Valuable Insights: September Regulatory Update

Kathleen Gravelle, chief risk officer for CareAllies, provides regulatory updates on the proposed physician fee schedule rule, Executive Branch activity, COVID-19 developments, and a look at the VP Candidates.

Continuum of Risk-Based Models

The Alternative Payment Model (APM) Framework provides a comprehensive view of the four approaches to payments - each moving health care organizations progressively towards population-based models.

CMS Adds Annual Wellness Visit to Audio-Only Covered Telehealth Services for Medicare FFS

CMS has specific guidance around what constitutes an annual wellness visit (AWV), along with documentation requirements. These visits typically take place in the doctor's office, but in response to the COVID-19 pandemic, newer guidance has been issued and allows for the AWV to take place via telehealth (audio with visual). Most recently, CMS has begun allowing the AWV to be completed via a telephone-only connection for those patients who do not have access to or the capability of video services. The following information is summarized from CMS guidance and applies to all AWVs.

Four Keys for Successful Value-Based Care

Learn more about what our customers consider to be the keys to their value-based reimbursement success.

Valuable Insights: Addressing the Social and Environmental Needs of Patients During COVID-19

Research has shown that non-clinical care, including a person's social and environmental conditions, can impact up to 80% of their health care outcomes. In this podcast, Kim Villarreal discusses how her team has been connecting with patients during COVID-19 to help answer questions, calm their fears and make sure they have what they need.

(9 min)

Breaking Down Barriers: Social Determinants of Health

There’s more to patients’ overall well-being than their physical health. But, there’s also more to addressing their overall well-being than the choices they make and the clinical care they receive. In this series, we suggest ways you can help break down these barriers.

Language and Health Literacy

Low health literacy, as well as language barriers, may impact a person’s ability to take responsibility for their health, as well as the health of their family. In this series, we suggest ways you can help break down these barriers.

Breaking Down Barriers: Violence and Abuse

Violence a­ffects patients of all ages, and it doesn’t just impact them physically. It can also have long-term emotional e­ffects. In this series, we suggest ways you can help break down these barriers.

Valuable Insights: Preparing for Disasters and Emergencies

We have all been impacted by COVID-19, but we need to acknowledge the possibility of additional disasters and emergencies. Dr. Joe Nicholson, CareAllies Chief Medical Officer, and Dr. Priya Suresh, Renaissance Physicians Chief Medical Officer, discuss preparing your practice, patients and employees for disasters and emergencies.

Breaking Down Barriers: Food Insecurity and Access to Foods That Support Healthful Eating

Fresh and nutritious foods are essential to good health. But for many, eating a healthful diet is not as simple as choosing to do so. In this series, we suggest ways you can help break down these barriers.

Breaking Down Barriers: Social Isolation

Social isolation can have a significant impact on patients’ overall well-being, especially elderly patients. In this series, we suggest ways you can help break down these barriers.

Social Determinants of Health COVID-19 Outreach Protocol

During these difficult times, it is important to reach out to patients who may need additional support addressing social determinants of health. The CareAllies Community Health Advocate Team (CHAT) created this guide to help you outline outreach protocols for your organization.

Evaluating Success Factors of a Medication Adherence Tracker Pilot Program in Improving Part D Medication Adherence Metrics in a Medicare Advantage Plan: Importance of Provider Engagement

Published by Journal of Managed Care & Specialty Pharmacy May 2020 edition. Research by Minh Hong, PharmD at CareAllies; Tara Esse, PharmD, BCACP at CareAllies; Aisha Vadhariya, PhD; Esteban Gallardo, PharmD at CareAllies; Maream Ashley Fosshat, PharmD at CareAllies; Jocelyne Mamvou, PharmD at CareAllies; Liana Bruce, PhD, MSPH; Omar Serna, PharmD, BCACP at CareAllies, and Susan Abughosh, PhD

Valuable Insights: May Regulatory Updates

Kathleen Gravelle, chief risk officer for CareAllies, provides regulatory updates on final interoperability rules from CMS and ONC, details on the final Medicare Advantage and Part D rate announcement, a summary of the upcoming Democratic National Convention, and news on some COVID-19 developments.

Valuable Insights: COVID-19 Interim Final Rule Impacts to ACOs

On April 30th, the Centers for Medicare & Medicaid Services issued another round of regulatory waivers and rule changes that impact ACOs. Erin DeLoreto, CareAllies Assistant Vice President of Value-based Programs, provides an overview of what providers should know.

Valuable Insights: Financial Support Available For Providers Through The CARES Act

The recently enacted Coronavirus Aid, Relief, and Economic Security (CARES) Act includes several programs and resources available to physicians and physician practices. Kathleen Gravelle, CareAllies Chief Risk Officer, provides a summary, and recorded webcast, of these provisions.

HHS Delays Enforcement of Interoperability Rules

Kathleen Gravelle, chief risk officer for CareAllies, provides a summary of key items included in The U.S. Department of Health and Human Services (HHS) policy, announced on 4/21/2020, allowing compliance flexibilities regarding the implementation of the interoperability final rules.

Valuable Insights: Recent CMS Updates Affecting ACOs

Recently, the Centers for Medicare & Medicaid Services announced several updates that affect accountable care organizations (ACOs). Erin DeLoreto, CareAllies Assistant Vice President of Value-based Programs, provides a summary, and recorded webcast, explaining these updates and the impact on ACOs.

Valuable Insights: Staying Connected While Distancing

The CDC has provided guidance on how to help protect yourself and slow the spread of COVID-19, and this guidance includes avoiding close contact with others. Dr. Joe Nicholson, CareAllies Chief Medical Officer, and Kim Villarreal, LCSW and CareAllies Community Health Advocate Team Lead, share some insight on how we can address concerns around the impact of “social distancing” on mental health.

(8 min)

Valuable Insights: News You Can Use

Kathleen Gravelle, chief risk officer for CareAllies provides regulatory updates for Part I and Part II of the Advance Notice released by CMS. 

Dr. Torkildsen Discusses The Medication Adherence Tracker Case Study During the 2019 APG Colloquium

Dr. William Torkildsen, Valley Organized Physicians Chairman, participated in the APG Colloquium panel, Case Studies in Excellence 2019: Pearls of Wisdom from the Field. Watch his portion of the panel to hear him talk about working with their management company, CareAllies, to improve medication adherence.

Valuable Insights: Annual Wellness Visits

Erin DeLoreto, assistant vice president, and Sandy Santangelo, quality manager, value-based programs, discuss identifying Medicare fee-for-service beneficiary health and risk factors through Annual Wellness Visits.

(.5 CME credit)

Valuable Insights: Care Coordination

Meredith Herpel from the Cigna Medicare Stars customer satisfaction team, talks about the impact care coordination can have on the patient experience.

(.5 CME credit)

Improving Outcomes and Patient Experience Through Medication Adherence

Medication adherence plays a vital role in ensuring that patients achieve desired health outcomes. But despite its importance in keeping patients well, adherence remains a challenge. To address medication adherence in South Texas, Valley Organized Physicians worked with CareAllies to develop a Medication Adherence Tracker (MAT). Dr. William Torkildsen will present this case study on the MAT during the APG Colloquium's Case Studies in Excellence 2019: Pearls of Wisdom from the Field.

Enhancing Statin Adherence Using a Motivational Interviewing Intervention and Past Adherence Trajectories in Patients with Suboptimal Adherence

Published by the Journal of Managed Care & Speciality Pharmacy in October 2019 edition. Research by Susan M. Abughosh, PhD; Aisha Vadhariya, PhD; Michael L. Johnson, PhD; E. James Essien, MD, DrPH; Tara Esse, PharmD, BCACP, Clinical Program Manager at CareAllies; Omar Serna, PharmD, BCACP, Clinical Operations Director at CareAllies; Esteban Gallardo, PharmD, Clinical Program Manager at CareAllies; Susan H. Boklage, MS, MPH; Jeannie Choi, PharmD; Marcia M. Holstad, PhD, FNP-BC, FAAN; and Marc L. Fleming, PhD, MPH, RPh

Valuable Insights Alert: 2020 Quality Payment Program Rule Released

Kathleen Gravelle, CareAllies Chief Risk Officer, and former program examiner at The White House Office of Management and Budget, provides an update on what was announced.

(6 min)

Valuable Insights: Reducing Readmissions

In this podcast we spoke with Teresa Alonzo, RN, BSN, an Alegis Care Transition of Care nurse, about the in-home care interventions she conducts with patients after they have been discharged from the hospital.

(17 min)

The Right Tools To Drive Change In Your Practice

John Parente, MD, senior medical director at CareAllies, discussed the excellent practice satisfaction results and process improvement outcomes IPA practices have received through their work with our Practice Transformation team.

The Impact of the Quality Payment Program (QPP) on Provider Reimbursement

The QPP includes fundamental charges to how Medicare Part B compensates providers beginning in 2019. The QPP creates a predictable payment system for providers that is aligned with improving quality and cost and eases the transition to value-based care.

Group-Based Trajectory Models to Identify Sociodemographic and Clinical Predictors of Adherence Patterns to Statin Therapy Among Older Adults

Published by American Health & Drug Benefits in June/July 2019 edition. Research by Aisha Vadhariya, PhD Candidate; Marc L. Fleming, PhD, MPH, RPh; Michael L. Johnson, PhD; E. James Essien, MD, DrPH; Omar Serna, PharmD, BCACP, Clinical Operations Director at CareAllies; Tara Esse, PharmD, BCACP, Clinical Program Manager at CareAllies; Jeannie Choi, PharmD; Susan H. Boklage, MS, MPH; Susan M. Abughosh, PhD.

Medication Adherence to Antihypertensive Triple-Combination Therapy Among Patients Enrolled in a Medicare Advantage Plan

Published by the Journal of Managed Care & Specialty Pharmacy in June 2019. Research by Xin Wang, PhD; Hua Chen, MD, PhD; Ekere Essien, MD, PhD; Jun Wu, PhD; Omar Serna, PharmD, BCACP; Rutugandha Paranjpe, MS; Susan Abughosh, PhD.

Valuable Insights: Diabetes Education

In this Valuable Insights podcast, we spoke with Audrey Jones, MD at Advantage Health Clinic in Alamo, Texas and Olga Oviedo, RN, MSN, certified diabetes educator at CareAllies, to understand how they identify and support patients who need additional diabetes education.

(14 min)

Your Participation for Medicare Shared Savings Program in 2019

This digital tool can help you determine which track you can participate in. Tracks correspond to your accountable care organization's (ACO's) proportion of revenue to expenditures and previous experience with risk.

Awareness Of The Atherosclerotic Cardiovascular Disease Risk Estimator Among Primary Care Physicians In A Medicare Advantage Plan

Published by Journal of Behavioral Health in April 2019. Research by Scarlet Najera; Tara Esse, PharmD, BCACP; Omar Serna, PharmD, BCACP; Aisha Vadhariya; Sanika Rege; Marc Fleming; Susan Abughosh; Jeannie Choi.

Valuable Insights: How Does Your Shared Savings Program Quality Reporting Affect Your MIPS Score?

Erin DeLoreto, assistant vice president of value-based programs for CareAllies, explains how your Shared Savings Program quality reporting impacts your MIPS score.

(.5 CME credit)

Valuable Insights: Getting Care and Appointments Quickly

Meredith Herpel, Cigna-HealthSpring Stars customer satisfaction, discusses how wait times can affect patient experience and satisfaction.

(.5 CME credit)

Valuable Insights: The Quality Payment Program

Kathleen Gravelle, chief risk officer for CareAllies, provides an overview of the Medicare incentive program.

(.5 CME credit)

Provider Intervention Increases Medication Adherence

Mayank Shah, MD, chief medical officer of Home-based Care Delivery Services, discussed how pharmacy professionals worked with providers to identify opportunities that improve health outcomes and affordability for their patients.

Valuable Insights Alert: Medicare Shared Savings Program Final Rule Released

On December 21st, the Centers for Medicare and Medicaid Services issued a final rule to update the Medicare Shared Savings Program, which includes retiring the traditional participation "tracks" and replacing them with new tracks for both existing and new accountable care organizations (ACOs). Kathleen Gravelle, CareAllies chief risk officer, and former program examiner at The White House Office of Management and Budget, provides an update on what was announced.

(5 min)

Giving You Insights That You Really Value

Beckie Croes, senior vice president of provider engagement and management services at CareAllies, discussed the highlights of our 2018 Valuable Insights education series and the enhancements made throughout the year based on provider feedback.

Effectiveness Of Mailed Letters To Improve Medication Adherence Among Medicare Advantage Plan Participants With Chronic Conditions

Published and licensed by Dove Medical Press Limited in December 2018. Research by Amanda Mann, PharmD; Tara Esse, PharmD, BCACP; Omar Serna, PharmD, BCACP; Liana Castel, PhD; Susan Abughosh, PhD.

Valuable Insights: Patient Engagement

Dr. Nicholas Gettas, CareAllies contributor, discusses best practices for getting and keeping patients engaged in their health.

(.5 CME credit)

Valuable Insights: Preventive Screenings

Dr. Diana Lozano from Valley Medicine Associates in Harlingen, Texas and Gina Dominguez, RN, embedded care coordinator for CareAllies discussed how they engage with patients to help get them the preventive care they need.

(13 min)

Valuable Insights Alert: 2019 Quality Payment Program Final Rule

On November 1st, the Centers for Medicare and Medicaid Services issued a final rule to update the 2019 Quality Payment Program, which was created under the Medicare Access and CHIP Reauthorization Act (MACRA). Kathleen Gravelle, CareAllies chief risk officer, and former program examiner at The White House Office of Management and Budget, provides an update on what was announced.

(5 min)

Valuable Insights: High-five for Physician Engagement

Beckie Croes, senior vice president of provider engagement for CareAllies, discussed best practices for motivating physicians and the support you need to succeed.

.5 CME credit

Valuable Insights: Medicare Advantage and Part D Star Ratings

Evet Rodrigues, CareAllies contributor and expert on Stars, CAHPS & HOS, discussed how to win by improving your patient experience.

CME credits: 1.0

Valuable Insights: Medication Adherence

William Torkildsen, MD from Port Isabel Health Clinic, and Rickie Cruz, LVN, an embedded care coordinator for CareAllies, discuss how they implemented a medication adherence tracker that helped make patients 20 times more likely to fill their prescriptions. (15 min)

Predict, Prioritize and Prevent

Rick Bennett, director of informatics and analytics, and Nicole Deaner, MSW, director of practice transformation for CareAllies discussed how to proactively drive cost rather than cost driving you (crazy).

Valuable Insights: Accountable Care

Dr. Nicholas Gettas, CareAllies contributor, discussed maximizing your clinical relationships for “value-able” care.

CME credits: 0.75

Valuable Insights Alert: Medicare Shared Savings Program Proposed Rule Released

On August 9, 2018, the Centers for Medicare and Medicaid Services issued a proposed rule to update the Medicare Shared Savings Program. Erin DeLoreto, assistant vice president of value-based programs for CareAllies, gives a 7-minute update on what was announced and the potential changes to the program.

Valuable Insights: Converting Data to Actionable Information

Rick Bennett, director of informatics and analytics at CareAllies, and Nicole Deaner, MSW, director of practice transformation at CareAllies discussed how to proactively drive cost rather than cost driving you (crazy).

Crucial Access: Primary Care

John Parente, MD, chief medical informatics officer of CareAllies, shares insights on developing PCP access strategies.

Valuable Insights: Care Delivered

John Parente, MD, chief medical informatics officer at CareAllies, discussed innovative access strategies to improve care delivery.

Taking Control of Your Outpatient Costs

Olan Soremekun, MD, MBA, vice president of value-based programs at CareAllies, on what physicians need to know to be in control of their outpatient costs and quality health outcomes.

Driving Your Financial Performance

Beckie Croes, senior vice president of provider engagement for CareAllies, led a discussion on the top drivers of financial performance for independent physicians.

Valuable Insights: Who’s Driving The Bus?

Beckie Croes, Senior Vice President, Provider Engagement at CareAllies, discusses top drivers of your financial performance and how to ensure you’re taking the wheel.

A Motivational Interviewing Intervention by Pharmacy Students to Improve Medication Adherence

Published in the May 2017 Journal of Managed Care & Specialty Pharmacy. Research by Susan Abughosh, PhD; Xin Wang, MS; Omar Serna, PharmD, BCACP; Tara Esse, PharmD, BCACP; Amanda Mann, PharmD; Santhi Masilamani, PharmD, CDE, MBA; Marcia McDonnell Holstad, PhD, FNP-BC; Ekere James Essien, MD, DrPH; and Marc Fleming, PhD, MPH.

Transform Your Organization with Physician Engagement

This white paper will help you to:

• Understand the effect provider engagement can have on your organization’s clinical and business performance
• Evaluate the engagement of providers in your organization
• Review tools and strategies to improve provider motivation

CareAllies Can Help You Successfully Transition to Value-based Care

We have the expertise and experience needed to develop solutions based on your needs now and as you grow.

Physician Perception of Patient Medication Adherence in a Cohort of Medicare Advantage Plans in Texas

Published in the March 2016 Journal of Managed Care & Specialty Pharmacy. Research by Amanda Winters, PharmD; Tara Esse, PharmD, BCACP; Archita Bhansali, MS; Omar Serna, PharmD, BCACP; Shivani Mhatre, PhD; Sujit Sansgiry, PhD.

Evaluating Pharmacist-Written Recommendations to Providers in a Medicare Advantage Plan: Factors Associated with Provider Acceptance

Published in the January 2016 Journal of Managed Care & Specialty Pharmacy. Research by Amanda Mann, PharmD; Tara Esse, PharmD, BCACP; Susan M. Abughosh, PhD; Omar Serna, PharmD, BCACP.

A Pharmacist Telephone Intervention to Identify Adherence Barriers and Improve Adherence Among Nonadherent Patients with Comorbid Hypertension and Diabetes in a Medicare Advantage Plan

Published in the January 2016 Journal of Managed Care & Specialty Pharmacy. Research by Susan M. Abughosh, PhD; Xin Wang, MS; Omar Serna, PharmD, BCACP; Chris Henges, PharmD; Santhi Masilamani, PharmD, CDE, MBA; Ekere James Essien, MD, DrPH; Nancy Chung, PharmD, BCACP; and Marc Fleming, PhD.

Quality Compensation Programs: Are They Worth All the Hype? A Comparison of Outcomes Within a Medicare Advantage Heart Failure Population

Published in the May 2013 Journal of Managed Care Pharmacy. Research by Tara Esse, PharmD, BCACP; Omar Serna, PharmD, BCACP; Abhishek Chitnis, PhD; Michael Johnson, PhD; and Nelson Fernandez, MD.