Examining the Differences Between Commercial and Medicare ACO Models
|
|
- Charles Mills
- 6 years ago
- Views:
Transcription
1 Examining the Differences Between Commercial and Medicare ACO Models Michelle Copenhaver December 10, 2015
2 Agenda 1 Understanding Accountable Care Organizations 2 Moving to Accountable Care: Enhancing the patient experience, lowering costs, and improving quality What you need to know and things to consider 3 Learnings from CMS Program Experience 2
3 Understanding Accountable Care Organizations (ACOs) A number of different value-based models exist, and share the same fundamental purpose and goals. An ACO is a group of health care providers who agree to share responsibility for the quality, cost, and coordination of care for a defined population of patients 1. Pioneer ACO Model and the Medicare Shared Savings Program (MSSP) Commercial Payer Value-Based Contract Medicare Advantage (MA) Value-Based Contract Common Goals: Focused on achieving the Triple Aim Designed to empower the primary care physician (PCP) and patient Dependent on increased transparency and data sharing, improved communication, and enhanced engagement with all involved parties Rewarded for quality and cost improvements 1 3
4 Moving to Accountable Care
5 Providing the Appropriate Level of Interaction Understanding each patient s health status and how to engage with them effectively. Intensity of Service Integrated Care Management Intensive Care Sick + Telemedicine + Home visits + Intensive Care Management Chronic Disease Management + Telephonic Care Management Wellness and Prevention + Automated Care Management Healthy 5
6 Improving the Patient Experience with Collaboration An ACO infrastructure requires shifting away from the traditional fee-for-service mentality. ACO Initiative Care and Disease Management Outreach Follow-up Care Duplication Care Coordination Member Out-of- Pocket Costs Access Data Analytics/ Reporting EHR/ HIE Benefits with Accountable Care.. Core capabilities enhanced via point-of-care data, doctor-patient relationship, and outreach Proactive outreach by providers and informed by data Consistent follow-up with patients and providers Reduced through interconnectivity across ACO Highly coordinated between physicians, plus gains from data sharing Reduced, due to improvements in efficiency and quality Enhanced access to care with an extended care team, after-hours care, patient portals, and other initiatives Creating actionable information through risk-stratification, predictive modeling, workflow analysis, and financial analysis Improved information exchange 6
7 Lowering Employer Costs while Improving Quality ACOs are designed to better manage populations, in turn improving the health of employees. ACO Initiative High-Quality Select Network Primary Care Care Coordination (CC) Clinical Integration Analytics Cost Reduction Employee Satisfaction Wellness What It Offers Complete physician Hospital Post-acute care network Excellent geographic and specialty capacity Increased preventive care and superior disease management Fully developed CC/ disease management structure coordinated between PCP and specialists Integrated team Committed delivery network Common protocols Pathways Communication EHR Interoperability Analytic tools Proven predictive models Risk stratification Intense focus on top 5% who drive 50% of the cost ACO at risk for performance or no reward Patient feedback surveys Biometric screening and other wellness resources with PCP encounters 7
8 Aligning Incentives with Quality and Efficiency Metrics Accountable care provides incentives to doctors to improve quality and meet efficiency metrics. Accountable Care Metrics Preventive Care Managing Chronic Conditions Efficiency Cancer Screenings: Colorectal, Cervical, Breast Diabetes LDL-C screening, HbHA1c, neuropathy prevention/care Asthma medication adherence for children and adults Heart disease LDL-C screening and beta blockers after MI Hospital Admissions and Readmissions Emergency Room Usage Generic Prescribing Rates 8
9 Engaging Patients is Critical to Success Patient engagement is critical for any provider organization, and it is especially vital for those making the move to a value-based model. Doctor s Office Care Tools Hospital An (AARP) study showed patients who were active in their care were less likely to be readmitted to the hospital (12% vs. 28%) or experience a medical error (20% vs. 35%). 1 Patient Patient-Centered care is a team effort. To succeed, we must take responsibility for care delivered to the patient between office and hospital visits. 1 Kropp, MD, MBA, CHIT, B., & Lenhart, J. (2015). 8 Steps to Patient-centered Care. Group Practice Journal. 9
10 Moving Toward Patient-Centered Care 8 Steps Before providers can achieve the Triple Aim, they must first develop a clear strategy for activating patients and engaging them in their care. 1. Start with provider teams 2. Offer variety and convenience 3. Meet patients where they are 4. Be a coach 5. Make it simple 6. Expand your team 7. Extend your reach Patient-Centered Care 8. Define and measure success 1 Kropp, MD, MBA, CHIT, B., & Lenhart, J. (2015). 8 Steps to Patient-centered Care. Group Practice Journal. 10
11 Comparing ACO Programs and Contracts Although the overall ACO objectives remain the same, details and requirements can vary widely between managed populations. Overview Population Under Management Pioneer ACO Model/MSSP Commercial Medicare Advantage Incentive programs run by the Centers for Medicare & Medicaid Services (CMS) Medicare fee-for-service patients (must have at least 5,000 attributed patients) Value-based care model collaborations with third-party payers Commercial members, including those who self-select an ACO benefit plan Value-based care model collaborations with third-party payers MA members Getting Started Formal application and approval Contract negotiations Contract negotiations Contract Length Minimum of 3 years Varies by payer Varies by payer Data-Sharing Reporting Marketing/Growth Payment Structure Raw claims data provided if patient has not declined to share information 33 quality measures: Data collection and GPRO reporting, claims-based reporting, CAHPS for ACOs survey Patient marketing and communications highly regulated Gain-sharing and risk-sharing options: must meet minimum savings rate and quality requirements in order to receive shared savings Actionable data provided in the form of organized reports: reports vary by payer Claims-based reporting: quality measures vary by payer and contract type Marketing to change patient behavior encouraged Bonus payments, gain-sharing and risk-sharing options: payment structure varies by payer and contract type Actionable data provided in the form of organized reports: reports vary by payer Claims-based reporting: quality measures vary by payer and contract type Patient marketing and communications highly regulated Bonus payments, gain-sharing and risk-sharing options: payment structure varies by payer and contract type 11
12 Managing Multiple Populations Considerations Providing enhanced care for patients while meeting requirements for all ACO contracts is key. CMS programs have less flexibility than commercial contracts. As value increases, so does the potential risk. Data is only good when you can use it. Populations differ in age, complexity, aversion to technology and engagement levels. Physician engagement and buy-in is essential. 12
13 Learnings from CMS Program Experience
14 Learning from Experience Participation in Pioneer ACO and MSSP Programs resulted in many learnings for medical group leaders. Pioneer ACO Sharp HealthCare, CA Pioneer ACO Atrius Health, MA Favorable utilization and quality performance Financial model concerns Dropped out of the Pioneer program Approached entire population the same way: single model of care Team focused on population health strategy Shared best practices for care delivery Financial accountability concerns Not used to relying heavily on Medicare for data 1 Hagland, M. (2014, September 29). Evolution and Revolution: What Medical Group Leaders Are Learning through their Federal ACO Participation. Healthcare Informatics 14
15 Learning from Experience Participation in Pioneer ACO and MSSP Programs resulted in many learnings for medical group leaders. MSSP ACO Family Health ACO, NY Pioneer ACO Banner Health Network, AZ Alliance of 3 federally qualified health centers Small Medicare population struggling with attribution requirements Cannot seek out lost patients only receiving data for those who are attributed Centralized support and resources Physicians are much more open to data-driven care delivery improvements Challenges integrating disparate data sources and getting timely information from Medicare 1 Hagland, M. (2014, September 29). Evolution and Revolution: What Medical Group Leaders Are Learning through their Federal ACO Participation. Healthcare Informatics 15
16 Learning from Experience What they are learning is how to truly implement team-based care. And that involves figuring who should do what, and what information they need in order to do that, he says. The old days of, we ll just take the claims data, do some analysis, and produce some reports, are over. You have to get the right data and information to the right people at the right moments. You have to do this in a population health context, to figure out which services you ll provide to which patients, at which levels. Jerry Penso, MD, chief medical and quality officer, American Medical Group Association (AMGA) 16
17 Q & A 17
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 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 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 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 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 informationSession 10: Integrating Data and Analytics into Provider Workflows Improves ACO Quality and Financial Performance
Session 10: Integrating Data and Analytics into Provider Workflows Improves ACO Quality and Financial Performance Joan Valentine, MSA, RN Executive Vice President Visiting Physicians Association David
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 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 informationReducing Hospital Admissions Through the Use of IT. Steven Milligan MD Medical Director of ACO Management Colorado Health Neighborhoods
Reducing Hospital Admissions Through the Use of IT Steven Milligan MD Medical Director of ACO Management Colorado Health Neighborhoods Conflict of Interest Steven Milligan, MD Has no real or apparent conflicts
More informationWHITE PAPER. Maximizing Pay-for-Performance Opportunities Proven Steps to Making P4P a Proactive, Successful and Sustainable Part of Your Practice
WHITE PAPER Maximizing Pay-for-Performance Opportunities Proven Steps to Making P4P a Proactive, Successful and Sustainable Part of Your Practice Maximizing Pay-for-Performance Opportunities In today s
More informationACO Practice Transformation Program
ACO Overview ACO Practice Transformation Program PROGRAM OVERVIEW As healthcare rapidly transforms to new value-based payment systems, your level of success will dramatically improve by participation in
More informationThe Future of HIE in Alaska
The Future of HIE in Alaska 1 Presentation Outline Developing a Roadmap for Alaska s HIE The Vision of AeHN: HIE 2.0 A Provider s Perspective 2 Brief History of Alaska s Health Information Exchange System
More informationAll ACO materials are available at What are my network and plan design options?
ACO Toolkit: A Roadmap for Employers What is an ACO? Is an ACO strategy right for my company? Which ACOs are ready? All ACO materials are available at www.businessgrouphealth.org What are my network and
More informationValue-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 informationAdvancing Primary Care Delivery
Advancing Primary Care Delivery Tenth National Pay for Performance Summit March 3, 2015 Simeon Schwartz, MD CEO, WESTMED Medical Group, P.C. WESTMED Medical Group Established 1996 by 16 physicians 300
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 informationPATH Program. Getting Started Guide
PATH Program Getting Started Guide We have a BIG opportunity. Together, we can empower and encourage people to take an active role in their health. Preventive health care services help people find and
More informationJumpstarting population health management
Jumpstarting population health management Issue Brief April 2016 kpmg.com Table of contents Taking small, tangible steps towards PHM for scalable achievements 2 The power of PHM: Five steps 3 Case study
More informationWhat Have we Learned from the Pioneer ACO Model?
What Have we Learned from the Pioneer ACO Model? Sherly Binu, CMMI December 7, 2016 Disclaimers 2 This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose
More informationImproving Diabetes Care in 75 Minutes. Moderator: Jerry Penso, M.D., M.B.A., President & CEO, AMGA
Improving Diabetes Care in 75 Minutes Moderator: Jerry Penso, M.D., M.B.A., President & CEO, AMGA SESSION OBJECTIVES 1. Identify specific tactics that health care delivery systems can implement to improve
More informationPreparing Your Infrastructure for New Payment Models
Preparing Your Infrastructure for New Payment Models For more information about WEDI webinars or if you are interested in speaking, please contact Samantha Holvey sholvey@wedi.org JANUARY 29: Assessing
More informationManaging Risk Through Population Health Initiatives
Managing Risk Through Health Initiatives Vicki DeBaca, DNS, RN Vice President, Health & Provider Services Sharp Rees-Stealy Medical Centers 1 Sharp Rees-Stealy Medical Centers San Diego s Multi-Specialty
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 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. Value-based Care delivers: Value-based Care means better health, better care and lower costs. Placing greater
More informationCOLLABORATING FOR VALUE. A Winning Strategy for Health Plans and Providers in a Shared Risk Environment
COLLABORATING FOR VALUE A Winning Strategy for Health Plans and Providers in a Shared Risk Environment Collaborating for Value Executive Summary The shared-risk payment models central to health reform
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 informationValue-based Care. Fact Sheet. How Value-based Care is improving quality and health.
How is improving quality and health. Working Smarter and Better to Help People Live Healthier Lives can help you lead the healthiest life possible. Imagine every health care professional you see understanding
More informationCPC+ CHANGE PACKAGE January 2017
CPC+ CHANGE PACKAGE January 2017 Table of Contents CPC+ DRIVER DIAGRAM... 3 CPC+ CHANGE PACKAGE... 4 DRIVER 1: Five Comprehensive Primary Care Functions... 4 FUNCTION 1: Access and Continuity... 4 FUNCTION
More informationINTRODUCTION TO POPULATION HEALTH. Kathy Whitmire, Vice President
INTRODUCTION TO POPULATION HEALTH Kathy Whitmire, Vice President 1 Learning Objectives 1. Provide an overall framework for population health 2. Allow clinics to understand why population health is important
More informationPopulation Health: Tamara Cull, MSW, LCSW, ACM National Director, Care Management, Value Based Programs and Operations November, 2014
In the Hospital and Health System ACO Tamara Cull, MSW, LCSW, ACM National Director, Care Management, Value Based Programs and Operations November, 2014 What We ll Be Discussing Who is CHI What are we
More informationGoals & Challenges for Outpatient Quality Directors. Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE
Goals & Challenges for Outpatient Quality Directors Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE Objectives Learn a practical way for Quality Directors to align Quality Measures
More 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 informationFrom Reactive to Proactive: Creating a Population Management Platform
Session D9 / E9 From Reactive to Proactive: Creating a Population Management Platform Richard Gitomer, MD Director, Brigham and Women s Primary Care Center of Excellence Vice Chair, Primary Care, Dept.
More informationManaging 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 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 informationMonarch HealthCare, a Medical Group, Inc.
Monarch HealthCare, a Medical Group, Inc. Accountable Care in the Independent Practice Model June 7, 2010 Jay J. Cohen, MD, MBA President/Chairman Monarch HealthCare Monarch HealthCare, a Medical Group,
More informationAlternative Managed Care Reimbursement Models
Alternative Managed Care Reimbursement Models David R. Swann, MA, LCSA, CCS, LPC, NCC Senior Healthcare Integration Consultant MTM Services Healthcare Reform Trends in 2015 Moving from carve out Medicaid
More informationGetting 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 informationUsing EHRs and Case Management to Improve Patient Care and Population Health
Using EHRs and Case Management to Improve Patient Care and Population Health Session #211, February 22, 2017 Thomas Schiller, MD and Jennifer Kuroda, SwedishAmerican Health System A Division of UW 1 Speaker
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 informationENHANCING PRESCRIBER RELATIONSHIPS: MAKING IT A WIN-WIN JULY 12, :00 5:00 PM
ENHANCING PRESCRIBER RELATIONSHIPS: MAKING IT A WIN-WIN JULY 12, 2017 3:00 5:00 PM ACPE UAN: 0107-9999-17-105-L04-P 0.2 CEU/2.0 hr Activity Type: Knowledge-Based Learning Objectives for Pharmacists: Upon
More 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 informationA Care Coordination Model for Value-Based Performance Programs
A Care Coordination Model for Value-Based Performance Programs Richard S. Chung, MD Chief Clinical Officer APS Healthcare 8th National Pay for Performance (P4P) Summit February 20, 2013 Hyatt Regency Hotel,
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 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 informationNextGen Population Health TEN TEN TEN TEN TE. Prevent Patients from Falling Through the Cracks in 10 Easy Steps
NextGen Population Health TEN TEN TEN TEN TE Prevent Patients from Falling Through the Cracks in 10 Easy Steps Proactive, automated patient engagement anytime, anywhere. Automate care management to improve
More information40,000 Covered Lives: Improving Performance on ACO MSSP Metrics
Success Story 40,000 Covered Lives: Improving Performance on ACO MSSP Metrics EXECUTIVE SUMMARY The United States healthcare system is the most expensive in the world, but data consistently shows the U.S.
More informationRural and Independent Primary Care.
Rural and Independent Primary Care www.caravanhealth.com Agenda 2015 Results from Rural ACO Participants Fundamental population health programs. Overview of additional rural value-based payments Opportunities
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 informationStrategy Guide Specialty Care Practice Assessment
Practice Transformation Network Strategy Guide Specialty Care Practice Assessment 1/20/2017 1 Strategy Guide: Specialty Care PAT 2.2 Contents: Demographics Tab: 3 Question 1: Aims... 3 Question 2: Aims...
More informationDraft Covered California Delivery Reform Contract Provisions Comments Welcome and Encouraged
TO: FROM: RE: State Based Marketplaces State Medicaid Directors Delivery Reform/Value Promoting Colleagues Peter V. Lee, Executive Director Draft Covered California Delivery Reform Contract Provisions
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 informationPatient Engagement in the Population Health Management Era
Patient Engagement in the Population Health Management Era Creagh Milford, DO, MPH President, Population Health Services A Catholic healthcare ministry serving Ohio and Kentucky Agenda Agenda I. Overview
More informationMedical Home as a Platform for Population Health
Medical Home as a Platform for Population Health Population Health Colloquium March 8, 2016 Emily Brower Vice President, Population Health Atrius Health Emily_Brower@atriushealth.org 2016 Atrius Health,
More informationCare Management at Mercy ACO
JANUARY 18 Care Management at Mercy ACO Case Study About Mercy Mercy ACO Care Management 01 Who they are Mercy ACO, one of the largest Accountable Care Organizations in the Midwest U.S. with 400+ service
More informationPopulation Health: Physician Perspective. Kallanna Manjunath MD, FAAP, CPE Medical Director AMCH DSRIP September 24, 2015
Population Health: Physician Perspective Kallanna Manjunath MD, FAAP, CPE Medical Director AMCH DSRIP September 24, 2015 Population Health: Physician Perspective Presentation objectives: Brief Bio Population
More informationHow an ACO Provides and Arranges for the Best Patient Care Using Clinical and Operational Analytics
Success Story How an ACO Provides and Arranges for the Best Patient Care Using Clinical and Operational Analytics HEALTHCARE ORGANIZATION Accountable Care Organization (ACO) TOP RESULTS Clinical and operational
More 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 informationAdopting a Care Coordination Strategy
Adopting a Care Coordination Strategy Authors: Henna Zaidi, Manager, and Catherine Castillo, Senior Consultant Current state of health care The traditional approach to health care delivery is quickly becoming
More informationCultural Transformation and the Road to an ACO Lee Sacks, M.D. CEO Mark Shields, M.D., MBA Senior Medical Director
Cultural Transformation and the Road to an ACO Lee Sacks, M.D. CEO Mark Shields, M.D., MBA Senior Medical Director AMGA Pre-conference Workshop 1 April 14, 2011 Washington, D.C. Disclosure Nothing in Today
More informationACOs in 2012: ACO Activity Doubles in 12 Months
Healthcare Benchmarks and Metrics July 2012 ACOs in 2012: ACO Activity Doubles in 12 Months www.hin.com The Healthcare Intelligence Network 800 State Highway 71, Suite 2 Sea Girt, NJ 08750 888-446-3530
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 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 informationTransforming Physician Practices: Evolution of ACOs in California. National Association of ACOs - Washington, DC October 2015
Transforming Physician Practices: Evolution of ACOs in California National Association of ACOs - Washington, DC October 2015 Integrated Healthcare Association Statewide multi-stakeholder leadership group
More informationKatherine Schneider, MD, MPhil Senior Vice President, Health Engagement July 29, 2011
Accountable Care: Health System View CHC Best Practices Forum Katherine Schneider, MD, MPhil Senior Vice President, Health Engagement July 29, 2011 Who we are Southeastern New Jersey s largest health system
More 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 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 informationBuilding the Universal Roadmap to Population Health Management
Building the Universal Roadmap to Population Health Management Executive Webinar January 21, 2016 Karen Handmaker, MPP, PCMH CCE IBM Watson Health House Keeping 1. Using the control panel Use the control
More informationThe long and winding road to Accountable Care
The long and winding road to Accountable Care Elliott Fisher, MD, MPH Director, The Dartmouth Institute John E. Wennberg Distinguished Professor Geisel School of Medicine The long and winding road Past
More information1.01 Government Programs: CMS and Pay for Performance: Current Issues. CMS Regional Administrator March 2009
1.01 Government Programs: CMS and Pay for Performance: Current Issues David Saÿen CMS Regional Administrator March 2009 Overview Why value-based purchasing? What demonstrations are underway? Hospital demonstrations
More information3/29/2013. Effective ACO Compliance. Objectives THE HEALTH CARE DILEMMA: ARE ACOS THE ANSWER? HCCA Compliance Institute April 21, 2013
Effective ACO Compliance HCCA Compliance Institute April 21, 2013 Margaret Hambleton, MBA, CHC, CHPC Sr. Vice President, Chief Compliance Officer St. Joseph Health System 1 Objectives Understand Accountable
More informationMeasuring High Performers and Assessing Readiness to Change Looking Beyond the Lamppost
Measuring High Performers and Assessing Readiness to Change Looking Beyond the Lamppost Mathematica Policy Research Washington, DC November 19, 2014 Moderator Timothy Lake Director of Health Research,
More informationMedicare Shared Savings ACOs: One Organization s Lessons Learned. Gregory A. Spencer MD FACP Chief Medical Officer Crystal Run Healthcare LLP
Medicare Shared Savings ACOs: One Organization s Lessons Learned Gregory A. Spencer MD FACP Chief Medical Officer Crystal Run Healthcare LLP Learning Objectives Identify organizational strengths and weaknesses
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 informationHello and welcome to. DART s ACO Standard and ACO Flex Health Plan.
Hello and welcome to DART s ACO Standard and ACO Flex Health Plan. The ACO Standard and ACO Flex plans both use Baylor Scott & White Quality Alliance (BSWQA) as its preferred network of doctors, hospitals,
More informationTransforming Clinical Care: Why Optimization of Clinical Systems Can t Wait
Transforming Clinical Care: Why Optimization of Clinical Systems Can t Wait A White Paper March 2016 Impact Advisors LLC 400 E. Diehl Road Suite 190 Naperville IL 60563 1-800-680-7570 Impact-Advisors.com
More informationPractice Implications for Accountable Care Organizations
Practice Implications for Accountable Care Organizations An Overview following the Final Rule Gregory M. Marsh, MPH, PMP December 14, 2011 Why CCME? Effective EHR/HIE Implementation will: Improve patient
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 informationPopulation Health Management. Ashley Rhude RHIA, CHTS-IM HIT Practice Advisor
Population Health Management Ashley Rhude RHIA, CHTS-IM HIT Practice Advisor Mission of OFMQ OFMQ is a not-for-profit, consulting company dedicated to advancing healthcare quality. Since 1972, we ve been
More informationSandra 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 informationActionable Data and Physician Engagement Drive ACO Success
Actionable Data and Physician Engagement Drive ACO Success Session #100, February 21, 2017 Christy Cawthon, University of Texas Southwestern Medical Center Sam Stearns, Verscend Technologies 1 Speaker
More informationTopics for Today s Discussion
MICAH Quality Network Population Insights Reporting and 2017 2018 PG5 P4P Program Year Updates Blue Cross Blue Shield of Michigan Hospital Incentive Programs August 18 th, 2017 Topics for Today s Discussion
More informationIMPROVING TRANSITIONS OF CARE IN POPULATION HEALTH
IMPROVING TRANSITIONS OF CARE IN POPULATION HEALTH TABLE OF CONTENTS 1. The Transitions Challenge 2. Impact of Care Transitions 3. Patient Insights from Project Boost 4. Identifying Patients 5. Improving
More informationSharp HealthCare ACO. Presented by: Donald C. Balfour, M.D. President and Medical Director Sharp Rees-Stealy Medical Group
Sharp HealthCare ACO Presented by: Donald C. Balfour, M.D. President and Medical Director Sharp Rees-Stealy Medical Group Institute for Quality Leadership Annual Conference October 4, 2012 Sharp ACO Collaborations
More informationPopulation Health. Collaborative Care. One interoperable platform. NextGen Care
Population Health. Collaborative Care. One interoperable platform. NextGen Care We ve become very proactive in identifying at-risk patients and getting them in our door before they get sick. Our physicians
More informationEmerging Models of Care Delivery Christy Mokrohisky Ex. Dir. of PI & Emerging Models
Emerging Models of Care Delivery Christy Mokrohisky Ex. Dir. of PI & Emerging Models 1 Sacred Encounters Perfect Care Healthiest Communities St. Joseph Heritage Healthcare Founded in 1994 Manage 7 Medical
More informationTotal Cost of Care Technical Appendix April 2015
Total Cost of Care Technical Appendix April 2015 This technical appendix supplements the Spring 2015 adult and pediatric Clinic Comparison Reports released by the Oregon Health Care Quality Corporation
More informationMEDICARE PART D STAR RATINGS & PHARMACY PERFORMANCE
MEDICARE PART D STAR RATINGS & PHARMACY PERFORMANCE LISA R. ERWIN, R.PH., CGP SENIOR CONSULTANT AUGUST 21, 2015 WHO IS GORMAN HEALTH GROUP? Gorman Health Group is the leading solutions and consulting firm
More informationIBM Watson Health Utica Park Clinic The need The solution The benefit
Utica Park Clinic Population health management helps Utica Park Clinic ease the transition to value-based care Overview The need Utica Park Clinic needed to balance the challenging financial implications
More informationCollaborative and Coordinated:
Collaborative and Coordinated: How Value-Based Care Programs are Driving Improvements in Quality and People s Health ISSUE DATE: NOVEMBER 2016 INTRODUCTION How the Shift from Volume to Value is Driving
More informationHow to Build a Medical Home
How to Build a Medical Home NOTE: Make sure your computer speakers are turned ON. Audio will be streaming through your speakers. If you do not have computer speakers, call the ACCMA at 510-654-5383 for
More informationRoadmap to accountable care: The chicken or the egg technology investment or clinical process improvement?
Roadmap to accountable care: The chicken or the egg technology investment or clinical process improvement? August 29, 2012 Meet the Presenters Michael Griffis CIO Innovative Practices Tucson, AZ Beth Hartquist,
More 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 informationHealth Care Evolution
Health Care Evolution Patient-Centered Medical Home to Clinical Integration & Accountable Care Ken Bertka, MD bertka@mindspring.com 419-346-8719 Agenda Top 3 Challenges of Health Care Reform PCMH & ACO
More informationStreamlining care processes with a data-driven approach
Streamlining care processes with a data-driven approach With Innovaccer s efficient and end-to-end care management solution Case Study Leading Iowa-based Mercy ACO deployed InCare to enable every member
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 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 informationIowa Medicaid: Innovations & Initiatives
Iowa Medicaid: Innovations & Initiatives ICD-10 ACA Expansion Presumptive Eligibility Health Information Technology PERM DHS Initiatives Adult Quality Measures SIM CDAC Topics 2 ICD-10 3 1 ICD-10 Background
More informationPractices for Improving Population Health
Practices for Improving Population Health February 13, 2014 1 Healthy Counties Initiative Sponsors 2 Webinar Recording and Evaluation Survey This webinar is being recorded and will be made available online
More informationCMS AMI and CABG Bundled Payment Initiative AMGA HF Collaborative December 13, 2016
CMS AMI and CABG Bundled Payment Initiative AMGA HF Collaborative December 13, 2016 Agenda Collaborative Learnings HF Correlation to AMI and CABG Bundled Payments CMS AMI & CABG Bundled Payment Programs
More information