Category: CMS

Aetna’s Compassionate Care Program is a case management initiative that specifically targets health plan members with advanced illness, focusing on improving the quality of care they receive. As a result, explains Dr. Joseph Agostini, senior medical director of Aetna Medicare, these patients get more of the type of care that they want and spend less…

Anxiety caused by the wait for a non-urgent appointment or lack of awareness that they are assigned a primary care physician are just two barriers to appropriate ER utilization by a diverse Medicaid population, explains Laura Linebach, director of quality improvement at L.A. Care Health Plan. As part of a health plan-hospital collaboration with a…

The use of nurse-only health advice lines to reduce avoidable ER visits is up 10 percent over 2010 levels, according to HIN’s second annual survey on reducing avoidable emergency room use. In this podcast, Melanie Matthews shares key metrics from the 2011 survey, including program availability, health advice line use, new benchmarks on contributions from…

When healthcare providers and health plan case managers join forces in the physician practice, the end result is “care completion,” explains Dr. Randall Krakauer, medical director for Aetna Medicare. In his second HealthSounds interview, Dr. Krakauer describes how the meshing of complementary patient data and knowledge from payor and provider improves the “completion factor” of…

While hospitals might find CMS’s pure Medicare bundled payments initiative too restrictive, it won’t prevent them from addressing their costs in a bundled payments fashion, predicts Steve Valentine, president of The Camden Group. In advance of HIN’s ei…

An Ohio collaborative of Medicaid plans is using a rapid cycle quality improvement approach to reduce avoidable ER visits by its Medicaid beneficiaries. One of the five regions targeted by the collaborative is Toledo, Ohio — known for having the highest emergency department utilization in the nation. Mina Chang, Ph.D., of the Bureau of Health…

As one of 10 participants in the CMS Physician Group Practice Demonstration, Dartmouth-Hitchcock has developed a competency in population health management that is being deployed in current and planned ACO pilots. Dr. Barbara Walters, Dartmouth-Hitchco…

To avoid missing other opportunities inherent in the ACO model, payors and providers shouldn’t get hung up waiting for CMS’s rule for Medicare accountable care organizations, advises Greg Mertz, senior project director with the Healthcare Strategy Grou…

Even though the specifics of Medicare’s Shared Savings Program have yet to be defined, physician organizations can still position themselves to achieve cost savings through an independent accountable care organization (ACO), notes Jeffrey R. Ruggiero, …