Health Reform, Medicaid Expansion and Challenges for Providers
|
|
- Isaac George
- 6 years ago
- Views:
Transcription
1 Health Reform, Medicaid Expansion and Challenges for Providers Jeff Moser Vice President, Sg2 May 31,
2 Agenda Market Update Redesigning Care
3 2012 Outlook: A Year Like No Other Unprecedented Threats Market share battles intensify Bad debt driven by deductibles/co-pays/tiered networks Risk-based payments pushed at providers Margin improvement paramount Role of the consumer IT implementation costs create risk New market entrants challenge models Health care mandates looming Confidential and Proprietary May 2012 Sg2 3
4 The Timeline of Health Care Reform Marches on, for Now The Prelude Market Expansion Regulation and Restructuring Constitutionality challenge? Republican-led rollbacks? Health insurance exchanges? Confidential and Proprietary May 2012 Sg2 4
5 : The Industry Is Getting Prepared Select Initiatives Within Health Reform Law, Market Expansion Hospital Payment Cuts Medicare DSH payments cut by 75% Avoidable admissions Insurance Market Reforms Guaranteed issue Essential benefit package defined Insurance industry moves to regulation Coverage Expansion Medicaid expanded to 133% of FPL, estimated 16 million covered State-based insurance exchanges Individual mandate to purchase (subsidies up to 400% of poverty level) DSH = disproportionate share hospital; FPL = federal poverty level. Confidential and Proprietary May 2012 Sg2 5
6 What Won t Change: The Era of Risk-Based Reimbursement Is Here Hospital Medicare Payment at Risk, Year by Year Oct 2010 Oct 2011 Oct 2012 Oct 2013 Oct 2014 Oct 2015 Oct 2016 Oct 2017 Oct 2018 Oct 2019 Oct 2020 Value-Based Purchasing 1% 2% 30-Day Readmissions 1 % 2 % 3% Hospital-Acquired Conditions 1% TOTAL 2 % 3 % 5% 6% Source: Sg2 Analysis, Confidential and Proprietary May 2012 Sg2 6
7 Sg2 Perspective on the Growth of Risk Contracting, Medicare Medicaid Dual Eligible Patients in Provider Risk Contracts Commercial Self-Pay Confidential and Proprietary May 2012 Sg2 7
8 Emerging Payment Models Will Take Various Forms High Insurance product Global capitation ACO Clinical integration program Disease-specific capitation Bundled episodes (pre- and post-care included) Bundled episodes (inpatient only) P4P/value-based purchasing Inpatient case rates (DRGs) Low Fee for service Scope of Risk High ACO = accountable care organization; P4P = pay for performance; DRG = diagnosis-related group. Confidential and Proprietary May 2012 Sg2 8
9 Risk Readiness Varies Widely From Market to Market Decision Scale Level of Readiness High Above Average Average Below Average Least Data Not Available Confidential and Proprietary May 2012 Sg2 9
10 What Does This Mean for a Typical Health System? Focused on inpatient business Strong physician referral channel ED as the front door for majority of admissions Excels at revenue cycle, LOS management Few System of CARE linkages Lots of inappropriate utilization and readmissions CFO pushed 5% cost reduction over the past 3 years ED = emergency department; LOS = length of stay; CARE = Clinical Alignment and Resource Effectiveness. Confidential and Proprietary May 2012 Sg2 10
11 Fast Forward to Hospital is is a success! Hospital is is growing and profitable. Physicians are happy. System wins best employer award. Weaker aspects of performance do not affect market or financial results. CMS = Centers for Medicare & Medicaid Services; PCP = primary care physician; PAA = potentially avoidable admission. Confidential and Proprietary May 2012 Sg2 11 CMS docks hospital 5% of revenues for PAAs, readmissions. Hospital is is excluded from private payers preferred tier networks. Patients shop to manage their out-ofpocket liability. PCPs redirect cases away to maximize their incentives/reduce penalty exposure. Profitability and market share erode.
12 Start by Asking New Questions Old Should we become an ACO? How are volumes? New What is our product? How good is our product? How are we changing the total cost of care? Confidential and Proprietary May 2012 Sg2 12
13 The Scope of Your Strategy Must Encompass the System of CARE Acuity Community-Based Care Ambulatory Procedure Center Hospital IP Rehab Acute Care Home Retail Pharmacy Wellness and Fitness Center Physician Clinic Diagnostic/ Imaging Center Urgent Care Center Post- Acute Care SNF Home Care OP Rehab CARE = Clinical Alignment and Resource Effectiveness; IP = inpatient; OP = outpatient; SNF = skilled nursing facility. Confidential and Proprietary May 2012 Sg2 13
14 Agenda Market Update Redesigning Care
15 Outpatient (OP) Growth Opportunities Will Overwhelm Inpatient (IP) Decline Adult IP Forecast US Market, Millions Population-Based Forecast +18% Adult OP Forecast US Market, Billions Sg2 Forecast +32% +15% Sg2 Forecast 3% Population-Based Forecast Forecast excludes 0 17 age group and psychiatry and obstetrics service lines. Sources: Impact of Change v10.0; NIS; Pharmetrics; CMS; Sg2 Analysis, Confidential and Proprietary May 2012 Sg2 15
16 Patients Are Coming From Mars, Physicians Are Leaving for Venus The Complicated Universe of Ambulatory Care Dr Jones, I m having knee pain. I can t keep up with my child anymore. I hope she doesn t tell me I am fat. Your blood pressure is high, and I am worried that you cannot walk up a flight of stairs. Let s have you come back next week to talk about your knee. How could they schedule this man for a 15-minute visit? My wife is really unhappy that I lost my job. I should schedule him for a treadmill in case he has silent ischemia with his diabetes. Confidential and Proprietary May 2012 Sg2 16
17 MDs Challenged With Aligning Patients Clinical Needs While Lowering Costs Care Customization Simple Visit Priority Delivery Ambulatory ICU Social ICU Team MLP Physician ICU = intensive care unit; MLP = midlevel provider. Physician MLP MLP Social worker Nurse Physician Nurse Social worker MLP Physician Behavioralists Setting Office Office Multispecialty practice Multispecialty practice Example Sprained ankle Multiple issues, pick 1 Serious chronic condition(s) Overweight smoker, uninsured Confidential and Proprietary May 2012 Sg2 17
18 Key to Customizing Priority Delivery Care: Increased Efficiency Utilize group visits to manage patients with similar diseases. Advantages Time saving (2 hours = 20 patients) Cost-effective (generate ~$15,000/physician/year) Addresses projected demand Increased access to PCPs Disadvantages Uncertain reimbursement coverage (eg, no CPT code) Concerns over patient confidentiality Unclear how to document every patient encounter High attrition rates CPT is a registered trademark of the American Medical Association. CPT = Current Procedural Terminology. Source: Jaber R et al. Fam Pract Manag 2006;13: Confidential and Proprietary May 2012 Sg2 18 Encounter Expectation Communication Service Supply & Demand
19 Segmenting Patients by Risk Welcome to the Ambulatory ICU Ambulatory ICU aims to reduce costs and improve quality. Multidisciplinary team approach to intensive care management for the highest-risk patients (80/20 rule) Eligible patients suffer from multiple chronic conditions. Dedicated care manager (eg, registered nurse, social worker) Strengthens primary care relationships and patient engagement through proactive outreach (eg, calls, s, visits) Creation of personalized care plan Thorough education in disease self-management Prompt access to care team for appointments and questions Use of evidence-based practices/medical assistance software to improve visit efficiency Source: California Healthcare Foundation. The ambulatory intensive caring unit: early experiences. Accessed October Confidential and Proprietary May 2012 Sg2 19
20 Segmenting Patients by Nonmedical Needs: Welcome to the Social ICU Social ICU Addresses Nonhealth Factors Working Against Seamless Care Model this after the ambulatory ICU (eg, multidisciplinary care team, patient education, proactive outreach). Focus on managing social factors that drive clinical conditions. Care manager determines social barriers (eg, uninsured, domestic violence, depression, substance abuse, air quality in home, access to healthy food). Team works with community support network to address these issues. Clinicians able to focus on treating disease after social issues are resolved. Personal Behaviors Social ICU Patient Encounter Expectation Communication Service Supply & Demand SES = socioeconomic status. Sources: Schroeder SA. N Engl J Med 2007;357: ; Wilper AP et al. Ann Intern Med 2008;149: ; Partnership for Clear Health Communication. What is health literacy? Accessed October Confidential and Proprietary May 2012 Sg2 20
21 System Optimization: Extensivist Clinic Created to Care for Uninsured Patients Texas Hospital Animated 9,000 patients with high utilization were responsible for 42% of the net hospital losses. Identified 4 patient classification for the program Established an expanded care team: physician, social worker, nurse practitioner, 4 community health aids Empowered care team to do whatever it takes Created a program phone line to be a direct point-of-contact Results Anecdotal evidence shows a reduction in ED and hospital utilization. Impact: Hospitals that create innovative care models can improve patient care with the right patient, right setting and right care. Confidential and Proprietary May 2012 Sg2 21
22 Consider the Rapidly Changing Role of Health System in Patient Engagement 14-Year-Old Patient With Diabetes Before Glucose readings reviewed quarterly in diabetes clinic. Handwritten logs incomplete, time consuming to analyze Delays in insulin dose changes, phone tag Delayed gratification, poor compliance Elevated hemoglobin A1c Admitted for hyperglycemia Now Online monitoring tools Frequent care team contact via e-visits Continuous glucose monitoring results sent electronically Insulin dosage changes made in real time Lower hemoglobin A1c No hospitalizations for uncontrolled diabetes Confidential and Proprietary May 2012 Sg2 22
23 Next Steps: Prepare for Care Redesign Benchmark performance against competitors. Understand market forecast for services. Anticipate how quickly your market may move toward new payment models. Identify diseases/service lines with subpar performance, high cost/low margins, quality variability, etc. Target efforts to services that are key to the goals established in the organization s strategic plan. Assemble a team of physicians, clinical staff, administrators, operations staff, patient advocate, etc. Address potential hurdles from the outset: physician resistance, questionable leadership support, insufficient IT, etc. Confidential and Proprietary May 2012 Sg2 23
24 Sg2 s analytics-based health care expertise helps hospitals and health systems integrate, prioritize and drive growth and performance across the continuum of care. Over 1,200 organizations around the world rely on Sg2 s analytics, intelligence, consulting and educational services Confidential and Proprietary May 2012 Sg2 24
Jumpstarting population health management
Jumpstarting population health management Issue Brief April 2016 kpmg.com Table of contents Taking small, tangible steps towards PHM for scalable achievements 2 The power of PHM: Five steps 3 Case study
More informationAdvocate Physician Partners approach to Population Health
Advocate Physician Partners approach to Population Health Don Calcagno President, Advocate Physician Partners March 9, 2016 Who are Advocate Health Care and Advocate Physician Partners? 1 Advocate Health
More 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 informationEmerging Issues in Post Acute Care Trends
Emerging Issues in Post Acute Care Trends Lavonne Elston, PT Senior Director of Operations & Strategic Initiatives Skilled Nursing & Rehabilitation Kingston HealthCare Company April 28, 2016 Disclosures
More informationMassMedic Healthcare and Payment Reform: Impact on Value Demonstration
MassMedic Healthcare and Payment Reform: Impact on Value Demonstration November 2, 2012 David Martin, Senior Director, Health Policy COVIDIEN, COVIDIEN with logo, Covidien logo and positive results for
More informationMedicare, Managed Care & Emerging Trends
Medicare, Managed Care & Emerging Trends LeadingAge Michigan 2015 Annual Leadership Institute August 12, 2015 Jon Lanczak, Manager Beth Sullivan, Senior Manager Plante Moran, PLLC Overall Theme Healthcare
More informationHealth Reform and IRFs
American Medical Rehabilitation Providers Association 8 th Annual AMRPA Educational Conference New Orleans, LA Health Reform and IRFs Planning Today for Success Tomorrow October 14, 2010 Agenda Introduce
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 informationBundled Payments to Align Providers and Increase Value to Patients
Bundled Payments to Align Providers and Increase Value to Patients Stephanie Calcasola, MSN, RN-BC Director of Quality and Medical Management Baystate Health Baystate Medical Center Baystate Health Is
More informationPlanning a Course to Population Health Management
Planning a Course to Population Health Management A Complimentary Webinar From healthsystemcio.com Your Line Will Be Silent Until Our Event Begins at 12:00 ET Thank You! Slide Deck: http://goo.gl/1w119j
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 informationSummary of U.S. Senate Finance Committee Health Reform Bill
Summary of U.S. Senate Finance Committee Health Reform Bill September 2009 The following is a summary of the major hospital and health system provisions included in the Finance Committee bill, the America
More informationPopulation Health Management in the Safety Net Elaine Batchlor, MD, MPH CEO, Martin Luther King, Jr. Community Hospital
Population Health Management in the Safety Net Elaine Batchlor, MD, MPH CEO, Martin Luther King, Jr. Community Hospital November 5, 2013 Martin Luther King, Jr. Community Hospital Page 1 11/05/2013 Agenda
More informationBrave New World: The Effects of Health Reform Legislation on Hospitals. HFMA Annual National Meeting, Las Vegas, Nevada
Brave New World: The Effects of Health Reform Legislation on Hospitals HFMA Annual National Meeting, Las Vegas, Nevada Highlights of PPACA Requires most Americans to have health insurance Expands coverage
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 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 informationUW MEDICINE ICD-10 Program UW MEDICINE ICD-10
UW MEDICINE ICD-10 Program UW MEDICINE ICD-10 There and back again INTEGRATION OF MANDATES ACO Quality Based Reimbursement Meaningful Use, P4P, etc. ICD-10 HIPAA, 5010 2 STRATEGIC OPPORTUNITIES Significant
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 informationCare Redesign: Budgeted Episodes for Total Knee Replacement
Care Redesign: Budgeted Episodes for Total Knee Replacement Wade Johannessen, PhD Director, Sg2 Allen Marsh Ortho/Neuro Service Line Director CaroMont Health October 13, 2011 Chicago London www.sg2.com
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 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 informationFirstHealth Moore Regional Hospital. Implementation Plan
FirstHealth Moore Regional Hospital Implementation Plan FirstHealth Moore Regional Hospital Implementation Plan For 2016 Community Health Needs Assessment Summary of Community Health Needs Assessment Results
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 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 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 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 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 informationChapter VII. Health Data Warehouse
Broward County Health Plan Chapter VII Health Data Warehouse CHAPTER VII: THE HEALTH DATA WAREHOUSE Table of Contents INTRODUCTION... 3 ICD-9-CM to ICD-10-CM TRANSITION... 3 PREVENTION QUALITY INDICATORS...
More informationIntegrated Health System
Integrated Health System Please note that the views expressed are those of the conference speakers and do not necessarily reflect the views of the American Hospital Association and Health Forum. Page 2
More informationUsing Facets of Midas+ Hospital Case Management to Support Transitions of Care. Barbara Craig, Midas+ SaaS Advisor
Using Facets of Midas+ Hospital Case Management to Support Transitions of Care Barbara Craig, Midas+ SaaS Advisor What does Transitional Care Include? Transitional Care is the smooth conversion of a patient
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 informationNYS Value Based Payments (VBP):
NYS Value Based Payments (VBP): Provider Associations, Community Based Organizations, and Consumer Advocates Town Hall Meeting Jason Helgerson NYS Medicaid Director December 16, 2016 2 Today s Agenda Agenda
More informationBreakThrough Care Center: A New Care Model for High Risk Patients. Dr. Richard Krouse Dr. Paul Merrick
BreakThrough Care Center: A New Care Model for High Risk Patients Dr. Richard Krouse Dr. Paul Merrick About DMG Why Population Health About BreakThrough Care Center Patient Stories Questions? About DuPage
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 informationAlternative Payment Models for Behavioral Health Kim Cox VP, Provider Network
Alternative Payment Models for Behavioral Health Kim Cox VP, Provider Network Kim Cox Vice President, Provider Network, Optum Kim Cox is Vice President of Provider Network. She joined Optum in February
More 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 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 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 informationHEALTH CARE REFORM MAKING IT WORK FOR LA COUNTY DEPARTMENT OF HEALTH SERVICES AND SAFETY NET SYSTEM
HEALTH CARE REFORM MAKING IT WORK FOR LA COUNTY DEPARTMENT OF HEALTH SERVICES AND SAFETY NET SYSTEM July 15, 2013 Alexander Li, MD DHS Ambulatory Care Network Our Story Affordable Care Act (Obamacare)
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 informationDesigning & Delivering Whole-Person Transitional Care Coordinating care across settings and over time to drive outcomes
Designing & Delivering Whole-Person Transitional Care Coordinating care across settings and over time to drive outcomes Amy E. Boutwell, MD, MPP CNYCC Annual Meeting November 6, 2017 Agenda Design data,
More informationFacility-Based Behavioral Health Program Professional Fees Reimbursement Policy Annual Approval Date. Approved By
Policy Number 2016RP505A Facility-Based Behavioral Health Program Professional Fees Reimbursement Policy Annual Approval Date 09/30/2016 Approved By Optum Behavioral Reimbursement Committee IMPORTANT NOTE
More informationHealthcare Leadership Council: John Perticone Golden Living 3/9/2016
Healthcare Leadership Council: Care Transitions in Post Acute Care John Perticone Golden Living 3/9/2016 Golden Living Profile Golden Living Centers and Communities 296 skilled nursing facilities 15 assisted
More informationClinical Documentation Improvement (CDI) Programs: What Role Should Compliance Play?
Clinical Documentation Improvement (CDI) Programs: What Role Should Compliance Play? June 17, 2016 Agenda Clinical Documentation Improvement (CDI) Perspective An Effective CDI Program Core Focus: Compliance
More informationAmbulatory Care Practice Trends and Opportunities in Pharmacy
Ambulatory Care Practice Trends and Opportunities in Pharmacy David Chen, R.Ph., M.B.A. Senior Director Section of Pharmacy Practice Managers ASHP Objectives Describe trends in health system pharmacy reported
More informationDecreasing Medical. Costs. Are your members listening to you? PRESENTED BY: September 22, 2016
Decreasing Medical Costs Are your members listening to you? PRESENTED BY: Aaron Crowell, Executive Vice President, MTM, Inc. Gary Jacobs, Executive Vice President, CareCentrix Dan Masciopinto, SVP of Product,
More informationA McKesson Perspective: ICD-10-CM/PCS
A McKesson Perspective: ICD-10-CM/PCS Its Far-Reaching Effect on the Healthcare Industry Executive Overview While many healthcare organizations are focused on qualifying for American Recovery & Reinvestment
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 informationCritical Access Hospitals and Cost-Based Reimbursement
Critical Access Hospitals and Cost-Based Reimbursement Jared Heim, CPA, Partner jheim@eidebailly.com 563.557.6169 Agenda for Today Overview of Critical Access Hospitals Overview of Health Care Reform Behavioral
More informationHealthy Aging Recommendations 2015 White House Conference on Aging
Healthy Aging Recommendations 2015 White House Conference on Aging Chronic diseases are the leading causes of death and disability in the U.S. and account for 75% of the nation s health care spending.
More informationEmerging Outpatient CDI Drivers and Technologies
7th Annual Association for Clinical Documentation Improvement Specialists Conference Emerging Outpatient CDI Drivers and Technologies Elaine King, MHS, RHIA, CHP, CHDA, CDIP, FAHIMA Outpatient Payment
More informationValue Based Care in LTC: The Quality Connection- Phase 2
Value Based Care in LTC: The Quality Connection- Phase 2 Joseph J. Tomaino, M.S., R.N., Principal Healthcare Transformation Consulting ChemRx/PharmMerica Geriatric Skilled Nursing Seminar December 7, 2017
More informationCourse Module Objectives
Course Module Objectives CM100-18: Scope of Services, Practice, and Education CM200-18: The Professional Case Manager Case Management History, Regulations and Practice Settings Case Management Scope of
More informationValue model in the new healthcare paradigm: Producing value at a single specialty center.
Value model in the new healthcare paradigm: Producing value at a single specialty center. State of Spine Surgery Think Tank June 17, 2017 Catherine MacLean, MD, PhD Chief Value Medical Officer Center for
More informationClinical Operations. Kelvin A. Baggett, M.D., M.P.H., M.B.A. SVP, Clinical Operations & Chief Medical Officer December 10, 2012
Clinical Operations Kelvin A. Baggett, M.D., M.P.H., M.B.A. SVP, Clinical Operations & Chief Medical Officer December 10, 2012 Forward-looking Statements Certain statements contained in this presentation
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 informationMedi-Cal and the Safety Net California Association of Health Plans Seminar Series Medi-Cal at its Core
Medi-Cal and the Safety Net California Association of Health Plans Seminar Series Medi-Cal at its Core August 3, 2017 Deborah Kelch Executive Director Insure the Uninsured Project 1 Safety-Net Definitions
More informationThe Community Care Navigator Program At Lawrence Memorial Hospital
The Community Care Navigator Program At Lawrence Memorial Hospital Presented By: Linda Gall, MSN, RN, ACM Director of Care Coordination October 21, 2011 Learning Objectives: 1. Describe the vision and
More informationIMAGES & ASSOCIATES O UR S ERVICES OPERATIONAL REVIEW AND ENHANCEMENT
O UR S ERVICES OPERATIONAL REVIEW AND ENHANCEMENT The Prospective Payment System (PPS) for Inpatient Rehabilitation Facilities creates both opportunities and challenges for facilities that provide comprehensive
More informationThe Right Tools for the Job: ASSEMBLING YOUR IMAGING STRATEGY
The Right Tools for the Job: ASSEMBLING YOUR IMAGING STRATEGY How to provide access to care in response to Anthem s Imaging Clinical Site of Care Review Policy and the evolving healthcare marketplace According
More informationInnovating Predictive Analytics Strengthening Data and Transfer Information at Point of Care to Improve Care Coordination
Innovating Predictive Analytics Strengthening Data and Transfer Information at Point of Care to Improve Care Coordination November 15, 2017 RRHA Healthcare Innovations Conference Agenda Arnot Health Overview
More informationSession 6 PD, Mitigating the Cost Impact of Trends in Hospital Billing Practices. Moderator/Presenter: Sabrina H.
Session 6 PD, Mitigating the Cost Impact of Trends in Hospital Billing Practices Moderator/Presenter: Sabrina H. Gibson, FSA, MAAA Presenters: Dawna Nibert Lawrence R. Smart, FSA, MAAA Society of Actuaries
More informationFramework for Post-Acute Care: Current and Future Issues for Providers
Framework for Post-Acute Care: Current and Future Issues for Providers Alan G. Rosenbloom Alliance for Quality Nursing Home Care March 2012 Overview of Presentation Post-Acute Care: Background and Trends
More informationEliminating Excessive, Unnecessary, and Wasteful Expenditures: Getting to a High Performance U.S. Health System
Eliminating Excessive, Unnecessary, and Wasteful Expenditures: Getting to a High Performance U.S. Health System Karen Davis President, The Commonwealth Fund IOM Workshop Series: The Policy Agenda September
More informationSECTION 9 Referrals and Authorizations
SECTION 9 Referrals and Authorizations General Information The PAMF Utilization Management (UM) Program is carried out by the Managed Care department. The UM Program is designed to ensure that all Members
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 information2019 Quality Improvement Program Description Overview
2019 Quality Improvement Program Description Overview Introduction Eon/Clear Spring s Quality Improvement (QI) program guides the company s activities to improve care and treatment for the member s we
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 informationAugust 25, Dear Ms. Verma:
Seema Verma Administrator Centers for Medicare & Medicaid Services Hubert H. Humphrey Building 200 Independence Avenue, S.W. Room 445-G Washington, DC 20201 CMS 1686 ANPRM, Medicare Program; Prospective
More informationRural Relevance in Oklahoma
Rural Relevance in Oklahoma OHA Annual Conference 2017 November 1, 2017 Agenda Introductions The Rural Relevance Study Impact of Current and Proposed Health Policies on Rural Providers Oklahoma Rural Hospitals:
More informationPitch Perfect: Selling Your Services to LTC Facilities
Pitch Perfect: Selling Your Services to LTC Facilities Lou Ann Brubaker, President Brubaker Consulting www.brubakerconsulting.com 301 535 5449 brubak97@aol.com Linkedin Disclosure Lou Ann Brubaker is the
More informationDriving Out Clinical Variation to Drive Up Your Bottom Line
In Cooperation With: Executive White Paper Series, October 2017 Driving Out Clinical Variation to Drive Up Your Bottom Line Hospitals have always worked to be efficient. Now more than ever, it is increasingly
More informationTEXAS HEALTHCARE TRANSFORMATION & QUALITY IMPROVEMENT PROGRAM. Bluebonnet Trails Community Services
TEXAS HEALTHCARE TRANSFORMATION & QUALITY IMPROVEMENT PROGRAM Regional Healthcare Partnership Region 4 Bluebonnet Trails Community Services Delivery System Reform Incentive Payment (DSRIP) Projects Category
More informationExplaining the Value to Payers
Explaining the Value to Payers Explaining the Value to Payers This document has been created to provide talking points for EMS agencies to explain to payers the value of EMS 3.0 services. Please review
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 informationCommunity Health Needs Assessment: St. John Owasso
Community Health Needs Assessment: St. John Owasso IRC Section 501(r) requires healthcare organizations to assess the health needs of their communities and adopt implementation strategies to address identified
More informationScenario Planning: Optimizing your inpatient capacity glide path in an age of uncertainty
Scenario Planning: Optimizing your inpatient capacity glide path in an age of uncertainty Scenario Planning: Optimizing your inpatient capacity glide path in an age of uncertainty Examining a range of
More informationMinnesota Perspective: Fairview Health Services. National Accountable Care Organization Congress October 25, 2010
Minnesota Perspective: Fairview Health Services National Accountable Care Organization Congress October 25, 2010 Fairview Overview Not-for-profit organization established in 1906 Partner with the University
More informationHealthcare Solutions Nuance Clintegrity Quality Management Solutions. Quality. The Discipline to Win.
Quality. The Discipline to Win. Brochure 2 It s not wanting to win that makes you a winner; it s refusing to fail. Peyton Manning, the first NFL quarterback to achieve 200 career wins (regular and post-season)
More informationReengineering Primary Care
Reengineering Primary Care Evolving Workforce and Workplace Models Joan Moss, RN, MSN Chief Nursing Officer and Senior Vice President, Sg2 Ricky Garcia Associate Vice President, Sg2 Agenda Workforce: Resourcing
More informationAirStrip ONE Cardiology
AirStrip ONE Cardiology A Synchronized View of the Vital Patient Data Needed to Improve Care Heart disease is the leading cause of death in the U.S. The associated costs exceed $100 billion annually. AirStrip
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 informationHigh-tech, high- cost care has shifted to low-tech care at a lower cost unregulated care, less overhead Times Union, January 7, 2014
High-tech, high- cost care has shifted to low-tech care at a lower cost unregulated care, less overhead Times Union, January 7, 2014 Times Union, Oversight sought for walk-in centers, January 7, 2014 An
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 informationPartners in the Continuum of Care: Hospitals and Post-Acute Care Providers
Partners in the Continuum of Care: Hospitals and Post-Acute Care Providers Presented to the Wisconsin Association for Home Health Care November 3, 2017 By: Laura Rose WHA Vice President, Policy Development
More informationAligning Executive, Physician and Staff Compensation with Population Health Goals
Aligning Executive, Physician and Staff Compensation with Population Health Goals WILLIAM F. JESSEE, MD, FACMPE Becker s Hospital Review 8th Annual Meeting Chicago, IL April 17, 2017 0 Welcome Today s
More informationThe National ACO, Bundled Payment and MACRA Summit. Success in Physician Led Bundles
The National ACO, Bundled Payment and MACRA Summit Success in Physician Led Bundles Disclaimer This material and/or presentation is provided for guidance and/or illustrative purposes only and should not
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 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 informationChronic Care Management INFORMATION RESOURCE
Contents Chronic Care Management INFORMATION RESOURCE Purpose... 1 What Is CCM?... 1 Background... 1 Initiating Visit and Person-Centered Plan... 2 Clinical Supervision... 2 Qualifications for Personnel
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 informationASPIRE to Reduce Readmissions
ASPIRE to Reduce Readmissions Amy E. Boutwell, MD, MPP President, Collaborative Healthcare Strategies Objectives Explain the value of a data-informed, whole-person approach to reducing readmissions Identify
More informationInnovative Business Activities in Health Care with Commercial Partners
Innovative Business Activities in Health Care with Commercial Partners Steve Witman, CPA, MBA Vice President of Business Development / Financial and Capital Planning LifeBridge Health March 4, 2014 Business
More informationpaymentbasics The IPPS payment rates are intended to cover the costs that reasonably efficient providers would incur in furnishing highquality
Hospital ACUTE inpatient services system basics Revised: October 2015 This document does not reflect proposed legislation or regulatory actions. 425 I Street, NW Suite 701 Washington, DC 20001 ph: 202-220-3700
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 informationHealth Home Flow Hypothetical Patient Scenario
Health Home Flow Hypothetical Patient Scenario Client Background: Soozie SoonerCare Soozie is a single female, age 42, 5'6" tall 215 pounds. She smokes 2 packs of cigarettes a day. At age 24, Soozie was
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 informationThe Long and Winding Road-map: From Waiver Services to VBP and Other Stops Along the Way
The Long and Winding Road-map: From Waiver Services to VBP and Other Stops Along the Way Mental Health Association in New York State, Inc. Annual Meeting Gregory Allen, MSW Director Division of Program
More informationWIN-WIN-WIN APPROACHES TO ACCOUNTABLE CARE
WIN-WIN-WIN APPROACHES TO ACCOUNTABLE CARE How Providers, Hospitals, Employers, and Patients Can All Benefit from Healthcare Payment and Delivery Reform Harold D. Miller President and CEO Center for Healthcare
More informationLESSONS LEARNED IN LENGTH OF STAY (LOS)
FEBRUARY 2014 LESSONS LEARNED IN LENGTH OF STAY (LOS) USING ANALYTICS & KEY BEST PRACTICES TO DRIVE IMPROVEMENT Overview Healthcare systems will greatly enhance their financial status with a renewed focus
More information