Category: ACO - CLAIMSMED

HHSC Update: New Provider Management and Enrollment System (PMES)

5/20/2019

The Texas Health and Human Services Commission (HHSC) is preparing to roll out its new provider and enrollment system. With the help of associating and switching some processes and systems, the new Provider Management and Enrollment System (PMES) will reduce administrative burden for providers.

The following processes and systems will be consolidated into the PMES system:

Manual enrollment processes
Texas Medicaid Healthcare Partnership (TMHP) systems
Long Term Care
Vendor drug program
HHSC long term services and supports
Medical transportation program

PMES Rollout Timetable and Feedback Opportunity:
Throughout 2019, the HHSC will be preparing for a March 2020 implementation of the new system:

May: Provider collaboration and feedback opportunities
October: User testing
November: User training
By March 2020: Fully operational

Providers are encouraged to submit feedback about their needs through the implementation period at this link: “CLICK HERE”

Benefits of New PMES System for Providers

Single system to manage information even for providers with different lines of business. Easier to update information and renew enrollment.
Online “smart” application – providers apply for multiple programs once. Only relevant fields that must be completed will be shown.
Timeline reduced for enrollment and re-validation. Real-time workflows and electronic validations will reduce submission processing cycles. PMES will issue status alerts and automatic reminders.

Read more about the PMES system in this HHSC fact sheet

Centers for Medicare & Medicaid Services increases the requirement for data in accountable care program

4/13/2017

From the Centers for Medicare and Medicaid Services (CMS), a new accountable care program looks to deepen support for Medicare and Medicaid beneficiaries by dealing the social requirements, like help with housing, food, interpersonal violence problems, utilities and transportation.

Study: Accountable Care Organization tools have lukewarm impacts on cost savings, improvement in healthcare

4/8/2017

In an attempt to give better care at lower costs, Accountable Care Organizations (ACOs) offer several tools for physicians who engage in those programs. But when inquired about the efficiency of those tools in a latest Health Affairs survey, most physicians were lukewarm on the topic, demonstrating that their own tools and processes could just as conveniently be used to help in the transition from volume to value.

MACRA Performance Scores can be enhanced by 30% through ACO Participation

3/29/2017

Eligible clinicians must strategize the implications of payment under the program with the 1st performance year for the new Merit-Based Incentive Payment System (MIPS) underway. In contrast to the Physicians Quality Reporting System, Meaningful Use (MU) and the Value-Based Modifier, the performance of each clinician has been placed by MIPS on a curve, and adjusts payments deployed on their precise location in the distribution in comparison to others.

January 30th, 2017

1/30/2017

DMC (Detroit Medical Center) is glad to declare it has been chosen to participate in the year of 2017 Centers for Medicare and Medicaid Services’s (CMS’s) Next Generation Accountable Care Organization (ACO) Model, a transformative step sponsored by the CMS Innovation Center. Michigan Pioneer ACO of DMC will sustain to merge with CMS to give Medicare beneficiaries with higher-quality care at lower charges as a Next Generation ACO model.

2018 Next Generation ACO Model Applications Reopened by CMS

1/24/2017

In accordance to the alternative payment model’s webpage, the providers who are interested in participating in the Next Generation Accountable Care Organization (ACO) model in the year of 2018 can now submit a letter of intent to Centers for Medicare and Medicaid Services (CMS).

CMS: ApolloMed Declares APA ACO As A Next Generation ACO

1/20/2017

An integrated population health management company, Apollo Medical Holdings, Inc. ("ApolloMed"), today declared that one of its subsidiaries, APA ACO, Inc. has been opted by the Centers for Medicare & Medicaid Services (CMS) to participate and engage in the Next Generation ACO Model ("NGACO Model"). CMS will partner with APA ACO and other ACOs experienced in coordinating care for populations of Medicare sufferers and whose providers are ready to assume higher levels of financial risk and reward under this latest Advanced Alternative Payment Model ("APM") through this innovative program. The NGACO Model builds upon ApolloMed's experience and infrastructure investments in the MSSP ACO program since the year of 2012.

New ACO Model developed to better serve dual eligibles

1/8/2017

On Dec. 15, the Centers for Medicare & Medicaid Services (CMS) declared that it was initiating an ACO pilot program targeted at beneficiaries enrolled in both Medicare and Medicaid.
In accordance to CMS officials, the Medicare-Medicaid Accountable Care Organization model is created to permit Medicare Shared Savings ACOs to be accountable for the care, as well as Medicare and Medicaid costs, for dual eligibles.

IRCCO ACO and RoundingWell Merges to Enable Improved Patient Engagement, Care Coordination

12/26/2016

An integrated care management software provider, RoundingWell, declared today a compliance with the Illinois Rural Community Care Organization (IRCCO) to deploy RoundingWell in support of an accountable care organization (ACO) initiative across the region of Illinois comprised of twenty-four critical access and rural hospitals, thirty-five rural health clinics, and fourteen independent rural physician practices. The care management platform of RoundingWell's will assist integrated clinician teams of IRCCO provide care for more than 24,000 Medicare beneficiaries.

Christiana Care Quality Merges with ACO for adding Two new health systems to Network

12/25/2016

For adding two health systems to the network Jan. 1, Care Quality merges with Accountable Care Organization (ACO).
The networks are Beebe Healthcare in Lewes and Atlantic General Hospital and Health System in the region of Berlin, Maryland. As eBrightHealth ACO, accountable care organization (ACO) will start doing business.