The Patient Centered Medical Home Will It Make A Difference?
|
|
- Ann James
- 5 years ago
- Views:
Transcription
1 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, Practice Advocacy & Improvement Division of Governmental Affairs & Public Policy mbarr@acponline.org
2 Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. Millions do not have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and protection. President Harry Truman Text from a speech he delivered to a joint session of Congress in 1945
3 So let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year. President Barack Obama Text from a speech he delivered to a joint session of Congress, February 24, 2009
4
5 State of the Nation s Health Care uninsured million employed 80% Projection s for million underinsured 18% ($2.6T) 20% 2017 $8,300 per capita in 2008 To $13,000 in 2017
6 Comparing to 02 03; 75, ,000 avoidable deaths Amenable Mortality: 15 th to 19 th <50% with access to rapid appointment 75% difficulty with after hours care 18% readmission rate within 30 days M care: High variability The Commonwealth Fund: Why Not the Best; 2008 Nolte & McKee: Measuring the Health of Nations: Updating an Earlier Analysis. Health Affairs, 27:1 (2008)
7 Escalating Costs, Decreasing Coverage Healthcare costs per U.S. auto vs. Germany & Japan $130 billion $1500 vs. $450 vs. $150 70% to 60% 98% vs. 23% Decreasing employersponsored coverage ( 70s to 06) Growth in premiums vs. inflation ( 00 07) Untreated illness & work absence; uninsured
8 Cost v Quality
9 Primary Care Score vs. Health Care Expenditures 1997 Source: The Commonwealth Fund, Data from B. Starfield, Why More Primary Care: Better Outcomes, Lower Costs, Greater Equity, Presentation to the Primary Care Roundtable: Strengthening Adult Primary Care: Models and Policy Options, October 3, 2006.
10 The Case for Health Care Reform Poor access to care, especially for the uninsured Escalating costs & volume of services No link between cost and quality Excessive administrative costs Dysfunctional payment system United States is lagging internationally Impending collapse of primary care
11 How can we fail to provide health insurance for 16% of our population, deliver uneven quality to the 84% of Americans who are insured, and yet pay 50% more per person than countries like France, Israel, and Britain, which cover all of their citizens? Ezekiel J. Emanuel, MD, PhD Healthcare, Guaranteed: A Simple, Secure Solution for America, 2008
12
13 A Dying Breed JAMA 2008: 2% of th year medical students (at 11 medical schools) planned careers in general internal medicine A 2004 survey of board certified internists found that after ten years of practice, 21% of general internists were no longer working in GIM compared to a 5% decrement for subspecialists Hauer, KE et al. JAMA. September 10, 2008; Vol 300, No. 10 p Lipner RS, Bylsma WH, Arnold GK, Fortna GS, Tooker J, Cassel CK: Ann Intern Med Jan 3;144(1):29 36
14 Projected shortage of 35 45,000 generalists for adults Jack M. Colwill, James M. Cultice, and Robin L. Kruse, Will Generalist Physician Supply Meet Demands Of An Increasing And Aging Population?, Health Affairs, Vol 27, Issue 3, w w
15 Imbalanced System
16 What is the Patient Centered Medical Home? a vision of health care as it should be a framework for organizing systems of care at both the micro (practice) and macro (society) level a model to test, improve, and validate part of the health care reform agenda
17 PCMH is Our Term to describe a pathway to excellent health care to re claim a role as advocates for our patients (with our patients & their families) to encourage team based care to create educational opportunities to attract medical students and residents to primary care
18 Community Health System Resources and Policies Self- Management Support Health Care Organization Delivery System Design Decision Support Clinical Information Systems Informed, Activated Patient Prepared, Proactive Practice Team Wagner EH. Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice. 1998: 1:2-4.
19 The Joint Principles of the PCMH Personal physician Physician directed medical practice Whole person orientation Care is coordinated and/or integrated Quality and safety Enhanced access to care Payment to support the PCMH Team based care: NP/PA RN/LPN Medical Assistant Office Staff Care Coordinator Nutritionist/Educator Pharmacist Behavioral Health Case Manager Social Worker Community resources DM companies Others
20 Building the Medical Home Collaboration Recognition Demonstration Advocacy Expansion Education Education Education
21 Important Questions 1. How do you recognize a PCMH? 2. How is care different? 3. Will physicians & their teams want to build the medical home? 4. How do we prepare physicians, students & residents?
22 1. Access & Communication 2. Patient Tracking & Registry Functions 3. Care Management 4. Patient Self Management Support 5. Electronic Prescribing 6. Test Tracking 7. Referral Tracking 8. Performance Reporting & Improvement 9. Advanced Electronic Communication Joint Principles of the Patient Centered Medical Home
23
24 The Process 1. Gap analysis take the pre test. 2. Analyze results. 3. Implement changes necessary 4. Retake the pre test. 5. If ready submit application to NCQA. Cost: Readiness assessment = $80 NCQA application fee: varies by size of practice from $450 for 1 physician to $2,700 for 6+
25 Stepping Up to Excellence Level 3: 75+ Points Level 2: Points Level 1: Points Increasing Complexity of Services
26 Demonstrates timely access and communication processes Organizes charts (paper or electronic) to facilitate team based care and tracking age appropriate and condition specific Level 2: Points interventions Identifies key clinical conditions Level among 1: Points population served & follows evidence based guidelines Level 3: 75+ Points Encourages and provides support for patient/family self management Addresses health literacy issues Tracks tests & referrals to assure completion Collects and reports on quality & satisfaction data to practice
27 Key Points for Level 1 PCMH Does not require electronic health record Will require registry & tracking functions Emphasis is on providing better care through: Access to care Organization of office structure & processes Enhancing patient self management; addressing health literacy issues Introduction of evidence based guidelines, measurement & quality improvement
28 Level 2 Level 3 Advanced access options for patients Electronic health record More, and more complex care coordination and patient support Robust population management Advanced reporting and quality improvement initiatives Additional technology solutions
29 More Features of a PCMH Practice Uses each team member to highest capability Supports cultural competency training Understands health literacy Establishes connections to the community Provides extensive self management support Engages a Patient/Family Advisory Group
30 More Features of a PCMH Practice Provides individualized written care plans and monitors adherence to the plan Assesses barriers to adherence and initiates plans to overcome them Collaborates with other physicians, external entities & institutions to insure timely access to information Manages transitions of care seamlessly
31 Specialty Care Connections PCMH is NOT a gatekeeper system Jointly develop/identify referral guidelines Emphasis on transitions in care & continuity Referral agreements Care transitions programs Some subspecialists may want to qualify as PCMH ACP in discussions with several groups regarding the PCMH model and primary care/specialty care interface (sharing care)
32 Practice Implications Challenges of transformation Initial capital and restructuring costs Ongoing support & maintenance Reporting on quality, cost and satisfaction Implementation of HIT coincident with PCMH
33 Blend of Modified Fee for Service and Bundled Per Patient Payment Perceived as Most Effective for Efficient Health Care System How effective do you think each of the following payment approaches would be in facilitating a more efficient health care system? A blend of the modified fee-for-service and bundled per-patient payment systems 62 Bundled per-patient payment (a single payment for all services provided to the patient during the year), with bonus payments for high quality 51 A modified fee-for-service system, with bonus payments for high quality and efficiency 23 K. Stremikis, S. Guterman, and K. Davis, Health Care Opinion Leaders' Views on Payment System Reform, The Commonwealth Fund, November 2008
34 Payment Models for the PCMH Fee For Service Enhanced RBRVS Add-on codes Performance Prospective Payment: -Structure -Care coordination & -Non face-to-face care -Adjusted for complexity of population & services Enhanced RBRVS Fee for Service Performance Global Payment Procedures Performance
35 Medicare Medical Home Demo Eight states 800 practices (approximately 50/location) Eligibility requirements Practice application and recognition process Beneficiary agreements Time line
36 MMHD Care Management Fee Per Member per Month Payments HCC Score <1.6 HCC Score >1.6 Blended Rate Tier 1 $27.12 $80.25 $40.40 Tier 2 $35.48 $ $51.70 HCC score indicates disease burden Estimate that 25% of beneficiaries with HCC <1.6 and Medicare costs at least 60% higher than average First 2% of savings not shared 80% of savings above 2% (minus fees) shared with practices
37 Other PCMH Demos
38
39 Growing Interest in the PCMH Patient Centered Primary Care Collaborative 300+ organizations; represent 50+ million people Articles in NEJM, JAMA, Health Affairs, Annals of Internal Medicine Trade & Lay Press Legislation Commercial payer demos Public payer demos
40 A Commitment to Excellence Patient centered communication Shared decision making Timely access to care Electronic health records Use of comparative effectiveness research & evidence based guidelines Measure, improve, measure Transparency & accountability Safety
41
42 Now, there are some who question the scale of our ambitions, who suggest that our system cannot tolerate too many big plans. Their memories are short, for they have forgotten what this country has already done, what free men and women can achieve when imagination is joined to common purpose and necessity to courage. What the cynics fail to understand is that the ground has shifted beneath them, that the stale political arguments that have consumed us for so long, no longer apply. President Barack Obama, January 20, 2009
Health Care Evolution
Health Care Evolution Patient-Centered Medical Home to Clinical Integration & Accountable Care Ken Bertka, MD bertka@mindspring.com 419-346-8719 Agenda Top 3 Challenges of Health Care Reform PCMH & ACO
More informationA Journey PCMH & Practice Transformation PCMH 101. Kentucky Primary Care Association Lexington Kentucky June 11, 2014
A Journey PCMH & Practice Transformation PCMH 101 Kentucky Primary Care Association Lexington Kentucky June 11, 2014 Overview of Journey Today What an overview of PCMH Why PCMH & practice transformation
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 informationPhysicians have a moral calling to promote the health of
Medicine and Public Issues Annals of Internal Medicine The Affordable Care Act and the Future of Clinical Medicine: The Opportunities and Challenges Robert Kocher, MD; Ezekiel J. Emanuel, MD; and Nancy-Ann
More informationStatement for the Record. American College of Physicians. Hearing before the House Energy & Commerce Subcommittee on Health
Statement for the Record American College of Physicians Hearing before the House Energy & Commerce Subcommittee on Health A Permanent Solution to the SGR: The Time Is Now January 21-22, 2015 The American
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 Patient-Centered Primary Care Collaborative: New Vision, New Strategic Plan, New Organizational Structure
The Patient-Centered Primary Care Collaborative: New Vision, New Strategic Plan, New Organizational Structure Marci Nielsen, PhD, MPH Executive Director Amy Gibson, MS, RN Chief Operating Officer Patient-Centered
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 informationCREATING A NEW NATIONAL WORKFORCE FOR INTERNAL MEDICINE
CREATING A NEW NATIONAL WORKFORCE FOR INTERNAL MEDICINE American College of Physicians A Position Paper 2006 CREATING A NEW NATIONAL WORKFORCE FOR INTERNAL MEDICINE A Position Paper of the American College
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 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 informationBuilding & Strengthening Patient Centered Medical Homes in the Safety Net
Blue Shield of California Foundation County Coverage Expansion Planning Workshop #2 Building & Strengthening Patient Centered Medical Homes in the Safety Net July 8, 2011 Presented by: Kathryn Phillips,
More 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 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 informationHealth Information Technology
ACO Congress Oct 25, 2010 Los Angeles, CA Patient Centered Medical Home and Accountable Care Organizations Health Information Technology David K. Nace MD, Medical Director, McKesson Corporation Co-Chair,
More informationExpansion of Pharmacy Services within Patient Centered Medical Homes. Jeremy Thomas, PharmD Associate Professor Department Pharmacy Practice
Expansion of Pharmacy Services within Patient Centered Medical Homes Jeremy Thomas, PharmD Associate Professor Department Pharmacy Practice What is a Patient Centered Medical Home (PCMH)? "an approach
More informationM4: Primary Care Teams: Learning from Effective Ambulatory Practices
M4: Primary Care Teams: Learning from Effective Ambulatory Practices Ed Wagner, MD, MPH, FACP, Director Emeritus, MacColl Center for Health Care Innovation Margaret Flinter, PhD, Senior Vice President
More informationFacing the Crisis of Adult Primary Care
Facing the Crisis of Adult Primary Care July 27, 2010 Thomas Bodenheimer MD Center for Excellence in Primary Care Department of Family and Community Medicine University of California, San Francisco Agenda
More informationPatient Centered Medical Home. History of PCMH concept. What does a PCMH look like? 10/1/2013. What is a Patient Centered Medical Home (PCMH)?
What is a Patient Centered Medical Home (PCMH)? Patient Centered Medical Home Jeremy Thomas, PharmD, CDE UAMS Department of Pharmacy "an approach to providing comprehensive primary care that facilitates
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 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 informationRe: Rewarding Provider Performance: Aligning Incentives in Medicare
September 25, 2006 Institute of Medicine 500 Fifth Street NW Washington DC 20001 Re: Rewarding Provider Performance: Aligning Incentives in Medicare The American College of Physicians (ACP), representing
More informationMarket Mover? The Emerging Role of CMS in P4P. Linda Magno Director, Medicare Demonstrations Group August 24, 2004
Market Mover? The Emerging Role of CMS in P4P Linda Magno Director, Medicare Demonstrations Group August 24, 2004 Why Medicare P4P? Quality & Patient Safety Significant room for improvement Significant
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 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 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 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 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 informationComparison of ACP Policy and IOM Report Graduate Medical Education That Meets the Nation's Health Needs
IOM Recommendation Recommendation 1: Maintain Medicare graduate medical education (GME) support at the current aggregate amount (i.e., the total of indirect medical education and direct graduate medical
More informationValue-based Purchasing: Trends in Ambulatory Care
August 17, 2011 The Tenth National Quality Colloquium Value-based Purchasing: Trends in Ambulatory Care Bettina Berman Project Director for Quality Improvement Jefferson School of Population Health Thomas
More informationFebruary 2007 ACP, AAFP, AAP, AOA joint statement
Patient Centered Medical Home in a Safety Net Community Health Clinic: The T Transformation f i off Eastside Adult Clinic Nicole Joseph, MD Denver Health GIM Grand G dr Rounds d February 7, 2012 OBJECTIVES
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 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 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 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 informationA Miracle of Modern Medicine. What medical discovery touches everyone in the United States?
Primary Care: A Miracle of Modern Medicine What medical discovery touches everyone in the United States? What medical breakthrough is proven to reduce the galloping growth of health care spending? What
More informationCare Coordination Overview. Janet Tennison, PhD UPV Standards October 8, 2013
Care Coordination Overview Janet Tennison, PhD UPV Standards October 8, 2013 What IS Care Coordination? The deliberate, proactive organization of patient care activities between two or more participants
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 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 informationTransformational Payment Reform: How will FQHC s survive?
Transformational Payment Reform: How will FQHC s survive? Arthur Chen, MD Senior Fellow/Family Practice Asian Health Services Oakland, CA artc@ahschc.org Learning Objectives Familiarity with major Payment
More informationCARE MANAGEMENT. within the PATIENT CENTERED MEDICAL HOME
CARE MANAGEMENT within the PATIENT CENTERED MEDICAL HOME Diane Cardwell, MPA, ARNP Practice Facilitator October 19, 2008 Care Management is a web of components that, when done right, creates a strong network
More informationPrimary Care 101: A Glossary for Prevention Practitioners
PREVENTION COLLABORATION IN ACTION Engaging the Right Partners Primary Care 101: A Glossary for Prevention Practitioners As the U.S. healthcare landscape continues to change under the Affordable Care Act
More informationFinancing of Community Health Workers: Issues and Options for State Health Departments
Financing of Community Health Workers: Issues and Options for State Health Departments ASTHO Technical Assistance Presentation Terry Mason, PhD Carl Rush, MRP Geoff Wilkinson, MSW This webinar is supported
More informationForces of Change- Seeing Stepping Stones Not Potholes
May 19, 2014 Forces of Change- Seeing Stepping Stones Not Potholes 2 3 4 Overview Demographics Long Term Care Financing Challenges Broad Health System Challenges Payment Reform Delivery System Reform Where
More informationJim Wotring, Gary Macbeth The Affordable Care Act
Jim Wotring, Gary Macbeth The Affordable Care Act National Technical Assistance Center for Children s Mental Health, Georgetown University 1 The Affordable Care Act What We are Going to Talk About Today
More informationAAFP Talking Points: Patient Centered Medical Home
November 2007 Patient Centered Medical Home What is a patient centered (or personal) medical home? The patient centered medical home model is based on the premise that the best health care is not episodic
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 informationSpecialty practices and primary care practices join forces in providing patient centered medical care
Welcome, Neighbor! Specialty practices and primary care practices join forces in providing patient centered medical care We often hear our patients express their frustration as they navigate among their
More informationIs HIT a Real Tool for The Success of a Value-Based Program?
Is HIT a Real Tool for The Success of a Value-Based Program? Sally Montes, MPH, RHIA, CCHP President, SM & Associates, Inc. smontes@sm-asociados.com (787) 306-1149 President, PR HFMA Chapter INTRODUCTION
More informationImplementing Health Reform: An Informed Approach from Mississippi Leaders ROAD TO REFORM MHAP. Mississippi Health Advocacy Program
Implementing Health Reform: An Informed Approach from Mississippi Leaders M I S S I S S I P P I ROAD TO REFORM MHAP Mississippi Health Advocacy Program March 2012 Implementing Health Reform: An Informed
More informationHOW WILL MINORITY-SERVING HOSPITALS FARE UNDER THE ACA?
HOW WILL MINORITY-SERVING HOSPITALS FARE UNDER THE ACA? Ashish K. Jha, MD, MPH Boston Medical Center, March 2012 Agenda for today s talk Why focus on providers that care for minorities and other underserved
More informationNew Models of Care- Looking at PCMH & Telehealth
New Models of Care- Looking at PCMH & Telehealth Paula Block, RN, BSN, Clinical Process Improvement Manager Montana Primary Care Association pblock@mtpca.org or 406.442.2750, ext. 1003 Agenda What is PCMH?
More informationHealthcare Workforce to Promote
Accreditation, Certification, and Credentialing: Levers for Training the Healthcare Workforce to Promote Children s Behavioral Health Marci Nielsen, PhD, MPH President & CEO Patient-Centered Primary Care
More informationPCMH and the Care of Complex High Cost Patients
PCMH and the Care of Complex High Cost Patients 15 th Annual International Summit on Improving Patient Care in the Office Practice and the Community March 10, 2014 Session A8/B8 Lucy Loomis, MD, MSPH,
More informationREPORT OF THE COUNCIL ON MEDICAL SERVICE. Hospital-Based Physicians and the Value-Based Payment Modifier (Resolution 813-I-12)
REPORT OF THE COUNCIL ON MEDICAL SERVICE CMS Report -I- Subject: Presented by: Referred to: Hospital-Based Physicians and the Value-Based Payment Modifier (Resolution -I-) Charles F. Willson, MD, Chair
More informationPaying for Primary Care: Is There A Better Way?
Paying for Primary Care: Is There A Better Way? Robert A. Berenson, M.D. Senior Fellow, The Urban Institute CHCS Regional Quality Improvement Initiative, Providence, R.I., July 25, 2007 1 Medicare Challenges
More informationBuilding Coordinated, Patient Centered Care Management Teams
Building Coordinated, Patient Centered Care Management Teams Jim Barr, MD CMO/VP Physician Network Development Optimus Healthcare Partners ACO & VP of Medical Services Aveta Health Solutions MSO Patient
More informationAttaining the True Patient-Center in the PCMH Through Health Coaching and Office-Based Care Coordination
Attaining the True Patient-Center in the PCMH Through Health Coaching and Office-Based Care Coordination Heartland Rural Physician Alliance Annual Conference IV May 8, 2015 William Appelgate, PhD, CPC
More informationNational ACO Summit. Third Annual. June 6 8, Follow us on Twitter and use #ACOsummit.
Third Annual National ACO Summit June 6 8, 2012 Follow us on Twitter at @ACO_LN and use #ACOsummit. Opening Plenary Session Welcome and Overview Mark McClellan, MD, PhD Director, Engelberg Center for Health
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 and the Accelerating Leap to Outcomes-Based Reimbursement. Craig J. Wilson
Population Health and the Accelerating Leap to Outcomes-Based Reimbursement Craig J. Wilson Agenda / Goals Define Population Health Management Review emerging reimbursement landscape eg MACRA Review why
More informationImproving Effectiveness in the PCMH. Shawn Stinson, MD FACP
Improving Effectiveness in the PCMH Shawn Stinson, MD FACP 1 Overview Introduction to BCBSSC PCMH program Must haves for successful outcomes in a primary care practice Agreement on evidence based practices
More informationVolume to Value Transition in the USA
Volume to Value Transition in the USA Lee A. Fleisher, M.D. Robert D. Dripps Professor and Chair of Anesthesiology Perelman School of Medicine at the University of Pennsylvania Email: lee.fleisher@uphs.upenn.edu
More informationTransforming a School Based Health Center into a Patient Centered Medical Home
Transforming a School Based Health Center into a Patient Centered Medical Home April 14, 2010 10:15 11:0 am Eugene F. Sun, MD, MBA Chief Medical Officer Molina Healthcare of New Mexico Outline Molina Healthcare
More informationRural Health A National Prospective. Alan Morgan Chief Executive Officer National Rural Health Association
Minnesota Rural Health Conference Rural Health A National Prospective Alan Morgan Chief Executive Officer National Rural Health Association NRHA Mission The National Rural Health Association is a national
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 informationRemaking Health Care in America
Remaking Health Care in America Joshua A. Derr Manager, Mayo Clinic Health Policy Center ASPMN National Conference 9/23/2010 2010 MFMER slide-1 2010MFMER slide-2 2010 MFMER slide-3 1 Source: New York Times
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 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 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 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 informationHealth Care Reform Provisions Affecting Older Adults and Persons with Special Needs 3/30/10
Health Care Reform Provisions Affecting Older Adults and Persons with Special Needs 3/30/10 On March 23, 2010, President Obama signed a comprehensive health care reform bill (H.R. 3590) into law. On March
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 informationFast-Track PCMH Recognition
Fast-Track PCMH Recognition i2i Systems integrated package of Population Health Management and reporting technology, documented processes and consulting services aligned with NCQA guidelines supports and
More informationNew Models of Care: Diabetes and the Triple Aim
Robert Gabbay MD, PhD, FACP Chief Medical Officer Joslin Diabetes Center Harvard Medical School Boston, MA The Triple Aim New Models of Care: Diabetes and the Triple Aim Healthcare is changing, what does
More informationJudith Schaefer, MPH MacColl Institute Missouri Foundation for Health September 27, 2010
Patient Centered Medical Home Judith Schaefer, MPH MacColl Institute Missouri Foundation for Health September 27, 2010 What is the Medical Home? History of Medical Home Pediatrics -Started as a movement
More informationSelf Care in Australia
Self Care in Australia A roadmap toward greater personal responsibility in managing health March 2009. Prepared by the Australian Self-Medication Industry. What is Self Care? Self Care describes the activities
More informationWHAT IT FEELS LIKE
PCMH and PCSP WHAT IT FEELS LIKE Presentation Outline Goals of the Patient Centered Medical Home and the Patient Centered Specialty Practice Identifying the Joint Principles Recognition Programs Standards
More informationPhysician Compensation From Volume to Value
Physician Compensation From Volume to Value Venson Wallin Managing Director BDO October 9, 2015 Venson Wallin - BDO Venson Wallin is a Managing Director in BDO Consulting, LLC and is the National Healthcare
More informationIntroducing AmeriHealth Caritas Iowa
Introducing AmeriHealth Caritas Iowa A presentation for Iowa providers. CPC; Q215 Iowa V1 Who We Are Who We Serve Agenda Our Mission AmeriHealth Caritas Iowa Why Partner With Us? Questions 2 2 Who We Are
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 informationMACRA for Critical Access Hospitals. Tuesday, July 26, 2016 Webinar
MACRA for Critical Access Hospitals Tuesday, July 26, 2016 Webinar MACRA presenters Harold D. Miller, President & CEO CHQPR Claudia Sanders, Sr. Vice President, Policy Development Andrew Busz, Policy Director,
More informationPolicy CHCS. Brief. Increasing Primary Care Rates, Maximizing Medicaid Access and Quality. Center for Health Care Strategies, Inc.
CHCS Center for Health Care Strategies, Inc. Increasing Primary Care Rates, Maximizing Medicaid Access and Quality Policy Brief By Tricia McGinnis, Julia Berenson, and Nikki Highsmith J ANUARY 2011 A s
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 information21 st Century Health Care: The Promise and Potential of a Learning Health System
21 st Century Health Care: The Promise and Potential of a Learning Health System Carolyn M. Clancy, MD Director Agency for Healthcare Research and Quality National Science Foundation Learning Health System
More informationHealthcare 2015: Win-win or lose-lose?
IBM Institute for Business Value Healthcare 2015: Win-win or lose-lose? A portrait and a path to successful transformation Presented at Disease Management Colloquium May 19, 2008 Jim Adams, IBM Center
More informationPiloting Bundled Medicare Payments for Hospital and Post-Hospital Care /
Piloting Bundled Medicare Payments for Hospital and Post-Hospital Care / A Study of Two Conditions Raises Key Policy Design Considerations March 2010 Policymakers are exploring many different models for
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 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 informationPatient Centered Medical Home The next generation in patient care
Patient Centered Medical Home The next generation in patient care Provider Training Module I OBJECTIVE To explain... What Patient Centered Medical Home is How it works Why it s important Where to begin
More informationUpdates from CMS: Value-Based Purchasing, ACOs, and Other Initiatives The Seventh National Pay for Performance Summit March 20, 2012
Updates from CMS: Value-Based Purchasing, ACOs, and Other Initiatives The Seventh National Pay for Performance Summit March 20, 2012 Presenters David Sayen, CMS Regional Administrator Betsy L. Thompson,
More informationExecutive Summary November 2008
November 2008 Purpose of the Study This study analyzes short-term risks and provides recommendations on longer-term policy opportunities for the Marin County healthcare delivery system in general as well
More informationAbout the National Standards for CYSHCN
National Standards for Systems of Care for Children and Youth with Special Health Care Needs: Crosswalk to National Committee for Quality Assurance Primary Care Medical Home Recognition Standards Kate
More informationOpportunities to Promote CV Risk Reduction within the PCMH. Objectives. Disclosure 4/15/2013
Opportunities to Promote CV Risk Reduction within the PCMH Cardiovascular Health Summit April 12, 2013 Billings, Montana F. Douglas Carr, MD, MMM, FACP Medical Director, Education & System Initiatives
More informationPEDIATRIC PRIMARY CARE and BEHAVIORAL HEALTH INTEGRATION
PEDIATRIC PRIMARY CARE and BEHAVIORAL HEALTH INTEGRATION AN OASIS IN THE FUTURE James N Bowen DO Chief Medical Officer The Guidance Center Flagstaff, AZ. WHAT WE WILL DISCUSS Why? What? How? When? WHY
More informationImproving Patient-Centered Medical Home (PCMH) Recognition: Board-Endorsed Recommendations of the PCPCC Accreditation Work Group
Improving Patient-Centered Medical Home (PCMH) Recognition: Board-Endorsed Recommendations of the PCPCC Accreditation Work Group BACKGROUND: Patient-Centered Primary Care Collaborative November 2015 The
More informationWelcome to. Primary Care and Public Health: Linking Public Health and Advanced Primary Care to Improve Outcomes
Welcome to ASTHO s Delivery and Payment Reform Technical Assistance Call Series Primary Care and Public Health: Linking Public Health and Advanced Primary Care to Improve Outcomes Presented by ASTHO and
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 informationBundled Payments Physician Engagement Issues
Bundled Payments Physician Engagement Issues George Isham, M.D., M.S. Chief Health Officer I tit t f M di i Institute of Medicine Washington, D.C. September 09, 2009 Many Policy Experts are Advocating
More informationManaged care consulting services
Managed care consulting services WeiserMazars Health Care Consulting Services WeiserMazars LLP is an independent member firm of Mazars Group. WeiserMazars Health Care Group Managed Care consulting services
More information