Many health care delivery organizations believe fee-for-service (FFS) and value-based care (VBC) economic models are at odds with each other. Many analogies highlight this divergence—with perhaps the most popular being the illustration of an individual with one foot grounded on the dock and the other foot on a boat slowly pulling away. While this visual is powerful, it overstates the necessity for an either-or approach. The tensions between the two models can make organizations very uncomfortable. FFS has been the backbone of the domestic health care delivery system for decades and offers rela ..read more

With the Strategy Accelerator program, efforts to strategically prioritize your physician alignment initiative take shape Note: Eric Lam, Associate Principal, Sg2, and Jennifer O’Connor, FACHE, Principal, Sg2, also contributed to this post. As internal and external pressures push care out of the hospital, health systems must identify the best clinical opportunities and local trends for expanding their ambulatory business. Innovator organizations understand there are both opportunities and vulnerabilities amid wide variations in which the shift is occurring in local markets. Precisely calibrati ..read more

Editor’s note: Shannon Stewart, Senior Consulting Director, Reliability and Management Systems, authored this post, which was originally published on Sg2’s parent company Vizient Inc’s blog. Hospitals and health systems are investing a lot of resources to thoughtfully and strategically plan how they will meet their communities’ needs in the future. They’re developing strategic plans that outline the path and steps needed to arrive at that future state. Embedding high-reliability principles—such as management systems that proactively engage employees—is essential to your hospital’s progress. To ..read more

Editor’s note: Terri Scannell, Vizient Senior Social Responsibility Director, authored this post, which was originally published on Sg2’s parent company Vizient Inc’s blog. Chances are, you may have heard of a little acronym called ESG. What you may not know, however, is what it means exactly and why it’s important for healthcare. After all, the last thing we need is another acronym. While it’s easy to explain what each letter stands for—environmental, social and governance—its implications are more complex. ESG is often used interchangeably with more familiar terms like sustainability and cor ..read more

Environmental factors are adversely impacting provider financials and weakening providers’ positions in fee-for-service (FFS) contracting. Providers have been working to regain financial stability after pandemic-driven volume swings that were quickly followed by workforce shortages—now the health care industry can add inflation to the list of considerable challenges. These pressures have quickly eroded already low operating margins and in most cases have been exacerbating losses for many providers and systems in 2022. Broad inflation is the latest environmental force adversely impacting provid ..read more

Medicare’s new Enhancing Oncology Model (EOM) is an important opportunity for oncology practices to participate in a voluntary alternative payment model (APM) designed to increase the value of care for Medicare fee-for-service (FFS) patients undergoing chemotherapy. This five-year model not only builds on the Oncology Care Model (OCM) and offers incentives to manage care while reducing spending under Medicare FFS, it also adds incentives to address health disparities. Set to begin July 1, 2023, potential EOM participants must submit a nonbinding application by September 30, 2022, to secure the ..read more

Editor’s Note: Jenna Stern, Vizient, AVP, Regulatory Affairs & Public Policy, also contributed to this post. In the absence of congressional intervention, a significant financial incentive for physicians to participate in value-based payment models will disappear at the end of 2022. To provide greater stability to providers reimbursed by Medicare, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) rescinded the flawed sustainable growth rate (SGR) methodology enacted by the 1997 Balanced Budget Act and aims to reward clinicians for value rather than volume. MACRA’s Quality Pa ..read more

Editor’s note: Joe Cummings, PhD, Vizient Technology Program Director, authored this post, which was originally published on Sg2’s parent company Vizient Inc’s blog. The COVID-19 pandemic has had a significant effect on our country’s most vulnerable populations, from who gets the SARS-CoV-2 virus to its impact on mental health and access to care. For example, the pandemic has tripled the already large numbers of people with depression, increased anxiety and substance abuse and has added to the backlog of wait lists for appointments and treatment. On the flipside, the pandemic has positively tr ..read more

Understanding the timeline: application process starts June 1, 2022 Medicare Shared Savings Program (MSSP) is Medicare’s established accountable care organization (ACO) program that allows for new participants every performance year (PY). To participate in MSSP, an organization must submit an application and be approved by CMS. For PY2023, the application process is as follows: An organization must submit a Notice of Intent to Apply (NOIA) before June 7, 2022. After submission, and once the organization has gained access to CMS’s ACO Management System, it can work on Phase 1 of the applicatio ..read more

Understanding the Transition: ACO REACH Replaces Current Direct Contracting Model On February 24, 2022, the Center for Medicare & Medicaid Innovation (CMMI) announced the ACO REACH (Realizing Equity, Access, and Community Health) Model, with an application period ending April 22, 2022. ACO REACH will replace the current Direct Contracting Model (DC) on January 1, 2023, as the highest level of risk/reward total cost of care model option for Medicare fee-for-service (FFS). The current DC model drew heavy scrutiny from certain stakeholders pointing to the potential of privatizing Medicare for ..read more