Issuers and their third-party administrators (TPA) were all working towards meeting the Dec. 19, 2014, deadline for the data production data submission to the Centers for Medicare and Medicaid Services (CMS). On the evening of Dec. 19, 2014, CMS officially notified all issuers that the deadline for the first preliminary run had been extended to Dec. 28, 2014, to ensure that most issuers are able to meet the requirement for the data-submission deadline to the EDGE server.
Proposed Changes to Promote Continued Participation and Growth
On Dec. 1, 2014, the Centers for Medicare and Medicaid (CMS) issued proposed changes to the Medicare Shared Savings Program (MSSP) to promote continued participation and growth. The proposed changes are intended to further support and incentivize ACOs to achieve the triple aim in improving patient satisfaction, quality and reducing the cost of care.
Within the 429-hundred-page document there are numerous proposed changes. Here, we examine three key changes that could impact ACOs regarding payment tracks and beneficiary assignment.
The introduction of the Affordable Care Act’s Health Insurance Marketplace has created a rapidly growing, competitive landscape with diverse audience segments. Member engagement has become a key focus for health plans to increase member interaction, preventive health assessments, and better self-care initiatives.
Member engagement programs can provide enormous benefits to both members and health plans, if executed properly. Members will benefit from increased access to care, enhanced awareness of their health status, and improved care management. Moreover, health plan providers are seeing reduced emergency room visits, a lower rate of unnecessary diagnostic tests and, most importantly, fewer gaps in care and greater risk score accuracy.
For ACOs preparing for the upcoming GPRO season in January, now is the time to ensure you have covered all your bases for the following key components: staffing, record collection, data abstraction, tracking and reporting, as well as audit readiness.
Staffing can be challenging for ACOs during GPRO season. It is important to plan ahead and determine whether it is possible to create capacities for medical staff members to execute the medical record reviews without their regular workload suffering—or whether it would be better to outsource this task to a vendor. Choosing the most efficient process, while ensuring quality outcomes, is the first key decision for an ACO.
Inovalon is pleased to announce that it has been approved by CMS as a third party administrator (TPA) for EDGE server data submission. The deadline for issuers or TPAs to submit data onto the CMS EDGE Server is fast approaching: December 5, 2014.
In addition to writing new or updating existing code necessary for submission, it is recommended that issuers and TPAs also use the remaining weeks before the deadline to undertake important tasks that can help facilitate the process, including the following:
- Analyze recent CMS updates
- Investigate numerous scenarios
- Adapt code to include changes and use cases
- Integrate code against underlying data
The final step is to release the code into production. Along with writing good software, it is essential for organizations also to have complete and accurate data in place, ensuring appropriate quality assurance and testing.