Topics for Today s Discussion

Size: px
Start display at page:

Download "Topics for Today s Discussion"

Transcription

1 MICAH Quality Network Population Insights Reporting and PG5 P4P Program Year Updates Blue Cross Blue Shield of Michigan Hospital Incentive Programs August 18 th, 2017 Topics for Today s Discussion 1 Review Population Health Insights Report 2 Wexford/Crawford PHO Presentation 3 Review Scoring Thresholds 4 Financial Impact of P4P Program 1

2 BCBSM Peer Group 5 P4P Program REVIEW: Population Insights Reporting Blue Cross Blue Shield of Michigan Hospital Incentive Programs August 18 th, BCBSM s Population Insights Reports Overview Semi annual reports that develop and display meaningful, volume driven relationships between: 1) PGIP participating Primary Care Physicians (PCPs) and 2) acute care hospitals PGIP participating Primary Care Physicians SubPO A Michigan Acute Care Hospitals SubPO C SubPO X BCBSM Members Key Takeaway: Population Insights reports reveal the natural relationships between PCPs and hospitals who receive incentives for providing care for the same groups of BCBSM members 3

3 Creating population based cost and utilization metrics Hospital level, population based metrics are created using a weighted average between: 1) Physician Organization performance and 2) % of hospital business from those groups PGIP participating Primary Care Physicians SubPO A SubPO C SubPO A cost and use metrics: $300 PMPM 200 ED visits/1, IP admissions/1,000 SubPO C cost and use metrics: $250 PMPM 250 ED visits/1, IP admissions/1,000 75% of Hospital Business 15% of Hospital Business SubPO X SubPO X cost and use metrics: $225 PMPM 150 ED visits/1, IP admissions/1,000 10% of Hospital Business Hospital ABC population based cost and use metrics: $285 PMPM ED visits/1, IP admissions/1,000 Key Takeaway: Population based performance for hospitals includes costs and utilization for all BCBSM members attributed to their partners; not limited to those services within 4 walls 4 5

4 1) Understanding who your Physician Organization partners are: Drop down menu to select hospital of choice PGIP participating PO and SubPO groups with a shared patient population with the hospital Average # of BCBSM members per PCP in this group Total count of BCBSM members attributed to PCPs in this group Number of PCPs participating in PGIP with these PO/SubPO groups 6 2) Strength of volume driven relationships with physician partners: Proportion of hospital utilizing members who chose to seek care at YOUR hospital (n, %) PGIP participating PO and SubPO groups with a shared patient population with the hospital Number of BCBSM members requiring hospital based services in given measurement year (n, %) Total count of BCBSM members attributed to PCPs in this group 7

5 3) How your hospital s population based metrics are calculated: From the hospital s perspective: proportion of BCBSM members who 1) walk through hospital s doors 2) have a care relationship with a PGIP PCP 8 4) Reviewing your hospital s population based cost metrics: 9

6 5) Reviewing your hospital s population based utilization metrics: Other metrics include: 1. Overall and ambulatory care sensitive inpatient (IP) admissions per 1, Day All Cause and Unplanned Readmission Rates 3. Generic pharmacy prescribing (%) 10 Community Based Population Health Jacque Runyon RN, BSN, MSA Transitions of Care Project Lead & Beth Oberhaus RN, BSN, MBA, PMP Clinical Operations Director

7 Physician Hospital Organization (PHO) overview A PHO is a vehicle that enables hospitals and physicians to work cooperatively towards accomplishing goals that benefit the patients in the community. A PHO is a legal entity which allows for clinical integration and joint contracting. The goal of the Wexford PHO is to keep health care local by focusing on the needs of the community with broad physician input and leadership The mission of the Wexford PHO is to support its members and hospital in the provision of quality health care that is efficient, promotes access and improves the health of people in our community 12 PHO Services Member Services Networking and collaboration Payer contract enrollment Provider relations support Education and training CME HIPAA 5010 ICD-10 Meaningful Use Contracting Services Clinical Integration Process Improvement Payer program support Registry Wellcentive PCMH/PCMN Support Care Management Patient Satisfaction Michigan Experience of Care (MiPEC) Community linkages 13

8 What is a PCMH? A patient-centered medical home is not a building, house, hospital or home healthcare service, but rather an approach to providing comprehensive primary care. In the patient-centered medical home the care team works in partnership with the patient and at times patient s family to assure that all of the medical and non-medical needs of the patient are met. Key Components: Cost Savings, Efficiency, and Patient Satisfaction 14 Principles of the Patient-Centered Medical Home A personal physician who coordinates all care for patients and leads the team. Physician-directed medical practice a coordinated team of professionals who work together to care for patients. Whole person orientation this approach is key to providing comprehensive care. Coordinated care that incorporates all components of the complex health care system. Quality and safety - medical practices voluntarily engage in quality improvement activities to ensure patient safety is always being met. Payment a system of reimbursement reflective of the true value of coordinated care and innovation 15

9 Capabilities Patient Provider Partnership Patient Registry Performance Reporting Individual Care Management Extended Access Test Results Tracking and Follow up Preventive Services Linkage to Community Services Self-Management Support Patient Web Portal Coordination of Care Specialists Pre-Consultation and Referral Process 16 We are all in this together Accountable Care Organization (CMS) Organized System of Care (BSBSM) Accountable Care Network (Priority Health) Clinical Integrated Networks (Super PHO s) 17

10 How are we measured HEDIS The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. Altogether, HEDIS consists of 81 measures across 5 domains of care. Health Plans (Measured and PAID) Diabetes Asthma Hypertension Mental Health Prevention Cost and Utilization 18 Measured together Most cost and quality measured are paid out at the PHO level based on our whole population of patients. We are accountable for the cost of the hospital stay and the quality of the stay even if they go to a hospital outside of our community. 19

11 Yearly review of Population Insight Reports Where are our patients going (within our partner hospitals?) Have we decreased the number of patients utilizing hospitals from year to year. Are our partner hospitals High cost? Are we impacting Primary Care Sensitive ED visits? Are we Impacting Ambulatory Care Sensitive Admissions? How about readmission rates? 20 Score card 21

12 Score Card Continued 22 How do we determine success 23

13 PCMH is the start 12 years ago PCMH started PCP to SCP referral processes improved Communication between provider increased Decrease of duplicate testing, increase patients confidence when provider talk We have not perfected this, but now everyone agrees it is important Need improved IT capabilities to really succeed. (HIPAA complaint texting, telemedicine, payment to support improve communication), ect. 24 Care Management Care Management added a needed layer to proactive management of patients. We can not wait until patients are sick to engage them and be successful in the triple aim (sick patients are expensive) Education, self management skills and connection to community resources are all key in improving cost, quality and patient satisfaction. 25

14 Care Management Case Study-Ms. W 50 y/o Female Type 2 DM, HF and Depression (main concerns) Also-hypertension, hyperlipidemia, Degenerative Disc Disease, lumbosacral radiculopathy and anxiety In May BMI of 39.3 A1C was 14.0 Wexford/Crawford PHO 26 Care Management Activities Initial assessment Phone calls and Face to Face visits Established Trusting Relationship Express Frustrations Identify barriers Patient Set Goals get out and move 10minutes a day, 4 days of the week bowl in a league again Wexford/Crawford PHO 27

15 Success One Patient at a Time Ms. W 5 months later more engaged in the management of her chronic health conditions. A1C was 8.3 lost 28lbs not missed a scheduled appointment since the onset of care management She stated that she finally feels empowered and encouraged to take the help that is being offered and use it. Wexford/Crawford PHO 28 Wrap up 29

16 Transitions of care Some time the hospital goals and the PCP goal don t line up! Care managers we quickly full and managing other needs. Hospital re-admission didn t decrease as much as we had hoped. SO, we added a liaison between hospital case management and ambulatory primary care and specialists. 30 Cadillac Hospital/Wexford PHO partnership Transitional Care Manager Focused on readmission rates Part of Ambulatory Care management team (embedded into PCP practice just like care managers) Manages top 6 diagnosis (COPD, Stroke, MI, Pneumonia, Orthopedic Surgery and DM) Manages 30 days in partnership with Care manager, home care, SNF, etc... Pre-hab for high risk surgical patients next step in the journey 31

17 The good the bad and the ugly Congestive Heart Failure Enhanced Recovery COPD Diabetes Behavioral Health Pharmacy 32 Process Barriers Chronic Disease Lack of Care Managers to reinforce education Lack of Palliative Care Services Lack of standard process, communication and education materials. Change across dispirit organizations is challenging. Patient engagement Provider engagement Cost of change Team Dynamics Lack of change management skills Lack of PCP s in community 33

18 Process Success Physician Leadership Senior Leadership Commitment (PHO and Hospital) Community engagement Payer Funding Role acceptance (PHO, Hospital and Community) Appetite for change 34 Time to think outside the Box 35 35

19 Future Payment reform is Purposely Disruptive Advanced Payment Models (Risk based payment) CPC+ Bundled Payments MACRA/MIPS Risk based contracts SIM-Community Health Workers 36 Need to Excel at FFS While Building for Value Based Payment FEE FOR SERVICE A business we know and love (and have thrived at) It s all about volume Maximize price to commercial payers to offset losses on government business Focus on specialists Crossing the Crevasse Clinical Integration is a way for physicians and health systems to bridge the gap between FFS reimbursement world and tomorrow s (today s) value based payment world VALUE BASED PAYMENT Brave new world New business model Focus on populations and episodes of care Primary care becomes key Profits from higher quality care in home setting Longitudinal payments for chronic care Bundled payment Joint contracts with payers Focus on data 37

20 38 Thank you for improving health care for the people of Michigan 39

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

Potential for an additional 5% PDCM-PCP BCBSM Value Based Reimbursement (VBR) onto your Patient Centered Medical Home designation VBR (estimated

Potential for an additional 5% PDCM-PCP BCBSM Value Based Reimbursement (VBR) onto your Patient Centered Medical Home designation VBR (estimated Revised 1/25/2018 1 Potential for an additional 5% PDCM-PCP BCBSM Value Based Reimbursement (VBR) onto your Patient Centered Medical Home designation VBR (estimated average of $4,000 per physician, varies

More information

Blue Cross Blue Shield of Michigan Advancing to the Next Generation of Value Based Pay for Performance

Blue Cross Blue Shield of Michigan Advancing to the Next Generation of Value Based Pay for Performance Blue Cross Blue Shield of Michigan Advancing to the Next Generation of Value Based Pay for Performance Physician Group Incentive Program, Patient Centered Medical Homes, and Moving From Fee for Service

More information

Launch PCMH Program. Organized Systems of Care (OSCs) Launch of PGIP based on Chronic Care Model. Risk-based Reimbursement

Launch PCMH Program. Organized Systems of Care (OSCs) Launch of PGIP based on Chronic Care Model. Risk-based Reimbursement Updated 1/19/2017 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Launch of PGIP based on Chronic Care Model Physician Organizations have the structure and technical expertise to create

More information

Patient-Centered Medical Home 101: General Overview

Patient-Centered Medical Home 101: General Overview Patient-Centered Medical Home 101: General Overview Publicly Available Slide Deck Last Updated: January 2015 Suggested Citation: PCPCC Map Tools. (2015). Patient-Centered Medical Home 101: General Overview.

More information

Provider-Delivered Care Management Frequently Asked Questions Revised March 2018

Provider-Delivered Care Management Frequently Asked Questions Revised March 2018 Provider-Delivered Care Management Frequently Asked Questions Revised March 2018 Table of Contents Section Name Page Background and Participation 2 Reimbursement and Billing 2 Training 5 Eligibility 7

More information

Tennessee Health Care Innovation Initiative

Tennessee Health Care Innovation Initiative Tennessee Health Care Innovation Initiative More information available at: http://www.tn.gov/hcfa/strategic.shtml State Innovation Model grant 2 1 State Innovation Model (SIM) funding Last week the Centers

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

Sandra Robinson, RN, MSN, ACM, CEN

Sandra Robinson, RN, MSN, ACM, CEN Developing and Measuring Care Coordination Outcome Goals and Objectives ACMA National Conference April 28, 2015 Cleveland Clinic Care Management Sandra Robinson, RN, MSN, ACM, CEN (robinss12@ccf.org) Joan

More information

POPULATION HEALTH PLAYBOOK. Mark Wendling, MD Executive Director LVPHO/Valley Preferred 1

POPULATION 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 information

Employer Breakout Session Payment Change in Ohio: What it Means for Employers

Employer Breakout Session Payment Change in Ohio: What it Means for Employers Employer Breakout Session Payment Change in Ohio: What it Means for Employers Moderators Jeff Biehl, Health Collaborative of Greater Columbus Frank A. Johnson, Maine Health Management Coalition Who is

More information

Accountable 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 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 information

Embedded Case Manager

Embedded Case Manager Embedded Case Manager Joann Sciandra, RN, BSN, CCM Medical Home Summit ProvenHealth Navigator Geisinger Health System An Integrated Health Service Organization Provider Facilities Managed Care Companies

More information

Healthcare Reimbursement Change VBP -The Future is Now

Healthcare 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 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

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

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

More information

Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual

Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual 2016 This document is a guide to the 2016 Arkansas Blue Cross and Blue Shield Patient-Centered Medical Home program (Arkansas

More information

Advocate Physician Partners approach to Population Health

Advocate Physician Partners approach to Population Health Advocate Physician Partners approach to Population Health Don Calcagno President, Advocate Physician Partners March 9, 2016 Who are Advocate Health Care and Advocate Physician Partners? 1 Advocate Health

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

Specialty Payment Model Opportunities Assessment and Design

Specialty Payment Model Opportunities Assessment and Design Approved for Public Release. Distribution Unlimited.14.2286. CMS Alliance to Modernize Healthcare (CAMH) Specialty Model Opportunities Assessment and Design Cardiology Technical Expert Panel April 8, 2014

More information

Michigan Primary Care Transformation (MiPCT) Project Frequently Asked Questions

Michigan Primary Care Transformation (MiPCT) Project Frequently Asked Questions Michigan Primary Care Transformation (MiPCT) Project Frequently Asked Questions Demonstration Design 1. What is the Michigan Primary Care Transformation (MiPCT) Project? The Centers for Medicare and Medicaid

More information

Healthcare Financial Management Association October 13 th, 2016 Introduction to Accountable Care Organizations and Clinically Integrated Networks

Healthcare Financial Management Association October 13 th, 2016 Introduction to Accountable Care Organizations and Clinically Integrated Networks Healthcare Financial Management Association October 13 th, 2016 Introduction to Accountable Care Organizations and Clinically Integrated Networks Agenda Define ACO, CIN, and Coordinated Care Review ACO/CIN

More information

Medicaid Payment Reform at Scale: The New York State Roadmap

Medicaid 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 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

The Alternative Quality Contract (AQC): Improving Quality While Slowing Spending Growth

The 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 information

BCBSM Physician Group Incentive Program. Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor

BCBSM Physician Group Incentive Program. Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor BCBSM Physician Group Incentive Program Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor Interpretive Guidelines 2017-2018 V12.0 Blue Cross Blue Shield of Michigan is a nonprofit

More information

The Michigan Primary Care Transformation (MiPCT) Project: An Overview. Medicaid Health Plan- MiPCT Coordination Meeting

The Michigan Primary Care Transformation (MiPCT) Project: An Overview. Medicaid Health Plan- MiPCT Coordination Meeting The Michigan Primary Care Transformation (MiPCT) Project: An Overview Medicaid Health Plan- MiPCT Coordination Meeting April 14, 2016 2 Welcome and Goals for the Day 3 Welcome! Our Goals for the Day Create

More information

The Michigan Primary Care Transformation (MiPCT) Project. PGIP Meeting Update March 09, 2012

The Michigan Primary Care Transformation (MiPCT) Project. PGIP Meeting Update March 09, 2012 The Michigan Primary Care Transformation (MiPCT) Project PGIP Meeting Update March 09, 2012 2 Agenda MiPCT March Launch meetings Care Management Update Performance Incentive Six Month Metrics MiPCT Quarterly

More information

BCBSM Physician Group Incentive Program. Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor

BCBSM Physician Group Incentive Program. Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor BCBSM Physician Group Incentive Program Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor Interpretive Guidelines Specialist Edition 2016-2017 Blue Cross Blue Shield of Michigan

More information

Blue Cross Blue Shield of Michigan. Organized Systems of Care

Blue Cross Blue Shield of Michigan. Organized Systems of Care Blue Cross Blue Shield of Michigan Organized Systems of Care 1 PGIP: Catalyzing Health System Transformation in Partnership with Providers 2005 2006 2007 2008 2009 2010 2011 2012 PGIP Chronic Care Model

More information

Goals & 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 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 information

Michigan Primary Care Transformation Project. HEDIS, Quality and the Care Manager s Role in Closing Gaps in Care

Michigan Primary Care Transformation Project. HEDIS, Quality and the Care Manager s Role in Closing Gaps in Care Michigan Primary Care Transformation Project HEDIS, Quality and the Care Manager s Role in Closing Gaps in Care 7.22.15 Topics for Today s Webinar Healthcare Effectiveness Data and Information Set (HEDIS)

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

United Medical ACO Participation Criteria

United Medical ACO Participation Criteria United Medical ACO Participation Criteria Items Requiring Practice Reporting 1) Submission of Reports: Practices must report A,B, and C to UMACO A. Thirty-four ACO Quality Measures -See Appendix A B. Average

More information

BCBSM Physician Group Incentive Program. Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor

BCBSM Physician Group Incentive Program. Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor BCBSM Physician Group Incentive Program Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor Interpretive Guidelines 2016-2017 V11.0 Blue Cross Blue Shield of Michigan is a nonprofit

More information

UPMC Health Plan. Value Based Insurance Design (VBID) Spark Your Health

UPMC Health Plan. Value Based Insurance Design (VBID) Spark Your Health UPMC Health Plan Value Based Insurance Design (VBID) Spark Your Health Value Based Insurance Design (VBID) Spark Your Health Medicare Advantage Summit April 6, 2017 Helene Weinraub 1 The statements contained

More information

Physician Engagement

Physician 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 information

Building & Strengthening Patient Centered Medical Homes in the Safety Net

Building & Strengthening Patient Centered Medical Homes in the Safety Net Blue Shield of California Foundation County Coverage Expansion Planning Workshop #2 Building & Strengthening Patient Centered Medical Homes in the Safety Net July 8, 2011 Presented by: Kathryn Phillips,

More information

Provider Guide. Medi-Cal Health Homes Program

Provider Guide. Medi-Cal Health Homes Program Medi-Cal Health Provider Guide This provider guide provides information on the California Medi-Cal Health (HHP) for Community-Based Care Management Entities (CB-CMEs), providers, community-based organizations,

More information

Mission Health Care Network. April 2017

Mission Health Care Network. April 2017 Mission Health Care Network April 2017 WHAT IS MISSION HEALTH CARE NETWORK? Mission Health Care Network is a Clinically Integrated Network including groups of doctors, the hospital and other health care

More information

The New Frontier: Value- Based Payment Models

The New Frontier: Value- Based Payment Models The New Frontier: Value- Based Payment Models Target Audience: Pharmacists and Pharmacy Technicians ACPE#: 0202-0000-18-026-L04-P/T Activity Type: Knowledge-based Target Audience: ACPE#: Activity Type:

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

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

California s Health Homes Program

California s Health Homes Program California s Health Homes Program HPSM Network Webinar 9/05/18 Goals for Today: Health Homes Program overview CB-CME requirements Program readiness and implementation timeline Gather take-away questions

More information

Joseph W. Thompson, MD, MPH Arkansas Surgeon General Director, Arkansas Center for Health Improvement

Joseph W. Thompson, MD, MPH Arkansas Surgeon General Director, Arkansas Center for Health Improvement Joseph W. Thompson, MD, MPH Arkansas Surgeon General Director, Arkansas Center for Health Improvement Arkansas Health System Improvement Workforce Payment System Health Information Technology Insurance

More information

Care Management in the Patient Centered Medical Home. Self Study Module

Care Management in the Patient Centered Medical Home. Self Study Module Care Management in the Patient Centered Medical Home Self Study Module Objectives Describe the goals of care management Identify elements of successful care management Recognize the 5 step Care Management

More information

The UNC Health Care System & BlueCross BlueShield of North Carolina Model Medical Practice: A Blueprint for Successful Collaboration

The UNC Health Care System & BlueCross BlueShield of North Carolina Model Medical Practice: A Blueprint for Successful Collaboration The UNC Health Care System & BlueCross BlueShield of North Carolina Model Medical Practice: A Blueprint for Successful Collaboration January 26, 2012 1 Session Overview Partners in Innovation and Service

More information

THE BEST OF TIMES: PHARMACY IN AN ERA OF

THE BEST OF TIMES: PHARMACY IN AN ERA OF OBJECTIVES THE BEST OF TIMES: PHARMACY IN AN ERA OF ACCOUNTABLE CARE Toni Fera, BS, PharmD October 17, 2014 1. Describe the role of pharmacists in accountable care organizations (ACO). 2. List four key

More information

MD, MBA, FACHE, FAAPL

MD, 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 information

Data-Driven Strategy for New Payment Models. Objectives. Common Acronyms

Data-Driven Strategy for New Payment Models. Objectives. Common Acronyms Data-Driven Strategy for New Payment Models Mark Sharp, CPA Partner msharp@bkd.com Objectives Understand new payment model reforms and bundling arrangements Learn how these new payment models can impact

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

Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual

Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual 2017 This document is a guide to the 2017 Arkansas Blue Cross and Blue Shield Patient-Centered Medical Home program (Arkansas

More information

BCBSM Physician Group Incentive Program. Patient-Centered Medical Home Domains of Function. Interpretive Guidelines

BCBSM Physician Group Incentive Program. Patient-Centered Medical Home Domains of Function. Interpretive Guidelines BCBSM Physician Group Incentive Program Patient-Centered Medical Home Domains of Function Interpretive Guidelines October 2009 Table of Contents Page 1.0 PATIENT-PROVIDER PARTNERSHIP 1 2.0 PATIENT REGISTRY

More information

Getting Started in a Medicare Shared Savings Program Accountable Care Organization

Getting Started in a Medicare Shared Savings Program Accountable Care Organization 1 Getting Started in a Medicare Shared Savings Program Accountable Care Organization Tuesday, September 16 th Pam Maxwell, Chief Growth Officer What is an ACO? Accountable Care Organizations (ACOs) are

More information

Geisinger s Use of Technology in Case Management and the Medical Home: A Heart Failure Study

Geisinger s Use of Technology in Case Management and the Medical Home: A Heart Failure Study Geisinger s Use of Technology in Case Management and the Medical Home: A Heart Failure Study JOANN SCIANDRA, RN, BSN, CCM DOREEN SALEK, BS, RN, CCS/CPC DANIEL MAENG, PHD February 18, 2015 Geisinger at

More information

Domain 1 Patient Engagement Speed Data Reports & Schedule

Domain 1 Patient Engagement Speed Data Reports & Schedule Domain 1 Patient Engagement Speed Data Reports & Schedule Suffolk Care Collaborative (SCC) Suffolk County Performing Provider System (PPS) Delivery System Reform Incentive Payment (DSRIP) Program 2 PRESENTATION

More information

Our Response to Health Reform: Collaborative Initiatives for Success

Our Response to Health Reform: Collaborative Initiatives for Success Our Response to Health Reform: Collaborative Initiatives for Success February 11, 2012 Joseph R Swedish, FACHE President and CEO Trinity Health Trinity Health: Unified Enterprise Ministry Serving Ten States

More information

Arkansas PCMH: Transformational Success Story. William Golden MD MACP Medical Director, AR Medicaid UAMS Prof. Int. Med and Public Health

Arkansas PCMH: Transformational Success Story. William Golden MD MACP Medical Director, AR Medicaid UAMS Prof. Int. Med and Public Health Arkansas PCMH: Transformational Success Story William Golden MD MACP Medical Director, AR Medicaid UAMS Prof. Int. Med and Public Health International Challenge All Health Systems Have Service Demand and

More information

The greatest difficulty in the world is not for people to accept new ideas but to get them to forget their old ones.

The greatest difficulty in the world is not for people to accept new ideas but to get them to forget their old ones. Dr. Marie S, Gustin Nursing Excellence Conference, 2012 The greatest difficulty in the world is not for people to accept new ideas but to get them to forget their old ones. John Maynard Keynes Chaos, Complexity,

More information

New Models of Care: Diabetes and the Triple Aim

New Models of Care: Diabetes and the Triple Aim Robert Gabbay MD, PhD, FACP Chief Medical Officer Joslin Diabetes Center Harvard Medical School Boston, MA The Triple Aim New Models of Care: Diabetes and the Triple Aim Healthcare is changing, what does

More information

How Title Xx Vermont s Broadening

How Title Xx Vermont s Broadening How Title Xx Vermont s Broadening Subtitle Xx APCD Offers New Opportunities to Drive Value & Efficiencies Adam Moody, Director of Analytic Operations Onpoint Health Data Pat Jones, Assistant Director Presenter,

More information

Succeeding in a New Era of Health Care Delivery

Succeeding 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 information

Breathing Easy: A Case Study on Asthma Prevention

Breathing Easy: A Case Study on Asthma Prevention Breathing Easy: A Case Study on Asthma Prevention Bob Morrow, MD, MBA Market President, Houston & Southeast Texas Blue Cross and Blue Shield of Texas @DrBobMorrow A Division of Health Care Service Corporation,

More information

EVOLENT HEALTH, LLC Diabetes Program Description 2018

EVOLENT HEALTH, LLC Diabetes Program Description 2018 EVOLENT HEALTH, LLC Diabetes Program Description 2018 1 Evolent Health Diabetes Program Description 2018 Table of Contents Section Page Number I. Introduction... 3 II. Program Scope... 3 III. Program Goals...

More information

Managing Patients with Multiple Chronic Conditions

Managing Patients with Multiple Chronic Conditions Best Practices Managing Patients with Multiple Chronic Conditions Dartmouth-Hitchcock Physicians Case Study Organization Profile Headquartered in Bedford, New Hampshire, Dartmouth-Hitchcock is a large

More information

DISEASE MANAGEMENT PROGRAMS. Procedural Manual. CMPCN Policy #5710

DISEASE MANAGEMENT PROGRAMS. Procedural Manual. CMPCN Policy #5710 DISEASE MANAGEMENT PROGRAMS Procedural Manual CMPCN Policy #5710 Effective Date: 01/01/2012 Revision Date(s) 11/18/2012; 10/01/13 ; 01/07/14 Approval Date(s) 12/18/2012 ; 10/23/13, 05/27,14 Annotated to

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

Building a Multi-System Clinically Integrated Network

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

More information

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

Value-Based Models: Two Successful Payer-Provider Approaches March 1, 2016

Value-Based Models: Two Successful Payer-Provider Approaches March 1, 2016 Value-Based Models: Two Successful Payer-Provider Approaches March 1, 2016 Clifford T. Fullerton, MD, MSc President, Baylor Scott & White Quality Alliance Chief Population Health Officer, Baylor Scott

More information

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

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

More information

Collaborative Activation of Resources and Empowerment Services Building Programs to Fit Patients vs. Bending Patients to Fit Programs

Collaborative Activation of Resources and Empowerment Services Building Programs to Fit Patients vs. Bending Patients to Fit Programs Organization: Solution Title: Calvert Memorial Hospital Calvert CARES: Collaborative Activation of Resources and Empowerment Services Building Programs to Fit Patients vs. Bending Patients to Fit Programs

More information

ACHIEVING POPULATION HEALTH: THE POWER OF TEAM BASED CARE

ACHIEVING POPULATION HEALTH: THE POWER OF TEAM BASED CARE ACHIEVING POPULATION HEALTH: THE POWER OF TEAM BASED CARE JAMES JERZAK M.D. KATHY KERSCHER, MBA BELLIN HEALTH GREEN BAY WI IHI NATIONAL FORUM 12 13 2017 2 GREEN BAY, WISCONSIN Agenda Why Team-Based Care

More information

Advocate Cerner Partnership Creates Big Data Analytics for Population Health

Advocate Cerner Partnership Creates Big Data Analytics for Population Health Advocate Cerner Partnership Creates Big Data Analytics for Population Health Tina Esposito, VP Center for Health Information Services Rishi Sikka, MD, Senior VP Clinical Operations Scottsdale Institute

More information

Keith Salzman, M.D. Chief Medical Information Officer, IBM

Keith Salzman, M.D. Chief Medical Information Officer, IBM Keith Salzman, M.D. Chief Medical Information Officer, IBM Smarter Care through Transformation Keith L Salzman, MD, MPH CMIO-IBM GBS Federal keithsal@us.ibm.com USA 2012 Ogden UT IOM-The Healthcare Imperative:

More information

Patient-Centered Medical Home Best Practices: Case Study Examples

Patient-Centered Medical Home Best Practices: Case Study Examples Patient-Centered Medical Home Best Practices: Case Study Examples Mona Chitre, PharmD, CGP Director of Clinical Services, Strategy, and Policy FLRx Pharmacy Management Excellus Health Plans Disclosures

More information

DSRIP Demonstration Year 1, Quarter 1-2 Domain 1 Patient Engagement Data Request

DSRIP Demonstration Year 1, Quarter 1-2 Domain 1 Patient Engagement Data Request DSRIP Demonstration Year 1, Quarter 1-2 Domain 1 Patient Engagement Data Request Webinar: Monday, October 5, 2015 Time: 1:30pm-3:00pm Presented by Suffolk Care Collaborative (SCC) Suffolk County Performing

More information

3M Health Information Systems. 3M Clinical Risk Groups: Measuring risk, managing care

3M Health Information Systems. 3M Clinical Risk Groups: Measuring risk, managing care 3M Health Information Systems 3M Clinical Risk Groups: Measuring risk, managing care 3M Clinical Risk Groups: Measuring risk, managing care Overview The 3M Clinical Risk Groups (CRGs) are a population

More information

Payer s Perspective on Clinical Pathways and Value-based Care

Payer 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 information

Moving from Fee-for-Service to Fee-for-Value: Blue Cross Blue Shield of Michigan s Value Partnership Programs

Moving from Fee-for-Service to Fee-for-Value: Blue Cross Blue Shield of Michigan s Value Partnership Programs Moving from Fee-for-Service to Fee-for-Value: Blue Cross Blue Shield of Michigan s Value Partnership Programs The Tenth National Pay for Performance Summit March 2015 Session Description This presentation

More information

Innovative Reimbursement Models Value-Based Insurance Design and the Medical Home En Route to an ACO Model

Innovative Reimbursement Models Value-Based Insurance Design and the Medical Home En Route to an ACO Model Innovative Reimbursement Models Value-Based Insurance Design and the Medical Home En Route to an ACO Model Mary Ellen Benzik,MD PCPCC Conference March 14, 2011 Community Collaboration to Transform Health

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

Transitioning Care to Reduce Admissions and Readmissions. Sven T. Berg, MD, MPH Julie Mobayed RN, BSN, MPH

Transitioning Care to Reduce Admissions and Readmissions. Sven T. Berg, MD, MPH Julie Mobayed RN, BSN, MPH Transitioning Care to Reduce Admissions and Readmissions Sven T. Berg, MD, MPH Julie Mobayed RN, BSN, MPH Disclaimer: Potential for Error Type One Error Rejecting the null hypothesis when it is true

More 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

Next Generation Physician Compensation Design in a Schizophrenic Payer Environment

Next 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 information

The Impact of Primary Care Practice Transformation on Cost, Quality, and Utilization

The Impact of Primary Care Practice Transformation on Cost, Quality, and Utilization EXECUTIVE SUMMARY The Impact of Primary Care Practice Transformation on Cost, Quality, and Utilization A SYSTEMATIC REVIEW OF RESEARCH PUBLISHED IN 2016 July 2017 PREPARED BY Made possible with support

More information

Jumpstarting population health management

Jumpstarting population health management Jumpstarting population health management Issue Brief April 2016 kpmg.com Table of contents Taking small, tangible steps towards PHM for scalable achievements 2 The power of PHM: Five steps 3 Case study

More information

Alternative Payment Models for Behavioral Health Kim Cox VP, Provider Network

Alternative 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 information

2015 Annual Convention

2015 Annual Convention 2015 Annual Convention Date: Tuesday, October 13, 2015 Time: 8:00 am 9:30 am Location: Gaylord National Harbor Resort and Convention Center, National Harbor 10 Title: Activity Type: Speaker: Opportunities

More information

ACOs: Transforming Systems with New Payment Models & Community Integration

ACOs: Transforming Systems with New Payment Models & Community Integration ACOs: Transforming Systems with New Payment Models & Community Integration Sunnah Kim PNP (Moderator), American Academy of Pediatrics Herbert Druilhet, RN, DNP, FNP-BC Lafayette General Medical Doctors

More information

The 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 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 information

Practice Transformation: Patient Centered Medical Home Overview

Practice Transformation: Patient Centered Medical Home Overview Practice Transformation: Patient Centered Medical Home Overview Megan A. Housley, MBA Business Development Director Kentucky Regional Extension Center The Triple Aim Population Health TRIPLE AIM Per Capita

More information

NH Medicaid Patient Centered Medical Home Pilot

NH Medicaid Patient Centered Medical Home Pilot NH Medicaid Patient Centered Medical Home Pilot Policy Day For Legislators Conference on Health Payment Reform May 11, 2009 Katie Dunn, RN, MPH State Medicaid Director 120 Overview Why do a PCMH pilot

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

Pursuing the Triple Aim: CareOregon

Pursuing the Triple Aim: CareOregon Pursuing the Triple Aim: CareOregon The Triple Aim: An Introduction The Institute for Healthcare Improvement (IHI) launched the Triple Aim initiative in September 2007 to develop new models of care that

More information

Lessons Learned in Care Management. Meghan Sheridan, RD, CDE Ohio Association of Community Health Centers 2017 Annual Conference

Lessons Learned in Care Management. Meghan Sheridan, RD, CDE Ohio Association of Community Health Centers 2017 Annual Conference Lessons Learned in Care Management Meghan Sheridan, RD, CDE Ohio Association of Community Health Centers 2017 Annual Conference 1 Objectives: Rationale for team-based care model Lessons learned in implementing

More information

Improving Medicaid Chronic Disease Care and Controlling Costs. The Case for Medical Homes and Community Networks

Improving Medicaid Chronic Disease Care and Controlling Costs. The Case for Medical Homes and Community Networks Improving Medicaid Chronic Disease Care and Controlling Costs The Case for Medical Homes and Community Networks L. Allen Dobson,Jr. MD FAAFP Chair -Board of Directors NC Community Care Networks, Inc HOME

More information

Provider Information Guide Complex Care and Condition Care Overview

Provider Information Guide Complex Care and Condition Care Overview Complex and Overview Introduction Complex and are essential components of Passport Health Plan s (Passport) Coordination services, which are used to support the practitioner-patient relationship and plan

More information

Population Health and the Accelerating Leap to Outcomes-Based Reimbursement. Craig J. Wilson

Population Health and the Accelerating Leap to Outcomes-Based Reimbursement. Craig J. Wilson Population Health and the Accelerating Leap to Outcomes-Based Reimbursement Craig J. Wilson Agenda / Goals Define Population Health Management Review emerging reimbursement landscape eg MACRA Review why

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