Showing posts with label aco. Show all posts
Showing posts with label aco. Show all posts

March 1, 2023

"Physician Enablement Companies" Allow Small and Independent Physicians to Compete

Back in the day, a bunch of us expended a lot of effort, creativity, and collaboration to streamline and standardize the electronic claim transaction(s) for healthcare. The idea was to have such a rigorous data specification, it could meet the needs of every US payer for every US physician, lab, hospital, clinic, or facility. It got us past the days when health plans could use their own numbering systems for practitioners and organizations, or insist on using their own "local codes" for certain procedures or charges.

Pretty cool, huh? We saved billions of dollars and billions of trees by moving the lion's share of healthcare administrative transactions to electronic formats. In fact, for claims, remittances, eligibility, and enrollments, the HIPAA standards were the ONLY legal way to transmit. Health plans had to accept ANY valid claim, from any size healthcare provider.

Everything was hunky dory for about a minute.

Then came value-based care. Or, more to the point, value-based reimbursement. All of a sudden, providers were "invited" to take on some of the risk traditionally borne by private insurers and public health plans like Medicare and Medicaid. If they could prove they saved money (I mean "improved outcomes regardless of cost"), they got a piece of it. Every month seemed to bring a new pilot program, each with its own, relatively unregulated reporting requirements. Negotiating a worthwhile contract or administering a profitable approach required new sets of skills, from technical to clinical to actuarial.

In other words, small providers, hospitals, and clinics took a hard shot to the bottom line.

Into this black hole rode a new breed of white horse. The Physician Enablement Company. Our friends at Fierce Healthcare tell a story of one such company, Privia Health

"The company's strategy is to partner with providers by setting up a single tax ID entity that facilitates payer negotiations and clinical alignment while maintaining a provider’s legacy ownership structure. It also organizes ACOs for risk-bearing value-based contracts and provides its tech and services platform."

The article also mentions other companies in the space, including Aledade, Vytalize Health
and Pearl Health.

"The movement of value-based care is long overdue and primary care providers and community providers are on the forefront of that movement," [Parth Mehrotra, Privia Health President and CFO] told Fierce Healthcare recently. "I am generally surprised that a lot of consolidation hasn't happened and people haven't caught up to UnitedHealth and what they've done with Optum. I think you're seeing a lot of that catch-up happening now from a strategy perspective," he said.

If your organization has a need to identify and contact US physicians, you might consider our Authoritative Physician Database™. We start with data we extract monthly from the CMS NPPES system, the "single source of truth" for practicing physicians, hospitals, and other healthcare providers. We then aggregate or derive further data and metadata, resulting in 1 million+ U.S. Physicians with specialties, practice group & hospital affiliations, graduation year, payments, phone, fax and more.

We also recommend letting Lowell and the Feat play you out.

April 12, 2016

Physician Quality Grading for Consumers

Update March 2023: Physician Compare data is available as part of a rich physician database compiled from Physician Compare and numerous other sources. All reported physician/facility affiliations are included, with more than 50,000 medical facilities covered. 

Columbia University Medical Center has just this week [week of 4/12/2016] published a guide to the Physician Compare quality data. While the release of physician quality data has been delayed, expectations are that it will appear in 2017.

CMS will generate star ratings based on data drawn from the Consumer Assessment of Healthcare Providers and Systems (CAHPS), the Physician Quality Reporting System (PQRS), as well as Accountable Care Organization (ACO) and claims data. CMS will set benchmarks based on the Achievable Benchmark of Care (ABC) methodology.

The data will be made available with the intent to help consumers to make informed decisions and to encourage physicians to improve performance, leading to more efficient and healthful outcomes.

CarePrecise will continue to monitor the project, and will begin including physician quality data in an upcoming product, The Authoritative Physician Database™, as it currently does with its product The Authoritative Hospital database™. CarePrecise is a leading supplier of healthcare provider data used in consumer-facing web and mobile applications, through special licensing arrangements.