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March 9, 2017

ACO roundup: CMS will expand RACs

Daily Briefing
    • The whiz-bang tech that helped one health system reduce patient falls. Mission Health piloted a "virtual sitter" system that significantly reduced patient falls—and has the potential to save the health system hundreds of thousands of dollars, three Mission Health leaders write in NEJM Catalyst. Cerner and Mission used Microsoft's Kinect sensor as the technological base for the program. Kinect uses a depth sensor and infrared camera to map the movement of objects in 3-D space and microphones to facilitate two-way communication, alerting a monitoring technician when a patient was at risk of falling. During the pilot from August to October 2015, the 98 monitored patients experienced no unassisted falls and no injuries, significantly less than unmonitored patients.

    • EHR-integrated electronic consult requests significantly improve access to specialty care. Since the Los Angeles County Department of Health Services implemented an electronic consult service in 2012, more than 3,000 primary care providers have signed up, and the number of consultations per month has increased from less than 100 in 2012 to more than 12,000 in 2015, according to a new study published in Health Affiars. Moreover, 25 percent of referrals are now resolved without a patient having to visit in person. The authors say the results are "likely relevant to any health system with significant constraints on specialty supply and access."

    • CMS will expand RACs. CMS is moving ahead with plans to extend the Medicare Recovery Audit Contractor (RAC) program to Medicare Advantage (MA), according to a spokesperson for the agency. RACs identify and recoup funds from cases in which providers allegedly inappropriately billed Medicare. CMS currently conducts Risk Adjustment Data Validation (RADV) audits on about 5 percent of MA contracts to determine whether MA insurers are overcharging and whether beneficiaries' diagnoses warrant higher payments. CMS proposed expanding the RAC program to all MA plans in 2015, and the agency last week said it "is in the process of contracting with a [RAC] to do additional audits." CMS said it plans to award a RAC contract this year to a private company to complete MA audits.

    From Advisory Board:

    • How to identify high performing primary care physicians. Strengthening you care network requires putting the right physicians in the right places. Learn how to identify the high-performing providers associated with your organization, and discuss strategies for using this information to strengthen your organization's network.

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    • Measuring your return on population health innovation. Across any risk-based contract, tracking changes in a population's per member per month spend is one industry standard to measure the impact of an organization's investments—especially during the early years of an intervention. Review our methodology for analyzing the return on population health investments, and then apply these skills using Population Health Advisor's newest tool: the Population Health Intervention ROI Estimator.

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