Specialty care improves outcomes and reduces costs for CMS

CMS Improves Outcomes & Reduces Costs with Specialty Care

Streamlining Specialty Care: CMS’s Innovation Center prioritizes strategies that improve personalized healthcare information, implement financial services, and support segment-based classifications.

A value-based approach to care must address underlying issues and individualized care to reduce patient outcomes.

CMS’s innovation strategy describes ongoing efforts to integrate personalized care into the healthcare system.

Previous studies have shown that Medicare beneficiaries see more specialists and receive a greater variety of care. Primary and specialty care providers should be involved in the patient’s health journey to promote person-centered care. CMS’s innovation strategy includes four processes that support the integration of personalized care and  value-based care.

The first step is to provide personalized medical information to doctors, hospitals, and other healthcare institutions in different ways and with different programs. This requires the integration of multiple information systems to support a wide range of providers and participants.

In February 2024, the New Innovation Center began providing shadow data on managed care organizations (ACOs) in the Medicare Savings Program (MSSP) and ACO Models Reflecting Equity, Access, and Population Health (REACH). Shadow data packages contain summary claims data that ACOs can use when working with adjusters. The data provides insight into the quality of care and can help ACOs better manage beneficiary needs.

Launching on July 1, 2024, participants in the Primary Care (MCP) Model will receive performance profiles of specific practices in their markets, providing a comprehensive overview of personalized care. Participants receive specific safeguards regarding donor care and beneficiary status through a sample reporting tool.

Following Notes on Episode-Based Activities:

The second focus is on the extreme nature of situations and situations based on the nature of the attacks where the beneficiaries lack attention. New Innovation Center Promotional Enhanced Payments (BPCI Advanced) A two-year model to support and increase provider engagement in value-based care initiatives.

The institution is evaluating a model that would encourage coordination between intensive care hospitals and other providers of post-intensive care services, such as surgery. CMS is also considering how such a model could include subsidies for safety net providers and beneficiaries.

A case-based approach allows professionals to play a more active role in patient management. The Good Experience Guide (GUIDE) model, which supports people with dementia and their carers, will come into force on July 1, 2024. The new Innovation Center also launched its Oncology Patient Care (EOM) model on July 1.

A new group was added in July 2023. Number of Kidney Care Course (KCC) participants.

Funding for Special Projects:

 The third item shows how the new Innovation Center strengthens collaboration between primary care providers and specialists. The MCP model was specifically coded to expand the use of e-consultation, which supports ongoing communication between primary and secondary specialty care providers and the patients they share.

The model develops targeted and specific activities that help participants identify and monitor gaps or outcomes in specialty care throughout the care continuum. Participants collect beneficiary-level population data and screen for health factors including food security and housing vulnerability.

The New Innovation Center is also evaluating efforts to encourage private healthcare providers to partner with primary care providers and beneficiaries in ACOs.

A planned long-term focus model can foster a professional commitment to value-based care, with risks increasing over time. The Center aims to focus on high-income geographic areas on a long-term, community-based basis that supports the opportunity for professionals to participate in primary care.

Application points used by the Model:

The final strategy focuses on strengthening professional partnerships with ACOs. The strategy should ensure that ACOs can meet the unique healthcare needs of their beneficiary populations and that beneficiaries have access to more efficient and coordinated care.

The new innovation center is exploring more ways to integrate community-based models, such as developing community goals that provide new ways to pay for increasingly expensive things. The agency is exploring how data sharing can bring expertise to ACOs through a value-based approach.

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