The healthcare world is changing in ways that many of us have never seen in our lifetime, with the possible exception of Medicare.

Size: px
Start display at page:

Download "The healthcare world is changing in ways that many of us have never seen in our lifetime, with the possible exception of Medicare."

Transcription

1 Patient Centered Medical Home A Medicaid Managed Care Alternative Tad P. Fisher Executive Vice President Florida Academy of Family Physicians The healthcare world is changing in ways that many of us have never seen in our lifetime, with the possible exception of Medicare.

2 It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change. Charles Darwin There will be winners and losers at all levels as a result of healthcare (health insurance) reform.

3 Today Today Pilots Today2013 Pilots*2012 Pilots* Source: The Advisory Board, 2010 *Medicare Pilots waiver of anti-trust & anti-kickback Source: Advisory Board Physicians & Staff Patients Happier staff Happier physicians Increased net revenue Increased take home pay in today s environment Team based care Decreased panel size? Relatively rapid returns from transformation Increased standardization of care Improved satisfaction Improved preventive care Improved quality measures Reduced ED utilization Reduced readmissions Reduced hospitalizations Longer team based appointments; enhanced communication Reduced per capita cost for certain chronic conditions

4 Team based care Focus on the top of license/training & interest Improved communication Improved data flow & access Right patient at the right time Patient centered aligned incentives outcomes, quality, cost External accountability outcomes, quality, cost Personal Physician trained to provide continuous, comprehensive care Physician Directed Medical Practice Whole Person Orientation Coordinated Care Quality and Safety Enhanced Access to Care Payment appropriately recognizes added value provided to the overall system

5 The Patient Centered Medical Home creates a framework for change The Patient Centered Medical Home creates a common language for change The Patient Centered Medical Home creates an opportunity for change Access to Care & Information Health care for all Same-day appointments After-hours access coverage Accessible patient and lab information Online patient services Electronic visits Group visits Practice Management Disciplined financial management Cost-Benefit decision-making Revenue enhancement Optimized coding & billing Personnel/HR management Facilities management Optimized office design/redesign Change management Practice-Based Services Comprehensive care for both acute and chronic conditions Prevention screening and services Surgical procedures Ancillary therapeutic & support services Ancillary diagnostic services Health Information Technology Electronic medical record Electronic orders and reporting Electronic prescribing Evidence-based decision support Population management registry Practice Web site Patient portal Care Management Population management Wellness promotion Disease prevention Chronic disease management Patient engagement and education Leverages automated technologies Quality and Safety Evidence-based best practices Medication management Patient satisfaction feedback Clinical outcomes analysis Quality improvement Risk management Regulatory compliance Care Coordination Community-based services Collaborative relationships Emergency room Hospital care Behavioral health care Maternity care Specialist care Pharmacy Physical Therapy Case Management Care transition Practice-Based Care Team Provider leadership Shared mission and vision Effective communication Task designation by skill set Nurse Practitioner / Physician Assistant Patient participation Family involvement options

6 Access to Care and information Practice Level Services Care Management Continuity of Care Services Practice Based Team Care Quality and Safety Health Information Technology Practice Management Patients 1. Trust 2. Ability to constructively manage conflict 3. Commitment to both one s own job and the larger mission 4. Ownership and accountability everyone is a leader in their own area. 5. Follow-through

7 Collaborative Care Coordinated Care Shared Responsibilities Community Resources Team Care in and outside the practice Interoperable Technology Shared vision/alignment Education Improved Outcomes! a. Quality b. Chronic Disease c. Transitions in care d. Satisfaction e. Efficiency (cost savings) f. Practice Financials

8 Culture of Improvement Performance Measurement Reliable Systems Great Outcomes Quality Built In Patient Service Patients Office Staff Physicians Community Convenient Access Personalized Care Care Coordination Financial Personnel Clinical Systems Practice Management Health IT Primary Care Process Automation (EHR) Communication Connectivity EBM Support Clinical Information Systems Continuous Healing Relationship Whole Person Orientation Family and Community Context Comprehensive Care

The Role of the Pharmacist in Value Based Health Care Systems. Len Fromer, M.D., FAAFP Assistant Clinical Professor UCLA School of Medicine

The Role of the Pharmacist in Value Based Health Care Systems. Len Fromer, M.D., FAAFP Assistant Clinical Professor UCLA School of Medicine The Role of the Pharmacist in Value Based Health Care Systems Len Fromer, M.D., FAAFP Assistant Clinical Professor UCLA School of Medicine It is not the strongest of the species that survives, nor the

More information

Preparing for DSRIP: Legal and Strategic Issues for Long-Term Care Providers. LeadingAge New York Webinar

Preparing for DSRIP: Legal and Strategic Issues for Long-Term Care Providers. LeadingAge New York Webinar Preparing for DSRIP: Legal and Strategic Issues for Long-Term Care Providers LeadingAge New York Webinar November 10, 2014 Tracy E. Miller, Esq. Health Care Group Bond, Schoeneck & King, PLLC Delivery

More information

From Surviving to Thriving in the QPP World

From Surviving to Thriving in the QPP World From Surviving to Thriving in the QPP World Today s Objectives Brief MACRA Overview Where are we going?: Advanced Alternative Payment Models (APMs) Where are we now? Merit Incentive-Based Payment System

More information

Optum Anesthesia. Completely integrated anesthesia information management system

Optum Anesthesia. Completely integrated anesthesia information management system Optum Anesthesia Completely integrated anesthesia information management system 2 Completely integrated anesthesia information management system Optum Anesthesia Information Management System (AIMS) helps

More information

Oregon 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 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 information

Brave 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 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 information

Overview of CMS HIT Initiatives. Kelly Cronin Senior Advisor to the Administrator Centers for Medicare and Medicaid Services September 2005

Overview of CMS HIT Initiatives. Kelly Cronin Senior Advisor to the Administrator Centers for Medicare and Medicaid Services September 2005 Overview of CMS HIT Initiatives Kelly Cronin Senior Advisor to the Administrator Centers for Medicare and Medicaid Services September 2005 A Variation Problem Dartmouth Atlas of Healthcare Decade of HIT:

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

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

Expansion of Pharmacy Services within Patient Centered Medical Homes. Jeremy Thomas, PharmD Associate Professor Department Pharmacy Practice

Expansion of Pharmacy Services within Patient Centered Medical Homes. Jeremy Thomas, PharmD Associate Professor Department Pharmacy Practice Expansion of Pharmacy Services within Patient Centered Medical Homes Jeremy Thomas, PharmD Associate Professor Department Pharmacy Practice What is a Patient Centered Medical Home (PCMH)? "an approach

More information

ACOs: California Style

ACOs: 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 information

RE: CMS-1677-P; Medicare Program; Request for Information on CMS Flexibilities and Efficiencies

RE: CMS-1677-P; Medicare Program; Request for Information on CMS Flexibilities and Efficiencies June 13, 2017 Ms. Seema Verma Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-1677-P P.O. Box 8011 Baltimore, MD 21244-1850 RE: CMS-1677-P;

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

Patient Centered Medical Home. History of PCMH concept. What does a PCMH look like? 10/1/2013. What is a Patient Centered Medical Home (PCMH)?

Patient Centered Medical Home. History of PCMH concept. What does a PCMH look like? 10/1/2013. What is a Patient Centered Medical Home (PCMH)? What is a Patient Centered Medical Home (PCMH)? Patient Centered Medical Home Jeremy Thomas, PharmD, CDE UAMS Department of Pharmacy "an approach to providing comprehensive primary care that facilitates

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

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

Oregon s Health System Transformation: The Coordinated Care Model. March 2014 Jeanene Smith MD, MPH Chief Medical Officer- Oregon Health Authority

Oregon s Health System Transformation: The Coordinated Care Model. March 2014 Jeanene Smith MD, MPH Chief Medical Officer- Oregon Health Authority Oregon s Health System Transformation: The Coordinated Care Model March 2014 Jeanene Smith MD, MPH Chief Medical Officer- Oregon Health Authority The Challenges Oregon Faced Rising healthcare costs outpacing

More information

NACDD and CDC Health Payer 101 Webinar Series. Webinar #4: Contracting 101

NACDD 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 information

INTERMACS has a Key Role in Reporting on Quality Metrics

INTERMACS has a Key Role in Reporting on Quality Metrics INTERMACS has a Key Role in Reporting on Quality Metrics Robert L Kormos MD FACS, FAHA FRCS(C) Director Artificial Heart Program University of Pittsburgh Medical Center The Patient Protection and Affordable

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

CPC+ CHANGE PACKAGE January 2017

CPC+ CHANGE PACKAGE January 2017 CPC+ CHANGE PACKAGE January 2017 Table of Contents CPC+ DRIVER DIAGRAM... 3 CPC+ CHANGE PACKAGE... 4 DRIVER 1: Five Comprehensive Primary Care Functions... 4 FUNCTION 1: Access and Continuity... 4 FUNCTION

More information

Spring User Conference May Sandestin, FL Detailed Agenda

Spring User Conference May Sandestin, FL Detailed Agenda Day One: Monday May 16, 2016 3 6 p.m. Conference Registration 5 6 p.m. Customer Welcome and Orientation for First-time Conference Attendees 6 8 p.m. Welcome Reception Day Two: Tuesday May 17, 2016 7 a.m.

More information

Accelerating Medicaid Innovation

Accelerating Medicaid Innovation Accelerating Medicaid Innovation Colorado Summit on Pediatric Home Asthma Interventions August 28, 2014 Mark A. Levine, MD Chief Medical Officer, Denver CMS Medicaid and CHIP The Center for Medicaid and

More information

Accountable Care Organizations: An AHA Research Synthesis Report

Accountable Care Organizations: An AHA Research Synthesis Report Accountable Care Organizations: An AHA Research Synthesis Report June 2010 TRANSFORMING HEALTH CARE THROUGH RESEARCH AND EDUCATION Accountable Care Organizations: An AHA Research Synthesis Report Accountable

More information

ECU Teacher s in Quality Academy Vidant Health Quality Program. Learning Session 1 March 24, 2014

ECU Teacher s in Quality Academy Vidant Health Quality Program. Learning Session 1 March 24, 2014 ECU Teacher s in Quality Academy Vidant Health Quality Program Learning Session 1 March 24, 2014 Objectives 1. Describe organizational approach to patient safety/quality improvement at Vidant Health and

More information

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

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

California Academy of Family Physicians Diabetes Initiative Care Model Change Package

California Academy of Family Physicians Diabetes Initiative Care Model Change Package California Academy of Family Physicians Diabetes Initiative Care Model Change Package Introduction The Care Model (CM) is a unique and proven approach for implementing proactive strategies that are responsive

More information

Transforming Delivery Systems for Population Health

Transforming Delivery Systems for Population Health Transforming Delivery Systems for Population Health George Isham, M.D., M.S. Senior Advisor, HealthPartners Senior Fellow, HealthPartners Institute for Education and Research October 9, 2015 Presenter

More information

Red Carpet Care: Intensive Case Management Program for Super-Utilizers

Red Carpet Care: Intensive Case Management Program for Super-Utilizers Red Carpet Care: Intensive Case Management Program for Super-Utilizers Alice Stollenwerk Petrulis, MD Linda C. Stokes, PhD The MetroHealth System Picture of MH MetroHealth 750 bed facility includes Rehab,

More information

7/7/17. Value and Quality in Health Care. Kevin Shah, MD MBA. Overview of Quality. Define. Measure. Improve

7/7/17. Value and Quality in Health Care. Kevin Shah, MD MBA. Overview of Quality. Define. Measure. Improve Value and Quality in Health Care Kevin Shah, MD MBA 1 Overview of Quality Define Measure 2 1 Define Health care reform is transitioning financing from volume to value based reimbursement Today Fee for

More information

Presented to the West Virginia Governance Forum May 2, 2014 Stonewall, West Virginia

Presented to the West Virginia Governance Forum May 2, 2014 Stonewall, West Virginia Keith J. Mueller, PhD Director, RUPRI Center for Rural Health Policy Analysis Head, Department of Health Management & Policy University of Iowa College of Public Health Keith-mueller@uiowa.edu Presented

More information

State Leadership for Health Care Reform

State 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 information

EMERGENCY DEPARTMENT CASE MANAGEMENT

EMERGENCY DEPARTMENT CASE MANAGEMENT EMERGENCY DEPARTMENT CASE MANAGEMENT By Linda Sallee, Haley Rhodes, Sapna Patel, Cathleen Trespasz Healthcare consumers are becoming more empowered to have healthcare on their terms. With telemedicine,

More information

Bundled Payments to Align Providers and Increase Value to Patients

Bundled Payments to Align Providers and Increase Value to Patients Bundled Payments to Align Providers and Increase Value to Patients Stephanie Calcasola, MSN, RN-BC Director of Quality and Medical Management Baystate Health Baystate Medical Center Baystate Health Is

More information

Sustaining a Patient Centered Medical Home Program

Sustaining a Patient Centered Medical Home Program Sustaining a Patient Centered Medical Home Program Partners Healthcare, Center for Population Health Colleen Blanchette Keri Sperry Terry Wilson-Malam Learning Objectives After this presentation, you will

More information

Is 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? 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 information

YOUR HEALTH INFORMATION EXCHANGE

YOUR HEALTH INFORMATION EXCHANGE YOUR HEALTH INFORMATION EXCHANGE Introduction to Health Information Exchange Healthcare organizations are experiencing substantial pressures from initiatives and reforms such as new payment models, care

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

ENHANCING PRESCRIBER RELATIONSHIPS: MAKING IT A WIN-WIN JULY 12, :00 5:00 PM

ENHANCING PRESCRIBER RELATIONSHIPS: MAKING IT A WIN-WIN JULY 12, :00 5:00 PM ENHANCING PRESCRIBER RELATIONSHIPS: MAKING IT A WIN-WIN JULY 12, 2017 3:00 5:00 PM ACPE UAN: 0107-9999-17-105-L04-P 0.2 CEU/2.0 hr Activity Type: Knowledge-Based Learning Objectives for Pharmacists: Upon

More information

Optimizing Operations through Data Collection and Dissemination. Raymond Belles, Jr. Managing Consultant

Optimizing Operations through Data Collection and Dissemination. Raymond Belles, Jr. Managing Consultant Optimizing Operations through Data Collection and Dissemination Raymond Belles, Jr. Managing Consultant rbelles@bkd.com Learning Objectives Define the changing healthcare landscape Identify trends in home

More information

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 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 information

Insights into Pharmacist Provided MTM Services-Present and Future

Insights into Pharmacist Provided MTM Services-Present and Future Insights into Pharmacist Provided MTM Services-Present and Future Anne Burns, RPh Vice President, Professional Affairs American Pharmacists Association Learning Objectives Describe the scope of MTM service

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

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

Value-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 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 information

PHCA Webinar January 30, Latsha Davis & McKenna, P.C. Kimber L. Latsha, Esq.

PHCA Webinar January 30, Latsha Davis & McKenna, P.C. Kimber L. Latsha, Esq. PHCA Webinar January 30, 2014 Latsha Davis & McKenna, P.C. Kimber L. Latsha, Esq. 1 2 Intended to: Encourage the development of ACOs in Medicare Promotes accountability for a patient population and coordinates

More information

Decreasing Medical. Costs. Are your members listening to you? PRESENTED BY: September 22, 2016

Decreasing Medical. Costs. Are your members listening to you? PRESENTED BY: September 22, 2016 Decreasing Medical Costs Are your members listening to you? PRESENTED BY: Aaron Crowell, Executive Vice President, MTM, Inc. Gary Jacobs, Executive Vice President, CareCentrix Dan Masciopinto, SVP of Product,

More information

New Opportunities for Case Management Leadership in our Changing Environment

New Opportunities for Case Management Leadership in our Changing Environment New Opportunities for Case Management Leadership in our Changing Environment 2012 ACMA Kentucky/Tennessee Chapter Case Management Conference By: W. June Simmons, MSW, CEO Partners in Care Foundation September

More information

Patient Centered Medical Home

Patient Centered Medical Home Patient Centered Medical Home A model of care where each patient has an ongoing relationship with a personal physician who leads a team that takes collective responsibility for patient care. The physician-led

More information

Appendix B: Formulae Used for Calculation of Hospital Performance Measures

Appendix B: Formulae Used for Calculation of Hospital Performance Measures Appendix B: Formulae Used for Calculation of Hospital Performance Measures ADJUSTMENTS Adjustment Factor Case Mix Adjustment Wage Index Adjustment Gross Patient Revenue / Gross Inpatient Acute Care Revenue

More information

HOSPITALS & HEALTH SYSTEMS: DATA-DRIVEN STRATEGY FOR BUNDLED PAYMENT SUCCESS 4/19/2016. April 20, 2016

HOSPITALS & HEALTH SYSTEMS: DATA-DRIVEN STRATEGY FOR BUNDLED PAYMENT SUCCESS 4/19/2016. April 20, 2016 HOSPITALS & HEALTH SYSTEMS: DATA-DRIVEN STRATEGY FOR BUNDLED PAYMENT SUCCESS April 20, 2016 Eddie Marmouget National Industry Partner emarmouget@bkd.com Eric Rogers Managing Consultant erogers@bkd.com

More information

Post Acute Continuum Lessons Learned from Geisinger s ProvenHealth Navigator

Post Acute Continuum Lessons Learned from Geisinger s ProvenHealth Navigator Post Acute Continuum Lessons Learned from Geisinger s ProvenHealth Navigator Janet Tomcavage, RN, MSN VP Health Services, Geisinger Health Plan Danville, PA February 3, 2012 Patient-centered primary care

More information

CMS-0044-P; Proposed Rule: Medicare and Medicaid Programs; Electronic Health Record Incentive Program Stage 2

CMS-0044-P; Proposed Rule: Medicare and Medicaid Programs; Electronic Health Record Incentive Program Stage 2 May 7, 2012 Submitted Electronically Ms. Marilyn Tavenner Acting Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building

More information

HEALTH CARE REFORM IN THE U.S.

HEALTH 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 information

W. Douglas Weaver, MD, MACC. American College of Cardiology SENATE FINANCE COMMITTEE

W. Douglas Weaver, MD, MACC. American College of Cardiology SENATE FINANCE COMMITTEE Statement of W. Douglas Weaver, MD, MACC On behalf of the American College of Cardiology Presented to the SENATE FINANCE COMMITTEE Roundtable on Medicare Physician Payments: Perspectives from Physicians

More information

Tomorrow s Healthcare: Better Quality, More Affordable, More Accessible

Tomorrow 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 information

College-wide Patient-Centered Medical Home Program Meharry Medical College

College-wide Patient-Centered Medical Home Program Meharry Medical College + The Key Elements: Using the Patient Centered Medical Home Model in Inter-Professional Education and Training Medical, Dental, and Public Health Education Curriculum Transformation Primary Care Residency

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

UnitedHealth Center for Health Reform & Modernization September 2014

UnitedHealth 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 information

OMC Strategic Plan Final Draft. Dear Community, Working together to provide excellence in health care.

OMC Strategic Plan Final Draft. Dear Community, Working together to provide excellence in health care. Dear Community, Working together to provide excellence in health care. This mission statement, established nearly two decades ago, continues to be fulfilled by our employees and medical staff. This mission

More information

Pennsylvania Patient and Provider Network (P3N)

Pennsylvania Patient and Provider Network (P3N) Pennsylvania Patient and Provider Network (P3N) Cross-Boundary Collaboration and Partnerships Commonwealth of Pennsylvania David Grinberg, Deputy Executive Director 717-214-2273 dgrinberg@pa.gov Project

More information

Kaiser Permanente: Integration, Innovation, and Capitation in Health Care

Kaiser Permanente: Integration, Innovation, and Capitation in Health Care Kaiser Permanente: Integration, Innovation, and Capitation in Health Care November 9, 2017 Molly Porter, MS, Director, Kaiser Permanente International Molly.porter@kp.org kp.org/international Copyright

More information

WELCOME. Kate Gainer, PharmD Executive Vice President and CEO Iowa Pharmacy Association

WELCOME. Kate Gainer, PharmD Executive Vice President and CEO Iowa Pharmacy Association WHAT IS MACRA? WELCOME Kate Gainer, PharmD Executive Vice President and CEO Iowa Pharmacy Association WELCOME Anthony Pudlo, PharmD, MBA, BCACP Vice President of Professional Affairs Iowa Pharmacy Association

More information

Examining the Differences Between Commercial and Medicare ACO Models

Examining the Differences Between Commercial and Medicare ACO Models Examining the Differences Between Commercial and Medicare ACO Models Michelle Copenhaver December 10, 2015 Agenda 1 Understanding Accountable Care Organizations 2 Moving to Accountable Care: Enhancing

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

Impact of an Innovative ADC System on Medication Administration

Impact of an Innovative ADC System on Medication Administration Impact of an Innovative ADC System on Medication Administration March 1, 2016 Nilesh Desai, BS, RPh, MBA Administrator Pharmacy and Clinical Operations Hackensack University Medical Center Conflict of

More information

Bundled Payments. AMGA September 25, 2013 AGENDA. Who Are We. Our Business Challenge. Episode Process. Experience

Bundled 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 information

Physician Compensation in an Era of New Reimbursement Models

Physician 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 information

As healthcare moves toward value-based care and risk-sharing payment models, many hospitals are taking a new look at ambulatory surgery centers (ASCs) as a transformational outpatient strategy with potential

More information

Implementing NYS Healthcare Reform Initiatives. Greg Allen, NYS Medicaid Policy Director

Implementing NYS Healthcare Reform Initiatives. Greg Allen, NYS Medicaid Policy Director Implementing NYS Healthcare Reform Initiatives Greg Allen, NYS Medicaid Policy Director MRT Waiver Amendment: NYS DSRIP Program overview en 2 NYS DSRIP Program: Key Goals Transformation of the health care

More information

Implementing Medicaid Value-Based Purchasing Initiatives with Federally Qualified Health Centers

Implementing Medicaid Value-Based Purchasing Initiatives with Federally Qualified Health Centers Implementing Medicaid Value-Based Purchasing Initiatives with Federally Qualified Health Centers Beth Waldman, JD, MPH June 14, 2016 Presentation Overview 1. Brief overview of payment reform strategies

More information

2017 Edition. MIPS Guide. The rule is in and Medicare physician payments are changing. What does that mean for you?

2017 Edition. MIPS Guide. The rule is in and Medicare physician payments are changing. What does that mean for you? 2017 Edition MIPS Guide The rule is in and Medicare physician payments are changing. What does that mean for you? MERIT-BASED INCENTIVE payment system The Merit-based Incentive Payment System (MIPS) combines

More information

Agenda. ACMA A Strong Base

Agenda. ACMA A Strong Base New Opportunities for Case Management Leadership in our Changing Environment 2012 ACMA Kentucky/Tennessee Chapter Case Management Conference By: W. June Simmons, MSW, CEO Partners in Care Foundation September

More information

Presentation to the CAH Administrator Meeting January 23 24, 2013 Helena, MT

Presentation to the CAH Administrator Meeting January 23 24, 2013 Helena, MT Presentation to the CAH Administrator Meeting January 23 24, 2013 Helena, MT Keith J. Mueller, Ph.D. Director, RUPRI Center for Rural Health Policy Analysis Head, Department of Health Management and Policy

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

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

Strategy Guide Specialty Care Practice Assessment

Strategy Guide Specialty Care Practice Assessment Practice Transformation Network Strategy Guide Specialty Care Practice Assessment 1/20/2017 1 Strategy Guide: Specialty Care PAT 2.2 Contents: Demographics Tab: 3 Question 1: Aims... 3 Question 2: Aims...

More information

PCMH: Recognition to Impact

PCMH: Recognition to Impact PCMH: Recognition to Impact 3.1.16 Prepared by: Shannon Nielson, MHA, PCMH CCE Prepared for: OACHC 2016 Annual Conference Centerprise, Inc Objectives Defining a Patient Centered Medical Home Translating

More information

Medical Management Program

Medical Management Program Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent Fraud, Waste and Abuse in its programs. The Molina

More information

Trends in Health Information Exchange (HIE) and Links to Medicaid Led Quality Improvement

Trends in Health Information Exchange (HIE) and Links to Medicaid Led Quality Improvement Trends in Health Information Exchange (HIE) and Links to Medicaid Led Quality Improvement July 25, 2007 Regional Quality Improvement Initiative Shannah Koss Avalere Health LLC Avalere Health LLC The intersection

More information

Accelerating the Impact of Performance Measures: Role of Core Measures

Accelerating the Impact of Performance Measures: Role of Core Measures Accelerating the Impact of Performance Measures: Role of Core Measures Mark McClellan, MD, PhD Director, Engelberg Center for Health Care Reform Senior Fellow, Economic Studies Leonard D. Schaeffer Chair

More information

Medicare, Managed Care & Emerging Trends

Medicare, 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 information

Exhibit 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) 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 information

Kaiser Permanente: Integration, Innovation, and Transformation in Health Care

Kaiser Permanente: Integration, Innovation, and Transformation in Health Care Kaiser Permanente: Integration, Innovation, and Transformation in Health Care March 2018 Karin Cooke, MBA, Director, Kaiser Permanente International Karin.C.Cooke@kp.org kp.org/international Copyright

More information

The Health Services Cost Review Commission s (HSCRC) global budget revenue contracts state:

The Health Services Cost Review Commission s (HSCRC) global budget revenue contracts state: Global Budget Revenue (GBR) Reporting on Investment in Infrastructure Background The Health Services Cost Review Commission s (HSCRC) global budget revenue contracts state: The Hospital shall provide an

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

Cultural Transformation and the Road to an ACO Lee Sacks, M.D. CEO Mark Shields, M.D., MBA Senior Medical Director

Cultural Transformation and the Road to an ACO Lee Sacks, M.D. CEO Mark Shields, M.D., MBA Senior Medical Director Cultural Transformation and the Road to an ACO Lee Sacks, M.D. CEO Mark Shields, M.D., MBA Senior Medical Director AMGA Pre-conference Workshop 1 April 14, 2011 Washington, D.C. Disclosure Nothing in Today

More information

Section 7. Medical Management Program

Section 7. Medical Management Program Section 7. Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent fraud, waste and abuse in its programs.

More information

Promoting Interoperability Performance Category Fact Sheet

Promoting Interoperability Performance Category Fact Sheet Promoting Interoperability Fact Sheet Health Services Advisory Group (HSAG) provides this eight-page fact sheet to help providers with understanding Activities that are eligible for the Promoting Interoperability

More information

Thought Leadership Series White Paper The Journey to Population Health and Risk

Thought Leadership Series White Paper The Journey to Population Health and Risk AMGA Consulting Thought Leadership Series White Paper The Journey to Population Health and Risk The Journey to Population Health and Risk Howard B. Graman, M.D., FACP White Paper, January 2016 While the

More information

ORLANDO EMA HIV/AIDS RYAN WHITE Part A PROGRAM OUTPATIENT/AMBULATORY MEDICAL CARE SERVICE STANDARDS OF CARE

ORLANDO EMA HIV/AIDS RYAN WHITE Part A PROGRAM OUTPATIENT/AMBULATORY MEDICAL CARE SERVICE STANDARDS OF CARE ORLANDO EMA HIV/AIDS RYAN WHITE Part A PROGRAM OUTPATIENT/AMBULATORY MEDICAL CARE SERVICE STANDARDS OF CARE Definition: The provision of professional diagnostic and therapeutic services rendered by a physician,

More information

How to Participate Today 4/28/2015. HealthFusion.com 2015 HealthFusion, Inc. 1. Meaningful Use Stage 3: What the Future Holds

How to Participate Today 4/28/2015. HealthFusion.com 2015 HealthFusion, Inc. 1. Meaningful Use Stage 3: What the Future Holds Meaningful Use Stage 3: What the Future Holds Dr. Seth Flam CEO, HealthFusion Presented by We ll begin momentarily Meaningful Use Stage 3: What the Future Holds Dr. Seth Flam CEO, HealthFusion Presented

More information

Moving the Dial on Quality

Moving 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 information

BCBSM Physician Group Incentive Program

BCBSM Physician Group Incentive Program BCBSM Physician Group Incentive Program Organized Systems of Care Initiatives Interpretive Guidelines 2012-2013 V. 4.0 Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee

More information

OVERVIEW. Helping people live healthier lives and helping make the health system work better for everyone

OVERVIEW. Helping people live healthier lives and helping make the health system work better for everyone OVERVIEW Helping people live healthier lives and helping make the health system work better for everyone About UnitedHealth Group UnitedHealth Group helps drive positive change in health care in the United

More information

IMPROVING TRANSITIONS OF CARE IN POPULATION HEALTH

IMPROVING TRANSITIONS OF CARE IN POPULATION HEALTH IMPROVING TRANSITIONS OF CARE IN POPULATION HEALTH TABLE OF CONTENTS 1. The Transitions Challenge 2. Impact of Care Transitions 3. Patient Insights from Project Boost 4. Identifying Patients 5. Improving

More information

CMS QUALITY MEASURES, COULD MEAN TO YOU MALNUTRITION, AND WHAT IT. Part I of Nutrition Division Webinar Series

CMS QUALITY MEASURES, COULD MEAN TO YOU MALNUTRITION, AND WHAT IT. Part I of Nutrition Division Webinar Series CMS QUALITY MEASURES, MALNUTRITION, AND WHAT IT COULD MEAN TO YOU Part I of Nutrition Division Webinar Series Welcome! During the webinar, the phone lines will be muted. There will be a 15 minute Q&A session

More information

Eligible Hours ( ) Achieving HIMSS Stage 7 and Gaining Physician Adoption of a Paperless Record CHC

Eligible Hours ( ) Achieving HIMSS Stage 7 and Gaining Physician Adoption of a Paperless Record CHC Below are the sessions that qualify for CPHIMS or CAHIMS continuing education (CE) hours. Check the column for all sessions attended and total the number of hours earned each day. At the end of the form,

More information

SWAN Alerts and Best Practices for Improved Care Coordination

SWAN Alerts and Best Practices for Improved Care Coordination SWAN Alerts and Best Practices for Improved Care Coordination IHIN and SWAN Course Overview Our Goal: To educate healthcare providers in how to manage SWAN alerts for meaningful impact at the point of

More information