Articles
Two Out of Three Ain’t Bad: Why CMMI Needs One More Change to Make EOM a Success
When the Oncology Care Model (OCM) was coming to an end, there was much excitement around its replacement model, the Enhancing Oncology Model (EOM). Unfortunately, with downside risk being mandatory from the outset, The Center for Medicare and Medicaid Innovation...
The Healthcare Maze Podcast, ft. DRM CEO Brian Kern
August 23, 2022 Deep Risk Management's CEO, Brian Kern, was featured on The Healthcare Maze podcast to discuss the advantages and disadvantages of physician organizations participating in value-based care. Listen to the podcast here: https://mjmaes.com/podcast/
Enhancing Oncology Model: Downside Risk
EOM Participants must take downside risk for all performance periods. They will choose from one of two risk arrangement (RA) options: RA 1: To qualify for savings, participants must reduce expenditures by more than 4% off the benchmark (96% of the benchmark, or the...
Enhancing Oncology Model (EOM): Highlights
5 Year Model; 6-Month Performance Periods (“PPs”) Begins 7/2023; Applications Due 9/30/22 Total cost of care (TCC) model, available to practices and payors. 7 Cancers: Breast, Chronic Leukemia, Small Intestine/ Colorectal, Lung, Lymphoma, Multiple Myeloma, Prostate....
The New False Claim: When Healthcare Payor Recoupment Results in Double-Dipping
The transition from a fee-for-service to value-based care (VBC) healthcare reimbursement system has been slow, but steady. Countless medical providers and health systems now participate in some form of shared savings or shared risk model under a VBC paradigm. These...
Complying with Value-Based Risk as Healthcare Providers Transition from Fee-for-Service
With the start of every new year, we reflect on the progress we have made in the past and the changes that are needed as we move forward into the future. The same holds true for the future of the healthcare industry as we continue to transition away from...
Top Five Reasons NOT to Buy Stop Loss from Your Commercial Insurer
Legal disputes over the results of commercial value-based care (VBC) contracts are mounting. Groups should immediately rethink their strategy to accept the “built in” stop loss from payors. Here’s why: 1..Negotiation Most groups in VBC programs with commercial...
Value-Based Advisory Board Requests Clarification of Proper Accounting from CMS for Reimbursed VBC Payments
In an important letter for value-based care (VBC) participants, Centers for Medicare & Medicaid Services (CMS) is asked to confirm that reimbursed expenditures are properly accounted for. Click here to read the letter. Visit our Advisory Board page for more...
Another Win for VBC: Hospital Price Transparency Mandate Upheld
In a major victory for the independent practice of medicine and the value-based care movement, a lawsuit brought by The American Hospital Association (AHA) against The US Dept. of HHS* was dismissed on summary judgment. The US District Court of DC upheld the mandate...
Value-Based Healthcare: Four Elements for Success
Value-Based Healthcare: Four Elements for Success As it exists under the current fee-for-service (FFS) paradigm, US Healthcare is unaffordable, untenable and unsustainable. It is crucial that the prevailing framework evolve with value-based care (VBC) models, which...
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