensify the incentive for shared savings as outlined in the Affordable Care
Act, making the policy more likely to meet the goals laid out in the law. In fact, Congress’s own
advisory group, the Medicare Payment Advisory Commission (MedPAC) has said that it
believes offering a two-sided risk model is necessary for the program to meet its potential.
MedPAC believes the two-sided risk model would increase the strength of the incentives to
control spending and volume.
That said, the rule is in proposed form and we are interested in hearing public and stakeholder
views on this and other parts of the proposal.
Data Sharing
The rule proposes to share beneficiary-identifiable data with an ACO. Does the beneficiary
get to opt-out of or opt-in to the data sharing?
Beneficiaries’ data will not be shared if they don’t want it to be shared. Beneficiaries will be
given information in writing about sharing personal health data the first time that they see an
ACO provider. At that time, they will be offered the opportunity to opt out of having their
Medicare claims data shared with the ACO. Under the proposal, the ACO would only be able to
request data for beneficiaries who have visited a primary care provider and who have not chosen
to opt-out of data sharing.
How do the privacy laws allow you to share data on a beneficiary’s use of services by non-
ACO providers with the ACO?
The HIPAA Privacy Rule permits CMS to share beneficiary identifiable data with ACO
providers for the purpose of treatment and operations. ACO providers are only allowed to use the
data for legally permissible purposes, according to the HIPAA Privacy Rule. The proposal takes
the extra step of giving beneficiaries to option of preventing this permissible sharing of data.
What type of data is CMS providing to ACOs?
One important barrier to improving care coordination is that doctors often lack full information
about the medical care their patients are or have received. In our discussions around the country
with providers on this topic, we heard that while providers may know about the services they
provide to the beneficiary, they don’t know about other services provided to the beneficiary.
CMS will provide doctors with the whole picture of medical services their patients are receiving.
Part A and B data elements may include: beneficiary ID, date of birth, gender, procedure codes,
diagnosis codes, dates of service, provider/supplier ID, and claim payment type. Part D data
elements may include beneficiary ID, prescriber ID, drug service date, drug product service ID,
and formulary identifier. This will help reduce duplicating care for patients – subjecting them to
multiple unnecessary tests – as well as reduce adverse events.
Physician vs. Hospital and Specialists ACOs
Given the risk-bearing emphasis in the rule, it seems likely that only hospitals would be
able to meet all your requirements. Isn’t your proposal just going to force doctors to give
up their practices and become employees of the hospital?
4. 4
No. The goal of the program is to encourage care coordination between all providers, including
physicians and hospitals. We think ACOs will develop in various innovative ways, according to
the unique needs of each community. Some ACOs will be networks of physician group practices,
others will be partnerships or joint ventures between hospitals and physicians, and others will
create innovative models to achieve the goals of the program.
The proposal includes options and incentives for physicians to other types of providers to form
and join ACOs. For example, there is an option for one-sided risk that will allow physician-
based ACOs time to ramp up to bearing down-side risk. And, small ACOs in rural and
underserved communities are exempt from the extra 2 percent minimum savings threshold,
allowing them to get savings sooner than other types of ACOs.
We are interested in obtaining comments on the proposed rule on the kinds of ACOs that will
form. We want to ensure a robust and varied field of providers, not a one-size fits all model, and
seek approaches that will facilitate the development of a varied field.
How are networks of physician practices, particularly small physician practices in rural
areas with limited resources, will be able to quality and function as ACOs? How many
rural ACOs do you expect could meet all your onerous requirements?
Improving care for patients in rural areas is critically important. The Affordable Care Act
included a number of provisions to assist rural providers, and the Medicare Shared Savings
Program provides flexibility to organizations to determine the best structure to form an ACO.
We expect ACOs to form in rural areas as networks of physician group practices work together
to coordinate care. We have proposed that certain critical access hospitals are eligible to
participate as an ACO which should encourage ACOs to form in rural areas. We think rural
providers will work together to creatively leverage resources to meet the requirements of the
program. And, small ACOs in rural and underserved communities are exempt from the extra 2
percent minimum savings threshold, allowing them to get savings sooner than other types of
ACOs.
We do not believe that the rule will disadvantage one group of providers over another, but look
forward to hearing comments from the community on this issue.
There is a higher “minimum savings threshold” before shared savings can be received for
small versus large ACOs. Isn’t this an obvious bias against the creation and inclusion of
small ACOs?
The reason to have a threshold in the first place is that there is often annual fluctuation in health
spending that has nothing to do with the performance of health care providers – and the smaller
the group of providers for which you are tracking spending, the greater that fluctuation. The
minimum savings threshold is designed to ensure that shared savings result from performance,
not from such fluctuations. That is why it is higher for small ACOs (3.9 percent) and lower for
5. 5
large ACOs (2 percent). That said, we welcome comments on this and other provisions of the
proposed regulation.
Why not let specialists rather than primary care doctors determine how beneficiaries are
assigned to ACOs? Specialists are often the primary care providers for seniors.
This proposed rule, and the Medicare program in general, recognize the importance of primary
care, no matter who delivers it. For example, the performance measures that determine how
much of the shared savings an ACO gets are blind to which ACO provider or supplier delivers it.
That said, the Affordable Care Act identifies certain types of physicians as primary care
providers, and that definition is used in this rule. We look forward to hearing comments on
whether this approach best achieves the goals of the Medicare Shared Savings Program.
Onerous Requirements
The proposed rule includes a number of onerous requirements prescribing how ACOs
must be structured, including governance structure, program integrity requirements, use
of savings, and 12 prescriptive patient centeredness criteria. Won’t this limit flexibility for
that ACOs need to innovate in the market?
The proposed rules do not impose requirements beyond those often required for other
organizations responsible for Medicare beneficiary health, such as hospitals, managed care
organizations or others. CMS has proposed certain criteria in order to make sure that ACOs are
real organizations that are prepared to accept accountability for beneficiary health.
From experience with Medicare Advantage plans and Medicare prescription drug plans, CMS
has learned the importance of setting requirements at the start of the program that set an
organization on a path to compliance in order to protect beneficiaries.
This proposal strikes the appropriate balance between setting reasonable requirements to protect
beneficiaries and allowing the industry the flexibility to innovate. We look forward to hearing
from the provider community how best to ensure integrity of the program, and care
improvements, through this new proposed regulation.
Isn’t the requirement that at least 50 percent of participants must be using EHRs a back-
door way to screen out rural providers and physicians in small group practices?
No – it is designed to ensure that the ACO providers and suppliers have the means of
communicating with each other, coordinating care, and minimizing the new reporting
requirements since many of the quality measures used in the Shared Savings Program are also
measures for “meaningful use” for electronic health records (EHRs). That said, we welcome
comments on this and other provisions of the proposed regulation.
Reevaluation of ACO Applications
The proposed rule indicates that CMS plans to reevaluate an ACO’s application every time
the ACO changes a business process or when a provider joins or leaves the ACO.
6. 6
What’s the rationale for this level of Federal oversight? How quickly is CMS going to
make these decisions?
We believe our proposal strikes the appropriate balance between setting reasonable requirements
to protect beneficiaries and allowing the industry the flexibility to innovate.
As with other industries, significant changes in ownership trigger review to ensure the entity
continues to meet standards that protect both patients and taxpayers. That is why we have
proposed review of certain changes to the ACO’s processes that are different from the ACO’s
initial application. The Agency will extend its customer focus to ensure organizations receive
timely response.
Waivers
On October 5th, CMS hosted an all day conference to solicit input from the industry about
items in the law that might need to be waived. The provider community offered numerous
suggestions for needed flexibilities. Yet, in the proposed rule, CMS is only proposing to
waive payment of shared savings. Why didn’t the Agency incorporate other suggestions
into the rule?
A: Existing rules designed to limit fraud and “kick-backs” that result from provider referring
patients to each other were often designed before organizations like ACOs were on the horizon.
We received helpful public comment from the October 5 meeting and also in response to the
November 17 Request for Information Regarding Accountable Care Organizations and the
Shared Savings Program. We used those comments in the development of our proposed rule and
the waiver notice with comment period.
The rule seeks public input on the possibility of additional or different waivers, as well as any
additional safeguards that might be necessary to protect beneficiaries and the Federal health care
programs. We will consider all comments that we receive in response to our proposal as we
finalize the rule.
Changing the Rules in the Middle of the Game
It appears that the proposed rule would allow CMS to change the rules of an ACO
agreement after the ACO signs such an agreement with CMS. What is the rationale for
changing the rules on providers in mid-stream?
The fundamental aspects of the ACO rules won’t change, after they become final. For example,
we do not anticipate that eligibility requirements relating to the structure and governance of the
ACO; calculation of sharing rate; and beneficiary assignment.
However, other aspects of the program may change as CMS works with participating ACOs and
beneficiaries to learn what is and is not working. Those potential program modifications, which
may include quality measures, routine program integrity requirements, processes for quality
management and patient engagement, and patient centeredness criteria, are unlikely to affect the
7. 7
ACO’s underlying organizational structure or its continued eligibility to participate in the
program.
The Financial Benchmark
The statute describes a straight-forward way to calculate the benchmark based on
historical costs of beneficiaries actually assigned. The rule proposes a complicated
benchmark that isn’t based on beneficiaries actually assigned to the ACO. Why did this
change, and isn’t this unfair to providers by not taking into account their specific patients?
The benchmark is the standard to which an ACO’s performance is compared. It should
represent the best estimate of what would otherwise happen in the absence of the ACO. We
believe that establishing the benchmark based on average beneficiary expenditures adjusted for
demographic characteristics would result in the best estimate of the ACO’s performance. That
said, we welcome comments on this and other provisions of the proposed regulation.
Why only share 50 to 60 percent of the savings that an ACO achieves with the ACO? Is
that fair?
Today, Medicare gets all of the savings when providers reduce unnecessary care – under the
Program and proposed rules, ACOs get a significant share of the savings. We think that this
strikes the right balance, but welcome comments on it and other provisions of the proposal.
Windfall Bonuses
Your financial benchmark is increased by the absolute amount of growth in per capita
Medicare fee-for-service expenditures. Won’t this provide windfall bonuses to areas that
are already efficient?
The statute requires that the financial benchmark be updated by the absolute amount of growth in
per capita fee-for-service Part A and B spending. This helps prevent spending in the program
from exceeding overall Medicare spending growth.
Withhold of Shared Savings
The proposed rule would withhold 25 percent of an ACO’s shared savings performance
payment to make sure the ACO is able to pay back any losses. How do you expect an ACO
to incur the expenses to implement effective care coordination interventions if legitimately
earned shared savings incentive payments are withheld?
The proposed rule balances the need to create reasonable incentives to help providers invest in
improving care coordination, and the need to protect the Medicare Trust Funds. We believe our
proposal is a reasonable approach to make sure the ACOs are able to pay Medicare for any losses
without creating an undue burden on providers. That said, we welcome comments on this and
other provisions of the proposed regulation.
Quality
8. 8
The proposed rule includes 65 quality measures to assess the quality of care furnished by
an ACO. However, the rule does not actually propose the specifics for certain measures or
establish the performance standards until after the period ends.
How can an ACO take steps to improve quality if the organization does not know the
quality requirements until after the fact?
As a reminder, in 2012, participating ACOs must report on these measures, but will not have
their shared savings affected by their performance on the standards. We think our proposed
quality measures give potential ACOs the information they need to decide whether they should
participate in the program. Many of the quality measures are measures endorsed by the National
Quality Forum and will be familiar to most ACOs. We expect to provide more details on the
quality measures in sub-regulatory guidance.
Cost Shifting
Won’t ACOs just shift their costs to other payers, leading to an increase in the overall
health care costs?
A number of safeguards are built in to ensure that ACOs produce savings to the system. For
example, the performance standards that ACOs must meet require them to develop processes and
interventions to improve care coordination for Medicare patients. Yet, ACOs will likely apply
those interventions to all patients, not just those assigned according to this program. This will
lead to system-wide savings. We also propose to stop participation of ACOs that are avoiding
at-risk patients as way to save money. We will monitor spending closely and calibrate the
Program policies to ensure that it is a win-win: better quality for patients and lower spending for
the health care system.
60-Day Comment Period
The proposed rule makes significant changes to the health care system and involves 4
major Departments of the government – yet it only gives the public 60 days to comment.
Why are you only giving the public 60 days to analyze your proposal and submit
comments?
60 days is the typical time provided for the public to comment on CMS proposed rules. The four
agencies have held numerous meetings and calls on key issues on the program, and have
conducted varying stakeholder sessions across the country over the past year to seek input from
interested parties. Our work in engaging the public and soliciting comment and ideas has been
ongoing for more than 12 months. HHS also announced it will hold a series of open-door forums
and listening sessions during the comment period to help the public understand what CMS is
proposing to do and to ensure that the public understands how to participate in the formal
comment process
Innovation Center ACOs
How is this proposal different from what the Innovation Center will test for ACOs? When
will your Innovation Center ACO proposal be released?
9. 9
A: The Center for Medicare and Medicaid Innovation is charged by the Affordable Care Act to
test innovative care and service delivery models. CMS is currently exploring how the Innovation
Center will test alternative payment models for Accountable Care Organizations (ACOs). Once
the Innovation Center releases a proposal, we will be able to provide additional information
comparing the Medicare Shared Savings Program and the testing of new delivery models by the
Innovation Center.
ACOs Based on Failed PGP Demo
The proposed ACO model is based on the Physician Group Practice (PGP) demonstration.
A recent article in the New England Journal of Medicine (NEJM) pointed out the PGP
demo was largely unsuccessful for most organizations in achieving shared savings. The
NEJM article estimated that most of the PGP demo sites did not recoup their investments
over a 3-year period. Since those PGP sites were large organizations that had the best
chances for success, why do you think ACOs would be successful under your proposal?
A: While many design parameters are similar to the PGP demo, there are some design
differences in the proposed rule. We have received significant interest in the proposed model and
we believe many organizations are eager to innovate and make the investments necessary to
change the delivery system. We also believe ACOs may see cost savings from improved
efficiency, in addition to receiving shared savings that would help the ACO recoup the upfront
infrastructure investment.
Won’t some ACOs become a monopoly and drive up costs while limiting access to care?
Need CMS to insert answer.