Healthcare Transformation. February 18, 2014
|
|
- Silvester Butler
- 5 years ago
- Views:
Transcription
1 Healthcare Transformation February 18, 2014
2 The Challenges
3 The global healthcare crisis Increasing technological possibilities Total healthcare cost growth has always surpassed GDP growth Increasing demand: Ageing of populations; lifestyle changes; public expectations Perfect Storm Fiscal Crisis 2
4 The U.S. has the highest healthcare expenditures per capita compared to other western countries U.S. spends two and half times the OECD* member country average *Orgazniation for Economic Cooperation and Development Source: 3
5 Practical impact U.S. healthcare costs (federal spending) to be the primary driver of U.S. debt in the near future Source: 4
6 Medicaid is a significant part of this challenge Total US Health Spending 100% 80% 12% 17% Other Public Medicaid 60% 20% Medicare 40% 20% 51% Private Health 0% Medicaid is unequaled among federal grant programs: more than 60 million children and adults rely on the program, and it s projected to grow to 80 million beneficiaries by 2020 if all states adopt the eligibility expansion in the ACA. (Rosenbaum 2013) Source: Kaiser Foundation 5
7 What do we get for the money spent? 6
8 Major opportunity: bending the cost curve through better outcomes The safety, patient centeredness, and effectiveness our healthcare systems delivery is suboptimal and this is particularly true of Medicaid: Care is too often too little, too much, or sometimes just wrong Too much wasted value in re-admissions, ER visits and admissions From the perspective of the patient, the care encountered appears highly fragmented. Coordination is increasing, but often limited and incomplete: Focus only on LTC, for example Often supplementary to provider s efforts not well integrated in them In a fascinating reversal of common sense economics, improving healthcare quality more often than not makes the delivery of healthcare less rather than more expensive. Cost Quality 7
9 Why do healthcare systems not deliver high value care efficiently? Because we pay providers to do so: We get exactly the results we have designed the system to achieve (Paul Batalden, The Dartmouth Institute for Health Policy and Clinical Practice) Producing high quality healthcare efficiently is not rewarded by higher revenues for providers. There are often substantial perverse incentives: We pay for individual activities, or for the existence of a building or an organization We pay whether things go right or wrong; we often actually pay extra when things go wrong We do not pay for the integration of all these individual activities, nor do we pay for the results that all this work delivers We pay for disjointed and non-coordinated inputs, not for integrated outcomes 8
10 Delivery system redesign Community and primary care Secondary and tertiary care Total scope of care Lifestyle interventions, prevention Medical and Health Homes, Care Coordination Optimizing gatekeeper function of primary care Restructuring acute and inpatient care supply side 9
11 The causal chain Financial and regulatory incentives drive a delivery system which realizes cost efficiency and quality outcomes: value 10
12 For Consideration. Six Steps to Reduce Spend and Improve Outcomes 1. Create population-based price and outcome transparency 2. Critically assess remaining FFS 3. Contract or otherwise stimulate MCOs to align current payment methodologies to incentivize positive health outcomes 4. Ensure the ability for current providers to reinvent themselves 5. Consider standardizing payment methodologies across multiple payers 6. Consider value-based benefit design 11
13 1. Create population-based price and outcome transparency Using existing data sources, create population based, regional heat maps of value delivered by the care delivery system Risk-adjusted 90 day stroke mortality (%) Percentage living at home 90 days after stroke per county 80% 75% 70% 65% 60% 55% 50% 45% 40% 15,000 $150,000 20,000 $250,000 25,000 $350,000 30,000 $450,000 35,000 $550,000 40,000 Average total costs (curative care and long term care) per stroke patient in the 1 year after stroke per county 12
14 2. Assess Remaining FFS - effects are amplified by existing silo s Double fragmentation GPs Physiotherapy care Pharmacies Drugs & Medical Devices Dietary care Dental care Home care Specialty X outpatient care Specialty Z inpatient care Specialty Y outpatient care Specialty Z inpatient care Rehabilitation Nursing home care Disabled care Mental care Patient-centered focus on overall Outcomes and Costs Payer s and Government s Organizational, Administrative and IT Architecture Payers selling plans Governments managing eligibility 13
15 Yes, we have moved massively into managed care (with capitated payments)... Source: 2012 Actuarial Report on the Financial Look for Medicaid. 14
16 Payments should be aligned to produce positive outcomes.but most patients are still in a FFS provider environment Many Managed Care Organizations (MCO) still follow a provider or functional focus rather than a population or patient centered focus Many providers below MCO are still using FFS with coordination on top (but frequently not truly integrated in provider focus) More often than not, incentives remain perverse for providers especially so for the dual eligible population No incentives for hospitals or professionals to reduce avoidable admissions or ER visits Often too low payments to really deliver pro-active & continuous ambulatory care required No incentives for hospitals to optimize post-acute transition Major cost-shifting incentives (SNF/hospital/residential care) 15
17 3. Pay for value: Two leading approaches, which are fully complimentary 1 Population based All individuals living in a circumscribed area Sometimes limited to insurance type (i.e., Medicare ACO, Medicaid medical home) 2 Case-based Subpopulations : All patients included with a given diagnosis (e.g., diabetes, arthrosis of the hip) or condition (e.g., high cardiovascular risk, frail elderly) 16
18 Case based payment for value: Bundling chronic care Primary Care Hospital (in-and outpatient) Home care/nursing homes Diagnosis/indication Quality outcomes Diabetic care For continuous care: Product is one year of care Boundaries redrawn & outcomes measured More risk to provider, boundary crossing requires innovative contracting mechanisms (multiple providers often involved, requiring subcontracting, etc.) This is what most patients look for or need This is the level at which quality is delivered and is meaningfully measurable Here the incentives are aligned: Reduce complications; reduce exacerbations; keep patients healthy 17
19 Case based payment for value: Bundling elective care Primary Care Hospital (in-and outpatient) Home care/nursing homes Diagnosis/indication Quality outcomes Hip replacement, CABG, etc. 90 days Surgery Boundaries redrawn & outcomes measured More risk to provider, boundary crossing requires innovative contracting mechanisms (multiple providers often involved, requiring subcontracting, etc.) This is what most patients look for or need This is the level at which quality is delivered and is meaningfully measurable Same principles also possible for cancer care, maternity care, etc. 18
20 Population-based payment for value Episodes are meaningless in the case of preventive and population-focused primary care Often there is no clear diagnosis Individual products would create an administrative nightmare (with a predictable explosion in volume) Contracting outcomes is possible here as well: e.g., % of patients admitted in LTC facility, or emergency department visits, and patient reported Acute trauma experience care measures Acute cardiovascular care Maternity care (pregnancy & delivery) Basic medical/ behavioral care & gatekeeper function Specialized behavioral health care Chronic care Oncological care Primary care Multimorbidity/frail elderly care Care for people with a handicap Elective care Secondary care Tertiary care 19
21 Contract or otherwise stimulate MCOs to align current payment methodologies incentivize positive health outcomes Trendlines State Medicaid Expenditures Without payment reform MCO with FFS & provider silo s True delivery system focused payment reform 20
22 4. Ensure the ability for current providers to reinvent themselves Currently, too little paid for value-added care and too much revenues for care that does not add value Payment reform should allow Total revenues of provider X providers to recreate themselves Value-reducing care (Avoidable re-admissions, complications, unwarranted ER visits etc.) Margin Value-neutral care (Reactive care for preventable conditions etc.) Value-added, pro-active care 21
23 4. Ensure the ability for current providers to reinvent themselves (continued) Currently, too little paid for value-added care and too much revenues for care that does not add value Payment reform should allow Total revenues of provider X providers to recreate themselves Value-neutral care (Reactive care for preventable conditions etc.) Margin Value-added, pro-active care 22
24 5. Consider standardizing payment methodologies across multiple payers Total Payment Universe in State Medicaid Other QHPs on Exchanges Medicare State s employees Plans 23
25 6. Consider value-based benefit design Rewarding choosing for high value provider patients opting for low value providers pay co-pay or co-insurance... Rewarding health behaviors Value Matrix 24
26 Foundations of Healthcare Transformation Improved Operational Efficiency, Cost Optimization and Patient Outcomes Prevention Programs and Life Sciences Patient Engagement Provider Transitions to New Service Delivery Models Payers Incentivize Change through Payment Reform Performance Analytics Data Services Technology Enablement Target Operating Model Transformation Regulatory Changes 25
27 Prevention Improved Operational Efficiency, Cost Optimization and Patient Outcomes Prevention Programs and Life Sciences Patient Engagement Provider Transitions to New Service Delivery Models Payers Incentivize Change through Payment Reform Performance Analytics Decrease Demand for Costly Healthcare Services Leverage advances in life sciences Target human services programs to avoid costly medical treatments later in an individuals life Develop individualized wellness program s Bend the demand curve for costly medical treatments Improving the human condition to mitigate the adverse effects of health determinants 26
28 Patient Engagement Improved Operational Efficiency, Cost Optimization and Patient Outcomes Prevention Programs and Life Sciences Patient Engagement Provider Transitions to New Service Delivery Models Payers Incentivize Change through Payment Reform Performance Analytics Patient Engagement Patients engaged in their own care An expectation of information availability in healthcare Patients will seek information that allows them to participate in not only their healthcare decisions, but also in their own wellness Participation may manifest itself in many ways: Changed personal behavior that is more consistent with ongoing wellness Greater out of cycle contact and interaction with practitioners using technologies such as messaging and mobile applications In home use of wireless devices to monitor the wellness and, in some cases, the recovery of patients Resulting in fewer costly hospital recovery stays Patient retention and review of the information in their own EHR or PHR, seeking to recognize patterns of improvement or wellness decline, etc. 27
29 Provider Transition Improved Operational Efficiency, Cost Optimization and Patient Outcomes Prevention Programs and Life Sciences Patient Engagement Provider Transitions to New Service Delivery Models Payers Incentivize Change through Payment Reform Performance Analytics Provider Transitions to New Service Delivery Models Providers will begin to embrace patient involvement and interaction outside of the normal treatment cycles Industry moves more toward integrated care that promotes provider accountability Not just for more positive results when treatment is required, but for maintaining patient wellness Preventing the demand for costly treatments proactively Begin to see affiliations of hospitals, providers and those providing specialized support services Effective information exchange across the entirety of the patient engagement 28
30 Payment Reform Improved Operational Efficiency, Cost Optimization and Patient Outcomes Prevention Programs and Life Sciences Patient Engagement Provider Transitions to New Service Delivery Models Payers Incentivize Change through Payment Reform Performance Analytics Payers Incentivize Change through Payment Reform Payers will begin to incentivize accountability for wellness Thus decreasing the demand for costly services once a condition has exacerbated to the point that it requires treatment This may come in the form of payment models based on: Capitation Bundled services Some other form that would support the accountability of the provider Some thoughts are also being given to the patient sharing some of the risk in this new accountability model since, after all, a provider can only develop a wellness strategy for an individual, the individual then needs to participate in the strategy execution. Patients may share in the benefit of this model such as in the form of reduced insurance premiums or co-pays for those patients that are willing and effective participants in maintaining their own wellness 29
31 Performance Analytics Improved Operational Efficiency, Cost Optimization and Patient Outcomes Prevention Programs and Life Sciences Patient Engagement Provider Transitions to New Service Delivery Models Payers Incentivize Change through Payment Reform Performance Analytics Data Analytics Implemented as a continuous improvement program and opportunity to analyze data for trends Greater comparative effectiveness data Performance ratings of hospitals and providers Correlation between dollars spent and patient outcomes Identification of redundant or unnecessary treatments or services to facilitate cost optimization decisions. Enhanced ability to make more data based decisions As access to more and more data is realized the opportunity for discovery due to data overlays increases Constant identification of patterns that would allow for consideration of process improvements, cost optimizations and more effective treatments that might benefit populations in general or specific demographics that may be most at risk. 30
32 Foundations of Healthcare Transformation Improved Operational Efficiency, Cost Optimization and Patient Outcomes Prevention Programs and Life Sciences Patient Engagement Provider Transitions to New Service Delivery Models Payers Incentivize Change through Payment Reform Performance Analytics Data Services Technology Enablement Target Operating Model Transformation Regulatory Changes 31
33 Thank you John Teeter KPMG Global Center of Excellence for Health KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. The KPMG name, logo and "cutting through complexity" are registered trademarks or trademarks of KPMG International Cooperative ("KPMG International").
Population Health or Single-payer The future is in our hands. Robert J. Margolis, MD
Population Health or Single-payer The future is in our hands Robert J. Margolis, MD Today s problems Interim steps Population health Alternatives Conclusions Outline $3,000,000,000,000 $1,000,000,000,000
More informationMedicaid Payment Reform at Scale: The New York State Roadmap
Medicaid Payment Reform at Scale: The New York State Roadmap ASTHO Technical Assistance Call June 22 nd 2015 Greg Allen Policy Director New York State Medicaid Overview Background and Brief History Delivery
More informationNew York State Medicaid Value Based Payment: Data Driven Strategies. Bundled Payment Summit June 27, 2017
New York State Medicaid Value Based Payment: Data Driven Strategies Bundled Payment Summit June 27, 2017 Panelists Moderator Paloma Hernandez Anthony Thompson Marc Berg President and CEO Urban Health Plan
More informationEmerging Models of Care Delivery Christy Mokrohisky Ex. Dir. of PI & Emerging Models
Emerging Models of Care Delivery Christy Mokrohisky Ex. Dir. of PI & Emerging Models 1 Sacred Encounters Perfect Care Healthiest Communities St. Joseph Heritage Healthcare Founded in 1994 Manage 7 Medical
More informationLong term commitment to a new vision. Medical Director February 9, 2011
ACCOUNTABLE CARE ORGANIZATION (ACO): Long term commitment to a new vision Michael Belman MD Michael Belman MD Medical Director February 9, 2011 Physician Reimbursement There are three ways to pay a physician,
More informationUsing Data for Proactive Patient Population Management
Using Data for Proactive Patient Population Management Kate Lichtenberg, DO, MPH, FAAFP October 16, 2013 Topics Review population based care Understand the use of registries Harnessing the power of EHRs
More informationJumpstarting population health management
Jumpstarting population health management Issue Brief April 2016 kpmg.com Table of contents Taking small, tangible steps towards PHM for scalable achievements 2 The power of PHM: Five steps 3 Case study
More informationRedesigning Post-Acute Care: Value Based Payment Models
Redesigning Post-Acute Care: Value Based Payment Models Liz Almeida-Sanborn, MS, PT President Preferred Therapy Solutions This session will address: Discussion of the emergence of voluntary and mandatory
More informationUsing An APCD to Inform Healthcare Policy, Strategy, and Consumer Choice. Maine s Experience
Using An APCD to Inform Healthcare Policy, Strategy, and Consumer Choice Maine s Experience What I ll Cover Today Maine s History of Using Health Care Data for Policy and System Change Health Data Agency
More informationNYS Value Based Payments (VBP):
NYS Value Based Payments (VBP): Provider Associations, Community Based Organizations, and Consumer Advocates Town Hall Meeting Jason Helgerson NYS Medicaid Director December 16, 2016 2 Today s Agenda Agenda
More informationThe Movement Towards Integrated Funding Models
The Movement Towards Integrated Funding Models Financial Models and Fiscal Incentives in Health Conference Board of Canada Toronto, December 1, 2015 Jason M. Sutherland Associate Prof, Centre for Health
More informationPhysician Compensation in an Era of New Reimbursement Models
2014 IHA Annual Membership Meeting Physician Compensation in an Era of New Reimbursement Models Taryn E. Stone Ice Miller LLP (317) 236-5872 taryn.stone@ Agenda Background New Reimbursement Models Trends
More informationMassHealth Initiatives:
MassHealth Initiatives: PCMHI, DUALS, PCC/BH Integration, PCPR Dr. Julian Harris CBHI and CYF Advisory Committee Joint Meeting November 5, 2012 Our Mission To improve the health outcomes of our diverse
More informationAccountable Care Organizations American Osteopathic Association Health Policy Day September 23, 2011
Accountable Care Organizations American Osteopathic Association Health Policy Day September 23, 2011 Cary Sennett MD PhD Cary Sennett, MD, PhD Managing Director, Engelberg Center for Health Care Reform
More informationMethods for Monitoring Total Cost of Care: Maryland s All-Payer Model
Methods for Monitoring Total Cost of Care: Maryland s All-Payer Model Health Services Cost Review Commission Call for Technical Papers January 10, 2014 kpmg.com Content Monitoring total cost of care 1
More informationBundled Payments. AMGA September 25, 2013 AGENDA. Who Are We. Our Business Challenge. Episode Process. Experience
Bundled Payments AMGA September 25, 2013 Who Are We AGENDA Our Business Challenge Episode Process Experience 1 Cleveland Clinic is transforming Fee for service Fee for value 3 Fast Facts 41,200 employees
More informationSummary and Analysis of CMS Proposed and Final Rules versus AAOS Comments: Comprehensive Care for Joint Replacement Model (CJR)
Summary and Analysis of CMS Proposed and Final Rules versus AAOS Comments: Comprehensive Care for Joint Replacement Model (CJR) The table below summarizes the specific provisions noted in the Medicare
More informationKPMG Digital Health Pulse April 2017
KPMG Digital Health Pulse 2017 April 2017 Research purpose and design To identify key perceptions about the pace of digital health adoption and key challenges to implementing virtual care programs at hospitals
More informationUnitedHealth Center for Health Reform & Modernization September 2014
Health Reform & Modernization September 2014 2014 UnitedHealth Group. Any use, copying or distribution without written permission from UnitedHealth Group is prohibited. Overview Why Focus on Primary Care?
More informationReinventing Health Care: Health System Transformation
Reinventing Health Care: Health System Transformation Aspen Institute Patrick Conway, M.D., MSc CMS Chief Medical Officer Director, Center for Clinical Standards and Quality Acting Director, Center for
More informationThe Impact of Health Care Reform on Long- Term Care
The Impact of Health Care Reform on Long- Term Care AMY RUNGE, CPA Moss Adams LLP Partner & National Practice Leader, Long-Term Care MARCY BOYD, CPA Moss Adams LLP Partner September 22, 2014 1 The material
More informationThe Alternative Quality Contract (AQC): Improving Quality While Slowing Spending Growth
The Alternative Quality Contract (AQC): Improving Quality While Slowing Spending Growth Dana Gelb Safran, ScD Senior Vice President, Performance Measurement and Improvement Presented at: MAHQ 16 April
More informationPaying for Value and Aligning with Other Purchasers
Paying for Value and Aligning with Other Purchasers NAMD Bootcamp, Lake Tahoe, May 18, 2014 Dianne Hasselman, Director, Value Based Purchasing, Center for Health Care Strategies Deidre Gifford, MD, Medicaid
More informationConnected Care Partners
Connected Care Partners Our Discussion Today Introducing the Connected Care Partners CIN What is a Clinically Integrated Network (CIN) and why is the time right to join the Connected Care Partners CIN?
More informationNACDD and CDC Health Payer 101 Webinar Series. Webinar #4: Contracting 101
NACDD and CDC Health Payer 101 Webinar Series Webinar #4: Contracting 101 Jennifer Nolty, Director, Innovative Primary Care National Association of Community Health Centers June 30, 2016 Contracting 101
More informationTrends in State Medicaid Programs: Emerging Models and Innovations
Trends in State Medicaid Programs: Emerging Models and Innovations Speakers: Barbara Edwards, Principal, Steve Fitton, Principal, Tina Edlund, Managing Principal, Moderator: Annie Melia, Information Services
More informationIntroduction to Value-Based Health Care Delivery
Introduction to Value-Based Health Care Delivery Prof. Michael E. Porter Harvard Business School January 6, 2009 This presentation draws on Michael E. Porter and Elizabeth Olmsted Teisberg: Redefining
More informationHealth Information Technology
ACO Congress Oct 25, 2010 Los Angeles, CA Patient Centered Medical Home and Accountable Care Organizations Health Information Technology David K. Nace MD, Medical Director, McKesson Corporation Co-Chair,
More informationNorth Carolina Medicaid Reform
North Carolina Medicaid Reform Sandy Terrell Director, Clinical Policy Health and Human Services NC Health Care History c.1952 Good Health Act 1965 Medicare & Medicaid c.1972 Office of Rural Health 1877
More informationThe MetroHealth System
The MetroHealth System June 16, 2016 Presentation to Ohio Joint Medicaid Oversight Committee Dr. James Misak, Vice Chair of Community and Population Health, Department of Family Medicine Susan Mego, Executive
More informationHEALTH CARE REFORM IN THE U.S.
HEALTH CARE REFORM IN THE U.S. A LOOK AT THE PAST, PRESENT AND FUTURE Carolyn Belk January 11, 2016 0 HEALTH CARE REFORM BIRTH OF THE AFFORDABLE CARE ACT Health care reform in the U.S. has been an ongoing
More informationMoving the Dial on Quality
Moving the Dial on Quality Washington State Medical Oncology Society November 1, 2013 Nancy L. Fisher, MD, MPH CMO, Region X Centers for Medicare and Medicaid Serving Alaska, Idaho, Oregon, Washington
More informationExecutive Summary 1. Better Health. Better Care. Lower Cost
Executive Summary 1 To build a stronger Michigan, we must build a healthier Michigan. My vision is for Michiganders to be healthy, productive individuals, living in communities that support health and
More informationAlternative Managed Care Reimbursement Models
Alternative Managed Care Reimbursement Models David R. Swann, MA, LCSA, CCS, LPC, NCC Senior Healthcare Integration Consultant MTM Services Healthcare Reform Trends in 2015 Moving from carve out Medicaid
More informationAdopting a Care Coordination Strategy
Adopting a Care Coordination Strategy Authors: Henna Zaidi, Manager, and Catherine Castillo, Senior Consultant Current state of health care The traditional approach to health care delivery is quickly becoming
More informationInnovative Business Activities in Health Care with Commercial Partners
Innovative Business Activities in Health Care with Commercial Partners Steve Witman, CPA, MBA Vice President of Business Development / Financial and Capital Planning LifeBridge Health March 4, 2014 Business
More informationAdopting Accountable Care An Implementation Guide for Physician Practices
Adopting Accountable Care An Implementation Guide for Physician Practices EXECUTIVE SUMMARY November 2014 A resource developed by the ACO Learning Network www.acolearningnetwork.org Executive Summary Our
More informationBrave New World: The Effects of Health Reform Legislation on Hospitals. HFMA Annual National Meeting, Las Vegas, Nevada
Brave New World: The Effects of Health Reform Legislation on Hospitals HFMA Annual National Meeting, Las Vegas, Nevada Highlights of PPACA Requires most Americans to have health insurance Expands coverage
More informationACOs: California Style
ACOs: California Style ACO Congress John E. Jenrette, M.D. Chief Executive Officer Sharp Community Medical Group November 2, 2011 California Style California Style A CO California Style California Style
More informationA strategy for building a value-based care program
3M Health Information Systems A strategy for building a value-based care program How data can help you shift to value from fee-for-service payment What is value-based care? Value-based care is any structure
More informationAmbulatory Care Practice Trends and Opportunities in Pharmacy
Ambulatory Care Practice Trends and Opportunities in Pharmacy David Chen, R.Ph., M.B.A. Senior Director Section of Pharmacy Practice Managers ASHP Objectives Describe trends in health system pharmacy reported
More informationTransitioning Care to Reduce Admissions and Readmissions. Sven T. Berg, MD, MPH Julie Mobayed RN, BSN, MPH
Transitioning Care to Reduce Admissions and Readmissions Sven T. Berg, MD, MPH Julie Mobayed RN, BSN, MPH Disclaimer: Potential for Error Type One Error Rejecting the null hypothesis when it is true
More informationExhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013)
Exhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013) 24 percent (52 ACOs) earned shared savings bonus 27 percent (60 ACOs) reduced spending,
More informationSucceeding in a New Era of Health Care Delivery
March 14, 2012 Succeeding in a New Era of Health Care Delivery Building Value-Based Partnerships LeadingAge Pennsylvania Kathleen Griffin, PhD, National Director Post-Acute and Senior Services 1 Your Presenter
More informationForces of Change- Seeing Stepping Stones Not Potholes
May 19, 2014 Forces of Change- Seeing Stepping Stones Not Potholes 2 3 4 Overview Demographics Long Term Care Financing Challenges Broad Health System Challenges Payment Reform Delivery System Reform Where
More informationIs HIT a Real Tool for The Success of a Value-Based Program?
Is HIT a Real Tool for The Success of a Value-Based Program? Sally Montes, MPH, RHIA, CCHP President, SM & Associates, Inc. smontes@sm-asociados.com (787) 306-1149 President, PR HFMA Chapter INTRODUCTION
More informationEmerging Outpatient CDI Drivers and Technologies
7th Annual Association for Clinical Documentation Improvement Specialists Conference Emerging Outpatient CDI Drivers and Technologies Elaine King, MHS, RHIA, CHP, CHDA, CDIP, FAHIMA Outpatient Payment
More informationUNITED STATES HEALTH CARE REFORM: EARLY LESSONS FROM ACCOUNTABLE CARE ORGANIZATIONS
UNITED STATES HEALTH CARE REFORM: EARLY LESSONS FROM ACCOUNTABLE CARE ORGANIZATIONS Stephen M. Shortell, Ph.D., M.P.H, M.B.A. Blue Cross of California Distinguished Professor of Health Policy and Management
More informationAlabama Medicaid Preparing the State for Reform through Regional Care Organizations. January 23, 2015
Alabama Medicaid Preparing the State for Reform through Regional Care Organizations January 23, 2015 Restarting the Conversation 2 Agenda Alabama s Healthcare Landscape I. RCO Rationale II. DSRIP Design
More informationKatherine Schneider, MD, MPhil Senior Vice President, Health Engagement July 29, 2011
Accountable Care: Health System View CHC Best Practices Forum Katherine Schneider, MD, MPhil Senior Vice President, Health Engagement July 29, 2011 Who we are Southeastern New Jersey s largest health system
More informationTomorrow s Healthcare: Better Quality, More Affordable, More Accessible
Tomorrow s Healthcare: Better Quality, More Affordable, More Accessible Victor J Dzau, MD President, National Academy of Medicine September 23, 2016 Fung Healthcare Leadership Summit Global Challenges
More informationHealthcare Solutions Nuance Clintegrity Quality Management Solutions. Quality. The Discipline to Win.
Quality. The Discipline to Win. Brochure 2 It s not wanting to win that makes you a winner; it s refusing to fail. Peyton Manning, the first NFL quarterback to achieve 200 career wins (regular and post-season)
More informationAdvanced Illness Management Leveraging Person Centered Care and Reengineering the Care Team Across the Continuum
Advanced Illness Management Leveraging Person Centered Care and Reengineering the Care Team Across the Continuum Betsy Gornet, FACHE Chief Advanced Illness Management Executive Sutter Health / Sutter Care
More informationValue-Based Payments 101: Moving from Volume to Value in Behavioral Health Care
Value-Based Payments 101: Moving from Volume to Value in Behavioral Health Care Nina Marshall, MSW Senior Director, Policy and Practice Improvement NinaM@TheNationalCouncil.org Bill Hudock Senior Public
More information23 rd Annual Health Sciences Tax Conference
23 rd Annual Health Sciences Tax Conference December 9, 2013 Disclaimer This content is for educational and discussion purposes only, and is not intended, and should not be relied upon, as accounting advice.
More informationThe Pain or the Gain?
The Pain or the Gain? Comprehensive Care Joint Replacement (CJR) Model DRG 469 (Major joint replacement with major complications) DRG 470 (Major joint without major complications or comorbidities) Actual
More informationRe: Rewarding Provider Performance: Aligning Incentives in Medicare
September 25, 2006 Institute of Medicine 500 Fifth Street NW Washington DC 20001 Re: Rewarding Provider Performance: Aligning Incentives in Medicare The American College of Physicians (ACP), representing
More informationGlobal Budget Revenue. October 8, 2015
Global Budget Revenue October 8, 2015 Goals Understand GBR s connection to the goals of Maryland s Demonstration Understand impact on budgeting and planning for RFP and future phases Answer questions that
More informationThe Accountable Care Organization Specific Objectives
Accountable Care Organizations and You E. Christopher h Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences CEO, OSU Faculty Group Practice Chair, Department of Surgery Ohio State
More informationAccountable Care Organizations
Accountable Care Organizations Randy Wexler, MD, MPH, FAAFP Associate Professor Vice Chair, Clinical Services Department of Family Medicine The Ohio State University Wexner Medical Center Objectives To
More informationValue-based Care. Fact Sheet. How Value-based Care is improving quality and health.
How is improving quality and health. Working Smarter and Better to Help People Live Healthier Lives can help you lead the healthiest life possible. Imagine every health care professional you see understanding
More informationHealthcare Reimbursement Change VBP -The Future is Now
Healthcare Reimbursement Change VBP -The Future is Now 1 On the Move Volume/ Fee-for-Service Fee-for-service reimbursement High quality not rewarded No shared financial risk Stand-alone systems can thrive
More informationModels of Accountable Care
Models of Accountable Care Medical Home, Episodes and ACOs Making it work Elliott Fisher, MD, MPH Director, Population Health and Policy The Dartmouth Institute for Health Policy and Clinical Practice
More informationStrategy for Quality Improvement in Health Care
Strategy for Quality Improvement in Health Care Neal D. Kohatsu, MD, MPH, DHCS Medical Director Desiree Backman, DrPH, RD, UC Davis Institute for Population Heath Improvement & DHCS Chief Prevention Officer
More informationOregon s Health System Transformation: Coordinated Care Model. November 2013 Jeanene Smith MD, MPH OHA Chief Medical Officer
Oregon s Health System Transformation: Coordinated Care Model November 2013 Jeanene Smith MD, MPH OHA Chief Medical Officer The Challenges Oregon Faced Rising healthcare costs outpacing state budget in
More informationValue Based Care An ACO Perspective
Value Based Care An ACO Perspective NCIOM Task Force on Accountable Care Communities January 24, 2018 Steve Neorr Chief Administrative Officer 2 3 4 5 Source: Banthin, Jessica. Healthcare Spending Today
More informationDECODING THE JIGSAW PUZZLE OF HEALTHCARE
DECODING THE JIGSAW PUZZLE OF HEALTHCARE HPCANYS Leadership Institute November 6, 2015 Carla R. Williams, MPA Director, O Connell & Aronowitz Healthcare Consulting Group WHAT IS GOING ON? ENVIRONMENT ACA
More informationSeptember 16, The Honorable Pat Tiberi. Chairman
1201 L Street, NW, Washington, DC 20005 T: 202-842-4444 F: 202-842-3860 www.ahcancal.org September 16, 2016 The Honorable Kevin Brady The Honorable Ron Kind Chairman U.S. House of Representatives House
More informationPartnering with hospitals to create an accountable care organization Elias N. Matsakis, Esq.
Partnering with hospitals to create an accountable care organization Elias N. Matsakis, Esq. There are many opportunities for physicians and hospitals to affiliate and clinically integrate so as to enable
More informationRoadmap for Transforming America s Health Care System
Roadmap for Transforming America s Health Care System America s health care system requires transformational change to provide all health care participants with broader access and choice, improved quality
More informationValue Based Care in LTC: The Quality Connection- Phase 2
Value Based Care in LTC: The Quality Connection- Phase 2 Joseph J. Tomaino, M.S., R.N., Principal Healthcare Transformation Consulting ChemRx/PharmMerica Geriatric Skilled Nursing Seminar December 7, 2017
More informationIntegrated Health System
Integrated Health System Please note that the views expressed are those of the conference speakers and do not necessarily reflect the views of the American Hospital Association and Health Forum. Page 2
More informationPediatric Population Health
JANUARY 25, 2018 Swedish Pediatric CME 2018 Pediatric Population Health Michael Dudas, MD Chief of Pediatrics, Virginia Mason Medical Center Co-Chair, Health Care Transformation Committee, WCAAP 1 Objectives
More informationPhysician Alignment Strategies and Options. June 1, 2011
Physician Alignment Strategies and Options June 1, 2011 1 Today s Discussion Review physician-hospital alignment objectives Understand the changing paradigm Evaluate alignment strategies for a new delivery
More informationMAKING PROGRESS, SEEING RESULTS
MAKING PROGRESS, SEEING RESULTS VALUE-BASED CARE REPORT HUMANA.COM/VALUEBASEDCARE Y0040_GCHK4DYEN 1117 Accepted 2 Americans are sick and getting sicker, with millions of us living with chronic conditions
More informationTHE REIMBURSEMENT SHIFT: PREPARING YOUR PRACTICE FOR PATIENT-CENTERED PAYMENT REFORM. November 20, 2015
THE REIMBURSEMENT SHIFT: PREPARING YOUR PRACTICE FOR PATIENT-CENTERED PAYMENT REFORM November 20, 2015 TODAYS PRESENTERS Kavon Kaboli Consultant Galen Healthcare Solutions Cece Teague Consultant Galen
More informationMACRA for Critical Access Hospitals. Tuesday, July 26, 2016 Webinar
MACRA for Critical Access Hospitals Tuesday, July 26, 2016 Webinar MACRA presenters Harold D. Miller, President & CEO CHQPR Claudia Sanders, Sr. Vice President, Policy Development Andrew Busz, Policy Director,
More informationACOs the Medicare Shared Savings Program And Other Healthcare Reform Payment Methods
A unique vision for an ever-changing healthcare environment ACOs the Medicare Shared Savings Program And Other Healthcare Reform Payment Methods Presented by Joe Laden, President, ORVA, LLC The Environment
More informationReforming Health Care with Savings to Pay for Better Health
Reforming Health Care with Savings to Pay for Better Health Mark McClellan, MD PhD Director, Initiative on Health Care Value and Innovation Senior Fellow, Economic Studies October 2014 National Forum on
More informationCritical Access Hospitals and Cost-Based Reimbursement
Critical Access Hospitals and Cost-Based Reimbursement Jared Heim, CPA, Partner jheim@eidebailly.com 563.557.6169 Agenda for Today Overview of Critical Access Hospitals Overview of Health Care Reform Behavioral
More informationIntro to Global Budgeting
Intro to Global Budgeting Jim Hester House Health Care Committee & Senate Health & Welfare Committee 1/21/10 Agenda Goal of global budgeting Global budget models and examples Global payment model and examples
More informationCLINICAL INTEGRATION DRIVERS, IMPACT, AND OPTIONS JOBY KOLSUN, D.O. MEDICAL DIRECTOR CLINICAL INTEGRATION LEE PHO
CLINICAL INTEGRATION DRIVERS, IMPACT, AND OPTIONS JOBY KOLSUN, D.O. MEDICAL DIRECTOR CLINICAL INTEGRATION LEE PHO Disclaimers My current position I am not offering advice on clinical integration Items
More informationState Leadership for Health Care Reform
State Leadership for Health Care Reform Mark McClellan, MD, PhD Director, Engelberg Center for Health Care Reform Senior Fellow, Economic Studies Leonard D. Schaeffer Chair in Health Policy Studies Brookings
More informationUC HEALTH. 8/15/16 Working Document
1) UC Health Mission Our mission is to make health care better. Each UC health system works to advance this mission in its community and as a system of health systems, we work together to catalyze innovation
More informationEliminating Excessive, Unnecessary, and Wasteful Expenditures: Getting to a High Performance U.S. Health System
Eliminating Excessive, Unnecessary, and Wasteful Expenditures: Getting to a High Performance U.S. Health System Karen Davis President, The Commonwealth Fund IOM Workshop Series: The Policy Agenda September
More informationCapitalizing on Comprehensive Care: Cultivating a Medicare Advantage Mindset
Capitalizing on Comprehensive Care: Cultivating a Medicare Advantage Mindset AUTHORS Dave Johnson Chief Executive Officer, 4sight Health Richard Jones Chief Executive Officer of Essence Healthcare & Chief
More informationMedicaid Managed Care Readiness For Agency Staff --
Medicaid Managed Care Readiness 101 -- For Agency Staff -- To Understand: Learning Objectives Basic principles of Managed Care as a payment vehicle for health care services The structure of the current
More informationMedicare, Managed Care & Emerging Trends
Medicare, Managed Care & Emerging Trends LeadingAge Michigan 2015 Annual Leadership Institute August 12, 2015 Jon Lanczak, Manager Beth Sullivan, Senior Manager Plante Moran, PLLC Overall Theme Healthcare
More informationPatient-Centered Medical Home 101: General Overview
Patient-Centered Medical Home 101: General Overview Publicly Available Slide Deck Last Updated: January 2015 Suggested Citation: PCPCC Map Tools. (2015). Patient-Centered Medical Home 101: General Overview.
More informationESSENTIAL STRATEGIES IN MEDI-CAL PAYMENT REFORM. Richard Popper, Director, Medicaid & Duals Strategy August 3, 2017
ESSENTIAL STRATEGIES IN MEDI-CAL PAYMENT REFORM Richard Popper, Director, Medicaid & Duals Strategy August 3, 2017 1 DISCLAIMER The enclosed materials are highly sensitive, proprietary and confidential.
More informationPaying for Outcomes not Performance
Paying for Outcomes not Performance 1 3M. All Rights Reserved. Norbert Goldfield, M.D. Medical Director 3M Health Information Systems, Inc. #Health Information Systems- Clinical Research Group Created
More informationPartners in the Continuum of Care: Hospitals and Post-Acute Care Providers
Partners in the Continuum of Care: Hospitals and Post-Acute Care Providers Presented to the Wisconsin Association for Home Health Care November 3, 2017 By: Laura Rose WHA Vice President, Policy Development
More informationHealthcare Analytics & Managing Population Health
Healthcare Analytics & Managing Population Health Victoria Tiase, MS, RN, Director Informatics Strategy, NewYork-Presbyterian Hospital Kathleen McGrow, MS, RN, PMP, Director Customer Marketing, Caradigm
More informationNavigating New York State s Transition to Managed Care
Navigating New York State s Transition to Managed Care December 3, 2014 Mary McKernan McKay, Ph.D Andrew F. Cleek, Psy.D. Meaghan E. Baier, LMSW Agenda Introduction of the Managed Care Technical Assistance
More informationAccountable Care and Governance Challenges Under the Affordable Care Act
Accountable Care and Governance Challenges Under the Affordable Care Act The First National Congress on Healthcare Clinical Innovations, Quality Improvement and Cost Containment October 26, 2011 Doug Hastings
More informationREDESIGNING HEALTH CARE FROM THE BOTTOM UP INSTEAD OF FROM THE TOP DOWN
REDESIGNING HEALTH CARE FROM THE BOTTOM UP INSTEAD OF FROM THE TOP DOWN Supporting Collaborative Regional Approaches to Sustainable High-Value Healthcare Harold D. Miller President and CEO Center for Healthcare
More informationTKG Health Systems Advisory Panel Meeting. Healthcare in 2017: Trends & Hot Topics. Tuesday, March 24 th, 2017 Gaylord Texan Resort, Grapevine, TX
TKG Health Systems Advisory Panel Meeting Healthcare in 2017: Trends & Hot Topics Tuesday, March 24 th, 2017 Gaylord Texan Resort, Grapevine, TX Executive Summary Key Trends The transition to value-based
More informationThe Long and Winding Road-map: From Waiver Services to VBP and Other Stops Along the Way
The Long and Winding Road-map: From Waiver Services to VBP and Other Stops Along the Way Mental Health Association in New York State, Inc. Annual Meeting Gregory Allen, MSW Director Division of Program
More informationAccountable Care Organizations. What the Nurse Executive Needs to Know. Rebecca F. Cady, Esq., RNC, BSN, JD, CPHRM
JONA S Healthcare Law, Ethics, and Regulation / Volume 13, Number 2 / Copyright B 2011 Wolters Kluwer Health Lippincott Williams & Wilkins Accountable Care Organizations What the Nurse Executive Needs
More informationA Model for Value-Based Provider/Payer Partnerships
A Model for Value-Based Provider/Payer Partnerships Page 1 With the recent spotlight on accountable care, payer and provider organizations are seeing an opportunity to collaborate to drive down medical
More information