The Aftermath of the Change Healthcare Cyberattack: A Call to Action for Health Plans

ATTAC Consulting Group | March 8, 2024

The recent cyberattack on Change Healthcare affected clinical-decision support, eligibility verifications, chart abstractions, and pharmacy operations, and has highlighted vulnerabilities within the industry’s digital infrastructure. In light of these disruptions, plans need to explore the broader implications, particularly concerning Part D, CAHPS, Star Ratings, and the overall operational and financial health of provider networks. The cyberattack directly impacts several key areas of Medicare Advantage plan operations, potentially influencing Star Ratings for 2025 and beyond. Data related to quality measures, outcomes, and patient satisfaction ­­­­– key components of Star Ratings – are at risk of being delayed, corrupted or lost. This disruption can hinder a plan’s ability to deploy quality interventions and develop future strategies to impact the critical components.

Update On The Medicare Value-Based Care Strategy: Alignment, Growth, Equity

Health Affairs | March 14, 2024

Medicare is responsible for more than one in five dollars spent on health care in the United States. Given its size and mission, Medicare programs and policies have a major role in transitioning the health care system away from fee-for-service payment, which incentivizes the quantity of care, and toward value-based payment, which incentivizes higher-quality care and more efficient spending. In July 2022, in Health Affairs Forefront, the Centers for Medicare and Medicaid Services (CMS) articulated our overall Medicare value-based care strategy of alignment, growth, and equity. Since then, CMS has promulgated several final rules for both traditional Medicare and Medicare Advantage (MA), announced new alternative payment models...

CMS’ ACO Primary Care Flex Model Could Offer Home-Based Care Providers Risk-Based Opportunity

Home Health Care News | March 19, 2024

The Centers for Medicare & Medicaid Services (CMS) announced a new voluntary model Tuesday – centered around primary care providers – that could offer home-based care providers more opportunity to dive into risk-based care. Dubbed the ACO Primary Care Flex Model (ACO PC Flex Model), it will provide one-time advanced shared savings payments and monthly prospective primary care payments to Accountable Care Organizations (ACOs) to empower primary care providers, according to a CMS release. The model was another creation of the CMS Innovation Center. But here’s the key note for home-based care providers: “People whose primary care provider participates in the ACO PC Flex Model may get care in more convenient ways, like care based at home or through virtual means, extra help managing chronic diseases, and more preventive health services to keep them healthy,” CMS Administrator Chiquita Brooks-LaSure said in a statement.

The burnout paradox: How addressing SDOH can reduce provider stress

Medical Economics | March 14, 2024

A 2023 Medical Economics® report found that over the course of their careers, 92% of physicians have experienced burnout. In addition, 62% of providers currently feel burned out. The American Medical Association officially defines burnout as including a reduced sense of personal achievement, emotional exhaustion and a sense of depersonalization, having less empathy toward patients in their care. Several factors contribute to provider burnout, such as increased work hours as well as additional bureaucratic and administrative work. Other variables that can further exacerbate feelings of stress include a lack of leadership support, an augmented focus on productivity, and disparities in individual and organizational value alignment. Organizations owe it to their physicians and other clinicians — and the patients they serve — to implement changes to counteract provider burnout. Although some effective solutions may seem counterintuitive, they are worth exploring.