Newly Released Government Health Data Key for Doctors, Hospitals in CMS / CMMI Value Based Care Programs

Share Article

RowdMap, Inc. talks about Using Government Benchmarks to Intelligently Transition into Value-Based Care and Delivery at Centers for Medicare and Medicaid Services / Center for Medicare & Medicaid Innovation Kentucky State Innovation Model Conference.

News Image
Often doctors create hidden value as those most effective at managing no and low value care create the most value for whoever owns the risk. Using the new data allows them to pick and succeed in the right value based program.

RowdMap, Inc. talks about Using Government Benchmarks to Intelligently Transition into Value-Based Care and Delivery at Centers for Medicare and Medicaid Services / Center for Medicare & Medicaid Innovation Kentucky State Innovation Model Conference.

Joshua Rosenthal, PhD, Chief Scientific Officer and Co-Founder at RowdMap, Inc., will be speaking on how doctors and hospitals can use newly released government data to intelligently transition into value-based care delivery and payment by identifying and managing no and low value care at the 2015 Kentucky State Innovation Model HIT Innovation Forum, Tuesday, September 29th, 2015 – Bowling Green, KY.

The Kentucky Cabinet for Health and Family Services received a grant from the Center for Medicare and Medicaid Innovation (CMMI) of the Centers for Medicare and Medicaid Services. The SIM initiative was created for states committed to population health improvement through planning, designing, testing and supporting evaluation of new payment and service delivery models. The objective of Kentucky’s SIM model design grant is to engage a diverse group of stakeholders, including public and commercial payers, providers, advocacy groups, employers and consumers, to develop a state health system innovation plan.

Rosenthal will be speaking on a panel entitled “Using Technology & Data Infrastructure to Realize the Potential of SIM Reforms, with Christopher Clark, Executive Director, Office of Administrative and Technology Services; Chief Information Officer, Kentucky Cabinet for Health and Family Services; Patricia Mactaggart Senior Advisor, Office of the National Coordinator; Greg Moody, Director, Office of Health Transformation, State of Ohio. http://chfs.ky.gov/NR/rdonlyres/B02BA1C6-F52E-49EE-97A7-81321ED49E58/0/SIMInnov_Agenda_Sept14.pdf

Last year the US spent $850BB on low and no value care from higher intensity, and riskier treatment options that deliver no additional benefits to patients. Thirty cents of every dollar and up to 42% of patients receive his care every year. This low and no value care is driven by a Fee for Service (FFS) economic model where doctors and hospitals are paid more for doing more, and higher intensity treatment. This unnecessary spending far outweighs fraud, waste and abuse, but is not identifiable from traditional utilization reviews and unit cost analysis.

The Centers for Medicaid and Medicare Services (CMS) and CMMI has created a number of innovation programs to move from FFS to shared risk and value-based care, delivery and payments including a State Innovation Model (SIM) program, awarding a SIM grant to the state of Kentucky. http://innovation.cms.gov/initiatives/State-Innovations-Round-Two/ CMS has made historic data releases including the largest data set of doctors and hospitals in history to support identifying provider practice patterns with national and regional benchmarks in order to transition the delivery of care to value based payments. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-06-01.html

Joshua Rosenthal, PhD of RowdMap, Inc. will be presenting on how doctors, provider-led systems, specialist groups, hospitals and post-acute centers such as skilled nursing facilities and long term care facilities are using this newly-released CMS data to intelligently move to risk and value-based arrangements including bundled payments, Accountable Care organizations (ACOs), Managed Shared Savings Programs (MSSPs) and payer-provider risk arrangements including full capitation. “Often doctors are creating hidden value as those most effectively managing no and low value care create the most value for whoever owns the risk, but fail to get credit for it in unit cost or utilization reviews, even when case mix adjusted. Using the public benchmark data allows providers to pick the right value based program to get credit for their work.” Joshua Rosenthal, Chief Scientific Officer, RowdMap, Inc.

About RowdMap, Inc. :
An Ernst and Young EY Entrepreneur Of The Year® winner, RowdMap helps health plans, government payers, providers, and hospital systems develop Risk-Readiness (SM) strategies to excel as they transition from fee-for- service to pay-for value. As CMS sunsets fee-for-service payments, RowdMap's Risk-Readiness (SM) Platform helps payers and providers identify and manage unwarranted and unexpected variation. RowdMap identifies ideal provider arrangements based on provider practice patterns and population characteristics within a geography. Payers and providers then use RowdMap to build strategies around these new risk relationships. RowdMap helps them enter new markets, segment populations, identify waste, design products, and understand referral patterns. RowdMap's platform comes preloaded with government benchmarks out of the box no IT integration required. RowdMap's Risk-Readiness (SM) Platform works across all market segments and has significantly larger returns than traditional, medical economic approaches.

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Joshua Rosenthal
Visit website