CareJourney Blog2020-04-06T12:17:29-04:00

Blog

A Pulse on Healthcare Insights, Trends, and Hot Topics

30Mar, 2020

Responding to a (Digital) “Call to Action” on COVID-19

We greatly appreciate our heroic frontline healthcare workers who are delivering much needed care during this public health emergency. To assist in the national response to the current pandemic, CareJourney is responding to a “call to action” issued by our nation’s Chief Technology Officer (a role held by our President, Aneesh Chopra), [...]

11Mar, 2020

Benchmarking ACO Network Utilization: Lessons Learned in Network Design and Performance

For organizations across the healthcare sector concerned with network building and management, utilization of the network among the attributed population is often a major area of focus. Whether from a provider or payer perspective, maintaining a high-performing network with high utilization allows organizations to more effectively manage the quality and cost of patient care. [...]

09Mar, 2020

Entering the “Consumer-First” Delivery Reform Era

Today, ONC & CMS finalized landmark rules to ensure safe, secure, standardized access to health information. Having spent some time on these issues, I’m pleased to read this White House post that puts these rules in historical context, and celebrates the bipartisan nature of this important endeavor. [...]

21Feb, 2020

Measuring the Success of Medicare Advantage Open Enrollment 2019

While much of the healthcare market hypes Open Enrollment (OE), for CareJourney, the months to follow are an equally exciting time. During OE, the Centers for Medicare and Medicaid (CMS) and health plans are able to recruit new (and retain existing) Medicare Advantage (MA) insurance plan beneficiaries as individuals select their choices for the year. [...]

31Jan, 2020

Understanding the Direct Contracting (DC) Payment Model

Earlier this year, the Center for Medicare and Medicaid (CMS) announced five new payment models designed to transform primary care by paying providers for outcomes rather than services. Direct Contracting and Primary Care First are two of these models announced by CMS to help encourage providers […]

27Jan, 2020

Investigating the Medicare Diabetes Prevention Program (MDPP)

Diabetes is a condition that affects more than 1 in 4 Americans age 65 and older.1 Centers for Medicare and Medicaid Services (CMS) estimated that Medicare spent $42 billion more on beneficiaries that have diabetes than it would have spent if those beneficiaries did not have diabetes. Let’s take a look at PMPY (Per Member Per Year) spend breakouts in 2018 [...]

09Jan, 2020

2018 MSSP ACO Results: Optimistic Savings Trends Encourage New CMS Risk Sharing Program

The Centers for Medicare and Medicaid Services (CMS) released the 2018 Financial Performance results on all Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP). CMS shared this data for the last six years, contributing to a more transparent, open evaluation of the program, and demonstrating how ACOs are not only increasing overall savings, but striving towards value-based care. [...]

06Jan, 2020

Exploring Variation in Healthcare Services in the Medicare Diabetic Population

As of February 2018, about 30 million people (or 9.4% of the U.S. population) suffered from diabetes; another 84 million people aged 18 or above had prediabetic symptoms.1 Diabetes is a chronic condition; proper and timely diabetes care management is critical to ensure that people with diabetes can avoid long-term sequelae and maintain their quality of life. [...]

20Dec, 2019

Medicare Advantage 101

Medicare is the federal health insurance program started in 1965 that is provided for individuals who meet certain criteria. Those who are over the age of 65, younger people who have certain disabilities, or anyone who has End-Stage Renal Disease (ESRD) qualify for Medicare insurance. In 1997 Medicare Advantage (at that time called Medicare+Choice) was signed into law which gave Medicare eligible beneficiaries more [...]

10Dec, 2019

An Exploration of the Primary Care First (PCF) Payment Model

Earlier this year, the Center for Medicare and Medicaid (CMS) announced five new payment models designed to transform primary care by paying providers for outcomes rather than services. One of the payment models is the Primary Care First (PCF) Model which is a voluntary, five-year alternative payment model (APM) aimed at reducing Medicare spending via prevention of acute hospital utilization, improving doctor-patient [...]

19Nov, 2019

Rethinking Referrals to Post-Acute Care

In the wake of the Affordable Care Act (ACA), hospitals have drawn attention from policymakers as key partners in reducing the overall cost of care. Consequently, the effort has led to an enhanced focus on preventing readmissions and reducing unnecessary care. The ACA implemented several policy measures to hold hospitals accountable for what happens to patients post-discharge. [...]

16Oct, 2019

UHS Case Study Webinar Recap: Improve Network Design and Management with Claims Data

Listen in as Mallory Cary, ACO Operations Director of Universal Health Services (UHS), one of the nation’s largest hospital management companies, and Abbas Bader, Director of Product Development at CareJourney discuss their collaboration on building better and more optimized networks using claims data and insights from CareJourney’s Network Advantage platform.

You […]

15Oct, 2019

Those Who Switch, Part 1: Understanding Geographic Trends in Medicare Advantage Enrollment

CareJourney’s Network Advantage platform is largely built upon the full Medicare fee-for-service claims dataset, but it is used by members to draw insights about population health and quality of care for all Medicare enrollees. While fee-for-service and Medicare Advantage beneficiaries are sometimes considered as two distinct groups, these populations are fluid, as beneficiaries can switch enrollments in any given year. [...]

27Sep, 2019

Member Spotlight: How a CareJourney Member Leverages Network Advantage and Population Insights for Market Expansion, Network Optimization & Integrity

The past decade has seen a remarkable increase in the number of lives covered in risk-based contracts. According to a recent article by Leavitt Partners published in Health Affairs, “At the end of the first quarter of 2018, we were tracking a total of 1,011 ACOs representing 1,477 distinct active accountable care payment contracts with public and private payers. [...]

27Aug, 2019

Tracking Unnecessary Care Through Claims-Derived Measures

As organizations continue the transition to value-based care, the need to (1) identify, (2) assess, and (3) eliminate wasteful spending continues to be a priority. From the identification perspective, initiatives like Choosing Wisely, started by the American Board of Internal Medicine, help both [...]

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