AI in healthcare and value-based care enablement are top developing trends in healthcare, but lack scalability so far, while big box retailers as providers and data interoperability have shown a high volume of activity in 2023, and are scaling with long-term trajectories. Rock Health’s report, which utilized data to determine the sequence of developments in the digital health space this year, shows there has been a great deal of activity in research, funding and partnerships pertaining to AI in healthcare and value-based care enablement in 2023.

It all starts with data. Hospitals and health systems have routinely named improving health equity as one of their leading goals. Lawrence Moss, CEO of Nemours Children’s Health, says it’s critical for hospitals to look at their own patient data to find if certain groups are having worse outcomes. In an interview with Chief Healthcare Executive®, Moss shares his own thoughts on how hospitals can make progress toward health equity. “It starts with examining, accepting and acting on their own data,” Moss says. Hospitals can look at certain key metrics and examine outcomes by racial groups, he says. To start, health systems could look at data on infection rates or asthma readmission rates stratified by rates, or other significant issues in their communities. Some health systems haven’t measured data in such a way, he says.

How Your ACO Can Optimize APP Reporting Using Medicare CQMs

Roji Health Intelligence | December 12, 2023

ACOs just gained a reprieve from implementing all-patient APP quality reporting in 2024. A provision in CMS’s Physician Fee Schedule Final Rule, which goes into effect on January 1, 2024, enables ACOs to report on Medicare patients only, based on CMS provision of eligible patient lists for three APP measures. If your ACO decides to delay aggregation of practice data for now, you need to consider how to optimize APP Reporting of Medicare CQMs. Using CMS’s list of patients eligible for measures will mean that your ACO will not need to aggregate data to determine who is eligible (“denominator” data). But make no mistake. Gathering measure responses (“numerator” data) from across your provider network will still require work from ACO staff.

During last week’s Primary Care Transformation Summit, Amy Nguyen-Howell, M.D., M.B.A., chief of the Office for Provider Advancement at Optum Health, and Nwando Olayiwola, M.D., M.P.H., chief health equity officer and senior vice president at Humana, detailed the data infrastructure they are building in their respective organizations to support health equity initiatives. As Humana’s first chief health equity officer, Olayiwola said her job is to make sure that they find a way to integrate health equity concepts into all the work that they do on the payer and provider sides. She noted that the company’s CenterWell provider organization has over 250 primary care clinics across the nation, as well as home care and pharmacy services.

ReferralPoint is a referral management solution for health systems, medical groups, and payers to transform their patient referral processes and support their fee-for-service and value-based care populations. Built on a top-performing population health platform, ReferralPoint uses cost and quality data to inform referral decisions to the highest quality, lowest cost, in-network providers then automates insurance verification, prior authorization, scheduling, and closing the loop. Seamless integration allows partners to increase revenue and savings, reduce leakage and costs, improve efficiency, and enhance patient satisfaction, all from within their EHR workflow.

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