Utilization of a Pay-for-Performance Program to Drive Quality and Reduce Cost
|
|
- Jean Pope
- 6 years ago
- Views:
Transcription
1 Utilization of a Pay-for-Performance Program to Drive Quality and Reduce Cost Thomas M. Deas, Jr., MD Vice President, Physician Development Theresa A. Bissonnette, MBA/HCM, CPHQ Director of Risk Adjustment and Quality North Texas Specialty Physicians November 16, 2016
2 Objectives Upon completion of this activity, participants should be able to: Understand the value of aligning compensation with quality performance measures Identify innovative compensation models for independent primary care and specialist physicians Describe the evolutionary process that must be undertaken in a practice to move from reporting to outcome measures. Recognize the challenges that are encountered in moving from reporting to outcome measures Outline the process for collecting, validating, and reporting quality measures Develop reports documenting physician performance 2
3 North Texas Specialty Physicians Independent Physician Association 3
4 North Texas Specialty Physicians (NTSP) Emerged in 1995 (HMO era) to manage specialist risk Physician led Evolved to primary care and 22 specialty divisions managing Medicare Advantage global risk Health plans: United Healthcare, Humana, and Care N Care Innovations: Health-e-Care, Sandlot HIE, Silverback TPA & Care Management, North TX Respecting Choices 4
5 North Texas Specialty Physicians (NTSP) Indispensable partner for our physician network engaging our physicians around... Common purpose the health of our member patients and CMS Quality Star Ratings Respect of their peers reporting and transparency of quality and cost performance Organizational culture physician leadership, innovation, and medical management Self-interest compensation linked to both quality and cost-effectiveness incentives, PCP referral base, specialty network, practice support, MACRA education, risk-adjustment, quality measures 5
6 Physician-led Governance NTSP Physician Board (PCP & Specialists) Primary Care Executive Committee 6 primary care physicians Medical Executive Committee 23 division chiefs from primary care, hospitalist, medical, and surgical divisions Quality Council Medical Management Committee Credentialing Committee 6
7 Subsidiary companies
8 8
9 9
10 Aligning compensation with quality and value Specialty division budgets, payout methodology, and cap surplus Specialty division Pay for Performance (P4P) Primary Care Physician (PCP) per member per month (PMPM) compensation Quality PMPM Risk-adjusted PMPM PCP gain-sharing incentives? 10
11 Medical and Surgical Specialty Division Compensation Q 6 month adjustment Budget $100,000/month Claims paid at 100% Medicare Budget =$100K x 6 = $600K Paid claims = MC rates Adjust to 112% MC = $600,000 6 month adjustment = $64,000 End of Year PAY FOR PERFORMANCE(P4P) LEADERSHIP CAP SURPLUS 11
12 Primary Care Compensation (member > 18 months, patient panel > 50) Fixed % of premium PMPM RAF >1.0 % PMPM bonus >1.2 % PMPM bonus Closed panel STARS -1.00% (if <400 members total) >3.9 % PMPM bonus >4.5 % PMPM bonus 12
13 Developing Measures PQRS (CMS.gov) NQF (qualityforum.com) QPS Tool HEDIS measures Potential measures described in the Request for Comments and Draft Call Letters from CMS Internally Developed 13
14 Specialists Developing Measures More traditional P4P measures (PQRS, NQF) Apply HEDIS CMS 5 Star measures where applicable HEDIS measures follow member PCPs Use these physician members as training ground for CMS 5 Star potential measures Traditional HEDIS measures Display measures Pharmacy measures Have to consider applicability to their practice 14
15 Developing Measures Discuss Measures with Division Approve Measure and Set Thresholds Develop Technical Specifications Present Data to Division and Quality Council Mock the Data 15
16 Developing Measures Release Specifications and Compliance Expectations to Divisions 16
17 Reporting process and outcome measures Process measures: Screening BMI, medication documentation, cancer screening Outcome measures: BP control, HgA1C < 9, surgical site infection, re-operation, post-op DVT, 30-day readmission, ER visits/1000 members 17
18 Quality Measures: Clinical Outcomes 18
19 Collecting, Validating and Reporting Quality Measures Reporting Collecting Claims data Paper submission Physician Attestation Validating Data Hub Entry 50% Threshold Month over Month Comparison Internal Physician Facing Timing 19
20 Collecting, Validating and Reporting Quality Measures 20
21 Collecting, Validating and Reporting Quality Measures 21
22 Collecting, Validating and Reporting Quality Measures 22
23 Collecting, Validating and Reporting Quality Measures Date Action P4P Measurement Period Begins Deadline to submit requests for alternate methods to demonstrate compliance with P4P measures NTSP will provide response to any requests for alternate methods to demonstrate compliance P4P Measurement Period Ends Final 2016 P4P refresh report released for distribution Deadline for documentation submission to show compliance for 2016 P4P P4P Bonus Checks Distributed 23
24 CRC Screening: Process measure, powerful impact Engage patients communicate/educate/remind Engage primary care physicians STAR rating and PMPM Quality Team support Timely reporting HealthFair 24
25 CRC Screening: Process measure, powerful impact Colorectal Cancer Surgery/1000 Members CNC Health Plans
26 PCP and Diabetes Case Study Initially PCPs participated in traditional P4P Switched to Star Rating bonus Year round chart chase strategy using QCs Attention to offices that collect their own labs 100% 90% 80% 70% 60% 50% 40% Diabetes HEDIS Measures 30% CDC Eye CDC A1c CDC Neph 2013 DOS 2014 DOS 2015 DOS 26
27 PCP and Diabetes Case Study Launched new HMO Product : CDC Eye 63.64% CDC Neph 100% CDC A1c 100% 27
28 Conclusion/Summary Align compensation with quality performance Move physicians from process to outcome measures Collect accurate and reliable information Develop dependable reporting for physicians 28
29 Contact Information Thomas M. Deas, Jr., MD Vice President of Physician Development Theresa A. Bissonnette, MBA/HCM, CPHQ Director of Risk Adjustment and Quality North Texas Specialty Physicians 1701 River Run, Suite 902 Fort Worth, TX
Gateway to Practitioner Excellence GPE 2017 Medicaid & Medicare
Gateway to Practitioner Excellence GPE 2017 Medicaid & Medicare Recognizing and Rewarding Excellent Practices Improving the Health of Gateway Members PRACTICE ELIGIBILITY (see PCMH slide #27 for separate
More informationQuality Incentive Programs. By: Amy Yearwood RN, BSN Physicians Network Quality Manager Huntsville Hospital
Quality Incentive Programs By: Amy Yearwood RN, BSN Physicians Network Quality Manager Huntsville Hospital Housekeeping 1. Using the control panel - Use the control panel on the right side of your screen
More informationGoals & Challenges for Outpatient Quality Directors. Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE
Goals & Challenges for Outpatient Quality Directors Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE Objectives Learn a practical way for Quality Directors to align Quality Measures
More informationNext Generation Physician Compensation Design in a Schizophrenic Payer Environment
Next Generation Physician Compensation Design in a Schizophrenic Payer Environment Presented to: 2015 Spring Managed Care Forum Friday, April 24, 2015 Today s agenda Setting the Stage Why are we Here?
More informationAnnual KPCA Meeting October 2014
Annual KPCA Meeting October 2014 Background Precision Healthcare Delivery, LLC (PHD) Louisville, Kentucky based company 12 years of operations as independent company (team has over 100 years of medical
More informationMedicare Advantage Star Ratings
Medicare Advantage Star Ratings December 2017 The Star Rating System measures how well Medicare Advantage (MA) and its prescription drug plans perform for consumers. As an integrated health system, Presbyterian
More informationESSENTIAL STRATEGIES IN MEDI-CAL PAYMENT REFORM. Richard Popper, Director, Medicaid & Duals Strategy August 3, 2017
ESSENTIAL STRATEGIES IN MEDI-CAL PAYMENT REFORM Richard Popper, Director, Medicaid & Duals Strategy August 3, 2017 1 DISCLAIMER The enclosed materials are highly sensitive, proprietary and confidential.
More informationBuilding an Ambulatory System of Care: Using Population Health to Combat Secular Trends & Achieve the Triple Aim
Building an Ambulatory System of Care: Using Population Health to Combat Secular Trends & Achieve the Triple Aim Christopher T. Olivia, MD, President June 11, 2014, All Rights Reserved and CONTINUUM HEALTH
More informationDevelopmental Screening Focus Study Results
Developmental Screening Focus Study Results February 28, 2018 Lisa Albers, MD, MC II Medical Quality Improvement Unit, Supervisor Managed Care Quality and Monitoring Division Objectives Review performance
More informationHEDIS Measures and the Family Physician Office. Pablo J Calzada DO, MPH, FAAFP, FACOFP
HEDIS Measures and the Family Physician Office Pablo J Calzada DO, MPH, FAAFP, FACOFP Disclaimer HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). NCQA and payers
More informationAmbulatory Care Delivery Strategy: The Key to Successful Population Health Management
Ambulatory Care Delivery Strategy: The Key to Successful Population Health Management Christopher T. Olivia, MD, President Michael Renzi, DO, Chief Medical Officer March 18, 2014 2014, Continuum Health
More informationTotal Cost of Care Technical Appendix April 2015
Total Cost of Care Technical Appendix April 2015 This technical appendix supplements the Spring 2015 adult and pediatric Clinic Comparison Reports released by the Oregon Health Care Quality Corporation
More informationPATH Program. Getting Started Guide
PATH Program Getting Started Guide We have a BIG opportunity. Together, we can empower and encourage people to take an active role in their health. Preventive health care services help people find and
More informationHouseCalls Objectives
Overview Agenda Overview Objectives Background Case studies Member Experience Primary Care Provider Experience Referrals and Follow-up Influence on Centers for Medicare & Medicaid Services (CMS) Star Ratings
More informationHumana Physician Quality Rewards Program 2014
Humana Physician Quality Rewards Program 2014 Medicare Glen Champlin MSO Director March 28, 2014 1430ALL0114-B What is CMS Stars and Why Should Providers Be Concerned? CMS Program of Quality & Performance
More information7/7/17. 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 informationINTEGRATED DATA ANALYTICS AND CARE WORKFLOW OPTIMIZATION
INTEGRATED DATA ANALYTICS AND CARE WORKFLOW OPTIMIZATION CASE STUDY October 2016 1 AGENDA 1 2 3 INTRODUCTIONS Speaker and System 4 Q+A VALUE OF INTEGRATED DATA Why effective ACOs require EHR, Claims, and
More informationMAKING PROGRESS, SEEING RESULTS
MAKING PROGRESS, SEEING RESULTS VALUE-BASED CARE REPORT HUMANA.COM/VALUEBASEDCARE Y0040_GCHK4DYEN 1117 Accepted 2 Americans are sick and getting sicker, with millions of us living with chronic conditions
More informationWELCOME. 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 informationCalifornia Pay for Performance: A Case Study with First Year Results. Tom Williams Integrated Healthcare Association (IHA) March 17, 2005
California Pay for Performance: A Case Study with First Year Results Tom Williams Integrated Healthcare Association (IHA) March 17, 2005 Agenda National Perspective California Program Overview Data Collection
More informationMedi-Cal Value Payments
Medi-Cal Value Payments P4P Program Overview Joel Gray joel.gray@anthem.com Linkedin.com/in/jgray123 4/26/2018 Anthem Blue Cross CA Medicaid Plan 1.2M Members 29 Counties 2 VBP/P4P Challenge Design a new
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 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 informationDisclaimer 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 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 informationOhio Department of Medicaid
Ohio Department of Medicaid Joint Medicaid Oversight Committee March 19, 2015 John McCarthy, Medicaid Director 1 Payment Reform Care Management Quality Strategy Today s Topics Managed Care Performance
More informationPost 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 informationValue-Based Reimbursements are Here: Are you Ready?
Value-Based Reimbursements are Here: Are you Ready? White Paper ELLIS MAC KNIGHT, MD Senior Vice President/CMO Published by Becker s Hospital Review April 2016 White Paper Value-Based Reimbursements are
More informationHHSC Value-Based Purchasing Roadmap Texas Policy Summit
HHSC Value-Based Purchasing Roadmap Texas Policy Summit Andy Vasquez, Deputy Associate Commissioner MCS, Quality & Program Improvement Section October 19, 2017 1 HHSC Value-Based Purchasing Roadmap Topics
More informationINFORMATION ABOUT YOUR OXFORD COVERAGE REIMBURSEMENT PART I OXFORD HEALTH PLANS OXFORD HEALTH PLANS (NJ), INC.
OXFORD HEALTH PLANS (NJ), INC. INFORMATION ABOUT YOUR OXFORD COVERAGE PART I REIMBURSEMENT Overview of Provider Reimbursement Methodologies Generally, Oxford pays Network Providers on a fee-for-service
More informationFast Facts 2018 Clinical Integration Performance Measures
IMPORTANT: LHP providers who do not achieve a minimum CI Score in 2018 will not be eligible for incentive distribution and will be placed on a monitoring plan for the 2019 performance year. For additional
More informationMIPS Scoring: Explanation and Estimation 2/7/2017 and 2/10/2017
CMS Transforming Clinical Practices Initiative and The Southern New England Practice Transformation Network (SNE PTN) MIPS 2017- Scoring: Explanation and Estimation 2/7/2017 and 2/10/2017 2 Review Determine
More informationCMS Quality Payment Program: Performance and Reporting Requirements
CMS Quality Payment Program: Performance and Reporting Requirements Session #QU1, February 19, 2017 Kristine Martin Anderson, Executive Vice President, Booz Allen Hamilton Colleen Bruce, Lead Associate,
More informationFrequently Asked Questions: HEDIS Attestations
November 2016 Frequently Asked Questions: HEDIS Attestations What is HEDIS? (Healthcare Effectiveness Data and Information Set) HEDIS stands for Healthcare Effectiveness Data and Information Set which
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 information2017 Quality Rewards Program
2017 Quality Rewards Program Overview High-level Program Description and Guidelines What Is Changing in 2017 Bonus Payments Description Payment Timing 2 Doc #: PCA-1-005014-02032017_03092017 Updated 06262017
More informationDecoding the QPP Year 2 Quality Measure Benchmarks and Deciles to Maximize Performance
Decoding the QPP Year 2 Quality Measure Benchmarks and s to Maximize Performance Leila Volinsky, MHA, MSN, RN, PCMH CCE, CPHQ Senior Program Administrator New England Regional Lead Quality Payment Program
More informationQuality: Finish Strong in Get Ready for October 28, 2016
Quality: Finish Strong in 2016. Get Ready for 2017 October 28, 2016 Agenda Stars: Medicare Advantage Quality Changes for 2017 Pay for Quality and PCMH Programs Important Announcements! 7 Stars: Medicare
More informationStrategic Implications & Conclusion
Kelly Court Chief Quality Officer Wisconsin Hospital Association Brian Vamstad Government Relations Consultant Gundersen Health System Overview and Key Takeaways of the Medicare Quality Payment Program
More informationN.E.W.T. Level Measurement:
N.E.W.T. Level Measurement: Voldemort or Dumbledore? Nathan Spell, MD, FACP Chief Quality Officer, Emory University Hospital Georgia Chapter Scientific Meeting American College of Physicians Savannah,
More informationMEANINGFUL USE STAGE FOR ELIGIBLE PROVIDERS USING CERTIFIED EMR TECHNOLOGY
MEANINGFUL USE STAGE 2 2014 FOR ELIGIBLE PROVIDERS USING CERTIFIED EMR TECHNOLOGY STAGE 2 REQUIREMENTS EPs must meet or qualify for an exclusion to 17 core objectives. EPs must meet 3 of the 6 menu measures.
More informationENHANCING 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 informationAlternative Payment Models for Behavioral Health Kim Cox VP, Provider Network
Alternative Payment Models for Behavioral Health Kim Cox VP, Provider Network Kim Cox Vice President, Provider Network, Optum Kim Cox is Vice President of Provider Network. She joined Optum in February
More informationMedicare & Medicaid EHR Incentive Programs. Stage 2 Final Rule Updates October 2, 2012 Rick Hoover & Andy Finnegan
Medicare & Medicaid EHR Incentive Programs Stage 2 Final Rule Updates October 2, 2012 Rick Hoover & Andy Finnegan What is in the Rule Changes to Stage 1 of meaningful use Stage 2 of meaningful use New
More information2017/2018. KPN Health, Inc. Quality Payment Program Solutions Guide. KPN Health, Inc. A CMS Qualified Clinical Data Registry (QCDR) KPN Health, Inc.
2017/2018 KPN Health, Inc. Quality Payment Program Solutions Guide KPN Health, Inc. A CMS Qualified Clinical Data Registry (QCDR) KPN Health, Inc. 214-591-6990 info@kpnhealth.com www.kpnhealth.com 2017/2018
More information4/10/2013. Learning Objective. Quality-Based Payment Models
Creating Best in Class Perioperative Services under Accountable Care and Value- Based Purchasing Becker s Healthcare Jeffry Peters Learning Objective How ACA/VBP changes how we measure surgical services
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 informationYour health comes first
Your health comes first Here are the many ways we re working to ensure the quality of your care At Amerigroup, our focus is on you. We want to help you get and stay healthy. That s why we have many programs
More informationAnthem BlueCross and BlueShield
Quality Overview BlueCross and BlueShield Accreditation Exchange Product Accrediting Organization: Accreditation Status: NCQA Health Plan Accreditation (Commercial HMO) Accredited Accreditation Commercial
More informationPerformance Incentives in the Southern California Permanente Medical Group (SCPMG):
Performance Incentives in the Southern California Permanente Medical Group (SCPMG): 1994-2007 Joel D. Hyatt, MD Assistant Medical Director Southern California Permanente Medical Group joel.d.hyatt@kp.org
More informationPBGH 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 informationKate Goodrich, MD MHS. Director, Center for Clinical Standards & Quality. Center for Medicare and Medicaid Services (CMS) May 6, 2016
Kate Goodrich, MD MHS Director, Center for Clinical Standards & Quality Center for Medicare and Medicaid Services (CMS) May 6, 2016 THE MEDICARE ACCESS & CHIP REAUTHORIZATION ACT OF 2015 Quality Payment
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 informationRestructuring Healthcare The Role of Technology
Restructuring Healthcare The Role of Technology Philip Gaziano, MD October 11, 2012 2 Physician Owned & Lead Organizations Accountable Care Associates, LLC (ACA): Founded in 2010, it is physician owned
More informationMACRA Frequently Asked Questions
Following the release of the Quality Payment Program Interim Final Rule, the American Medical Association (AMA) conducted numerous informational and training sessions for physicians and medical societies.
More informationDeveloping Community-Based Pediatric Health Services By Tackling Financials First
Emerging Practices Profile Developing Community-Based Pediatric Health Services By Tackling Financials First Children s Mercy Hospitals and Clinics (Kansas City) Case Study Fall 2012 Profile Snapshot Children
More informationAccelerating 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 informationNew Jersey Medicaid Medical Home Demonstration Project Report to the Legislature
New Jersey Medicaid Medical Home Demonstration Project Report to the Legislature November 2012 Division of Medical Assistance and Health Services NJ Department of Human Services Introduction In September,
More informationBeyond Meaningful Use: Driving Improved Quality. CHCANYS Webinar #1: December 14, 2016
Beyond Meaningful Use: Driving Improved Quality CHCANYS Webinar #1: December 14, 2016 Agenda The Current State Measuring Monitoring & Reporting Quality. Meaningful Use 2018 and Beyond The New Quality Payment
More informationSVS QUALITY AND PERFORMANCE MEASURES COMMITTEE (QPMC) New Member Orientation
SVS QUALITY AND PERFORMANCE MEASURES COMMITTEE (QPMC) New Member Orientation 2017-2018 SVS QPMC Quality and Performance Measures Committee Policy and Advocacy Council (Chair Sean Roddy) Chair: Brad Johnson,
More informationBeyond RVUs: Changing Your Primary Care Compensation Plan from Volume to Value
Beyond RVUs: Changing Your Primary Care Compensation Plan from Volume to Value Objectives Compare different primary care compensation models Identify keys to success and best methods for transitioning
More informationEnhancing Outcomes with Quality Improvement (QI) October 29, 2015
Enhancing Outcomes with Quality Improvement (QI) October 29, 2015 Learning Objectives! Introduce Quality Improvement (QI)! Explain Clinical Performance Person-Centered Medical Home (PCMH) Measures! Implement
More information2012 QUEST Primary Care HMSA. Patient-Centered Medical Home. and. Pay-for-Quality. Getting Started and Ongoing Management
2012 QUEST Primary Care HMSA Patient-Centered Medical Home and Pay-for-Quality Getting Started and Ongoing Management P r o g r a m G u i d e Table of Contents Overview....2 Introduction....4 Basic Requirements,
More informationPrimary Care Provider Orientation. Over 1.4 million people have chosen Molina Healthcare
Primary Care Provider Orientation Over 1.4 million people have chosen Molina Healthcare 2012 Molina Healthcare Mission Statement Our mission is to provide quality health services to financially vulnerable
More informationExhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013)
Exhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013) 24 percent (52 ACOs) earned shared savings bonus 27 percent (60 ACOs) reduced spending,
More informationProduct and Network Innovation: Strategies to Achieve Triple Aim Success. Patrick Courneya, MD Medical Director, HealthPartners October 31, 2013
Product and Network Innovation: Strategies to Achieve Triple Aim Success Patrick Courneya, MD Medical Director, HealthPartners October 31, 2013 Agenda About Minnesota s Market Measurement building blocks
More informationPlease stand by. There is no audio being streamed right now. We are doing a audio/sound check before we begin the presentation 10/28/2015 1
Please stand by There is no audio being streamed right now. We are doing a audio/sound check before we begin the presentation 10/28/2015 1 Webinar Tips Today s webinar is a one-way audio broadcast through
More informationThree 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 informationQuality Measurement and Reporting Kickoff
Quality Measurement and Reporting Kickoff All Shared Savings Program ACOs April 11, 2017 Sandra Adams, RN; Rabia Khan, MPH Division of Shared Savings Program Medicare Shared Savings Program DISCLAIMER
More informationHow 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 informationMD, MBA, FACHE, FAAPL
Washington Association of Medical Staff Services Vancouver, Washington Ambulatory Credentialing and Privileging Jon Burroughs, MD, MBA, FACHE, FAAPL April 20, 2018 The Healthcare Transformation Journey:
More informationYour First Capitation Contract: How to Ensure That You Have an Adequate Cap Rate. October 23, 2017
Your First Capitation Contract: How to Ensure That You Have an Adequate Cap Rate October 23, 2017 Introduction Speakers Chris Girod, FSA MAAA Principal and Consulting Advisory, Milliman Bill Gil Former
More informationLessons for Community Pharmacy from the USC / AltaMed CMMI Healthcare Innovation Award (Round 1)
Lessons for Community Pharmacy from the USC / AltaMed CMMI Healthcare Innovation Award (Round 1) Steven W. Chen PharmD, FASHP, FCSHP, FNAP Associate Professor and Chair Titus Family Department of Clinical
More information2015 MEANINGFUL USE STAGE 2 FOR ELIGIBLE PROVIDERS USING CERTIFIED EMR TECHNOLOGY
2015 MEANINGFUL USE STAGE 2 FOR ELIGIBLE PROVIDERS USING CERTIFIED EMR TECHNOLOGY STAGE 2 REQUIREMENTS EPs must meet or qualify for an exclusion to 17 core objectives EPs must meet 3 of the 6 menu measures.
More informationMedicare Quality Payment Program: Deep Dive FAQs for 2017 Performance Year Hospital-Employed Physicians
Medicare Quality Payment Program: Deep Dive FAQs for 2017 Performance Year Hospital-Employed Physicians This document supplements the AMA s MIPS Action Plan 10 Key Steps for 2017 and provides additional
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 information9/28/2011. Learning Agenda. Meaningful Use and why it s here. Meaningful Use Rules of Participation. Categories, Objectives and Thresholds
Coding on the River 10/01/2011 Christina Catalano University of Florida Jacksonville Healthcare Inc. Director, EHR Compliance and Meaningful Use Learning Agenda Meaningful Use and why it s here Meaningful
More informationMarket Mover? The Emerging Role of CMS in P4P. Linda Magno Director, Medicare Demonstrations Group August 24, 2004
Market Mover? The Emerging Role of CMS in P4P Linda Magno Director, Medicare Demonstrations Group August 24, 2004 Why Medicare P4P? Quality & Patient Safety Significant room for improvement Significant
More informationNote: Accredited is the highest rating an exchange product can have for 2015.
Quality Overview Accreditation Exchange Product Accrediting Organization: NCQA HMO (Exchange) Accreditation Status: Accredited Note: Accredited is the highest rating an exchange product can have for 215.
More informationCommunity Paramedicine Seminar July, 20th 2015
Community Paramedicine Seminar July, 20th 2015 Partners DHS/MDH Hospitals EMS Medical Directors Primary care Home health Hospice Public health Affiliated clinics FQHC's CHC Look-alikes Commercial & Gov
More informationPress Release: CMS Office of Public Affairs, Monday, January 31, 2005 MEDICARE "PAY FOR PERFORMANCE (P4P)" INITIATIVES
Press Release: CMS Office of Public Affairs, 202-690-6145 Monday, January 31, 2005 MEDICARE "PAY FOR PERFORMANCE (P4P)" INITIATIVES Medicare has various initiatives to encourage improved quality of care
More informationAn Overview of NCQA Relative Resource Use Measures. Today s Agenda
An Overview of NCQA Relative Resource Use Measures Today s Agenda The need for measures of Resource Use Development and testing RRU measures Key features of NCQA RRU measures How NCQA calculates benchmarks
More informationHIMSS Southern California David Sayen March 28, 2017
HIMSS Southern California David Sayen March 28, 2017 You re cured! 4 3 3 2 2 1 1 - Government Non-Government Medicare Group Practice Demo Physician Quality Reporting Initiative Premier Hospital P4P
More informationMaking Sense of What s Next: Value Based P4P Measurement & MACRA. Mike Weiss, DO September 23, 2016
Making Sense of What s Next: Value Based P4P Measurement & MACRA Mike Weiss, DO September 23, 2016 Making Sense of What s Next in VBP4P Background Drivers and Imperatives 2016-2021 Measure Set Strategy
More informationAHA-AMGA Learning Fellowship. Monthly Webinar January 12, :00-3:30 pm ET
AHA-AMGA Learning Fellowship Monthly Webinar January 12, 2017 2:00-3:30 pm ET Reminder: March Meeting Gaylord Texan Resort 1501 Gaylord Trail Grapevine, TX 76051 (817) 778-1000 Check-in is 3:00 p.m. Check-out
More informationMedicare & Medicaid EHR Incentive Programs. Stage 2 Final Rule Jason McNamara Technical Director for Health IT HIMSS Meeting April 25, 2013
Medicare & Medicaid EHR Incentive Programs Stage 2 Final Rule Jason McNamara Technical Director for Health IT HIMSS Meeting April 25, 2013 What is in the Rule Changes to Stage 1 of meaningful use Stage
More informationClinical 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 informationHealth Coaching in Team-Based Care. Recipes for Success
Health Coaching in Team-Based Care Recipes for Success Today s Presenters Iowa Chronic Care Consortium/Clinical Health Coach William Appelgate, PhD, CPC Executive Director ICCC, Founder and President,
More informationMedication Management Services in Connecticut
Medication Management Services in Connecticut Connecticut Department of Public Health, UConn School of Pharmacy and Community Pharmacies Mehul Dalal, MD, MSc, MHS - Chronic Disease Director, CT Department
More informationPay-for-Performance. GNYHA Engineering Quality Improvement
Pay-for-Performance GNYHA Engineering Quality Improvement The Writing Is On The Wall IOM Report - Rewarding Provider Performance: Aligning Incentives In Medicare 9/21/06 Medicare P4P and quality improvement
More informationLead the way Your guide to Aexcel
Lead the way Your guide to Aexcel For designations effective January 1, 2018 38.02.800.1 G (6/17) aetna.com We re helping build a better health care system one that is more transparent to you and to your
More informationPROPOSED MEANINGFUL USE STAGE 2 REQUIREMENTS FOR ELIGIBLE PROVIDERS USING CERTIFIED EMR TECHNOLOGY
PROPOSED MEANINGFUL USE STAGE 2 REQUIREMENTS FOR ELIGIBLE PROVIDERS USING CERTIFIED EMR TECHNOLOGY On February 23, the Centers for Medicare & Medicaid Services (CMS) posted the much anticipated proposed
More information2017 Transition Into Value Based Care
2017 Transition Into Value Based Care Provider Meeting August 3 rd, 2017 Objectives Define MACRA, MIPS, and APM Overview of MIPS Performance Categories within the Quality Payment Program (QPP) Provide
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 informationCMS Incentive Programs: Timeline And Reporting Requirements. Webcast Association of Northern California Oncologists May 21, 2013
CMS Incentive Programs: Timeline And Reporting Requirements Webcast Association of Northern California Oncologists May 21, 2013 Objective This webcast will address CMS s Incentive Program reporting requirements
More informationProposed Meaningful Use Content and Comment Period. What the American Recovery and Reinvestment Act Means to Medical Practices
Proposed Meaningful Use Content and Comment Period What the American Recovery and Reinvestment Act Means to Medical Practices Session Objectives Gain a basic understanding of CMS EHR Incentive Program.
More informationPartnering with Public Health Departments in Managed Care. THIS AREA CAN BE LEFT BLANK or ADD A PICTURE
Partnering with Public Health Departments in Managed Care THIS AREA CAN BE LEFT BLANK or ADD A PICTURE 2/3/2017 The Value of Medicaid Managed Care States Have Seen the Value of Medicaid Managed Care 75
More informationImproving Quality Outcomes in a Risk-Based World: A Davies Story Session #100, March 7, 2018
Improving Quality Outcomes in a Risk-Based World: A Davies Story Session #100, March 7, 2018 David Cloyed, MS, RN-BC, Applications Manager, Nebraska Medicine Tammy Winterboer, PharmD, BCPS, Director, Clinical
More informationCOMPREHENSIVE QUALITY STRATEGY REPORT (CQS) 2017 Report Draft
COMPREHENSIVE QUALITY STRATEGY REPORT (CQS) 2017 Report Draft CQS Report--Purpose Florida Medicaid is required to furnish a written quality strategy to the federal Centers for Medicare and Medicaid Services
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 information