The CCHIT ACO HIT Framework A Guide to Success while Assuming Accountability for Cost, Quality, and Patient Engagement

Size: px
Start display at page:

Download "The CCHIT ACO HIT Framework A Guide to Success while Assuming Accountability for Cost, Quality, and Patient Engagement"

Transcription

1 The CCHIT ACO HIT Framework A Guide to Success while Assuming Accountability for Cost, Quality, and Patient Engagement Karen M Bell, MD Chair, CCHIT 2013 Accountable Care HIT Strategies Summit September 10, 2013 San Francisco, CA

2 Why an ACO HIT Framework? Changing reimbursement policies encourage greater accountability for cost, quality, and patient focused care Federal ACO/MSS rule Commercial insurers offering multiple types of ACO models Some states mandating accountable care from Medicaid providers More than 450 providers groups in some form of financial risk arrangement Different from HMO capitation of the 1990s Emphasis on quality of care as well as patient engagement No designated gatekeepers -- patients seek care where they wish Belief in the power of HIT to support new structures and processes Many new provider groups unclear about what they will need and where to start their HIT roadmaps No structured comprehensive public discussion at the implementation level 2013 Slide 2 September

3 Value of the Framework Provider groups taking on financial risk -- self assessment and roadmap development, depending on organizational goals Payers -- assess readiness of proposed AC partners to take on risk; partnership opportunities Developers -- fill gaps Policy makers HITPC ACO WG recommendations All of us -- enhanced structured discussion and understanding of what it means to move along the continuum from current care to a transformed delivery system 2013 Slide 3 September

4 Silos Preclude Person Focused Health and Care Payer Care: Focused on the Member (Employer) and Costs Contracts with multiple providers Benefits vary per member Available networks per member Claims (what was paid for) Diagnoses (on claims) Clinical data extracted for quality measurement purposes (HEDIS) for NCQA, PQRI, etc.) Emphasis on measurement Provider Based Care: Focused on the Patient and Care Workflows Reimbursed by multiple payers under multiple contractual arrangements Cares for multiple patients with multiple benefit structures/networks Cares for patients who see multiple other providers Has information on care generated at point of care only Community Based Care: Focused on Individual Needs Outcomes and goals End of life wishes, living wills, etc. Cultural preferences Health risks Patient monitored data Pastoral, social, familial caregiver support Independent of payer or provider 2013 Slide 4 September

5 2013 Slide 5 September

6 The Framework Part 1: Summary Represents a provider orientation -- how care delivery functions at the organizational level Grounded in goals and objectives of care delivery Process oriented in the accountable care delivery environment with necessary functions outlined for each process 2013 Slide 6 September

7 2013 Slide 7 September

8 Important Consideration Emphasis on Primary HIT requirements common to all organizations in the accountable care arena and to all processes Sharing of health information among providers internal and external to organization as well as with patients and their designated caregivers Data integration from multiple sources -- clinical, operational, financial and patient derived Specific patient safety features Strong privacy and security protections Can be implemented in multiple ways Can be implemented by different partners 2013 Slide 8 September

9 2013 Slide 9 September

10 The Framework Part 2: HIT Capabilities Each process and its functions are defined in detail HIT capabilities optimally supporting each of the 64 discrete functions are outlined Patient safety features are bolded MU 2014 criteria are starred 2013 Slide 10 September

11 Care Coordination Care Coordination involves two different but related aspects of patient care. One provides information to the clinician who must be able to access from and provide relevant clinical data to multiple sources in order to determine and provide for appropriate next steps in diagnosis or treatment. The other is to assure that patients are in the appropriate setting as they transition among multiple levels of care. Both are important for providing high quality care as well as mitigating excess, both must incorporate patient needs and preferences, and both are highly dependent on the ability to quickly and easily send and query health information on a given patient to and from multiple electronic sources Slide 11 September

12 2013 Slide 12 September

13 The Framework Part 3: An ACO HIT Glide Path Based on how the care environment will likely change as provider organizations become more and more accountable for quality, costs and customer loyalty Acknowledges accountable care as really about healthcare transformation Each organization will have a unique glide path, commensurate with its own short and long term goals Functions and HIT capabilities may be more limited in early stages of healthcare transformation and grow incrementally as needed 2013 Slide 13 September

14 The Goal: Healthcare Transformation Focus Current Situation Transitioning Environment Transformed Future Clinical Culture Physician centric, individualistic, authoritative Primary care based teams, may include patient and designees True collaboration with all providers, patients and designees Cost Efficiency Cost measurement based on silos of payer claims Care coordination and care management processes Strong business analytics, contracts and improved clinical processes Reimbursement Incentive Mostly FFS, moving into upside financial risk Significant up and downside risk Most patients under global payment arrangements Patient Involvement Patient satisfaction surveys (to the patient) Patient outreach and follow up (for the patient) Patient as partners (with the patient) Quality of Care Reporting on a myriad of measures to a myriad of entities Manage specific cohorts to individual goals CQI based care process reengineering 2013 Slide 14 September

15 2013 Slide 15 September

16 Financial Management: It s All About the Data Data sources - all payer data bases, consolidated clinical data from multiple EHRs, operational systems Business Intelligence Analyses Descriptive reports, dashboards, trends, etc. Predictive applied statistics and modeling Prescriptive linear programming and regressions to analyze options Revenue Cycle Management Book different types of reimbursements and their cycles Pay clinicians other than straight FFS Identify and plan for areas of loss Supplier management Other: attribution, leakage, program evaluation 2013 Slide 16 September

17 Knowledge Management: With a Little Help From Your Friends CDS beyond alerts and reminders to clinicians Diagnostic and treatment options CDS to patients and designees Document management and search engines for advanced business analytics Personalized medicine Outcomes based on patient supplied data with respect to function, overall health and meeting of goals 2013 Slide 17 September

18 Patient Engagement: Keep your Pasture Greener Simplify: easy to seek all care with or through you Educate: to the patient Communicate: for the patient including follow up and making appointments as in PCMHs Incorporate: with the patient including both their preferences and their advice 2013 Slide 18 September

19 Clinician Engagement: Culture Eats Technology for Lunch Provide good data on practice and patients Administrative simplification Support for collaboration Supply or link to useful information Assessment tools Up to date clinical information programs Relevant payer, public health, research, community resources and cultural links 2013 Slide 19 September

20 How to Use the ACO HIT Framework Step 1: Map short and long term goals and objectives to the broad areas on the Glide Path and corresponding processes and functions Step 2: Assume 2014 ONC Certified products; focus on Primary HIT Requirements Step 3: Conduct internal assessment of HIT capabilities that support the identified processes and functions that match your goals Step 4: Roadmap the gaps: functions first, then HIT support 2013 Slide 20 September

21 The ACO Workgroup Reports into the HITPC Recommendations due end of December 2013 Initial focus on developing certification criteria for Meaningful Use Stage 3 Current direction Continued review of Framework elements Assessing what exists now in MU against ACO needs High priority interoperability standards Data integration policies to support business analytics Other Federal policy levers to support ACOs 2013 Slide 21 September

22 The Goal of Health Reform Payers Patient Focused Health & Care Providers Community based care 2013 Slide 22 September

23 Thank You! Access to the interactive CCHIT ACO HIT Framework with User s Guide We welcome general comments and feedback regarding either CCHIT s work or the ACO WG activity Contacts: kbell@cchit.org Karen Bell, Chair & ACO Workgroup sreber@cchit.org Sue Reber, Outreach Director 2013 Slide 23 September

Using Data for Proactive Patient Population Management

Using 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 information

Health Information Technology

Health 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 information

Accountable Care Organizations American Osteopathic Association Health Policy Day September 23, 2011

Accountable 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 information

Driving Business Value for Healthcare Through Unified Communications

Driving Business Value for Healthcare Through Unified Communications Driving Business Value for Healthcare Through Unified Communications Even the healthcare sector is turning to technology to take a 'connected' approach, as organizations align technology and operational

More information

Succeeding with Accountable Care Organizations

Succeeding with Accountable Care Organizations Succeeding with Accountable Care Organizations The Point B Webinar Series October 25, 2011 Today s Discussion Key ACO trends and emerging models Critical success factors for building an ACO Developing

More information

NextGen Population Health TEN TEN TEN TEN TE. Prevent Patients from Falling Through the Cracks in 10 Easy Steps

NextGen Population Health TEN TEN TEN TEN TE. Prevent Patients from Falling Through the Cracks in 10 Easy Steps NextGen Population Health TEN TEN TEN TEN TE Prevent Patients from Falling Through the Cracks in 10 Easy Steps Proactive, automated patient engagement anytime, anywhere. Automate care management to improve

More information

Coastal Medical, Inc.

Coastal Medical, Inc. A Culture of Collaboration The Organization Physician-owned group Currently 19 offices across the state of Rhode Island and growing 85 physicians, 101 care providers The Challenge Implement a single, unified

More information

Roadmap to accountable care: The chicken or the egg technology investment or clinical process improvement?

Roadmap to accountable care: The chicken or the egg technology investment or clinical process improvement? Roadmap to accountable care: The chicken or the egg technology investment or clinical process improvement? August 29, 2012 Meet the Presenters Michael Griffis CIO Innovative Practices Tucson, AZ Beth Hartquist,

More information

Population Health. Collaborative Care. One interoperable platform. NextGen Care

Population Health. Collaborative Care. One interoperable platform. NextGen Care Population Health. Collaborative Care. One interoperable platform. NextGen Care We ve become very proactive in identifying at-risk patients and getting them in our door before they get sick. Our physicians

More information

HIT Glossary and Acronym List

HIT Glossary and Acronym List HIT Glossary and Acronym List November 2011 FACT SHEET ACA Patient Protection and Affordable Care Act (see PPACA). ACO Accountable Care Organization: A group of health care providers (e.g. primary care,

More information

Russell B Leftwich, MD

Russell B Leftwich, MD Russell B Leftwich, MD Chief Medical Informatics Officer Office of ehealth Initiatives, State of Tennessee 1 Eligible providers and hospitals can receive incentives for meaningful use of certified EHR

More information

ACO: Ready or Not? Presented by: Robert C. Tennant Vice President. May 10, 2012

ACO: Ready or Not? Presented by: Robert C. Tennant Vice President. May 10, 2012 ACO: Ready or Not? Presented by: Robert C. Tennant Vice President May 10, 2012 About Health Directions Founded in 1985 as a Management Services Organization ( MSO ) for a South Chicago health system Evolved

More information

Clinical Integration and P4P: Using Pay for Performance to Build Clinical Integration within a Physician-Hospital IPA

Clinical Integration and P4P: Using Pay for Performance to Build Clinical Integration within a Physician-Hospital IPA Clinical Integration and P4P: Using Pay for Performance to Build Clinical Integration within a Physician-Hospital IPA March 9, 2010 Presented by: Michael Edbauer, DO, Vice President, Medical Affairs CIPA

More information

All ACO materials are available at What are my network and plan design options?

All ACO materials are available at   What are my network and plan design options? ACO Toolkit: A Roadmap for Employers What is an ACO? Is an ACO strategy right for my company? Which ACOs are ready? All ACO materials are available at www.businessgrouphealth.org What are my network and

More information

How to Improve HEDIS Reporting Among Providers and Improve Your Health Plan Rankings

How to Improve HEDIS Reporting Among Providers and Improve Your Health Plan Rankings How to Improve HEDIS Reporting Among Providers and Improve Your Health Plan Rankings Introduction In today s value-focused market, health plan rankings, such as those calculated by the National Committee

More information

Technology Fundamentals for Realizing ACO Success

Technology Fundamentals for Realizing ACO Success Technology Fundamentals for Realizing ACO Success Introduction The accountable care organization (ACO) concept, an integral piece of the government s current health reform agenda, aims to create a health

More information

Informatics, PCMHs and ACOs: A Brave New World

Informatics, PCMHs and ACOs: A Brave New World Informatics, PCMHs and ACOs: A Brave New World R. Clark Campbell, MSN, RN-BC, CPHIMS, FHIMSS Kathleen Kimmel, RN, BSN, MHA, CPHIMS, FHIMSS Engagement Executive with Health Catalyst Objectives - Define

More information

Michigan s Vision for Health Information Technology and Exchange

Michigan s Vision for Health Information Technology and Exchange Michigan s Vision for Health Information Technology and Exchange Health information exchange or HIE is the mobilization of health care information electronically across organizations within a region, community

More information

Transitioning to a Value-Based Accountable Health System Preparing for the New Business Model. The New Accountable Care Business Model

Transitioning to a Value-Based Accountable Health System Preparing for the New Business Model. The New Accountable Care Business Model Transitioning to a Value-Based Accountable Health System Preparing for the New Business Model Michael C. Tobin, D.O., M.B.A. Interim Chief medical Officer Health Networks February 12, 2011 2011 North Iowa

More information

Tribal Health. Integrated Tribal Health Center Solutions Five Steps to Better Tribal Health Outcomes

Tribal Health. Integrated Tribal Health Center Solutions Five Steps to Better Tribal Health Outcomes Tribal Health Integrated Tribal Health Center Solutions Five Steps to Better Tribal Health Outcomes Join the Tribal Health leader Tap into the single, shared database of our EHR and practice management

More information

Decision Support Project Team. Fall 2010

Decision Support Project Team. Fall 2010 Decision Support Project Team Engineering the System of Healthcare Delivery ESD 69 HST 926j HC 750 MIT Seminar on Health Care Systems Innovation ESD.69, HST.926j, HC.750 MIT Seminar on Health Care Systems

More information

ACO Practice Transformation Program

ACO Practice Transformation Program ACO Overview ACO Practice Transformation Program PROGRAM OVERVIEW As healthcare rapidly transforms to new value-based payment systems, your level of success will dramatically improve by participation in

More information

Payment Reform Strategies. Ann Thomas Burnett BlueCross BlueShield of South Carolina

Payment Reform Strategies. Ann Thomas Burnett BlueCross BlueShield of South Carolina Payment Reform Strategies Ann Thomas Burnett BlueCross BlueShield of South Carolina Disclosure I have no relevant financial relationships with commercial interests to disclose. The Current Market Landscape

More information

Value-Based Readiness: Setting the Right Pace

Value-Based Readiness: Setting the Right Pace HEALTHLEADERS MEDIA INTELLIGENCE REPORT MAY 2017 Value-Based Readiness: Setting the Right Pace An Independent HealthLeaders Media Report Supported by: An Independent HealthLeaders Media Report Powered

More information

Medicare Physician Payment Reform:

Medicare Physician Payment Reform: Medicare Physician Payment Reform: Implications and Options for Physicians and Hospitals Background The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law on April 14, 2015.

More information

A Practical Approach Toward Accountable Care and Risk-Based Contracting: Design to Implementation

A Practical Approach Toward Accountable Care and Risk-Based Contracting: Design to Implementation A Practical Approach Toward Accountable Care and Risk-Based Contracting: Design to Implementation Daniel J. Marino, President/CEO, Health Directions Asad Zaman, MD June 19, 2013 Session Objectives Establish

More information

The National ACO, Bundled Payment and MACRA Summit. Success in Physician Led Bundles

The National ACO, Bundled Payment and MACRA Summit. Success in Physician Led Bundles The National ACO, Bundled Payment and MACRA Summit Success in Physician Led Bundles Disclaimer This material and/or presentation is provided for guidance and/or illustrative purposes only and should not

More information

Adopting Accountable Care An Implementation Guide for Physician Practices

Adopting 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 information

CIO Legislative Brief

CIO Legislative Brief CIO Legislative Brief Comparison of Health IT Provisions in the Committee Print of the 21 st Century Cures Act (dated November 25, 2016), H.R. 6 (21 st Century Cures Act) and S. 2511 (Improving Health

More information

Models of Accountable Care

Models 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 information

Health Information Exchange in Minnesota

Health Information Exchange in Minnesota Health Information Exchange in Minnesota Minnesota Rural Health Conference Duluth, MN June 21, 2016 Anne Schloegel Minnesota Department of Health Office of Health Information Technology Office of Health

More information

Texas ACO invests in the Quanum portfolio to improve patient care

Texas ACO invests in the Quanum portfolio to improve patient care Case study: Premier Management Company North Texas Texas ACO invests in the Quanum portfolio to improve patient care Premier Management Company (PMC) manages 3 accountable care organizations (ACOs) in

More information

ARRA New Opportunities for Community Mental Health

ARRA New Opportunities for Community Mental Health ARRA New Opportunities for Community Mental Health Presented to: The Indiana Council of Community Behavioral Health Kevin Scalia Executive Vice-President, Corporate Development February 11, 2010 Overview

More information

Improving Care and Lowering Costs: The Use of Clinical Data by Medicaid Managed Care Organizations. April 26, 2018

Improving Care and Lowering Costs: The Use of Clinical Data by Medicaid Managed Care Organizations. April 26, 2018 Improving Care and Lowering Costs: The Use of Clinical Data by Medicaid Managed Care Organizations April 26, 2018 Agenda Welcome and Overview of Interview Results Claudia Ellison, Director of Programs,

More information

Accountable Care Organizations. What the Nurse Executive Needs to Know. Rebecca F. Cady, Esq., RNC, BSN, JD, CPHRM

Accountable 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 information

Michigan Primary Care Association

Michigan Primary Care Association Michigan Primary Care Association Improving Outcomes Finance & Quality through Integrated Information Conference June 2-3, 2016 Shanty Creek Resorts Bellaire, MI Definition and Purpose HRSA s Health Center

More information

HIE Data: Value Proposition for Payers and Providers

HIE Data: Value Proposition for Payers and Providers HIE Data: Value Proposition for Payers and Providers Session #21, March 6, 2018 Laura McCrary, Executive Director, KHIN Tara Orear, Senior Ambulatory Systems Analyst, Newman Regional Health Dirk Rittenhouse,

More information

Jumpstarting population health management

Jumpstarting 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 information

Connected Care Partners

Connected 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 information

MACRA, MIPS, and APMs What to Expect from all these Acronyms?!

MACRA, MIPS, and APMs What to Expect from all these Acronyms?! MACRA, MIPS, and APMs What to Expect from all these Acronyms?! ACP Pennsylvania Council Meeting Saturday, December 5, 2015 Shari M. Erickson, MPH Vice President, Governmental Affairs & Medical Practice

More information

improvement program to Electronic Health variety of reasons, experts suggest that up to

improvement program to Electronic Health variety of reasons, experts suggest that up to Reducing Hospital Readmissions March/2017 The readmission rate for patients discharged to a skilled nursing facility is 25% within 30 days1. What can senior care providers do to reduce these hospital readmissions?

More information

Emerging Tools and Technology for Consumer Engagement in Health Care

Emerging Tools and Technology for Consumer Engagement in Health Care Emerging Tools and Technology for Consumer Engagement in Health Care Speakers: Matt McGeorge, Senior Consultant, Jean Glossa M.D., Principal, October 15, 2015 HealthManagement.com HealthManagement.com

More information

Quality Improvement in the Advent of Population Health Management WHITE PAPER

Quality Improvement in the Advent of Population Health Management WHITE PAPER Quality Improvement in the Advent of Population Health Management WHITE PAPER For healthcare organizations whose reimbursement and revenue are tied to patient outcomes, achieving performance on quality

More information

State Medicaid Directors Driving Innovation: Continuous Quality Improvement February 25, 2013

State Medicaid Directors Driving Innovation: Continuous Quality Improvement February 25, 2013 State Medicaid Directors Driving Innovation: Continuous Quality Improvement February 25, 2013 The National Association of Medicaid Directors (NAMD) is engaging states in shared learning on how Medicaid

More information

Nursing Knowledge: Big Data Research for Transforming Healthcare HIMSS NI Nurse Executive Workgroup January 9, 2014

Nursing Knowledge: Big Data Research for Transforming Healthcare HIMSS NI Nurse Executive Workgroup January 9, 2014 Nursing Knowledge: Big Data Research for Transforming Healthcare HIMSS NI Nurse Executive Workgroup January 9, 2014 Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS, FAAN Vice President, Informatics, HIMSS President,

More information

KEYS TO QUALITY HCCN. A Project of the Keystone Community Health Alliance

KEYS TO QUALITY HCCN. A Project of the Keystone Community Health Alliance KEYS TO QUALITY HCCN A Project of the Keystone Community Health Alliance INTRODUCTIONS NNCC and HCCN History HCCN Staff HRSA s HCCN Program NNCC and HCCN Background 501(c)3 non-profit organization providing

More information

URAC Patient Centered Medical Home

URAC Patient Centered Medical Home URAC Patient Centered Medical Home Presented by: Cynthia Cook, RN, BSN Sr. Director Business Development Data Only 27% of U.S. adults can easily contact their primary care physicians by telephone, obtain

More information

CoxHealth: A Case Study in Launching a Co-Branded Medicare Advantage Plan

CoxHealth: A Case Study in Launching a Co-Branded Medicare Advantage Plan CoxHealth: A Case Study in Launching a Co-Branded Medicare Advantage Plan Guiding a Health System s Journey to Value with a Collaborative Payer Partner Situation $1.3 billion, five-hospital system in the

More information

EHR for the PCMH A Doctor s Perspective. Medical Home Summit

EHR for the PCMH A Doctor s Perspective. Medical Home Summit EHR for the PCMH A Doctor s Perspective Medical Home Summit Salvatore Volpe MD FAAP FACP CHCQM www.svolpemd.com March 15, 2011 Learning Objectives Why I adopted an EHR My experience: what I needed to do

More information

Describe the process for implementing an OP CDI program

Describe the process for implementing an OP CDI program 1 Outpatient CDI: The Marriage of MACRA and HCCs Marion Kruse, RN, MBA Founding Partner LYM Consulting Columbus, OH Learning Objectives At the completion of this educational activity, the learner will

More information

Finding a Faster Path to Value-Based Care

Finding a Faster Path to Value-Based Care Finding a Faster Path to Value-Based Care June 2016 Executive Summary The U.S. healthcare system is progressing along a continuum from volume- to valuebased care models where physicians and health systems

More information

Disclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws.

Disclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws. Disclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws. This should not be used as legal advice. Itentive recognizes that

More information

Complex Patient Care Redesign: ThedaCare Innovation. Gregory Long, MD Chief Medical Officer

Complex Patient Care Redesign: ThedaCare Innovation. Gregory Long, MD Chief Medical Officer Complex Patient Care Redesign: ThedaCare Innovation Gregory Long, MD Chief Medical Officer ThedaCare Northeastern Wisconsin An Integrated Community Health System; >7000 employees Primary service area of

More information

Health Care Evolution

Health Care Evolution Health Care Evolution Patient-Centered Medical Home to Clinical Integration & Accountable Care Ken Bertka, MD bertka@mindspring.com 419-346-8719 Agenda Top 3 Challenges of Health Care Reform PCMH & ACO

More information

Alternative Managed Care Reimbursement Models

Alternative 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 information

Healthcare Workforce to Promote

Healthcare Workforce to Promote Accreditation, Certification, and Credentialing: Levers for Training the Healthcare Workforce to Promote Children s Behavioral Health Marci Nielsen, PhD, MPH President & CEO Patient-Centered Primary Care

More information

Ten Tips for Accountable Care Success TEN TEN TEN TEN TE. Retooling for the Shifting Healthcare Landscape

Ten Tips for Accountable Care Success TEN TEN TEN TEN TE. Retooling for the Shifting Healthcare Landscape Ten Tips for Accountable Care Success TEN TEN TEN TEN TE Retooling for the Shifting Healthcare Landscape That s right. It s time to retool. To prepare. Healthcare is changing and it s changing fast. A

More information

The Patient Protection and Affordable Care Act Summary of Key Health Information Technology Provisions June 1, 2010

The Patient Protection and Affordable Care Act Summary of Key Health Information Technology Provisions June 1, 2010 The Patient Protection and Affordable Care Act Summary of Key Health Information Technology Provisions June 1, 2010 This document is a summary of the key health information technology (IT) related provisions

More information

COLLABORATING FOR VALUE. A Winning Strategy for Health Plans and Providers in a Shared Risk Environment

COLLABORATING FOR VALUE. A Winning Strategy for Health Plans and Providers in a Shared Risk Environment COLLABORATING FOR VALUE A Winning Strategy for Health Plans and Providers in a Shared Risk Environment Collaborating for Value Executive Summary The shared-risk payment models central to health reform

More information

WHAT IT FEELS LIKE

WHAT IT FEELS LIKE PCMH and PCSP WHAT IT FEELS LIKE Presentation Outline Goals of the Patient Centered Medical Home and the Patient Centered Specialty Practice Identifying the Joint Principles Recognition Programs Standards

More information

Bad Data s Effect on Population Health Performance

Bad Data s Effect on Population Health Performance Session #180: Bad Data s Effect on Population Health Performance Wednesday April 15, 2015 1-2pm Bill Gillis Chief Information Officer DISCLAIMER: The views and opinions expressed in this presentation are

More information

Blueprint For Success: The Patient Centered Medical Home

Blueprint For Success: The Patient Centered Medical Home Blueprint For Success: The Patient Centered Medical Home Kay Lynn Olmsted, DNP, FNP-BC Assistant Professor, University of South Alabama Donna Hodnicki, PhD, FNP-BC, FAAN Professor Emeritus, Georgia Southern

More information

Improving Western NY s Population Health Using Patient Centered Medical Home

Improving Western NY s Population Health Using Patient Centered Medical Home Improving Western NY s Population Health Using Patient Centered Medical Home Presented by: Dr. Riffat Sadiq Western NY Medical Center Jeanette Ball, RN BSN PCMH CCE CTG Health Solutions Session C7 IHI

More information

Three C s of Change in the Value-Based Economy: Competency, Culture and Compensation. April 4, :45 5:00 pm

Three C s of Change in the Value-Based Economy: Competency, Culture and Compensation. April 4, :45 5:00 pm Three C s of Change in the Value-Based Economy: Competency, Culture and Compensation April 4, 2014 3:45 5:00 pm 1 Introduction Kevin McCune, MD Chief Medical Officer Advocate Medical Group Peg Stone Vice

More information

UPDATE ON MEANINGFUL USE. HITECH Stimulus Act of 2009: CSC Point of View

UPDATE ON MEANINGFUL USE. HITECH Stimulus Act of 2009: CSC Point of View HITECH Stimulus Act of 2009: CSC Point of View UPDATE ON MEANINGFUL USE Introduction The HITECH provisions of the American Recovery and Reinvestment Act of 2009 provide a commanding $36 billion dollars

More information

Innovative Business Activities in Health Care with Commercial Partners

Innovative 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 information

Building a Multi-System Clinically Integrated Network

Building a Multi-System Clinically Integrated Network Building a Multi-System Clinically Integrated Network 22 nd Annual AHA Leadership Summit July 2014 Valence Health Has Been Helping Provider Organizations Progress Toward Value-Based Care Since 1996 Technology-enabled

More information

Medicare. Shared. Whitepaper. Savings:A PrActicAl Path to Accountable care SPONSORED BY. Medicare. Shared. 1 A sponsored Medical Economics whitepaper

Medicare. Shared. Whitepaper. Savings:A PrActicAl Path to Accountable care SPONSORED BY. Medicare. Shared. 1 A sponsored Medical Economics whitepaper Medicare Shared Whitepaper Savings:A PrActicAl Path to Accountable care SPONSORED BY Medicare Shared Savings:A PrActicAl Path to Accountable care 1 A sponsored Medical Economics whitepaper Medicare Ambulatory

More information

Healthcare's Grand Transformation with Primary Care

Healthcare's Grand Transformation with Primary Care WEBINAR SYNOPSIS Healthcare's Grand Transformation with Primary Care 9th August 2018 SPEAKERS Paul Grundy David Nace, M.D. Founding President of the Patient-Centered Primary Care Collaborative (PCPCC),

More information

Long term commitment to a new vision. Medical Director February 9, 2011

Long 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 information

Quality, Cost and Business Intelligence in Healthcare

Quality, Cost and Business Intelligence in Healthcare Quality, Cost and Business Intelligence in Healthcare Maitri Vaidya Population Health Executive DBA, MHA, CPHQ May 2016 Where are we going? IHI Triple Aim Improve the patient experience of care Lower

More information

PBGH Response to CMMI Request for Information on Advanced Primary Care Model Concepts

PBGH Response to CMMI Request for Information on Advanced Primary Care Model Concepts PBGH Response to CMMI Request for Information on Advanced Primary Care Model Concepts 575 Market St. Ste. 600 SAN FRANCISCO, CA 94105 PBGH.ORG OFFICE 415.281.8660 FACSIMILE 415.520.0927 1. Please comment

More information

FIVE FIVE FIVE FIVE FIV

FIVE FIVE FIVE FIVE FIV Technology and Data s Impact on Population Health FIVE FIVE FIVE FIVE FIV 5 Steps to an Effective and Sustainable Population Health Management Program This ebook will share critical information about population

More information

Accountable Care: Clinical Integration is the Foundation

Accountable Care: Clinical Integration is the Foundation Solutions for Value-Based Care Accountable Care: Clinical Integration is the Foundation CLINICAL INTEGRATION CARE COORDINATION ACO INFORMATION TECHNOLOGY FINANCIAL MANAGEMENT The Accountable Care Organization

More information

THE 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 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 information

Sharp HealthCare ACO. Presented by: Donald C. Balfour, M.D. President and Medical Director Sharp Rees-Stealy Medical Group

Sharp HealthCare ACO. Presented by: Donald C. Balfour, M.D. President and Medical Director Sharp Rees-Stealy Medical Group Sharp HealthCare ACO Presented by: Donald C. Balfour, M.D. President and Medical Director Sharp Rees-Stealy Medical Group Institute for Quality Leadership Annual Conference October 4, 2012 Sharp ACO Collaborations

More information

Comparison of Health IT Provisions in H.R. 6 (21 st Century Cures Act) and S (Improving Health Information Technology Act)

Comparison of Health IT Provisions in H.R. 6 (21 st Century Cures Act) and S (Improving Health Information Technology Act) Comparison of Health IT Provisions in H.R. 6 (21 st Century Cures Act) and S. 2511 (Improving Health Information Technology Act) Policy Proposal Health Software Regulation Senate Innovations Initiative

More information

Care Management at Mercy ACO

Care Management at Mercy ACO JANUARY 18 Care Management at Mercy ACO Case Study About Mercy Mercy ACO Care Management 01 Who they are Mercy ACO, one of the largest Accountable Care Organizations in the Midwest U.S. with 400+ service

More information

Making the Case for Quality: How to Engage Clinical Staff in QI Activities

Making the Case for Quality: How to Engage Clinical Staff in QI Activities Making the Case for Quality: How to Engage Clinical Staff in QI Activities Kelley Montague, RN Indiana Rural Health Association 2017 Annual Conference June 13-14, 2017 1 Objectives: Understand the importance

More information

Building the Universal Roadmap to Population Health Management

Building the Universal Roadmap to Population Health Management Building the Universal Roadmap to Population Health Management Executive Webinar January 21, 2016 Karen Handmaker, MPP, PCMH CCE IBM Watson Health House Keeping 1. Using the control panel Use the control

More information

The New York State Value-Based Payment (VBP) Roadmap. Primary Care Providers March 27, 2018

The New York State Value-Based Payment (VBP) Roadmap. Primary Care Providers March 27, 2018 The New York State Value-Based Payment (VBP) Roadmap Primary Care Providers March 27, 2018 1 Housekeeping All lines have been muted To ask a question at any time, use the Chat feature in WebEx We will

More information

Patient-Centered Medical Home 101: General Overview

Patient-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 information

Executive Summary 1. Better Health. Better Care. Lower Cost

Executive 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 information

Where Do We Go From Here? The Value of Sustaining Practice Transformation

Where Do We Go From Here? The Value of Sustaining Practice Transformation Where Do We Go From Here? The Value of Sustaining Practice Transformation MASSACHUSETTS LEAGUE OF COMMUNITY HEALTH CENTERS ANNUAL CLINICAL CONFERENCE November 19, 2013 Nicole Van Borkulo, MEd Senior Consultant

More information

WHITE PAPER. Maximizing Pay-for-Performance Opportunities Proven Steps to Making P4P a Proactive, Successful and Sustainable Part of Your Practice

WHITE PAPER. Maximizing Pay-for-Performance Opportunities Proven Steps to Making P4P a Proactive, Successful and Sustainable Part of Your Practice WHITE PAPER Maximizing Pay-for-Performance Opportunities Proven Steps to Making P4P a Proactive, Successful and Sustainable Part of Your Practice Maximizing Pay-for-Performance Opportunities In today s

More information

Essentia Health. A View on Information Technology. ND HIMS Conference April 12, Tim Sayler, COO Essentia Health - West

Essentia Health. A View on Information Technology. ND HIMS Conference April 12, Tim Sayler, COO Essentia Health - West Essentia Health A View on Information Technology ND HIMS Conference April 12, 2017 Tim Sayler, COO Essentia Health - West Me Discussing Information Technology Who is Essentia Overview Why: Information

More information

The Minnesota Accountable Health Model STATE INNOVATION MODEL (SIM) GRANT OVERVIEW, GOALS, & ACTIVITIES

The Minnesota Accountable Health Model STATE INNOVATION MODEL (SIM) GRANT OVERVIEW, GOALS, & ACTIVITIES The Minnesota Accountable Health Model STATE INNOVATION MODEL (SIM) GRANT OVERVIEW, GOALS, & ACTIVITIES What is the? Funding awarded to Minnesota by the CMS Innovation Center In partnership under the Minnesota

More information

THE BUSINESS OF PEDIATRICS: BETTER CARE = BETTER PAYMENT. 19 th CNHN Pediatric Practice Management Seminar Thursday, December 6, 2016

THE BUSINESS OF PEDIATRICS: BETTER CARE = BETTER PAYMENT. 19 th CNHN Pediatric Practice Management Seminar Thursday, December 6, 2016 THE BUSINESS OF PEDIATRICS: BETTER CARE = BETTER PAYMENT 19 th CNHN Pediatric Practice Management Seminar Thursday, December 6, 2016 SMALLER VS BIGGER? WHAT PRACTICE SIZE IS JUST RIGHT? Mark Weissman,

More information

The Patient-Centered Medical Home Model of Care

The Patient-Centered Medical Home Model of Care The Patient-Centered Medical Home Model of Care May 11, 2017 Louise Bryde Principal Presentation Outline Imperatives for Change Overview: What Is a Patient-Centered Medical Home? The Medical Neighborhood

More information

Analytics in Action. Using Data to Improve Care and Reduce Costs CUSTOM MEDIA SPONSORED BY

Analytics in Action. Using Data to Improve Care and Reduce Costs CUSTOM MEDIA SPONSORED BY Analytics in Action Using Data to Improve Care and Reduce Costs CUSTOM MEDIA SPONSORED BY Imagine an 82-year-old gentleman walks in to your emergency department. He presents with a productive cough and

More information

Definition of Meaningful Use of Certified EHR Technology for Hospitals Approved by the HIMSS Board of Directors April 24, 2009

Definition of Meaningful Use of Certified EHR Technology for Hospitals Approved by the HIMSS Board of Directors April 24, 2009 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 Definition of Meaningful Use of Certified EHR Technology for Hospitals Approved by

More information

Value Based Payment. June 1, 2017

Value Based Payment. June 1, 2017 Value Based Payment June 1, 2017 MCTAC Overview What is MCTAC? MCTAC is a training, consultation, and educational resource center that offers resources to all mental health and substance use disorder providers

More information

The Future of HIE in Alaska

The Future of HIE in Alaska The Future of HIE in Alaska 1 Presentation Outline Developing a Roadmap for Alaska s HIE The Vision of AeHN: HIE 2.0 A Provider s Perspective 2 Brief History of Alaska s Health Information Exchange System

More information

The Value of Integrating EMR and Claims/Cost Data in the Transition to Population Health Management

The Value of Integrating EMR and Claims/Cost Data in the Transition to Population Health Management The Value of Integrating EMR and Claims/Cost Data in the Transition to Population Health Management By Jim Hansen, Vice President, Health Policy, Lumeris November 19, 2013 EXECUTIVE SUMMARY When EMR data

More information

Readmission Prevention Programs. Vice President, Strategy & Development June 6, 2017

Readmission Prevention Programs. Vice President, Strategy & Development June 6, 2017 Readmission Prevention Programs Paul M. Duck @paulduck Vice President, Strategy & Development June 6, 2017 About Beacon Health Options Headquartered in Boston; more than 70 locations in the US and UK 5,000

More information

One Medicine: Incorporating Population Health Principles and Best Practices into Clinical Workflow

One Medicine: Incorporating Population Health Principles and Best Practices into Clinical Workflow One Medicine: Incorporating Population Health Principles and Best Practices into Clinical Workflow March 5, 2018 Jayne Bassler President, Population Health Services Organization Senior Vice President,

More information

Outcomes Measurement in Long-Term Care (LTC)

Outcomes Measurement in Long-Term Care (LTC) ASHA Short Course Outcomes Measurement in Long-Term Care (LTC) Bill Goulding, MS/CCC-SLP November 19, 2012 How Do We Show Value? Easy to measure! Not so easy! V $$$ A L Impact? Cost U Benefit E What do

More information

The Influence of Health Policy on Clinical Practice. Dr. Kim Kuebler, DNP, APRN, ANP-BC Multiple Chronic Conditions Resource Center

The Influence of Health Policy on Clinical Practice. Dr. Kim Kuebler, DNP, APRN, ANP-BC Multiple Chronic Conditions Resource Center The Influence of Health Policy on Clinical Practice Dr. Kim Kuebler, DNP, APRN, ANP-BC Multiple Chronic Conditions Resource Center Disclaimer Director: Multiple Chronic Conditions Resource Center www.multiplechronicconditions.org

More information

Small Rural Hospital Transitions (SRHT) Project. Rural Relevant Measures: Next Steps for the Future

Small Rural Hospital Transitions (SRHT) Project. Rural Relevant Measures: Next Steps for the Future Small Rural Hospital Transitions (SRHT) Project Rural Relevant Measures: Next Steps for the Future Paul Moore, DPh Senior Health Policy Advisor Federal Office of Rural Health Policy, Health Resources &

More information

Value-based Payment: What Have We Learned and Where Are We Headed?

Value-based Payment: What Have We Learned and Where Are We Headed? Value-based Payment: What Have We Learned and Where Are We Headed? March 13, 2018 2:00 3:00 PM ET Logistics Presentation Slides and How to Participate in Today s Session You can download the presentation

More information