Preventing Readmissions and Reducing Utilization of Unnecessary Services

By Ivy Xiwen Deng
Data Visualization by Sanat Malhotra

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 […]

By Blair Ford Mohney and Sarah Grace

In the last post, we highlighted trends in the migration of beneficiaries between Medicare fee-for-service and Medicare Advantage in the United States. In doing so, we can understand why this is such a hot topic for so many of our members across various markets. […]

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 […]

By Sarah Grace and Blair Ford Mohney
Data Visualization by Cody Elias

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 […]

By Ivy Xiwen Deng

Signed into law in March of 2010, the Affordable Care Act directed the release of Medicare data to the private and public sectors for performance measurement.

Until today, we haven’t had a trusted or transparent measure of costs or outcomes for the healthcare delivery system at the physician level. […]

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. [...]

By Timmy Del Vecchio

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 providers […]

By Edward Yurcisin

The Centers for Medicare & Medicaid Services (CMS) recently held the second annual Blue Button 2.0 Developer Conference on the 54th anniversary of Medicare. There were several key takeaways from the conference [...]

By Chris M. Lester

Community-level social determinants of health and economic distress explain some differences in health service utilization and disparities in health outcomes among Americans broadly, and perhaps especially among Medicare enrollees due to their age or disability status. […]

By Charlotte Jackson

Among people whose job it is to mine healthcare data for insights on population health and quality of care, there can be a tendency to assume that insights generated from one source of data (e.g., traditional Medicare) will naturally prove to hold true when applied globally to all patients […]

By Deepika Kumar

Listen in as Aneesh shares with CareJourney members and partners the key highlights from HIMSS 2019; covering topics such as Consumer-Directed Exchange, Bulk APIs regulations, FHIR Accelerators, and more. […]

By Ben Bigelow

The ecosystem of healthcare data is vast. There are electronic health records (EHRs), medical claims, lab results, biometrics, and a whole slew of other data sources, including open data published by organizations like the Center for Medicare and Medicaid Services (CMS). […]

By Timmy Del Vecchio, graphic by Ben Bigelow

As CMS recently made unembargoed Performance Year (PY) 2017 results available to ACOs in late August, ACOs were able to view not only PY 2017 financial expenditures relative to benchmarks, but also the ACO’s overall quality score for the performance year. For an ACO […]

By Ben Bigelow

Last week, CMS published the 2017 performance year results for the Medicare Shared Savings Program (MSSP). It comes on the heels of a new proposed rule from CMS that is meant to drive more accountable care organizations (ACOs) to take on downside risk, something few ACOs have […]

By Abbas Bader

As most of you are already aware, CMS released a rule proposing changes to the Medicare Shared Savings Program earlier this month.  By now, you have probably read several summaries of the key provisions of the rule, if not the full 607 pages of the rule itself.  In a […]

By Edward Yurcisin

As our President, Aneesh Chopra, often notes, there appears to be a “generational consensus” from leaders in Washington seeking to tap the expertise of the American people to solve big problems. This is exactly what happened on Monday August 13^thwhen the White House Office of American Innovation and CMS […]

By Chris Lester and Sabrina Chugani

Roughly 20 percent of the United States population lives in rural areas. Despite this, rural America faces a number of health-related challenges, some of which are structural, while some are related to regional differences in health and health care in this country. Compounding these issues, incomes […]

By Vinith Annam

Creating Patient Risk Groups

In a previous blog post titled Harnessing Open Health Data & Methodologies to Serve Value-based Care Networks, CareJourney discussed Harvard T.H. Chan School of Public Health’s development of a publically available patient segmentation model which identifies a small percentage of Medicare beneficiaries who account for […]

By Deepika Kumar

Our patient segmentation model finds that for MSSP populations across the country, most patients fall into the major complex chronic illness segment (to qualify for this segment, a patient must have two or more complex conditions or at least 6 non-complex conditions) and historically most of the day-to-day […]

By Aneesh Chopra, President and Co-Founder of CareJourney

Earlier today, at the opening ceremonies for the largest health IT conference of the year, Jared Kushner made a surprise appearance committing, unequivocally, to a “whole of government” approach to ensure patients and their caregivers can connect their health data to any application that helps […]