Collaborative Ventures Network CMS and State Innovation. Tony Rodgers Executive Healthcare Consultant and Strategist
|
|
- Neal Lewis
- 5 years ago
- Views:
Transcription
1 Collaborative Ventures Network CMS and State Innovation Tony Rodgers Executive Healthcare Consultant and Strategist 1
2 Topics Covered The US Healthcare Cost Dilemma Drivers of Healthcare Innovation CMS and AHCCCS Initiatives Value-Based Payment Models: Challenges and Opportunities Managing Value-Based Performance 2
3 Healthcare Cost Dilemma Over the period of , national health spending is projected to grow at an average rate of 5.5% annually, which would be 1.0% faster than the expected annual increase in GDP during these years. The healthcare share of GDP is projected to rise from 17.9% in 2016 to 19.7% by National health expenditures are projected to reach $5.7 trillion in 2026, up 77% from The prices for medical goods and services are expected more than double annually from an average annual growth rate of 1.1to an annual growth rate of 2.5 percent over the next ten years. Challenges of State and Federal Health Care Policy Makers How can we expand coverage when the cost of healthcare keep rising at a faster rate than the Gross National Product? How can we control cost when the population is aging and 20% of the patient population consume 80% of healthcare cost? How can we assure access to affordable healthcare coverage when more and more healthy individuals are opting out of health care coverage? 3
4 US Healthcare Cost and Utilization Dilemma Pediatric and Adult ED visits Statistics FY 2015 Age Cohort 0 18 years years 65+ years US Population 78,473, ,311,200 46,447,200 All ED visits Number of visits 30,047,000 86,102,900 26,775,600 Rate per 1,000 population Treat-and-release ED visits 29,066,900 76,635,500 17,653,500 Treat and Release ED Visits Rate per 1,000 population Treat and Release ED visits as percent of total 96.7% 89.0% 65.9% ED visits resulting in hospital admission as a percent of total ED visits that resulted in hospital admission: rate per 1,000 population Percent of ED visits that resulted in a hospital admission 980,100 9,467,500 9,122,
5 National Trend in Cost Per Stay Has Been Relatively Flat Medicare Medicaid 5
6 Inpatient Trends for Arizona Adult Medicaid Expansion Medicare Medicaid Private Coverage Uninsured 6
7 Inpatient Stays: Mental Health and Substance Use Medicaid Medicaid Medicare 7
8 Arizona Adult Diabetes: Inpatient Stays 8
9 Arizona All Emergency Room Visits 9
10 Adult Emergency Room Visits Medicaid Medicaid 10
11 All EmerD Pediatric Visits 11
12 Drivers of Health Care Innovation 12
13 The Eras of Major Healthcare Innovation Primary Driver of Healthcare Innovation ERA 1: Medical Science Driven Innovation: Germ Theory ERA 2: Health Science Driven Innovation: Chronic Disease and Illness Management ERA 3: Technology and Health Information Science Driven Innovation: Population Health and Life Span Health, and Wellness Focus of Innovation Innovation focus: new medicines and drugs improving clinical care approaches to reduce the mortality and morbidly rate of patients. This resulted in the rise of the US acute care and specialty care system. Innovation focus: specialty care management Acute care sub-specialties This resulted in the emergence of healthcare systems and networks that could manage acute and post acute care. Innovation focus: Integrated systems of care Mega data and healthcare Clinical Informatics to inform to support person-centered care Meaning use of health data and technology to address population health, improve life span health, and functional status. 13
14 Each Period of Health Care Innovation Built on Knowledge Gained in the Previous Era Medical Science Germ Theory Health Science Chronic Disease and Illness Health Information Science Clinical Care Innovation Integrated Chronic Disease and Illness Management Innovation Person-Centered and Population Health Innovation 14
15 THE ERA OF HEALTHCARE INFORMATION SCIENCE Health Information Driven Person- Centered Model of Care Design and Innovation Predictive Modeling and Risk Analysis to More Effectively Manage Healthcare Cost and Service Utilization Population Health Management Data and Analytics Disease Registries 15
16 Information Driven Healthcare QUALTIY PERFORMANCE CARE MANAGEMENT PERFORMANCE POPULATION HEALTH PERFORMANCE COST AND UTILIZATION PERFORMANCE PATIENT EXPERIENCE PERSORMANCE Structural Measures Process Measures Outcome Measures Readmission Rate Reduction Unnecessary ER Visits Reduction in Duplicate Services Preventive Care Measures Reduction of Health Disparities Reduction in Patient Risk Factors Reduction Total Cost of Care Contain Acute Care Cost, and Utilization Efficient Use of Resources Patient Experience Measures Patient Engagement, Health Literacy, Patient Adherence 16
17 Innovations in Population Health Management Must Cause a Paradigm Shift from just Sick Care Focus to Population and Individual Life Span Health Optimal Health Improved Health Outcomes Early Intervention! Current Health System Results Poor High Risk Communities and Populations Infants Adolescents Adults Seniors Age 20% of Americans are On a this trajectory! 17
18 Population Health Management POPULATION HEALTH MANAGEMENT FRAMEWORK Patient Health Risk Assessment Intervention Screening Socioeconomic Community Risk Assessment Risk Stratification Linkages to community resources Social Service Integration and collaboration Community Partnerships and Collaborations Housing and Stabilization Support Beneficiary Population Health Analytical Tools Patient Health Registries and Database Care Gaps and Performance Dashboards Care Gap Analysis Integrated Team Based Model of Care Comprehensive Case/Care Management and Coordination Complex Case Management 24/7 Nurse Triage and Information Line Behavioral Health workforce competency building Resource capacity development Tools for continuous performance improvement Transition of Care support Connectivity to patients, care givers, and families Community Health Workers Virtual integration with physical health services Tools for Telehealth and Remote Monitoring Tools 18
19 CMS Innovation Center: Payment and Delivery Reform Research and Development Center The CMS Innovation Center priorities for innovation in payment and delivery system models focus on: 1. Innovative models of care and new payment approaches that focus health conditions that offer the greatest opportunity to improve care, quality, and reduce costs. 2. Delivery system approaches that better meet the needs of the most vulnerable individuals, while addressing health disparities. 3. Promote patient-centeredness to achieve better outcomes, while engaging broad segments of the delivery system in valuebased payment arrangements that reduce cost. 19
20 AHCCCS Payment and Delivery System Evolution AHCCCS is pursuing the implementation of longterm strategies to bend the cost curve and improve member health outcomes. The strategy is to leverage the AHCCCS managed care model to deploy value based health care systems: Improve patients experience and population health Contain per-capita health care costs to the rate of general inflation Create aligned incentives with MCO and provider partners, Enact performance expectations that reward innovation and results Encourage and support continuous quality improvement and learning AHCCCS Initiatives Transforming the health care system to an integrated care coordination system Implement a holistic approach to health care by integrating behavioral and physical health for persons with serious mental illness Alignment of Medicare and Medicaid for dual eligible Individuals Simplifying the system of care for children with special health care needs Improve coordination within the justice system to transition people leaving the criminal justice system Expand the meaningful use of EHR/HIE and telemedicine technologies 20
21 Value-Based Payment Arrangements 21
22 Key Elements in the Design Value-Based Payment Arrangements Value-Based Payment Model Elements Payer Attribution or Assignment Methodologies Quality Measures and Benchmarks Total Cost of Care Benchmark Risk Adjustment Factors Scope of Services Provider Accountability The process used by payers to attribute or assigned a patient to an accountable provider. Attribution parameters can include: The criteria used to determine which providers are eligible for patient assignment The minimum and maximum length of time (in months) that the patient is attributed/assigned to the provider for the purpose of performance reporting and alternative payment. Patient opt-in opt-out criteria Patient s knowledge and compliance with attribution or assignment to the provider The population appropriate measures and benchmarks. The average total healthcare cost per beneficiary per year. Target healthcare expenditure level is usually determined from previous years claims data. The formulas and factors used to stratify patient by risk categories or create risk groupings. The scope of services that are included in the value-based payment arrangement and on which the total cost of care benchmark analysis is based. The method used to determine which specific provider is accountable for quality and cost performance. Data Collection and Reporting Requirements The specific data sources, data types, and data sets that must be collected and for performance reporting and analysis. 22
23 The CMS Priorities for New Payment Models New payment models should: Improve care for patients who are receiving a specific treatment or medical procedures. Improve care during a specific time periods or cycle of care for patients who have a specific health condition or combination of conditions. Deliver more coordinated, efficient care for patients who have a specific condition or are receiving a specific treatment or medical procedure. Improve the efficiency of care and/or outcomes for patients receiving care for multiple chronic conditions or at multiple provider sites in the healthcare delivery system. Improve care for patients with specific conditions or who are in early stages of a condition to prevent the conditions progression to a more acute stage. Improve care for the health conditions of a population of patients, or to prevent the development of health problems in a population of patients with particular risk factors. Support delivery of innovative model of care or a different mix of services that reduce acute care utilization and cost for a population or group of patients. Better align healthcare provider payment with patient health outcomes. 23
24 Value-Based Payment Arrangements Most value-based payment arrangements are poorly designed and structured to achieve the desired result. Many payers lack a basic understanding of the of the importance of apply behavioral economics principles to the payment model design. Four Key Behavioral Economics Principles the must be addressed in the Design of Value-Based Payment Arrangements Principle 1: Adequate financial reward to incentivize the required provider behavior that will achieve the desired outcome. Principle 2: Address the provider s upfront cost to in terms to IT and practice transformation cost. Principle 3: There must be balance between the risk and reward. Principle 4: The overall payment opportunity must reflect the provider s on-going operational or administrative burden associated with the requirements of value base payment. 24
25 Provider s Value-Based Payment Dilemma Without reductions in the total cost of care across the target population, there will be insufficient net savings to finance new models of care interventions that are necessary to produce the net savings level. 25
26 The Challenge of Transitioning from Fee for Service to Value-Based Payment 26
27 Information Infrastructure for Value-Based Payment Arrangements Moving beyond just the treatment of illness and disease to achieve improved population health outcomes requires new health information tools and analytical capabilities. Population Health Information and Analytics Platform Data Integration Software Tools Data Warehouse or Data Repository, Cost and Quality Performance Analysis & Reporting Tools Patient Master File Index Patient Disease Registry Population health analytical tools Healthcare cost analytical tools Risk Stratification Tool & Comorbidity Index Actionable health information and analysis is key to support: Patient care management and coordination of care Quality and cost performance improvement Reduce unnecessary healthcare service utilization Identification and management of patient care gaps Clinical management of high risk high cost patients Population health outcome management 27
28 Provider Influenced Value Based Care Healthcare Care Process Inputs Schematic for Improving Healthcare Value Providers clinical knowledge and competency Use of Evidencebased clinical care processes Application of medical and e-health technology Performance Accountability Integration and Coordination of Care Provider and Patient engagement Domains of Healthcare Value-Base Performance Cost of Care Resources used Manpower cost Facility cost Medical device cost Medical Technology Administration and Operations Performance Improvement Behavior Continuous evaluation & improvement of healthcare performance Continuous learning Outcome from the Care Process Health Outcomes Population Health Functional Status Quality of Life Personal Productivity Physician and Healthcare Provider Behaviors Meaningful Use of EHR Systems & E-Health Solutions Effective Use of Health Information Technologies Use of health analytics Patient/Provider e- connectivity Person- Centered Care Medical Homes Team approach Effective care management and coordination Patient s Care Experience Satisfaction with Care Engagement in Care Trust and Respect Investment in Wellness Shared Decision Making & Engagement of Patients Continuity of Care Accountable for patient health literacy Provider/patient accountability Performance Analysis Platform EHR and HIE Platform Health Information Infrastructure Use of Information Management Tools for Health Data Analysis and Clinical Information Management 28
29 Managing Value-Based Performance 29
30 The Challenges of Controlling Cost and Utilization Inherent in value-based payment arrangements is the accountability for patients healthcare cost and service utilization: 1. Managing the total cost of care below a target benchmark requires the managing and coordinating the patient s care throughout the delivery system. 2. The highest cost patients have complex multiple chronic illnesses often with significant social and economic challenges. 3. Reducing cost long-term requires continuity of relationship between and provider and patient population. 30
31 Episode of Care Payment Scheme for Colorectal Cancer Screening and Colonoscopy Procedure 60 day Episode of Care Life Cycle from Event Initiation to Episode Completion $120 $ $2, $2, Ave. Total Cost Physician $120 Pharmacy $12.50 Colonoscopy Diagnostic Procedure= $2,480 Physician Follow up= $90 Patient Instruction on Bowel Preparation Clinic Registration, Financial Screening, & Nurse Prep Pathology Lab Event Ends: No Cancer Identified Patient Education Given Day 1 Prep Bowel Day 60 Medication Initiating Event: Assessment for Appropriateness and Referral By Primary Care Provider Pre-Procedure Workup Procedure Prep & Sedation Colonoscopy Diagnostic/Therapeutic Procedures w/biopsies Procedure Patient Follow up Visit Explanation of Results Action as necessary Post Procedure 31
32 Total Cost of Care Benchmark Benchmarking Cost for Target Patient Population Cost for Target Group of Patients Total Cost of Care Benchmarking The payer determines the benchmark healthcare cost target based on historical beneficiary healthcare cost data. The total cost of care benchmark adjustments: Service and cost trend factors Service carve outs Benefit or healthcare policy changes Risk factors Efficiency adjustments or other total cost of care contingencies factors (e.g. reinsurance) The cost of care benchmark is important because it is used to compare the impact of the provider network on the total cost of care. Category of Services Inpatient Service Average Units of Services Per Patient Per Year Cost Per Unit of Service Per Patient Cost Per Year 3.6 days $1,250 $4, Outpatient Hospital 4.5 visits $ $ Emergency Room Visits 1.2 visits $ $ Primary Care 3.2 visits $85.00 $ Specialty Care 2.4 visits $ $ Prescription Drugs 56 scripts $45.00 $2, Laboratory Services 25 tests $38.00 $ Imaging and Radiology 3.2 procedures $ $ Other Institutional 0.8 days $ $ Case Management 3.5 units $45.00 $ Other Medical Services 4.5 services $55.00 $ Average Annual Per Beneficiary Total Cost of Care Benchmark $10,
33 Value-based care assumptions: Managing Cost and Utilization for Value-Based Payment Arrangements Evidence-based person-centered care interventions will reduce unnecessary acute care and other service utilization and costs. The standard care interventions are implemented for the entire assigned patient population. The results of the care intervention will be sustainable. Current Total Cost Baseline : $3,968 PMPY PLUS Cost of the Alternative Model of Care Intervention $90 PMPY MINUS Net cost and utilization reduction from new model: $220 PMPY EQUALS New Total Cost of Care Level $3,838 PMPY 3.3% SAVINGS Expected Change in Patient Population Cost and Utilization TOTAL UNITS UNIT COST TOTAL COST OF CARE Services Per 1000 Beneficiaries Expen Per Baseline Pro Forma SERVICE BASKET Baseline % Change Pro Forma Service PBPM PBPM Inpatient hospital Acute inpatient 2,200 admits -10.0% 1,980 admits $9,100 $1,668 $1,502 Post-acute care Skilled nursing 400 admits -7.0% 372 admits $13,000 $433 $403 Inpatient rehab 95 admits 95 admits $15,000 $119 $119 Inpatient LTCH 20 admits 20 admits $32,700 $55 $55 Home Health 550 episodes 10.0% 605 episodes $5,500 $252 $277 Total PAC $859 $854 Other benefits/services OP services 6,200 events -7.0% 5,766 events $630 $326 $303 Emergency room 1,100 visits 1,100 visits Evaluation & Mgmt 30,000 visits 15.0% 34,500 events $90 $225 $259 Procedures 6,500 events 6,500 events $325 $176 $176 Imaging 7,500 events 7,500 events $85 $53 $53 Lab tests 15,000 events 15,000 events $25 $31 $31 Other tests 4,000 events 4,000 events $35 $12 $12 Prescription Drugs/vac. $360 $360 DME 2,000 events 2,000 events $150 $25 $25 ASC proced. 700 events 700 events $415 $24 $24 Hospice 200 admits 200 admits $9,200 $153 $153 Other 55.0% $56 $87 Total Medicare Cost of Care $3,968 $3,838 33
34 General Schematic for Value-Based Performance Improvement Person-Centric & Population Centric Information Supported Outcome Oriented Continuous Performance Improvement Payer Value Based Payment 3 Shared Performance Risk Performance Improvement Management Analyze Patient and Population Health Data for Opportunities for Performance Improvement 2 Improved Health Outcomes Outcome Data and Information 1 Patients and Populations Value-Based Payment Use Health Information Analytics to Identify Performance Improvement Opportunities 4 Take Actions to Improve Performance Outcomes Elements of Value-Based Payment Providers Assessing Patient Risk Factors and Health Status Collect Cost and Quality Performance Data Analyze and Report Performance Results Financial Gain or Loss 34
35 Performance Analysis and Improvement Requires wide-spread use of clinical informatics and data analytics 1. Identify high risk patients 2. Identify gaps in care 3. Identify opportunities to improve performance 4. Compare performance among CVN participating providers 5. Support care management and patient engagement 35
36 Summary Keys To Success The Key Success Factors for Competing in a Value Based Care Market Effective Person- Centered Care Performance Management & Improvement Clinically Integrated Provider Network Data Management and Data Analytics Infrastructure Effective Care Management & Care Coordination Population Health Management Effective Management of Financial Risk Effective Provider Network Governance & Leadership 36
37 Thank You Tony Rodgers, Chief of Healthcare Strategy 37
What s Next for CMS Innovation Center?
What s Next for CMS Innovation Center? A Guide to Building Successful Value-Based Payment Models Given CMMI s New Focus on Voluntary, Home-Grown Initiatives W W W. H E A L T H M A N A G E M E N T. C O
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 informationPOPULATION HEALTH PLAYBOOK. Mark Wendling, MD Executive Director LVPHO/Valley Preferred 1
POPULATION HEALTH PLAYBOOK Mark Wendling, MD Executive Director LVPHO/Valley Preferred www.populytics.com 1 Today s Agenda Outline LVHN, LVPHO and Populytics Overview Population Health Approach Population
More informationBCBSM 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 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 informationA 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 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 informationUpdates from CMS: Value-Based Purchasing, ACOs, and Other Initiatives The Seventh National Pay for Performance Summit March 20, 2012
Updates from CMS: Value-Based Purchasing, ACOs, and Other Initiatives The Seventh National Pay for Performance Summit March 20, 2012 Presenters David Sayen, CMS Regional Administrator Betsy L. Thompson,
More informationAccountable Care and the Laboratory Value Proposition. Les Duncan Director of Operations Highmark Health - Home and Community Services
Accountable Care and the Laboratory Value Proposition Les Duncan Director of Operations Highmark Health - Home and Community Services Agenda The Goals and Status of Delivery System Reform and Alternative
More informationHealth System Transformation. Discussion
Health System Transformation Patrick Conway, M.D., MSc CMS Chief Medical Officer Deputy Administrator for Innovation and Quality Director, Center for Medicare & Medicaid Innovation Director, Center for
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 informationPrimary Care Transformation in the Era of Value
Primary Care Transformation in the Era of Value CMS Innovation Center & Primary Care Bruce Finke, MD Janel Jin, MSPH Gabrielle Schechter, MPH Center for Medicare & Medicaid Innovation Centers for Medicare
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 information2018 Annual Research Meeting (ARM) Conference Theme Areas of Focus
2018 Annual Research Meeting (ARM) Conference Theme Areas of Focus The 2018 ARM is organized around the following 21 themes in health services research and policy: AGING, DISABILITY, AND END-OF-LIFE This
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 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 informationCentral Ohio Primary Care (COPC) Spotlight on Innovation
Central Ohio Primary Care (COPC) Spotlight on Innovation BY BETTER MEDICARE ALLIANCE MARCH 2017 Central Ohio Primary Care Spotlight on Innovation 1 Central Ohio Primary Care (COPC) Spotlight on Innovation
More informationFuture of Patient Safety and Healthcare Quality
Future of Patient Safety and Healthcare Quality Patrick Conway, M.D., MSc CMS Chief Medical Officer Director, Center for Clinical Standards and Quality Acting Director, Center for Medicare and Medicaid
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 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 informationAccountable Care Atlas
Accountable Care Atlas MEDICAL PRODUCT MANUFACTURERS SERVICE CONTRACRS Accountable Care Atlas Overview Map Competency List by Phase Detailed Map Example Checklist What is the Accountable Care Atlas? The
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 informationThe 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 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 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 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 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 informationExamining 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 informationACO 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 informationPreparing 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 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 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 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 informationNorth Country Community Mental Health Response to MDCH Request for Information Medicare and Medicaid Dual Eligible Project September 2011
North Country Community Mental Health Response to MDCH Request for Information Medicare and Medicaid Dual Eligible Project September 2011 1. What is working well in the current system of services and supports
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 informationPhysician Engagement
Pathways for Successful Accountable Care Organizations: Physician Engagement Thomas Kloos, MD Jim Barr, MD Atlantic ACO & Optimus Healthcare Partners ACO Helping providers Care Better for their patients.
More informationThe Drive Towards Value Based Care
The Drive Towards Value Based Care Thursday, March 3, 2016 Michael Aratow, MD, FACEP Chief Medical Information Officer, San Mateo Medical Center Gaurav Nagrath, MBA, Sr. Strategist, Population Health Research
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 informationREGISTRIES IN ACCOUNTABLE CARE: WHITE PAPER. Draft White Paper for Fourth Edition of AHRQ Registries for Evaluating Patient Outcomes: A User's Guide
REGISTRIES IN ACCOUNTABLE CARE: WHITE PAPER Draft White Paper for Fourth Edition of AHRQ Registries for Evaluating Patient Outcomes: A User's Guide Introduction Patient registries, when properly designed
More informationImproving Care and Managing Costs: Team-Based Care for the Chronically Ill
Improving Care and Managing Costs: Team-Based Care for the Chronically Ill Cathy Schoen Senior Vice President The Commonwealth Fund www.commonwealthfund.org cs@cmwf.org High Cost Beneficiaries: What Can
More informationTransformational paradigms poised to redefine healthcare delivery. November 2016
Transformational paradigms poised to redefine healthcare delivery November 2016 Frost & Sullivan s Transformational Health Practice Addresses the Forces Driving Change in Healthcare Factors Transforming
More informationThe Minnesota Statewide Quality Reporting and Measurement System (SQRMS)
The Minnesota Statewide Quality Reporting and Measurement System (SQRMS) Denise McCabe Quality Reform Implementation Supervisor Health Economics Program June 22, 2015 Overview Context Objectives and goals
More informationCPC+ 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 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 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 informationI. Coordinating Quality Strategies Across Managed Care Plans
Jennifer Kent Director California Department of Health Care Services 1501 Capitol Avenue Sacramento, CA 95814 SUBJECT: California Department of Health Care Services Medi-Cal Managed Care Quality Strategy
More information3/19/2013. Medicare Spending Per Beneficiary: The New Link Between Acute and Post Acute Providers
The New Link Between Acute and Post Acute Providers Carol Quiring, RN President and CEO, Home Care and Hospice Saint Luke s Health System Shauna Thompson, RHIT Senior Director, Quality & Patient Safety
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 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 informationCultural 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 informationGetting Ready for the Maryland Primary Care Program
Getting Ready for the Maryland Primary Care Program Presentation to Maryland Academy of Nutrition and Dietetics March 19, 2018 Maryland Department of Health All-Payer Model: Performance to Date Performance
More informationThe 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 informationPopulation Health: Physician Perspective. Kallanna Manjunath MD, FAAP, CPE Medical Director AMCH DSRIP September 24, 2015
Population Health: Physician Perspective Kallanna Manjunath MD, FAAP, CPE Medical Director AMCH DSRIP September 24, 2015 Population Health: Physician Perspective Presentation objectives: Brief Bio Population
More informationTransforming Louisiana s Long Term Care Supports and Services System. Initial Program Concept
Transforming Louisiana s Long Term Care Supports and Services System Initial Program Concept August 30, 2013 Transforming Louisiana s Long Term Care Supports and Services System Our Vision Introduction
More informationPartnering with Managed Care Entities A Path to Coordination and Collaboration
Partnering with Managed Care Entities A Path to Coordination and Collaboration Presented by: Caroline Carney Doebbeling, MD, MSc Chief Medical Officer, MDwise May 9, 2013 Agenda Are new care models on
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 informationPopulation 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 informationSucceeding in Value-Based Care CareConnect Journey
Succeeding in Value-Based Care CareConnect Journey Donna Mueller VP Network Development dmueller@infinityrehab.com 360-201-2703 Jake Arrastia VP Strategy Development & Innovation jrarrastia@infinityrehab.com
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 informationMeasure Applications Partnership (MAP)
Measure Applications Partnership (MAP) Uniform Data System for Medical Rehabilitation Annual Conference Aisha Pittman, MPH Senior Program Director National Quality Forum August 9, 2012 Overview MAP Background
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 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 informationAlternative Payment Models and Health IT
Alternative Payment Models and Health IT Health DataPalooza Preconference May 8, 2016 Kelly Cronin, MS, MPH, Director, Office of Care Transformation, ONC/HHS HHS Goals for Medicare Payment Reform In January
More informationHEALTHY EMPLOYEES HEALTHY EMPLOYEE BENEFIT PLAN
HEALTHY EMPLOYEES HEALTHY EMPLOYEE BENEFIT PLAN At a point in time when many employers are forced to cut benefits healthcare costs are increasing at 3 to 4 times the rate of inflation access to quality
More informationMedicaid-CHIP State Dental Association
Medicaid-CHIP State Dental Association Silver Tsunami MARY E. FOLEY, MPH Executive Director Medicaid-CHIP State Dental Association 2013 National Oral Health Conference April 2013 MSDA Who We Are Directors,
More informationProgram Overview
2015-2016 Program Overview 04HQ1421 R03/16 Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross and Blue Shield Association and incorporated as Louisiana Health Service
More informationHealth 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 informationMichigan 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 informationPartnership HealthPlan of California Strategic Plan
Partnership HealthPlan of California 2017 2020 Strategic Plan Partnership HealthPlan of California 2017 2020 Strategic Plan Message from the CEO While many of us have given up making predictions, myself
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 informationQuality, 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 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 informationMedicaid Update Special Edition Budget Highlights New York State Budget: Health Reform Highlights
Page 1 of 6 New York State April 2009 Volume 25, Number 4 Medicaid Update Special Edition 2009-10 Budget Highlights David A. Paterson, Governor State of New York Richard F. Daines, M.D. Commissioner New
More informationTransforming 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 informationOne 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 informationRe: Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations, Proposed rule.
June 3, 2011 Donald Berwick, MD Administrator Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1345-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore,
More informationPatient Centered Medical Home The next generation in patient care
Patient Centered Medical Home The next generation in patient care Provider Training Module I OBJECTIVE To explain... What Patient Centered Medical Home is How it works Why it s important Where to begin
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 informationCathy Schoen. The Commonwealth Fund Grantmakers In Health Webinar October 3, 2012
Innovating Care for Chronically Ill Patients Cathy Schoen Senior Vice President The Commonwealth Fund www.commonwealthfund.org cs@cmwf.org Grantmakers In Health Webinar October 3, 2012 Chronically Ill:
More informationMedicare-Medicaid Payment Incentives and Penalties Summit
Medicare-Medicaid Payment Incentives and Penalties Summit Patrick Conway, M.D., MSc CMS Chief Medical Officer and Director, Office of Clinical Standards and Quality May 31, 2012 Objectives Outline methods
More informationHow an ACO Provides and Arranges for the Best Patient Care Using Clinical and Operational Analytics
Success Story How an ACO Provides and Arranges for the Best Patient Care Using Clinical and Operational Analytics HEALTHCARE ORGANIZATION Accountable Care Organization (ACO) TOP RESULTS Clinical and operational
More informationUsing benchmarking to improve Quality
Using benchmarking to improve Quality Bent Grubb Laursen, MD, Physician lead, Accenture Denmark @ DocBlogIt DANISH HEALTHCARE SYSTEM IS BETTER THAN THE SWEDISH HEALTHCARE SYSTEM Pride Complacency Insult
More informationDivision C: Increasing Choice, Access, and Quality in Health Care for Americans TITLE XV: Provisions Relating to Medicare Part A
Division C: Increasing Choice, Access, and Quality in Health Care for Americans TITLE XV: Provisions Relating to Medicare Part A Sec. 15001. Development of Medicare study for HCPCS versions of MS-DRG codes
More informationCOOK COUNTY HEALTH & HOSPITALS SYSTEM
COOK COUNTY HEALTH & HOSPITALS SYSTEM Strategic Planning Town Hall Meetings May 2016 Strategic Planning Timeline February-June 2016 Strategic planning presentations and discussions at CCHHS Board of Directors
More informationPOPULATION HEALTH MANAGEMENT
POPULATION HEALTH MANAGEMENT PROGRAMS, MODELS, AND TOOLS July 14, 2015 Lee Martinez, MA, LAC Manager Health Home Development Agenda Introduction Goals and Objectives Population Health Management and the
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 informationThe 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 informationSession 1. Measure. Applications Partnership IHA P4P Mini Summit. March 20, Tom Valuck, MD, JD Connie Hwang, MD, MPH
Measure Session 1 Applications Partnership IHA P4P Mini Summit March 20, 2012 Tom Valuck, MD, JD Connie Hwang, MD, MPH Agenda Session 1 Measure Applications Partnership (MAP) Context and Guiding Principles
More informationBuilding a healthy legacy together. Presentation by Shelley Lipon, Executive Regional Director, Canada Health Infoway to ICTAM October 28, 2009
Building a healthy legacy together Presentation by Shelley Lipon, Executive Regional Director, Canada Health Infoway to ICTAM October 28, 2009 Expectations What Canadians expect from their health care
More informationPayer s Perspective on Clinical Pathways and Value-based Care
Payer s Perspective on Clinical Pathways and Value-based Care Faculty Stephen Perkins, MD Chief Medical Officer Commercial & Medicare Services UPMC Health Plan Pittsburgh, Pennsylvania perkinss@upmc.edu
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 informationRoadmap 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 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 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 informationMinnesota s Plan for the Prevention, Treatment and Recovery of Addiction
Minnesota s Plan for the Prevention, Treatment and Recovery of Addiction Background Beginning in June 2016, the Alcohol and Drug Abuse Division (ADAD) of the Minnesota Department of Human Services convened
More informationDRAFT Complex and Chronic Care Improvement Program Template. (Not approved by CMS subject to continuing review process)
DRAFT Complex and Chronic Care Improvement Program Template Performance Year 2017 (Not approved by CMS subject to continuing review process) 1 Page A. Introduction The Complex and Chronic Care Improvement
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 informationCommunity-based Care Coordination (CCC) Maturity Assessment RidgePointe Healthcare District
Who/What Program Elements Level 1. Beginning Level 2. Progressing Level 3. Intermediate Level 4. Advanced Organization(s) sponsoring CCC Providers Community services Patients (pts) Payers A. LEADERSHIP
More informationChallenges and Opportunities for Improving Health and Healthcare in Ohio through Technology
Challenges and Opportunities for Improving Health and Healthcare in Ohio through Technology Ohio Health IT Advocacy Day Craig Brammer, CEO cbrammer@healthbridge.org @CraigABrammer Challenge #1: Information
More informationVocabulary of Healthcare Reform Glossary
White Paper Vocabulary of Healthcare Reform Glossary Raymond Fabius, MD, CPE, FACPE Linda MacCracken, MBA Jill Pritts, MBS January 2012 Terms included (alphabetical order) Access to Health Services Accountable
More information