Hospitals and Health Systems

With ACA implementation comes a stronger emphasis on Value Based healthcare. Medicare and commercial health plans have moved aggressively to reward hospitals and health systems for fewer infections and readmissions and increased coordination of care, especially those with chronic illness. The Medicare Shared Savings Program (MSSP) has created the opportunity for hospitals and health systems to collaborate with physicians in achieving savings in acute and post-acute care settings. The Bundled Payment for Care Improvement (BPCI) initiative seeks to achieve significant overall savings for the Medicare program by giving providers strong incentives to reduce inpatient and post-acute care costs.

The primary, indeed only, vehicle for participating in MSSP is the Accountable Care Organization (ACO). As of early 2015, the Center for Medicare and Medicaid Services (CMS) had contracted with over 400 ACOs covering over 7 million Medicare lives. Commercial plans also contract with ACOs, which account for perhaps an additional 10-12 million lives covered by these arrangements. Physician groups and hospital systems are the primary sponsors of ACOs, with health plans preferring so far to contract with rather than sponsor their own.

Valiante – Healthcare Management Solutions provides services to hospitals and health systems:

  • ACO design and development
  • Physician role in governance and operations
  • BPCI design and development
  • Back office analytical tools and IT/HIE infrastructure
  • Care coordination team
  • Beneficiary communication
  • Health plan, Medicare Advantage, Medicaid plan, TPA options