CMS aims for all Medicare fee-for-service beneficiaries to be in care arrangements accountable for quality and total cost of care by 2030 — just five years away. Most hospitals and practices remain unprepared for this significant transition. A recent survey by the Association of Clinical Documentation Integrity Specialists (ACDIS) found that only 26% of hospitals have an outpatient CDI program capable of effectively capturing acute and chronic disease burdens across various care settings. Meeting “Deadline 2030” demands transformational leadership capable of engaging physicians in accountable care organizations (ACOs), achieving cost efficiency, and meeting CMS quality benchmarks, thereby creating a win-win for providers and hospitals. This session provides a practical blueprint based on one healthcare organization’s successful transition, highlighting a robust outpatient CDI program focused on capturing patient risk across outpatient clinics and affiliated practices.
Learning Objectives:
Formulate metrics to measure success in value-based care, including CMS hierarchical condition categories (HCCs), risk adjustment, and Medicare shared savings arrangements
Develop a blueprint for achieving value-based care success, emphasizing prospective chart reviews to compliantly enhance risk adjustment factor (RAF) scores within a heavily scrutinized regulatory environment
Design an organizational leadership and vision strategy essential for transitioning from fee-for-service to pay-for-performance and value-based care models
