Health Care Evolution
|
|
- Darren Walsh
- 6 years ago
- Views:
Transcription
1 Health Care Evolution Patient-Centered Medical Home to Clinical Integration & Accountable Care Ken Bertka, MD
2 Agenda Top 3 Challenges of Health Care Reform PCMH & ACO Definitions Current State of Primary Care New Direction PCMH Evidence for the PCMH Path to Clinical Integration & Accountable Care 2
3 Payment Reform Population Management Patient Engagement Patient Engagement Enhanced Access Better communication Care coordination Self-management Team care Payment Reform Practice Efficiency Blended payments PMPM care coordination Pay-for-performance Transformation Population Management Data driven focus top chronic conditions at-risk populations preventive care Clinical Integration/ACO
4 PCMH & ACO Definitions 4
5 High-Level Definitions Patient-Centered Medical Home (PCMH) ~ Model of primary care high performing practice ~ Based on the Joint Principles of the PCMH ~ Key elements accessibility, comprehensiveness, coordination of care, continuity of care, team work, population management (practice level) Accountable Care Organization (ACO) subset of Clinical Integration ~ Local accountability for a defined population quality, access, cost, patient satisfaction ~ Aligned incentives across physicians, hospitals, other clinicians & providers of health care ~ Applies the Joint Principles of the PCMH across an entire system of care ~ Requires clinical integration (Advisory Board Definition) - Network of physicians working in collaboration - Physician-led initiatives to improve the quality & efficiency of care. Strong management and health information technology support. - Legal basis for collective negotiation by independent physicians on basis of improved clinical outcomes & efficiencies. 5
6 Current State of Primary Care 6
7 Primary Care is Stressed The demands on primary care are high Workforce shortage ~ 78 million baby boomers reach age 65 beginning in 2011 ~ Estimated shortage of 40,000-60,000 primary care physicians over the next 10 years Procedure-oriented payment system works against primary care Care coordination & population management are lacking Appointment wait times are too long Health care reform expanded coverage does not expand access and does not address work force 40% family physicians considered leaving their practices in 2010 (M3 USA poll of 3,729 FPs) 7
8 8 Source: The Advisory Board, 2010
9 9 Source: The Advisory Board, 2010
10 Cost Centers of Health Care Home health care, 3% Nursing care facilities, 5% Personal care, 5% Medical Public health, 3% goods, 3% Cost of insurance, 5% Hospital Care, 31% Investment, 6% Primary Care, 6% Specialists, 15% Dental & Other, 7% 10 Prescription Drugs, 10%
11 Medicare Hospital Readmissions 19.6% Hospital readmission rate within 30 days ~ 18.4% in CT Responsible for 17% of Medicare hospital payments Top re-admission diagnoses (initial admission dx) ~ Heart failure ~ Pneumonia ~ COPD ~ Psychoses ~ GI problems 2012 Hospital trust fund (Part A) revenues drop below expenditures 2024 Part A trust fund exhausted SGR 30% cut in 2012? Jencks, Williams, Coleman. N Engl J Med 2009; 360:
12 New Direction Patient-Centered Medical Home 12
13 Joint Principles of Patient- Centered Medical Home Personal physician Physician-directed medical practice Team approach Whole person orientation Coordination of care Quality & safety Enhanced access Payment for added value 13
14 Practice-based Care Team Great Outcomes Health Information Technology Practice Management Practice Organization Health IT Care Management Quality and Safety Quality Measures Patient Experience Access to Care and Information Continuity of Care Services Practice Services Patient-Centered Medical Home = High Performing Primary Care Practice 14
15 Payment Reform Advocacy Blended Payment Model Pay for Performance- Clinical and Patient Experience Pay for Performance- Clinical and Patient Experience Fee for Service for Visits/Procedures Fee for Service for Visits/Procedures Care Coordination Payment (monthly payment based upon the level of PCMH) Care Coordination Payment (monthly payment based upon the level of PCMH) 15
16 Today Tomorrow Traditional Practice My patients are those who make appointments with me Patients chief complaint determines care Care is determined by today s problem and time available today PCMH Our patients are those who are registered in our medical home We systematically assess all our patients health needs to plan care Care is determined by a proactive plan to meet patients needs without visits Care varies by scheduled time and memory or skill Care is standardized according to evidence-based of the doctor guidelines Patients are responsible for coordinating their own care I know I deliver high-quality care because I m well trained Acute care is delivered during the next available appointment and to walk-ins It s up to the patient to tell us what happened to them Clinic operations center on meeting the doctor s needs A team of professionals coordinates all patients care We measure our quality and make rapid changes to improve it Acute care is delivered by open-access and nonvisit contacts We track tests and consultations, and follow-up after ED and hospital visits A multidisciplinary team works at the top of our licenses/training to serve patients 16
17 Evidence for the PCMH Just Keeps Growing 17
18 PCMH Pilot Outcomes Pilot Incentives Hospitalization Reduction ED Visit Reduction Total Savings (per patient) Colorado Medical Home for Children Community Care of North Carolina P4P 18% $215-$1,129 PMPM payment 40% 16% $516 Geisinger (Proven Health Navigator) P4P PMPM payment Shared savings 18% $500 Group Health Cooperative PMPM payment 16% 29% $10 PMPM Intermountain Health Care (Care Management Plus) P4P % 0.7-3% $640-$1,650 MeritCare Health System & BCBS of ND PMPM payment Shared savings 6% 24% $530 Driving Quality Gains and Cost Savings Through Adoption of Medical Homes, Health Affairs $119K savings/pcp
19 Patient-Centered Care = Decreased Health Care Utilization 509 adult patients, 1 year study Davis Observation Codes measure patient-centeredness Controlled for sex, age, education, income, self-reported health status, obesity, alcohol abuse, & smoking Patient-centeredness above median associated with: ~ Decreased visits for specialty care ~ Decreased hospitalizations ~ Decreased laboratory & diagnostic tests ~ Decreased total charges 34% ($1,435 vs. $948) Bertakis et al., JABFM, May-June,
20 TransforMed Small Practice Results 2-year outcomes data 36 unrelated, independent practices Improved Finances ~ Practice revenue 11% increase ~ Physician salaries 14% increase ~ These results are without payment reform Improved Satisfaction ~ Physician satisfaction 58% increase ~ Staff satisfaction 66% increase Quality ~ One year data indicates that independent practices can improve quality while lowering costs consistent with results from large, integrated systems 20
21 PCMH Pilot Outcomes Physicians & Staff Happier staff Happier physicians Increased revenue Increased take-home pay in today s payment environment Team-based care Relatively rapid returns from transformation Increased standardization of care Patients Improved satisfaction Improved preventive care Improved quality measures Reduced ED utilization Reduced readmissions Reduced hospitalizations Longer team-based appointments Enhanced patient communication Reduced per capita cost for certain chronic conditions 21
22 Comprehensive Primary Care Initiative (October, 2011) 5-7 Regional markets ~ 75 primary care practices in each market ~ 200 Medicare patients/practice ~ EHR or registry; preference given to EHR MU Stage 1 Public- & private-payer partnership ~ 60% practices revenue generated from participating payers ~ letter of intent from payers by November 15 Medicare/Medicaid payment reform for primary care ~ Traditional fee-for-service payments ~ Risk adjusted care coordination PMPM fee average $20 (range $8-$40) reduces to average $15 in years 3 & 4 ~ Shared savings increased reliance in years 3 & 4 Operational Summer 2012 CMS has authority to expand to across the country if the initiative is shown to improve quality & lower costs 22
23 Path to Clinical Integration & Accountabilty 23
24 PCMH. Then what? What is missing? 24
25 Triple Aim Improved care for individuals patient experience Improved health for populations Reduced cost 25
26 PPACA Implications for Physicians Improved access ~ Include teams of non-physicians ~ Engage & monitor patients at home Incentives to change clinical practice ~ Exceptional patient experience ~ Shared clinical goals ~ Shared decision making ~ Proactively manage preventive care ~ Expand use of EHRs ~ Collaboration with hospitals dramatically reduce readmissions ~ Patient-centered outcomes research to tailor care Removing barriers ~ Administrative simplification 26 Annals of Internal Medicine, August 23, 2010 Robert Kocher, MD; Ezekiel Emanuel, MD; Nancy-Ann DeParle, JD
27 Evolution of Care All Physicians Team-based care Focus on the top of license, training & interest Improved communication patient engagement Clinical integration Patient engagement including those who need encouragement/incentive to engage Patient-centered aligned incentives outcomes, quality, cost Population management 27 External accountability outcomes, quality, cost Payment reform
28 Clinical Integration Accountable Care What is still missing?
29 Payment Reform will Drive Clinical Integration Today Today Pilots Today 2012 Pilots 2012 Pilots Source: The Advisory Board, Clinical Integration
30 New Bundled Payment Initiative August 23, 2011 Model 1 Model 2 Model 3 Model 4 Services Covered in Bundle Payment Hospital & physician services during hospitalization only Hospital, physician, & other providers during hospitalization & in post-acute discharge phase (includes lab & DME) Hospital, physician, & other providers during post-acute discharge phase only (includes lab & DME) Prospective bundled payment to hospital for hospital, physician, & other clinician services during hospitalization CMS Center for Innovation authorized by the Affordable Care Act Goal Better health, better care, lower cost Begins in 2012 Definition of episode of care to be defined 30
31 Medicare Shared Savings ACO 31
32 Clinical Integration Clinical Integration is NOT Physician employment A return to capitation of the 80s Electronic health records IPA/PHO messenger contract model Gimmick to bypass anti-trust law Program led by the hospital Clinical Integration is A network of physicians working in collaboration usually with a hospital A program of physician-led initiatives to improve the quality and efficiency of patient care. ~ Strong management and health information technology support. Legal basis for collective negotiation by independent physicians on the basis of improved clinical outcomes and efficiencies. Advisory Board,
33 Essential Elements for CI/ACO Physician commitment & leadership ~ Governance ~ PCMH ~ senior-level, full-time medical director ~ Culture of teamwork & shared commitment Financial resources ~ CMS estimate - $1.8 million to start ~ AHA-sponsored study - $ $26.1 million to start Clinical guidelines & standardized care across the continuum of care Data collection & analysis performance measurement Population management ~ Early identification of high-risk individuals Patient engagement ~ Proactive interactions Payment reform ~ Aligned financial incentives
34 Capitation vs. ACO Economics Management Environment Capitation Era Discounts Withholds Lower utilization Prevention Patients enroll into a gatekeeper model Booming economy Limited informatics ACO - Clinical Integration Contracts at current price Incentives Appropriate utilization Chronic disease management Attribution Relationships then care coordination Recession Robust informatics 34
35 Revised - Medicare Shared Savings ACO - 1 Term Organization Physiciandirected Proposed 3 years, participation voluntary, April 1 & July 1, 2012 start dates Separate legal entity, 75% of Board must be providers, 1 board member must represent Medicare beneficiaries Full-time medical director, physician-directed QA & PI committee Antitrust Safety zone below 30% market share, mandatory review above 50% Increased flexibility for rural hospitals & physicians Fraud & Abuse Size Patient Assignment 65 Quality measures minimal attainment levels after year #1 Waiver for shared savings distributions Minimum 5,000 lives, primary care coverage Assigned retrospectively at the end of each year based upon plurality of primary care services; patients have freedom of choice to have services performed anywhere Preliminary/prospective assignment with quarterly updates Patient/Caregiver experience 7 7 (CAHPS Survey) Care coordination 16 6 Patient safety 2 Preventive measures 9 8 At-risk/Frail elderly Reduced to 33 quality measures EHR Meaningful Use requirement waived
36 Revised - Medicare Shared Savings ACO - 2 One-sided model (first 2 years then twosided) Two-sided model (all 3 years) Processes & strategy plans Benchmark calculation Marketing Proposed Savings threshold 3.9% (5,000 pts) 2% (50,000 pts) first dollar share in savings above threshold Share 50% of savings above threshold up to 7.5% maximum savings threshold Downside risk after year 2 removed 25% withhold on shared savings removed Savings threshold 2% - share in savings from first dollar once threshold is reached Share 60% of savings up to a 10% maximum savings threshold If loss above 2% threshold pay 40% (1 minus share rate) back to CMS up to a cap (5%, 7.5%, 10% - years 1, 2, 3) 25% withhold on shared savings removed Promote evidence-based medicine Patient engagement Report internally on quality & cost metrics Coordinate care 3-year lookback then updated annually Includes Indirect Graduate Medical Education (IME) - Removed Includes Disproportionate Share Hospital (DSH) payments - Removed Prior approval by CMS of all patient marketing materials Revised to file and use procedure as currently allowed for Medicare Advantage Plans
37 Current Delivery Systems with ACO Potential
38 High-Level Definitions Patient-Centered Medical Home (PCMH) ~ Model of primary care high performing practice ~ Based on the Joint Principles of the PCMH ~ Key elements accessibility, comprehensiveness, coordination of care, continuity of care, team work, population management (practice level) Accountable Care Organization (ACO) subset of Clinical Integration ~ Local accountability for a defined population quality, access, cost, patient satisfaction ~ Aligned incentives across physicians, hospitals, other clinicians & providers of health care ~ Applies the Joint Principles of the PCMH across an entire system of care ~ Requires clinical integration (Advisory Board Definition) - Network of physicians working in collaboration - Physician-led initiatives to improve the quality & efficiency of care. Strong management and health information technology support. - Legal basis for collective negotiation by independent physicians on basis of improved clinical outcomes & efficiencies. 38
39 The best way to predict the future is to create it Peter Drucker 39
40 Thank you!! Ken Bertka, MD, FAAFP Cell:
Long 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 information4/9/2016. The changing health care market THE CHANGING HEALTH CARE MARKET. CPAs & ADVISORS
CPAs & ADVISORS experience support // ADVANCED PAYMENT MODELS: CJR Eric. M. Rogers MEd. RT(R) Managing Consultant The changing health care market THE CHANGING HEALTH CARE MARKET HHS goal of 30% of traditional
More informationSucceeding in a New Era of Health Care Delivery
March 14, 2012 Succeeding in a New Era of Health Care Delivery Building Value-Based Partnerships LeadingAge Pennsylvania Kathleen Griffin, PhD, National Director Post-Acute and Senior Services 1 Your Presenter
More 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 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 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 informationHealthcare 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 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 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 informationACO REVIVAL. Medicare Shared Savings Program Final Regulation Overview. Blue & Co., LLC Healthcare Reform Symposium Thursday, November 3, 2011
ACO REVIVAL Medicare Shared Savings Program Final Regulation Overview Blue & Co., LLC Healthcare Reform Symposium Thursday, November 3, 2011 11/03/2011 1 Introductions John Redding, MD, MBA Manager Healthcare
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 informationMEDICARE COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL (CCJR) Preparing for Risk-Based Outcomes of Bundled Care 8/12/2015.
MEDICARE COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL (CCJR) Preparing for Risk-Based Outcomes of Bundled Care August 13, 2015 Eric M. Rogers MEd RT(R) Managing Consultant erogers@bkd.com Jeff Bond President
More informationEpisode Payment Models Final Rule & Analysis
Episode Payment Models Final Rule & Analysis February 15, 2017 Agenda Overview Changes from Proposed Rule Categorization of Episodes Episode Attribution Reconciliation Quality Performance Cardiac Rehab
More informationA Practical Approach Toward Accountable Care and Risk-Based Contracting: Design to Implementation
A Practical Approach Toward Accountable Care and Risk-Based Contracting: Design to Implementation Daniel J. Marino, President/CEO, Health Directions Asad Zaman, MD June 19, 2013 Session Objectives Establish
More informationHOSPITALS & HEALTH SYSTEMS: DATA-DRIVEN STRATEGY FOR BUNDLED PAYMENT SUCCESS 4/19/2016. April 20, 2016
HOSPITALS & HEALTH SYSTEMS: DATA-DRIVEN STRATEGY FOR BUNDLED PAYMENT SUCCESS April 20, 2016 Eddie Marmouget National Industry Partner emarmouget@bkd.com Eric Rogers Managing Consultant erogers@bkd.com
More 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 informationCPAs & ADVISORS. experience support // ADVANCED PAYMENT MODELS: CJR
CPAs & ADVISORS experience support // ADVANCED PAYMENT MODELS: CJR Andy M. Williams Partner BKD Eric M. Rogers Managing Consultant BKD Will McLeod VP of Patient Services McLeod Health Emily Adams Associate
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 informationESSENTIAL STRATEGIES IN MEDI-CAL PAYMENT REFORM. Richard Popper, Director, Medicaid & Duals Strategy August 3, 2017
ESSENTIAL STRATEGIES IN MEDI-CAL PAYMENT REFORM Richard Popper, Director, Medicaid & Duals Strategy August 3, 2017 1 DISCLAIMER The enclosed materials are highly sensitive, proprietary and confidential.
More 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 informationREPORT OF THE BOARD OF TRUSTEES
REPORT OF THE BOARD OF TRUSTEES B of T Report 21-A-17 Subject: Presented by: Risk Adjustment Refinement in Accountable Care Organization (ACO) Settings and Medicare Shared Savings Programs (MSSP) Patrice
More informationInformatics, PCMHs and ACOs: A Brave New World
Informatics, PCMHs and ACOs: A Brave New World R. Clark Campbell, MSN, RN-BC, CPHIMS, FHIMSS Kathleen Kimmel, RN, BSN, MHA, CPHIMS, FHIMSS Engagement Executive with Health Catalyst Objectives - Define
More 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 informationMACRA Fall into Place. By Stephanie Cecchini, CPC, CEMC, CHISP, AAPC Fellow, AAPC MACRA Prof
MACRA Fall into Place By Stephanie Cecchini, CPC, CEMC, CHISP, AAPC Fellow, AAPC MACRA Prof About the Presenter https://www.linkedin.com/in/stephaniececchini 2 Introduction Love it Hate it Don t know a
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 informationThe Patient Centered Medical Home Will It Make A Difference?
The Patient Centered Medical Home Will It Make A Difference? 2009 Population Health Colloquium Department of Health Policy Thomas Jefferson University March 2009 Michael S. Barr, MD, MBA, FACP Vice President,
More informationUsing Data for Proactive Patient Population Management
Using Data for Proactive Patient Population Management Kate Lichtenberg, DO, MPH, FAAFP October 16, 2013 Topics Review population based care Understand the use of registries Harnessing the power of EHRs
More informationRedesigning Post-Acute Care: Value Based Payment Models
Redesigning Post-Acute Care: Value Based Payment Models Liz Almeida-Sanborn, MS, PT President Preferred Therapy Solutions This session will address: Discussion of the emergence of voluntary and mandatory
More informationMIPS, MACRA, & CJR: Medicare Payment Transformation. Presenter: Thomas Barber, M.D. May 31, 2016
MIPS, MACRA, & CJR: Medicare Payment Transformation Presenter: Thomas Barber, M.D. May 31, 2016 Michael Porter- Value Based Care Delivery, Annals of Surgery 2008 Principals: Define Value as a Goal Care
More informationPhysician Engagement
Pathways for Successful Accountable Care Organizations: Physician Engagement Thomas Kloos, MD Jim Barr, MD Atlantic ACO & Optimus Healthcare Partners ACO Helping providers Care Better for their patients.
More informationHealthcare Reimbursement Change VBP -The Future is Now
Healthcare Reimbursement Change VBP -The Future is Now 1 On the Move Volume/ Fee-for-Service Fee-for-service reimbursement High quality not rewarded No shared financial risk Stand-alone systems can thrive
More 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 informationAccountable Care Organizations: An AHA Research Synthesis Report
Accountable Care Organizations: An AHA Research Synthesis Report June 2010 TRANSFORMING HEALTH CARE THROUGH RESEARCH AND EDUCATION Accountable Care Organizations: An AHA Research Synthesis Report Accountable
More informationPOPULATION HEALTH PLAYBOOK. Mark Wendling, MD Executive Director LVPHO/Valley Preferred 1
POPULATION HEALTH PLAYBOOK Mark Wendling, MD Executive Director LVPHO/Valley Preferred www.populytics.com 1 Today s Agenda Outline LVHN, LVPHO and Populytics Overview Population Health Approach Population
More 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 informationAccountable Care Organizations Under Medicare Shared Savings Program PROPOSED RULE
Accountable Care Organizations Under Medicare Shared Savings Program PROPOSED RULE The information in this document summarizes a proposed rule issued by the Centers for Medicare and Medicaid id Services.
More informationPatient-Centered Medical Home 101: General Overview
Patient-Centered Medical Home 101: General Overview Publicly Available Slide Deck Last Updated: January 2015 Suggested Citation: PCPCC Map Tools. (2015). Patient-Centered Medical Home 101: General Overview.
More informationFebruary 9, 2012 Orlando, Florida
American Health Lawyers Association Physician and Physician Organizations Law Institute Regulatory & Payment Issues and the Patient Centered Medical Home February 9, 2012 Orlando, Florida John E. Wyand,
More informationStrategic Implications & Conclusion
Kelly Court Chief Quality Officer Wisconsin Hospital Association Brian Vamstad Government Relations Consultant Gundersen Health System Overview and Key Takeaways of the Medicare Quality Payment Program
More informationHEALTHCARE 20/20: LEARNING FORWARD
HEALTHCARE 20/20: LEARNING FORWARD Quality Improvement Workshop - Pfizer Webinar #1 April 15, 2013 Bernard M. Rosof, MD CEO Louis H. Diamond, MD President QHC is dedicated to improving the quality and
More informationTransitioning 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 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 informationSucceeding in Value-Based Care CareConnect Journey
Succeeding in Value-Based Care CareConnect Journey Donna Mueller VP Network Development dmueller@infinityrehab.com 360-201-2703 Jake Arrastia VP Strategy Development & Innovation jrarrastia@infinityrehab.com
More informationAccountable Care Organizations American Osteopathic Association Health Policy Day September 23, 2011
Accountable Care Organizations American Osteopathic Association Health Policy Day September 23, 2011 Cary Sennett MD PhD Cary Sennett, MD, PhD Managing Director, Engelberg Center for Health Care Reform
More informationReforming Health Care with Savings to Pay for Better Health
Reforming Health Care with Savings to Pay for Better Health Mark McClellan, MD PhD Director, Initiative on Health Care Value and Innovation Senior Fellow, Economic Studies October 2014 National Forum on
More informationThe Patient-Centered Medical Home Model of Care
The Patient-Centered Medical Home Model of Care May 11, 2017 Louise Bryde Principal Presentation Outline Imperatives for Change Overview: What Is a Patient-Centered Medical Home? The Medical Neighborhood
More informationIntegrating Population Health into Delivery System Reform
Integrating Population Health into Delivery System Reform Population Health Roundtable IOM Jim Hester Washington DC June 13, 2013 Theme The health care system is transitioning from payment rewarding volume
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 informationImplementing Medicaid Value-Based Purchasing Initiatives with Federally Qualified Health Centers
Implementing Medicaid Value-Based Purchasing Initiatives with Federally Qualified Health Centers Beth Waldman, JD, MPH June 14, 2016 Presentation Overview 1. Brief overview of payment reform strategies
More informationMedicare / Accountable Care Organization CHS Finance Division CPE Day November 2, 2015
Medicare / Accountable Care Organization CHS Finance Division CPE Day November 2, 2015 Steve Neorr Chief Administrative Officer, Triad HealthCare Network Jeff Jones Chief Financial Officer, Cone Health
More informationSucceeding with Accountable Care Organizations
Succeeding with Accountable Care Organizations The Point B Webinar Series October 25, 2011 Today s Discussion Key ACO trends and emerging models Critical success factors for building an ACO Developing
More informationRequest for Information Regarding Accountable Care Organizations (ACOs) and Medicare Shared Savings Programs (CMS-1345-NC)
Via Electronic Submission Donald Berwick, MD, MPP Administrator Centers for Medicare & Medicaid Services ATTN: CMS-1345-NC 7500 Security Blvd. Baltimore, MD 21244-8013 Re: Request for Information Regarding
More informationQuestions and Answers on the CMS Comprehensive Care for Joint Replacement Model
Questions and Answers on the CMS Comprehensive Care for Joint Replacement Model MEGGAN BUSHEE, ESQ. 704.343.2360 mbushee@mcguirewoods.com 201 North Tryon Street, Suite 3000 Charlotte, North Carolina 28202-2146
More informationAccountable Care and Governance Challenges Under the Affordable Care Act
Accountable Care and Governance Challenges Under the Affordable Care Act The First National Congress on Healthcare Clinical Innovations, Quality Improvement and Cost Containment October 26, 2011 Doug Hastings
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 informationPatient Centered Medical Home: Transforming Primary Care in Massachusetts
Patient Centered Medical Home: Transforming Primary Care in Massachusetts Judith Steinberg, MD, MPH Deputy Chief Medical Officer Commonwealth Medicine UMass Medical School Agenda Overview of Patient Centered
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 informationNCQA s Patient-Centered Medical Home Recognition and Beyond. Tricia Marine Barrett, VP Product Development
NCQA s Patient-Centered Medical Home Recognition and Beyond Tricia Marine Barrett, VP Product Development National Committee for Quality Assurance (NCQA) Private, independent non-profit health care quality
More informationThe New World of Value Driven Cardiac Care
1 The New World of Value Driven Cardiac Care Disclosures MPA Healthcare Solutions is an analytic health care consultancy that provides clients with insight into clinical performance; aids them in the evaluation,
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 informationNext Generation Physician Compensation Design in a Schizophrenic Payer Environment
Next Generation Physician Compensation Design in a Schizophrenic Payer Environment Presented to: 2015 Spring Managed Care Forum Friday, April 24, 2015 Today s agenda Setting the Stage Why are we Here?
More 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 informationModels of Accountable Care
Models of Accountable Care Medical Home, Episodes and ACOs Making it work Elliott Fisher, MD, MPH Director, Population Health and Policy The Dartmouth Institute for Health Policy and Clinical Practice
More informationThe Future of Delivery System Reform in Medi-Cal: Moving Medi-Cal Forward
The Future of Delivery System Reform in Medi-Cal: Moving Medi-Cal Forward Cindy Mann Partner Manatt Health July 13, 2016 Agenda 2 Project Overview Medi-Cal Today Vision for the Future of Medi-Cal Near
More informationLaying the Foundation for Successful Clinical Integration
The Governance Institute Laying the Foundation for Successful Clinical Integration Webinar November 29, 2011, 2:00pm ET/11:00am PT Daniel M. Grauman President & CEO DGA Partners, Bala Cynwyd, PA dgrauman@dgapartners.com
More informationUsing Quality Data to Market to Referral Sources BUSINESS OF HEALTHCARE
Using Quality Data to Market to Referral Sources Cindy Mason Change as a Matter of Survival BUSINESS OF HEALTHCARE 2 National Transformation of Healthcare the Affordable Care Act provides CMS the flexibility
More informationRe: Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations, Proposed rule.
June 3, 2011 Donald Berwick, MD Administrator Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1345-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore,
More 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 informationAHLA. David A. DeSimone Vice President and General Counsel AtlantiCare Egg Harbor Township, NJ
AHLA HH. Achieving Patient Centered Medical Home (PCMH) and Meaningful Use (MU) Status How to Transform the Physician Practice in Light of Health Reform David A. DeSimone Vice President and General Counsel
More informationDelivery System Reform The ACA and Beyond: Challenges Strategies Successes Failures Future
Delivery System Reform The ACA and Beyond: Challenges Strategies Successes Failures Future Arnold Epstein MSU 2018 Health Care Policy Conference April 6, 2018 The Good Ole Days 2 Per Capita National Healthcare
More informationPractice Transformation Networks
Practice Transformation Networks The project described was supported by Funding Opportunity Number CMS-1L1-15-003 from the U. S. Department of Health & Human Services, Centers for Medicare and Medicaid
More informationRisk Adjusted Diagnosis Coding:
Risk Adjusted Diagnosis Coding: Reporting ChronicDisease for Population Health Management Jeri Leong, R.N., CPC, CPC-H, CPMA, CPC-I Executive Director 1 Learning Objectives Explain the concept Medicare
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 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 informationMACRA, MIPS, and APMs What to Expect from all these Acronyms?!
MACRA, MIPS, and APMs What to Expect from all these Acronyms?! ACP Pennsylvania Council Meeting Saturday, December 5, 2015 Shari M. Erickson, MPH Vice President, Governmental Affairs & Medical Practice
More informationValue-Based Care Contracting and Legal Issues
Session 4b Value-Based Care Contracting and Legal Issues Presented by: Janet Walker Farrer General Counsel and Insurance Legal Department Chair Ascension Health Leah Stewart Associate Vice President for
More informationCMS Quality Payment Program: Performance and Reporting Requirements
CMS Quality Payment Program: Performance and Reporting Requirements Session #QU1, February 19, 2017 Kristine Martin Anderson, Executive Vice President, Booz Allen Hamilton Colleen Bruce, Lead Associate,
More informationBundled Payments. AMGA September 25, 2013 AGENDA. Who Are We. Our Business Challenge. Episode Process. Experience
Bundled Payments AMGA September 25, 2013 Who Are We AGENDA Our Business Challenge Episode Process Experience 1 Cleveland Clinic is transforming Fee for service Fee for value 3 Fast Facts 41,200 employees
More informationPALLIATIVE CARE: CHARTING A COURSE MEETING OF THE PATIENT QUALITY OF LIFE COALITION FEBRUARY 18, 2015
PALLIATIVE CARE: CHARTING A COURSE MEETING OF THE PATIENT QUALITY OF LIFE COALITION FEBRUARY 18, 2015 HENRY R. DESMARAIS, MD, MPA HEALTH POLICY ALTERNATIVES, INC. A POSSIBLE OPTION MENU QUALITY Ø Add palliative
More informationQuality Circles. Nursing as a Revenue Center NDNQI
IS YOUR ORGANIZATION ACCOUNTABLE? 2011 NDNQI Conference Miami, FL Victoria L. Rich, PhD, RN, FAAN Chief Nurse Executive, University of Pennsylvania Medical Center Associate Executive Director, Hospital
More informationCMS Quality Program Overview
CMS Quality Program Overview AMGA/Press Ganey Survey Collaboration September 13, 2012 Presenter Information Incorporated in 1985, Press Ganey was one of the first companies to provide patient satisfaction
More informationDisclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws.
Disclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws. This should not be used as legal advice. Itentive recognizes that
More informationProduct and Network Innovation: Strategies to Achieve Triple Aim Success. Patrick Courneya, MD Medical Director, HealthPartners October 31, 2013
Product and Network Innovation: Strategies to Achieve Triple Aim Success Patrick Courneya, MD Medical Director, HealthPartners October 31, 2013 Agenda About Minnesota s Market Measurement building blocks
More 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 informationThe Center for Medicare & Medicaid Innovations: Programs & Initiatives
The Center for Medicare & Medicaid Innovations: Programs & Initiatives Rob Stone, Esq. American Health Lawyers Association Institute on Medicare & Medicaid Payment Issues March 30-April 1, 2012 CMMI Mission
More informationAccountable Care Organizations
Accountable Care Organizations Randy Wexler, MD, MPH, FAAFP Associate Professor Vice Chair, Clinical Services Department of Family Medicine The Ohio State University Wexner Medical Center Objectives To
More informationQuality, Cost and Business Intelligence in Healthcare
Quality, Cost and Business Intelligence in Healthcare Maitri Vaidya Population Health Executive DBA, MHA, CPHQ May 2016 Where are we going? IHI Triple Aim Improve the patient experience of care Lower
More informationThe Pain or the Gain?
The Pain or the Gain? Comprehensive Care Joint Replacement (CJR) Model DRG 469 (Major joint replacement with major complications) DRG 470 (Major joint without major complications or comorbidities) Actual
More informationPayer s Perspective on Clinical Pathways and Value-based Care
Payer s Perspective on Clinical Pathways and Value-based Care Faculty Stephen Perkins, MD Chief Medical Officer Commercial & Medicare Services UPMC Health Plan Pittsburgh, Pennsylvania perkinss@upmc.edu
More informationPayment Reform Strategies. Ann Thomas Burnett BlueCross BlueShield of South Carolina
Payment Reform Strategies Ann Thomas Burnett BlueCross BlueShield of South Carolina Disclosure I have no relevant financial relationships with commercial interests to disclose. The Current Market Landscape
More informationAccountable Care and the Laboratory Value Proposition. Les Duncan Director of Operations Highmark Health - Home and Community Services
Accountable Care and the Laboratory Value Proposition Les Duncan Director of Operations Highmark Health - Home and Community Services Agenda The Goals and Status of Delivery System Reform and Alternative
More informationTransforming Clinical Practice Initiative (TCPI) A Service Delivery Innovation Model. Better Health. Better Care. Lower Cost.
Transforming Clinical Practice Initiative (TCPI) A Service Delivery Innovation Model Better Health. Better Care. Lower Cost. 1 Context for Transforming Clinical Practice With the passage of the Affordable
More informationPopulation Health or Single-payer The future is in our hands. Robert J. Margolis, MD
Population Health or Single-payer The future is in our hands Robert J. Margolis, MD Today s problems Interim steps Population health Alternatives Conclusions Outline $3,000,000,000,000 $1,000,000,000,000
More informationMedicare & Medicaid EHR Incentive Program. Betsy L. Thompson, MD, DrPH EHR Summit October 4, 2010
Medicare & Medicaid EHR Incentive Program Betsy L. Thompson, MD, DrPH EHR Summit October 4, 2010 1 Overview Background and Policy Context EHR Incentive Program Basics Who is Eligible to Participate How
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 informationGetting Ready for the Maryland Primary Care Program
Getting Ready for the Maryland Primary Care Program Presentation to Maryland Academy of Nutrition and Dietetics March 19, 2018 Maryland Department of Health All-Payer Model: Performance to Date Performance
More informationPhysician Practice Connections Patient-Centered Medical Home (PPC-PCMH ) Johann Chanin
Physician Practice Connections Patient-Centered Medical Home (PPC-PCMH ) Johann Chanin Colorado Patient-Centered Medical Home Demonstration Project Meeting January 15, 008 Today NCQA quality measurement
More informationThought 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 informationHere is what we know. Here is what you can do. Here is what we are doing.
With the repeal of the sustainable growth rate (SGR) behind us, we are moving into a new era of Medicare physician payment under the Medicare Access and CHIP Reauthorization Act (MACRA). Introducing the
More informationMichigan 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