THE PATH TO AFFORDABLE HEALTHCARE
|
|
- Julie Nancy O’Brien’
- 5 years ago
- Views:
Transcription
1 THE PATH TO AFFORDABLE HEALTHCARE MYLIA CHRISTENSEN CHIEF OPERATING OFFICER HEALTHINSIGHT AffordHC18 AffordableCareTogether 1
2 The path to affordable healthcare Role of regional collaboration Mylia Christensen Chief Operating Officer HealthInsight Chair of NRHI Affordability Committee
3 Affordability Advisory Group Members Ana English Cindy Munn Jerry Reeves Julie Sonier Karen Feinstein Louise Probst Nancy Giunto Sara Medley Chris Queram Robert Ferguson Sara Bolton Meredith Roberts Tomasi David Puelle (Puelle Design) Ellen Gagnon Jolie Ritzo 3
4 4
5 We have an unsustainable problem. Harder choices are coming. Health spending as a share of U.S. GDP, 1963 to selected years 13.4% 15.4% 17.4% 19.3% 10.1% 5.4% 7.2% * 2023P *2013 figure reflects a 3.1% increase in gross domestic product (GDP) and a 3.6% increase in national health spending over the prior year. See page 27 for a comparison of economic growth and health spending growth. Notes: Health spending refers to national health expenditures. Projections shown as P. Source: National Health Expenditure Data, Centers for Medicare & Medicaid Services (CMS), 2014 (historical) and 2015 (projections), CALIFORNIA HEALTHCARE FOUNDATION 5
6 We have an unsustainable problem. Harder choices are coming. Between 2006 to 2016 premiums are up 77% Healthcare costs will consume half of household income by Premiums and out-of-pocket expenses Household income Source: Henry J Kaiser Family Foundation, September 19, Premiums and Worker Contributions Among Workers Covered by Employer Sponsored Coverage. Source: Young RA, DeVoe JE. Who Will Have Health Insurance in the Future? An Updated Projection. Am Fam Med 2012; 10(2): PMCID: PMC
7 Percent change in middle income households spending on basic needs ( ). Healthcare 24.8% Food at home Housing Total Transportation Total food Food away from home Clothing Source: Brookings Institution, Wall Street Journal 7
8 Medicaid crowds out education. Source: National Association of State Budgets Officers 8
9 Understanding the problem
10 We ALL created this problem. We ALL need to be part of the solution. Patients Payers Providers Purchasers Policymakers 10
11 11
12 The major drivers of affordability. Solving one issue in isolation does not achieve the goal. 12
13 Addressing the drivers of affordability has systemic benefits in addition to the positive economic impact. + HEALTH Healthier populations: use fewer resources increase productivity enhance communities - WASTE Unnecessary clinical procedures: increase clinical harm cause emotional distress incur financial harm Administrative burden: increases cost is burning out providers - PRICE High prices: don t correlate with quality incentivize waste misallocate resources 13
14 What would it take to fix all this? Transparency Data & Information Aligning Incentives Community Engagement Collaboration Across Sectors New Payment Models Informed Consumers Who could do all this? 14
15 There is hope. Patients Payers Providers Purchasers Policymakers In many regions across the country we are coming together to untangle complexities and find a path to affordability. 15
16 So, what are we doing about it?
17 17
18 Health Summary Using SDoH data to reduce ambulatory caresensitive hospitalizations Combined SDoH (e.g., insurance type, race/ethnicity, language preference, education, household income) with clinical data for increased care coordination and improved primary care. Linking social determinants of health and utilization Outcomes: Hospitalization rates decreased by 106 more per 100,000 adults than they did in comparative counties 5,764 hospitalizations for ambulatory care-sensitive conditions were averted between Graph source: Health Affairs, Association Of A Regional Health Improvement Collaborative With Ambulatory Care Sensitive Hospitalizations, February
19 Health Summary Route 66 Accountable Health Community Leverages technology to address gaps in clinical services and health-related social needs of Medicare and Medicaid beneficiaries. Program screens for five SDoH with patients - food, shelter, transportation, domestic violence, & public utility access Power of interoperability Program documents measures and integrates information into HIE and provider EHRs Testing positive for SDoH measures triggers program to coordinate services and inform clinical sites as to whether those services were delivered Program went live May 1, 2018 outcomes to be determined 19
20 Health Summary Care coordination/medical Neighborhoods Creating medical neighborhoods for increased care coordination lead to improved health. Data sharing to improve whole person health Improved referral pattern allowed for EDs to identify primary care providers for highutilizers Reduced variation across systems; enabled adopting/spreading best practices Tracked patient history to avoid duplication of services and error 20
21 Health Summary Improving end-of-life care NJHCQI developed a plan that shares tactical solutions to improve end-of-life care for New Jersey adults. This plan was developed in response to a poll: 60% of New Jersey adults had no written documents expressing their wishes for care at the end of their lives. Finding solutions to respect patient wishes The plan calls for improved: Technology Payment reform Education Culture 21
22 Health Summary Supporting providers in Caring for ME 2016: Maine passed legislation enacting comprehensive and aggressive limits on opioid prescribing. MQC partnered with Maine Medical Association to create: Caring for ME an effort to bring together a wide set of partners to promote shared messages, educational resources, and practical tools for healthcare providers Addressing Maine s opioid epidemic Goals: Support prevention efforts Maintain compassionate/trauma-informed approach to chronic pain management Improve safety of opioid prescribing Appropriately diagnose addiction Improve access to effective treatments Maine has seen the largest decrease (25%) in the country in opioid prescribing between
23 Outcomes Health Maine has seen the largest decrease in the country in opioid prescribing over the year. Addressing Maine s opioid epidemic 23
24 Price Summary Untangling the Cost Drivers: A Comparison of Total Cost Between Five States Measuring and comparing total cost of care It s not just price or just waste in the system In-depth analyses make it possible to identify important differences in regional cost drivers. It s not just care patterns and delivery systems It s different state-to-state (sometimes within a state) 24
25 Price Background Relative cost of care Measuring and comparing total cost of care Bringing the higher than average cost states highlighted above down to the average of the participating states could potentially save over $1 billion. 25
26 Price Outcomes Where are we headed? America s healthcare cost crisis will not be solved by data alone, and it cannot be solved without it The Total Cost of Care measure set provides a high-level framework to learn about cost; this framework combined with quality reporting completes the value equation Expanding to include Medicare and Medicaid reporting provides a comprehensive view of the market Measuring and comparing total cost of care Regional Health Improvement Collaboratives (RHICs ) extensive local networks provide a natural highway for sharing this data and coordinating action 26
27 Price Index Background Price Detailed insight High Price 1.15 High Price Low Use High Price High Use , Translating information into action Low Price Low Price Low Use Low High Use Use Resource Use Index (RUI) Other Oregon Clinics Clinic Low Price High Use Individual patient data is attributed to primary care providers and includes: Risk adjusted for fair comparison Total Cost of Care and Resource Use Indices, with breakouts of inpatient & outpatient usage, professional & pharmacy claims, and inpatient admissions & emergency 27
28 Price Summary Making cost and quality information public Wear the Cost campaign provides cost and quality information for consumers. Empowering consumers Goals: Patients/providers become more aware of variation among hospitals statewide reduce costs help patients make high-value choices. Empowering consumers to get involved in their own healthcare, with numerous ways to take action. 28
29 Price Summary Benchmarking & hot-spotting to improve care Created second version of California Regional Health Care Cost & Quality Atlas state s largest improvement measurement tool that tracks: Clinical quality Hospital utilization Cost of care Roadmap to cost and quality improvement Data gathered from 29M insured Californians showed wide variation of costs and quality across state (2013 & 2015). Outcomes: Clinical quality varied by average of 25% across 19 areas in 2015 Clinical quality improved modestly from , while costs increased 3.85% annually IHA plans to update Atlas with 2017 data by end of
30 Waste Understanding clinical waste Summary Shining a light on waste in Washington state Overuse of low-value services introduces the unnecessary risk of adverse physical and financial harm for patients, drives up costs for purchasers and insurers, and strains the system. Outcomes: This report examined 47 common treatment approaches known by the medical community to be overused More than 45% of the healthcare services examined were determined to be low value Approximately 1.3 million individuals received one of these 47 services; among these individuals, almost one-half (47.9%) received a low value service 36% of spending on the healthcare services examined went to low value treatments and procedures - this amounts to an estimated $282 million in wasteful spending 30
31 Waste Summary Controlling administrative waste Of 89 measures across 9 programs sets, only 4 were in all sets, while 60 were in only 1 or 2 sets. Outcomes: Common Standard Measure Set used for P4P Reducing measurement burden Single set of results used by health plans for rewarding healthcare systems and provider for delivering high value care Healthcare providers benefit from reduced administrative waste and can apply comprehensive interventions across all patients 31
32 Waste Background Controlling administrative waste Reducing measurement burden IHA stakeholders identified 9 key measurement programs particularly relevant for ACO alignment considerations. 32
33 Waste Summary Removing unnecessary services PRHI aims to remove unnecessary services and pay for what matters, with a focus on perinatal care. The maternal mortality rate in the U.S. is 3x higher than any other developed country. Paying for what matters 33
34 Waste Summary Reducing unnecessary Medicare patient readmissions Established a standard set of quality measures to improve rural hospital care and reduce unnecessary admissions. Goal: identify and field test measures for rural, community-based programs that reflect clinical quality, patient and family experience, and resource utilization as a metric of financial impact. Improving rural care coordination Data used to standardize and coordinate processes in providing palliative care Emphasized important role standard measures play in supporting integration and communication Worked to connect patients with community resources Resulted in 7,168 fewer unnecessary hospital readmissions. 34
35 Waste Summary Building a common measure set Led a committee that researched and selected 32 unique comparative measures. Chose measures that were aligned across payers and could be reported reliably. Improving health & minimizing burden Goals: Improve quality/value of care Reduce provider reporting complexity Align healthcare organizations 35
36 What do all these initiatives have in common?
37 They re bringing together all parties for safer, higher quality, more affordable care that works better for everyone. 37
38 Regional Health Improvement Collaboratives (RHICs) Regional Focus Neutral Conveners Non-Profit 38
39 The Role of RHICs Patient Education Analysis & Reporting Regional Focus Neutral Conveners Non-Profit Paying for What Matters Quality Improvement 39
40 RHICs currently work in many regions across the U.S. 40
41 Multiple Stakeholders, Varied Tactics One Goal Health Members engage from positions of particular knowledge, experience and strengths: RHIC RHIC Population Health Payment Reform Quality Improvement Data Analysis Affordability Price RHIC Waste Cross pollinate best practices Disseminate educational materials Lead community dialogue 41
42 Partnering for greater reach NRHI is recruiting national partners to join forces and reach a broader public audience with the message of why affordability matters and what we can do about it. Regional Efforts Health National Partner Regional Efforts Price NRHI Regional Efforts Waste National Partner 42
43 JAN 25, 2017 Health Plans Spend $1,000 More Per Patient Depending On Region Bruce Japsen, CONTRIBUTOR The Road To Affordability: How Collaborating At The Community Level Can Reduce Costs, Improve Care, And Spread Best Practices Elizabeth Mitchell NOVEMBER 14, 2017 While practices struggle with MACRA, value-based payment systems past due, expert says by Joanne Finnegan Dec 4, :30pm Although many physician practices struggle to get on board with the new Medicare payment system implemented by MACRA, 43
44 Rational common interests and rational individual interests are in conflict. Our failure as a nation to pursue the Triple Aim meets the criteria for what Garrett Harden called a tragedy of the commons. As in all tragedies of the commons, the great task in policy is not to claim that stakeholders are acting irrationally, but rather to change what is rational for them to do. - Don Berwick, Health Affairs, May/June
45 45
46 46
47 Do your part to make healthcare more affordable 47
48 Thank you. Questions?
Elizabeth Mitchell December 1, Transforming Healthcare in an Uncertain Environment
Transforming Healthcare in an Uncertain Environment Elizabeth Mitchell, President & CEO Network for Regional Healthcare Improvement 2017 We have a problem Health Spending as a Share of GDP United States,
More informationMedicare Total Cost of Care Reporting
Issue Brief Medicare Total Cost of Care Reporting True health care transformation requires access to clear and consistent data. Three regions are working together to develop reporting that is as consistent
More informationExamples of Measure Selection Criteria From Six Different Programs
Examples of Measure Selection Criteria From Six Different Programs NQF Criteria to Assess Measures for Endorsement 1. Important to measure and report to keep focus on priority areas, where the evidence
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 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 informationAdvancing Quality & Improving Care: Getting to the Results that Matter. Shantanu Agrawal, MD, MPhil October 9, 2018
Advancing Quality & Improving Care: Getting to the Results that Matter Shantanu Agrawal, MD, MPhil October 9, 2018 Results with National Impact Lives saved Drop in early elective delivery rates 2010-2016
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 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 informationPennsylvania Patient and Provider Network (P3N)
Pennsylvania Patient and Provider Network (P3N) Cross-Boundary Collaboration and Partnerships Commonwealth of Pennsylvania David Grinberg, Deputy Executive Director 717-214-2273 dgrinberg@pa.gov Project
More 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 informationThe influx of newly insured Californians through
January 2016 Managing Cost of Care: Lessons from Successful Organizations Issue Brief The influx of newly insured Californians through the public exchange and Medicaid expansion has renewed efforts by
More informationKate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS
Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS CMS support of Health Care Delivery System Reform (DSR) will result in better care, smarter spending, and healthier
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 informationConnected Care Partners
Connected Care Partners Our Discussion Today Introducing the Connected Care Partners CIN What is a Clinically Integrated Network (CIN) and why is the time right to join the Connected Care Partners CIN?
More 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 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 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 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 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 informationPaying for Outcomes not Performance
Paying for Outcomes not Performance 1 3M. All Rights Reserved. Norbert Goldfield, M.D. Medical Director 3M Health Information Systems, Inc. #Health Information Systems- Clinical Research Group Created
More informationOverview of CMS HIT Initiatives. Kelly Cronin Senior Advisor to the Administrator Centers for Medicare and Medicaid Services September 2005
Overview of CMS HIT Initiatives Kelly Cronin Senior Advisor to the Administrator Centers for Medicare and Medicaid Services September 2005 A Variation Problem Dartmouth Atlas of Healthcare Decade of HIT:
More informationCommunity Health Workers: ACA and Redesign Funding Opportunities
Community Health Workers: ACA and Redesign Funding Opportunities What are the Goals of the Affordable Care Act and Redesign? Increased Coverage Better Population Health Higher Quality, More-Patient Centered
More informationStrategic Alignment in Health Care
Strategic Alignment in Health Care Presented to CAJPA Fall Conference 9/15/16 1 Transforming Care Delivery Value-Based Pay for Performance Oncology Practice of the Future Maternity Care Focus - C-Sections
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 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 informationEvolving Roles of Pharmacists: Integrating Medication Management Services
Evolving Roles of Pharmacists: Integrating Management Services Marie Smith, PharmD, FNAP Palmer Professor and Assistant Dean, Practice and Policy Partnerships UCONN School of Pharmacy (marie.smith@uconn.edu)
More informationCenters for Medicare & Medicaid Services: Innovation Center New Direction
Centers for Medicare & Medicaid Services: Innovation Center New Direction I. Background One of the most important goals at CMS is fostering an affordable, accessible healthcare system that puts patients
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 informationTRANSFORMING HEALTHCARE DELIVERY A Pathway to Affordable, High-Quality Care in America
TRANSFORMING HEALTHCARE DELIVERY A Pathway to Affordable, High-Quality Care in America TABLE OF CONTENTS Executive Summary... 3 A Pathway to Affordable, High-Quality Care in America... 7 Appendix... 18
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 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 informationExecutive Summary. Leadership Toolkit for Redefining the H: Engaging Trustees and Communities
Executive Summary Leadership Toolkit for Redefining the H: Engaging Trustees and Communities Report produced by the AHA Committee on Research and Committee on Performance Improvement 2015 Executive Summary
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 informationQUALITY PAYMENT PROGRAM
NOTICE OF PROPOSED RULE MAKING Medicare Access and CHIP Reauthorization Act of 2015 QUALITY PAYMENT PROGRAM Executive Summary On April 27, 2016, the Department of Health and Human Services issued a Notice
More informationACOs the Medicare Shared Savings Program And Other Healthcare Reform Payment Methods
A unique vision for an ever-changing healthcare environment ACOs the Medicare Shared Savings Program And Other Healthcare Reform Payment Methods Presented by Joe Laden, President, ORVA, LLC The Environment
More informationMedicaid Practice Benchmark Report
Issue Brief Medicaid Practice Benchmark Report Overview In 2015, the Maine Health Management Coalition (MHMC) distributed its first Medicaid Practice Benchmark Report to over 300 pediatric and adult practices,
More informationUnitedHealth Center for Health Reform & Modernization September 2014
Health Reform & Modernization September 2014 2014 UnitedHealth Group. Any use, copying or distribution without written permission from UnitedHealth Group is prohibited. Overview Why Focus on Primary Care?
More informationPursuing 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 informationState Policy Report #47. October Health Center Payment Reform: State Initiatives to Meet the Triple Aim. Introduction
Health Center Payment Reform: State Initiatives to Meet the Triple Aim State Policy Report #47 October 2013 Introduction Policymakers at both the federal and state levels are focusing on how best to structure
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 informationQuality Measures and Federal Policy: Increasingly Important and A Work in Progress. American Health Quality Association Policy Forum Washington, D.C.
Quality Measures and Federal Policy: Increasingly Important and A Work in Progress American Health Quality Association Policy Forum Washington, D.C. February 9, 2016 Quality Journey NCQA Develops Health
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 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 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 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 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 informationCLINICAL INTEGRATION DRIVERS, IMPACT, AND OPTIONS JOBY KOLSUN, D.O. MEDICAL DIRECTOR CLINICAL INTEGRATION LEE PHO
CLINICAL INTEGRATION DRIVERS, IMPACT, AND OPTIONS JOBY KOLSUN, D.O. MEDICAL DIRECTOR CLINICAL INTEGRATION LEE PHO Disclaimers My current position I am not offering advice on clinical integration Items
More informationTrends in State Medicaid Programs: Emerging Models and Innovations
Trends in State Medicaid Programs: Emerging Models and Innovations Speakers: Barbara Edwards, Principal, Steve Fitton, Principal, Tina Edlund, Managing Principal, Moderator: Annie Melia, Information Services
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 informationRe: Rewarding Provider Performance: Aligning Incentives in Medicare
September 25, 2006 Institute of Medicine 500 Fifth Street NW Washington DC 20001 Re: Rewarding Provider Performance: Aligning Incentives in Medicare The American College of Physicians (ACP), representing
More informationForces of Change- Seeing Stepping Stones Not Potholes
May 19, 2014 Forces of Change- Seeing Stepping Stones Not Potholes 2 3 4 Overview Demographics Long Term Care Financing Challenges Broad Health System Challenges Payment Reform Delivery System Reform Where
More informationShifting from Volume to Value-based Healthcare. November 2014 Briefing
Shifting from Volume to Value-based Healthcare November 2014 Briefing The Healthcare Collaborative of Greater Columbus is a non-profit, public-private partnership. We serve as a catalyst, convener, and
More informationHHS DRAFT Strategic Plan FY AcademyHealth Comments Submitted
HHS DRAFT Strategic Plan FY 2018 2022 AcademyHealth Comments Submitted 10.26.17 AcademyHealth was pleased to have an opportunity to comment on the U.S. Department of Health and Human Services (HHS) draft
More informationOregon s Health System Transformation: Coordinated Care Model. November 2013 Jeanene Smith MD, MPH OHA Chief Medical Officer
Oregon s Health System Transformation: Coordinated Care Model November 2013 Jeanene Smith MD, MPH OHA Chief Medical Officer The Challenges Oregon Faced Rising healthcare costs outpacing state budget in
More informationPerson-Centered Accountable Care
Person-Centered Accountable Care Nelly Ganesan, MPH, Senior Director, Avalere s Evidence, Translation and Implementation Practice October 12, 2017 avalere.com @NGanesanAvalere @avalerehealth Despite Potential
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 informationVolume to Value Transition in the USA
Volume to Value Transition in the USA Lee A. Fleisher, M.D. Robert D. Dripps Professor and Chair of Anesthesiology Perelman School of Medicine at the University of Pennsylvania Email: lee.fleisher@uphs.upenn.edu
More information5D QAPI from an Operational Approach. Christine M. Osterberg RN BSN Senior Nursing Consultant Pathway Health Pathway Health 2013
5D QAPI from an Operational Approach Christine M. Osterberg RN BSN Senior Nursing Consultant Pathway Health Objectives Review the post-acute care data agenda. Explain QAPI principles Describe leadership
More informationOHA s Quality & Accountability Metrics: Measuring CCO Performance. State of Oregon Research Academy September 17, 2014
OHA s Quality & Accountability Metrics: Measuring CCO Performance State of Oregon Research Academy September 17, 2014 Health System Transformation: Achieving the Triple Aim 2 Our Health System Transformation
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 informationPhysician Compensation in an Era of New Reimbursement Models
2014 IHA Annual Membership Meeting Physician Compensation in an Era of New Reimbursement Models Taryn E. Stone Ice Miller LLP (317) 236-5872 taryn.stone@ Agenda Background New Reimbursement Models Trends
More informationACCOUNTABLE CARE ORGANIZATION & ALTERNATIVE PAYMENT MODEL SUMMIT
ACCOUNTABLE CARE ORGANIZATION & ALTERNATIVE PAYMENT MODEL SUMMIT The Centers for Medicare and Medicaid Services Kate Goodrich, MD MHS Director, Clinical Standards & Quality Chief Medical Officer 1 DISCLAIMERS
More informationPHCA Webinar January 30, Latsha Davis & McKenna, P.C. Kimber L. Latsha, Esq.
PHCA Webinar January 30, 2014 Latsha Davis & McKenna, P.C. Kimber L. Latsha, Esq. 1 2 Intended to: Encourage the development of ACOs in Medicare Promotes accountability for a patient population and coordinates
More 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 informationHealth Care Reform An Integrated Health Care Delivery System Perspective
Health Care Reform Insights Health Care Reform An Integrated Health Care Delivery System Perspective Andrew McCulloch A national imperative: True health care reform requires innovation and integration
More informationThe Future of Healthcare Delivery; Are we ready?
The Future of Healthcare Delivery; Are we ready? Lisa K. Saladin, PT, PhD, FAPTA Dean and Professor Medical University of South Carolina copyright LisaSaladin 2016 Objectives 1. Discuss 5 of the projected
More informationUsing An APCD to Inform Healthcare Policy, Strategy, and Consumer Choice. Maine s Experience
Using An APCD to Inform Healthcare Policy, Strategy, and Consumer Choice Maine s Experience What I ll Cover Today Maine s History of Using Health Care Data for Policy and System Change Health Data Agency
More informationMACRA & Implications for Telemedicine. June 20, 2016
MACRA & Implications for Telemedicine June 20, 2016 Presentation Overview Introductions Deep Dive Into MACRA Implications for Telemedicine Questions Growth in Value-Based Care Over Next Two Years Growth
More informationCovered California s Core Building Blocks for Improving Quality and Lowering Costs
Covered California s Core Building Blocks for Improving Quality and Lowering Costs Strengthen valuebased, patientcentered benefit design to improve access to primary care. Require providers to meet quality
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 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 informationAccountable Care A path toward accountability for health and health care
1 Accountable Care A path toward accountability for health and health care Managing Health System Capacity: Market and Policy Solutions December 1, 2008 Elliott Fisher, MD, MPH The Dartmouth Institute
More informationOregon 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 informationPBM SOLUTIONS FOR PATIENTS AND PAYERS
PBM SOLUTIONS FOR PATIENTS AND PAYERS Reducing Prescription Drug Costs Designing Solutions for Employers, Unions, and Government Programs Delivering High Patient Satisfaction and Improved Outcomes Improving
More informationA Brave New World: Lessons Learned From Healthcare Reform. Brandy Shumaker, MBA, LPTA, LNHA Regional Vice President HealthPRO/Heritage
A Brave New World: Lessons Learned From Healthcare Reform Brandy Shumaker, MBA, LPTA, LNHA Regional Vice President HealthPRO/Heritage 1 Learning Objectives Participants will understand: The impact health
More informationPost-Acute Care. December 6, 2017 Webinar Louise Bryde and Doug Johnson
Post-Acute Care December 6, 2017 Webinar Louise Bryde and Doug Johnson Topics for Discussion Background What Is Post Acute Care? Lexicon Levels of Care Why Focus on Post Acute Care? Emerging PAC Trends
More informationHolding the Line: How Massachusetts Physicians Are Containing Costs
Holding the Line: How Massachusetts Physicians Are Containing Costs 2017 Massachusetts Medical Society. All rights reserved. INTRODUCTION Massachusetts is a high-cost state for health care, and costs continue
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 informationPresentation to the CAH Administrator Meeting January 23 24, 2013 Helena, MT
Presentation to the CAH Administrator Meeting January 23 24, 2013 Helena, MT Keith J. Mueller, Ph.D. Director, RUPRI Center for Rural Health Policy Analysis Head, Department of Health Management and Policy
More informationPrimary goal of Administration Patients Over Paperwork
Meaningful Measures Presented by: Maria Durham, Director, Kevin Larsen, MD, Director Continuous Improvement and Strategic Planning, Centers for Medicare & Medicaid Services Discussion Topics Introduction
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 informationConnecticut SIM: Enabling Accountable Care and Accountable Communities
Connecticut SIM: Enabling Accountable Care and Accountable Communities SIM SYMPOSIUM FROM ACCOUNTABLE CARE TO ACCOUNTABLE COMMUNITIES: HOW CONNECTICUT S STATE INNOVATION MODEL INITIATIVE IS DRIVING REFORM
More informationIs HIT a Real Tool for The Success of a Value-Based Program?
Is HIT a Real Tool for The Success of a Value-Based Program? Sally Montes, MPH, RHIA, CCHP President, SM & Associates, Inc. smontes@sm-asociados.com (787) 306-1149 President, PR HFMA Chapter INTRODUCTION
More informationMedicaid Efficiency and Cost-Containment Strategies
Medicaid Efficiency and Cost-Containment Strategies Medicaid provides comprehensive health services to approximately 2 million Ohioans, including low-income children and their parents, as well as frail
More informationCritical Access Hospital Quality
Critical Access Hospital Quality Current Performance and the Development of Relevant Measures Ira Moscovice, PhD Mayo Professor & Head Division of Health Policy & Management School of Public Health, University
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 informationTrends in Health Information Exchange (HIE) and Links to Medicaid Led Quality Improvement
Trends in Health Information Exchange (HIE) and Links to Medicaid Led Quality Improvement July 25, 2007 Regional Quality Improvement Initiative Shannah Koss Avalere Health LLC Avalere Health LLC The intersection
More 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 Care Report. February How Value-based Care is improving quality and health.
Value-based Care Report February 2018 How Value-based Care is improving quality and health. 1 Value-based Care means better health, better care and lower costs. Placing greater emphasis on value in health
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 informationExecutive, Legislative & Regulatory 2018 AGENDA. unitypoint.org/govaffairs
Executive, Legislative & Regulatory 2018 AGENDA unitypoint.org/govaffairs Dear Policy Makers and Community Stakeholders, In the midst of tumultuous times, we bring you our 2018 State Legislative Agenda.
More informationMedPAC June 2013 Report to Congress: Medicare and the Health Care Delivery System
MedPAC June 2013 Report to Congress: Medicare and the Health Care Delivery System STEPHANIE KENNAN, SENIOR VICE PRESIDENT 202.857.2922 skennan@mwcllc.com 2001 K Street N.W. Suite 400 Washington, DC 20006-1040
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 informationValue-Based Contracting and Payer-Provider Collaboration
Value-Based Contracting and Payer-Provider Collaboration David Moroney, MD September 21, 2017 Agenda Introduction and Takeaways Current Value-Based Programs BlueCross BlueShield of Tennessee Mission and
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 informationStrategy for Quality Improvement in Health Care
Strategy for Quality Improvement in Health Care Neal D. Kohatsu, MD, MPH, DHCS Medical Director Desiree Backman, DrPH, RD, UC Davis Institute for Population Heath Improvement & DHCS Chief Prevention Officer
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 informationBackground and Context:
Session Objectives: Practice Transformation: Preparing for a Value Based Purchasing Environment Susan Brown, MPH, CPHIMS May 2, 2016 Understand the timeline and impact of MACRA/MIPS on health care payment
More informationWorkhorse or Unicorn: Incentive Realignment and Health Improvement After One Year of ACOs. Objectives
Session L23 These presenters have nothing to disclose Workhorse or Unicorn: Incentive Realignment and Health Improvement After One Year of ACOs By James E. Orlikoff and Len Nichols Sunday, December 9,
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 information