Strategic Alignment in Health Care
|
|
- Alban Robbins
- 5 years ago
- Views:
Transcription
1 Strategic Alignment in Health Care Presented to CAJPA Fall Conference 9/15/16 1
2 Transforming Care Delivery Value-Based Pay for Performance Oncology Practice of the Future Maternity Care Focus - C-Sections Choosing Wisely Narcotic Safety Initiative
3 Transformation to value-based care Health Care today Providers are fragmented and unable to coordinate care well Fee for service payment systems drive fragmentation, rewards unnecessary care Inconsistent quality with no line of sight for member care across the continuum Principles of Value-Based Care Pay for VALUE, not volume Rewards and incentives for quality, health outcomes, and patient satisfaction Providing doctors and hospitals with tools and real-time patient data to transform their practices Integration of patient care across the care continuum Helping consumers to become active in their healthcare through transparency and technology 3
4 Evidence clearly shows that more does not equal better care. Studies estimate 30 cents of every healthcare dollar goes to care that is ineffective or redundant. 4
5 Healthcare Costs The Challenge Drivers of Cost: Fragmentation Lack of accountability & coordination Narrow focus of providers Waste/redundancy Difficult system for consumers to navigate Today 5
6 Shifting paradigms Fragmented health care based on fee for service model Coordinated experiences founded on pay for performance Passive involvement Member is empowered and actively engaged
7 Brief History of Value-Based Pay for Performance (VBP4P) A shared savings incentive program to stem the commercial HMO cost trend in CA while continuing to improve quality. Statewide collaboration: The Integrated Healthcare Association (IHA) Health plans Physician organizations (POs). Pay for Performance (P4P) launched in 2001 and expanded to include Valued-Based Incentives in 2013 to address utilization and cost management. 10 health plans and more than 200 California Provider Organizations caring for 9 million Californians in commercial HMOs or POS.
8 What Does VB P4P Look Like at BSC? BSC began participating in VB P4P closely tracks with Our mission as a not-for-profit health plan, to ensure all Californians have access to high-quality health care at an affordable price Our Values: creative solutioning and agility, while acting with integrity to get results. Our Strategic Truths: To Change the Game and to Be Bold and Think Big Reinforces that providers can impact the highest dollar care services while actively maintaining quality standards. To date, BSC has awarded over $137M to participating Provider Organizations.
9 VB P4P Goals VB P4P incentivizes Provider Organizations throughout the course of the program while Blue Shield assesses the ability of each participating Provider Organization to: Improve population health outcomes in key clinical areas; Ensure patient satisfaction; Align with CMS meaningful use of health information technology; Manage the overall cost of care; and Encourage patients to access appropriate care resources.
10 How Is Performance Measured? Three domains in the VB P4P program design: 1. Quality: Prevention and chronic care management measures Patient experience measures from the Patient Assessment Survey Meaningful use of HIT to improve patient care 2. Total Cost of Care (TCC): The actual costs associated with care for members attributed to a PO 3. Appropriate Resource Units (ARU): A set of efficiency measures to improve the delivery of appropriate and quality care
11 Tomorrow s healthcare starting today 11
12 Specialty Care Management: Oncology cancer care today oncology practice of the future Rapid paradigm shift in diagnosis & treatment approach, from cancer site to tumor genomic profile Care not evidence-based in up to 30% of adult cancer patients Patients not well informed of diagnosis, treatment options, likely outcomes & cost Quality of cancer care not well measured Provider and drug reimbursement not aligned with rational care Patient wishes for care at end of life not documented/followed Scientifically advanced molecular diagnostics & personalized therapy Real-time clinical decision support to promote evidence based medicine Embedded shared decision making & delivery of preference-concordant care Robust quality metrics, including patient-reported outcomes Reimbursement that rewards quality and value Respect for patient autonomy throughout care & end of life
13 Oncology practice of the future Whole-person, patient-centered care Compensation models reflecting quality and value Delivery of evidence-based medicine, and faster adoption of it into practice Ongoing processes to assess and address patient needs, with support that extends beyond the clinical setting Shared decision making to align treatment selection with patient s preferences and values
14 Maternity Care Focus: C-sections Blue Shield has joined Covered California, California Maternal Quality Care Collaborative (CMQCC) and Leapfrog Group, among others, to address the troubling trend of increasing C-section rates. Our goal is to lower the nulliparous term singleton vertex (NTSV) cesarean section rate to the Healthy People 2020 target of 23.9%, the emerging standard. How will we do this? Five pronged approach involving the member, physician and hospital in a collaborative environment.
15 Maternity Care Focus: C-sections Member Engagement: Our Prenatal Program features collateral and telephonic coaching that educates women that C-section is major surgery. Our program also promotes text4baby, a free text messaging service for pregnant women and new moms. Physician Engagement: Our Provider Education Program a collaboration of Quality Improvement and MCS Enhanced Clinical Programs is under development and will provide to providers with key messages and evidence-based practice guidelines from expert sources. Hospital Engagement: Our plan to address low-performing hospitals in targeted rating regions (managed by the Regional Delivery Network team) will use Maternal Data Center tools as well other elements that are under review. Contracting: We re working to align incentives for POs and hospitals. We have piloted blended case rates in two hospitals and are reviewing the data for possible expansion. Data: Key to measurement and improvement using the Plan-Do-Check- Act model is key. Blue Shield has encouraged its hospital partners to participate in the Maternal Data Center and 90% of ACO hospitals are now participating
16 What is Choosing Wisely 100+ campaign topics Specialty society endorsed All in Plain English and Spanish Support conversations PDFs, for easy printing Suited for , linking, hosting Suited for clinic display/handouts Great for social media posting To access the free Consumer Reports materials: ConsumerHealthChoices.org/Choosing Source: Consumer Reports
17 Examples of Choosing Wisely Materials: Pregnancy Care Source: Consumer Reports
18 Examples of Choosing Wisely Materials: Cancer Care Source: Consumer Reports
19 How Is BSC Supporting The Choosing Wisely Campaign? National Grantee In 2015 BSC helped form a collaborative including the Institute for Healthcare Improvement, Sharp Rees-Stealy Medical Group, Sutter Health and California chapter of the American College of Physicians. The goal of the collaborative is to leverage the Choosing Wisely materials to reduce overuse by 20% in 5 key areas within 3 years: Avoidance of antibiotics for adults with acute bronchitis Imaging for uncomplicated headache Don t perform repetitive CBC and chemistry testing Imaging for nonspecific low back pain Preoperative stress testing Our collaborative is one of only 14 collaboratives nationally to receive grant funding from ABIM Foundation and the Robert Woods Johnson Foundation. BSC also takes part in the California State Workgroup on Reducing Overuse co-chaired by CalPERS, the California Department of Health Care Services and Covered California, to address overuse of selected medical care across public and private payers.
20 How Is BSC Supporting The Choosing Wisely Campaign? Statewide Policy Development BSC takes part in the California State Workgroup on Reducing Overuse co-chaired by CalPERS, the California Department of Health Care Services and Covered California, to address overuse of selected medical care across public and private payers. Collectively the workgroup covers 15 million California consumers. The charter of the workgroup is to develop, initiate, monitor and evaluate approaches to reducing the overuse of selected unnecessary and wasteful medical services in CA. The statewide workgroup is primarily focusing on reducing: Cesarean section for low-risk, first-time birth Diagnostic imaging for low back pain Opioid overuse
21
22
23
24
25
26
ACOs: 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 informationMedi-Cal Performance Measurement: Making the Leap to Value-Based Incentives. Dolores Yanagihara IHA Stakeholders Meeting October 3, 2018
Medi-Cal Performance Measurement: Making the Leap to Value-Based Incentives Dolores Yanagihara IHA Stakeholders Meeting October 3, 2018 Why Standardization? MEDI-CAL CROSS PRODUCT San Francisco Health
More informationtransforming california s healthcare safety net through value-based care
issue brief transforming california s healthcare safety net through value-based care The Patient Protection and Affordable Care Act (ACA) continues to provide California with an extraordinary opportunity
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 informationKristen Miranda Vice President Strategic Partnerships and Innovation March 20, 2013
california case study: a model for accountable care Kristen Miranda Vice President Strategic Partnerships and Innovation March 20, 2013 1 program framework and core tenets To achieve measurable results,
More informationCase Study: Maternity Payment and Care Redesign Pilot
Case Study: Maternity Payment and Care Redesign Pilot October 2015 1 For more information, contact: Brynn Rubinstein, MPH Senior Manager Transform Maternity Care brubinstein@pbgh.org 2 Large variation
More information2018 Hospital Pay For Performance (P4P) Program Guide. Contact:
2018 Hospital Pay For Performance (P4P) Program Guide Contact: QualityPrograms@iehp.org Published: December 1, 2017 Program Overview Inland Empire Health Plan (IEHP) is pleased to announce its Hospital
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 informationW. Douglas Weaver, MD, MACC. American College of Cardiology SENATE FINANCE COMMITTEE
Statement of W. Douglas Weaver, MD, MACC On behalf of the American College of Cardiology Presented to the SENATE FINANCE COMMITTEE Roundtable on Medicare Physician Payments: Perspectives from Physicians
More informationReport from the National Quality Forum: National Priorities Partnership Quarterly Synthesis of Action In Support of the Partnership for Patients
Report from the National Quality Forum: National Priorities Partnership Quarterly Synthesis of Action In Support of the Partnership for Patients August 2012 Supporting Patient Safety through the National
More informationThe influx of newly insured Californians through
January 2016 Managing Cost of Care: Lessons from Successful Organizations Issue Brief The influx of newly insured Californians through the public exchange and Medicaid expansion has renewed efforts by
More informationProgram Overview
2015-2016 Program Overview 04HQ1421 R03/16 Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross and Blue Shield Association and incorporated as Louisiana Health Service
More informationEvolution of ACOs in California. Accountable Care Congress Los Angeles November 11, 2014 Jill Yegian, Ph.D.
Evolution of ACOs in California Accountable Care Congress Los Angeles November 11, 2014 Jill Yegian, Ph.D. Integrated Healthcare Association Statewide multi stakeholder leadership group that promotes quality
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 informationExecutive Summary 1. Better Health. Better Care. Lower Cost
Executive Summary 1 To build a stronger Michigan, we must build a healthier Michigan. My vision is for Michiganders to be healthy, productive individuals, living in communities that support health and
More 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 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 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 informationFQHC Incentive Payments: A Critical Practice for Quality and Patient Satisfaction
FQHC Incentive Payments: A Critical Practice for Quality and Patient Satisfaction Meaghan McCamman Assistant Director of Policy California Primary Care Association 1 Agenda Incentives in PPS: what does
More information10/6/2017. FQHC Incentive Payments: A Critical Practice for Quality and Patient Satisfaction. Agenda. Incentives in PPS: what does excludable mean?
FQHC Incentive Payments: A Critical Practice for Quality and Patient Satisfaction Meaghan McCamman Assistant Director of Policy California Primary Care Association Agenda Incentives in PPS: what does excludable
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 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 informationNote: Accredited is the highest rating an exchange product can have for 2015.
Quality Overview Accreditation Exchange Product Accrediting Organization: NCQA HMO (Exchange) Accreditation Status: Accredited Note: Accredited is the highest rating an exchange product can have for 215.
More informationapproved Nevada s State Innovation Model (SIM) Round October 2015 Division of Health Care Financing and Policy Introduction to SIM
Nevada State Innovation Model (SIM) October 2015 1 Introduction to SIM The Center for Medicare and Medicaid Services (CMS) approved Nevada s State Innovation Model (SIM) Round Two application to improve
More informationBlue Cross Blue Shield of Michigan Advancing to the Next Generation of Value Based Pay for Performance
Blue Cross Blue Shield of Michigan Advancing to the Next Generation of Value Based Pay for Performance Physician Group Incentive Program, Patient Centered Medical Homes, and Moving From Fee for Service
More informationUC HEALTH. 8/15/16 Working Document
1) UC Health Mission Our mission is to make health care better. Each UC health system works to advance this mission in its community and as a system of health systems, we work together to catalyze innovation
More informationTransforming Maternity Care
Transforming Maternity Care Blueprint for Action: Steps Toward a High Quality, High Value Maternity Care System Opportunities for Health Plans NIHCM, April 13, 2010 R. Rima Jolivet, CNM, MSN, MPH Transforming
More informationCIGNA Collaborative Accountable Care
CIGNA Collaborative Accountable Care Connecting in ways that help make achieving health easier, more effective and more affordable October 14, 2016 Michael L. Howell, MD, MBA, FACP Market Medical Executive/Sr.
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 informationmember handbook blueshieldca.com/bscbluegroove
member handbook blueshieldca.com/bscbluegroove With Main Groove, you get a Personal Physician from our medical provider network, and predictable, lower outof-pocket costs than with Basic Groove, plus access
More informationBlue Cross Blue Shield of Michigan. Organized Systems of Care
Blue Cross Blue Shield of Michigan Organized Systems of Care 1 PGIP: Catalyzing Health System Transformation in Partnership with Providers 2005 2006 2007 2008 2009 2010 2011 2012 PGIP Chronic Care Model
More informationSucceeding with Accountable Care Organizations
Succeeding with Accountable Care Organizations The Point B Webinar Series October 25, 2011 Today s Discussion Key ACO trends and emerging models Critical success factors for building an ACO Developing
More 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 informationState Medicaid Directors Driving Innovation: Continuous Quality Improvement February 25, 2013
State Medicaid Directors Driving Innovation: Continuous Quality Improvement February 25, 2013 The National Association of Medicaid Directors (NAMD) is engaging states in shared learning on how Medicaid
More informationBuilding the Oncology Medical Home John D. Sprandio, M.D., FACP Consultants in Medical Oncology & Hematology, P.C. Oncology Management Services, LLC
Building the Oncology Medical Home John D. Sprandio, M.D., FACP Consultants in Medical Oncology & Hematology, P.C. Oncology Management Services, LLC Oncology Patient-Centered Medical Home Update Background
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 informationPiloting Performance Measurement of Physician Organizations in Medi-Cal Managed Care: Findings and Implications
Issue Brief No. 13 January 2015 Piloting Performance Measurement of Physician Organizations in Medi-Cal Managed Care: Findings and Implications Ann Hardesty, Project Manager Jill Yegian, Senior Vice President,
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 informationCore Metrics for Better Care, Lower Costs, and Better Health
Core Metrics for Better Care, Lower Costs, and Better Health IOM Roundtable on Value & Science-Driven Health Care September 27, 2012 Washington, D.C. Sam Nussbaum, M.D. Executive Vice President, Clinical
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 informationMedicaid Reform in Iowa. Kirk Norris President/CEO Iowa Hospital Association
Medicaid Reform in Iowa Kirk Norris President/CEO Iowa Hospital Association Iowa Medicaid Expansion The Iowa Health and Wellness Plan Began January 1, 2014 Covers Iowans age 19-64 with incomes to 138%
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 informationReport from the National Quality Forum: National Priorities Partnership Quarterly Synthesis of Action In Support of the Partnership for Patients
Report from the National Quality Forum: National Priorities Partnership Quarterly Synthesis of Action In Support of the Partnership for Patients November 30, 2012 Quarterly Update at a Glance Since the
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 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 informationCare Redesign: An Essential Feature of Bundled Payment
Issue Brief No. 11 September 2013 Care Redesign: An Essential Feature of Bundled Payment Jett Stansbury Director, New Payment Strategies, Integrated Healthcare Association Gabrielle White, RN, CASC Executive
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 informationCenters for Medicare & Medicaid Services: Innovation Center New Direction
Centers for Medicare & Medicaid Services: Innovation Center New Direction I. Background One of the most important goals at CMS is fostering an affordable, accessible healthcare system that puts patients
More informationSUCCESSES OF VIRGINIA S SIM DESIGN
SUCCESSES OF VIRGINIA S SIM DESIGN SIM Structure Process + Strategy Convened hundreds of stakeholders from all regions and constituencies to develop solutions to some of our most complex health care challenges.
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 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 informationStandardizing Medi-Cal Pay for Performance Advisory Committee Meeting. November 3, 2016
Standardizing Medi-Cal Pay for Performance Advisory Committee Meeting November 3, 2016 Agenda Welcome & Introductions Core Measure Set MY 2017 EAS Measure Set Update Benchmarks Core Measure Set Adoption
More informationRe: Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations, Proposed rule.
June 3, 2011 Donald Berwick, MD Administrator Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1345-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore,
More informationVirtual Meeting Track 2: Setting the Patient Population Maternity Multi-Stakeholder Action Collaborative. May 4, :00-2:00pm ET
Virtual Meeting Track 2: Setting the Patient Population Maternity Multi-Stakeholder Action Collaborative May 4, 2017 1:00-2:00pm ET Highlights and Key Takeaways MAC members participated in the virtual
More informationPhysician Alignment Strategies and Options. June 1, 2011
Physician Alignment Strategies and Options June 1, 2011 1 Today s Discussion Review physician-hospital alignment objectives Understand the changing paradigm Evaluate alignment strategies for a new delivery
More informationValue Based P4P MY 2016 Total Cost of Care Preliminary Results. February 27, 2018 Lindsay Erickson, Director Thien Nguyen, Project Manager
Value Based P4P MY 2016 Total Cost of Care Preliminary Results February 27, 2018 Lindsay Erickson, Director Thien Nguyen, Project Manager Agenda Total Cost of Care measure overview Methodology Update MY
More informationCare Coordination is More Than a Care Coordinator
Care Coordination is More Than a Care Coordinator Jennifer P. Lundblad, PhD, MBA CA State Rural Health Association November 7, 2013 Objectives As a result of this session, participants will: Understand
More informationA strategy for building a value-based care program
3M Health Information Systems A strategy for building a value-based care program How data can help you shift to value from fee-for-service payment What is value-based care? Value-based care is any structure
More informationCoastal Medical, Inc.
A Culture of Collaboration The Organization Physician-owned group Currently 19 offices across the state of Rhode Island and growing 85 physicians, 101 care providers The Challenge Implement a single, unified
More informationValue Based P4P Program Updates MY 2017 & MY 2018
Value Based P4P Program Updates MY 2017 & MY 2018 January 31, 2018 Lindsay Erickson, Director Ginamarie Gianandrea, Senior Program Coordinator Thien Nguyen, Project Manager Brandi Melville, Health Care
More informationCalifornia Community Health Centers
California Community Health Centers Financial & Operational Performance Analysis, 2011-2014 Prepared by Sponsored by Blue Shield of California Foundation Introduction This report, prepared by Capital Link
More informationFor fully insured groups of 100 or more eligible employees. HealthyOutcomes. A fully-integrated health management solution that works for you
For fully insured groups of 100 or more eligible employees HealthyOutcomes wellness case management condition care maternity A fully-integrated health management solution that works for you HealthyOutcomes
More informationTelehealth: Overcoming the challenges of implementing innovative health care solutions
Telehealth: Overcoming the challenges of implementing innovative health care solutions NRTRC 5 TH ANNUAL CONFERENCE MARCH 22, 2016 ROKI CHAUHAN, MD, FAAFP Disclaimer 2 The material presented here is being
More informationMedical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management
G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify Medical Management G.6 When to Notify Medical Management G.11 Case Management Services G.14 Special Needs Services
More informationLaying the Foundation for Successful Clinical Integration
The Governance Institute Laying the Foundation for Successful Clinical Integration Webinar November 29, 2011, 2:00pm ET/11:00am PT Daniel M. Grauman President & CEO DGA Partners, Bala Cynwyd, PA dgrauman@dgapartners.com
More informationAdvancing Quality & Improving Care: Getting to the Results that Matter. Shantanu Agrawal, MD, MPhil October 9, 2018
Advancing Quality & Improving Care: Getting to the Results that Matter Shantanu Agrawal, MD, MPhil October 9, 2018 Results with National Impact Lives saved Drop in early elective delivery rates 2010-2016
More 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 informationTRANSFORMING HEALTHCARE DELIVERY A Pathway to Affordable, High-Quality Care in America
TRANSFORMING HEALTHCARE DELIVERY A Pathway to Affordable, High-Quality Care in America TABLE OF CONTENTS Executive Summary... 3 A Pathway to Affordable, High-Quality Care in America... 7 Appendix... 18
More informationFrequently Asked Questions
Frequently Asked Questions What is the Compass Practice Transformation Network (Compass PTN)? The Compass Practice Transformation Network (Compass PTN) was founded by the Iowa Healthcare Collaborative
More informationConsumer Preferences, Hospital Choices, and Demand-side Incentives
Consumer Preferences, Hospital Choices, and Demand-side Incentives David I Auerbach, PhD Director of Research, Massachusetts Health Policy Commission Co-authors: Amy Lischko, Susan Koch-Weser, Sarah Hijaz
More informationMedical Management. G.2 At a Glance. G.2 Procedures Requiring Prior Authorization. G.3 How to Contact or Notify Medical Management
G.2 At a Glance G.2 Procedures Requiring Prior Authorization G.3 How to Contact or Notify G.4 When to Notify G.7 Case Management Services G.10 Special Needs Services G.12 Health Management Programs G.14
More informationHitting a Grand Slam. The Four Trends. Today s Objectives 3/20/ Trends that Streamline Clinical Operations & Save Financial Resources
Hitting a Grand Slam 4 Trends that Streamline Clinical Operations & Save Financial Resources Carolyn J. Humphrey, RN, MS, FAAN President, CJ Humphrey Associates The Four Trends Evidence based Clinical
More informationAdvances in Osteopathic Medicine
Advances in Osteopathic Medicine Moving the value of osteopathic care from patients to populations Richard Snow DO, MPH Applied Health Services - Principal Choptank Community Health System Primary Care
More informationVALUE BASED ORTHOPEDIC CARE
VALUE BASED ORTHOPEDIC CARE Becker's 14th Annual Spine, Orthopedic and Pain Management- Driven ASC Conference + The Future of Spine June 9-11, 2016 Swissotel, Chicago, IL LES JEBSON Administrator, Adjunct
More informationThe New York State Value-Based Payment (VBP) Roadmap. Primary Care Providers March 27, 2018
The New York State Value-Based Payment (VBP) Roadmap Primary Care Providers March 27, 2018 1 Housekeeping All lines have been muted To ask a question at any time, use the Chat feature in WebEx We will
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 informationUsing An APCD to Inform Healthcare Policy, Strategy, and Consumer Choice. Maine s Experience
Using An APCD to Inform Healthcare Policy, Strategy, and Consumer Choice Maine s Experience What I ll Cover Today Maine s History of Using Health Care Data for Policy and System Change Health Data Agency
More 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 informationQuality of Life Conversation On Advance Care Planning
Quality of Life Conversation On Advance Care Planning Information Packet Page 1 About the Integrated Healthcare Association The nonprofit Integrated Healthcare Association (IHA) convenes diverse stakeholders,
More informationModels of Accountable Care
Models of Accountable Care Medical Home, Episodes and ACOs Making it work Elliott Fisher, MD, MPH Director, Population Health and Policy The Dartmouth Institute for Health Policy and Clinical Practice
More informationPartnering with Public Health Departments in Managed Care. THIS AREA CAN BE LEFT BLANK or ADD A PICTURE
Partnering with Public Health Departments in Managed Care THIS AREA CAN BE LEFT BLANK or ADD A PICTURE 2/3/2017 The Value of Medicaid Managed Care States Have Seen the Value of Medicaid Managed Care 75
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 informationDRIVING VALUE-BASED POST-ACUTE COLLABORATIVE SOLUTIONS. Amy Hancock, CEO Presented to: CPERI April 16, 2018
DRIVING VALUE-BASED POST-ACUTE COLLABORATIVE SOLUTIONS Amy Hancock, CEO Presented to: CPERI April 16, 2018 Cross-Continuum Road-Mapping Post-acute partners are beginning to utilize tools to identify new
More informationChallenges and Opportunities for Improving Health and Healthcare in Ohio through Technology
Challenges and Opportunities for Improving Health and Healthcare in Ohio through Technology Ohio Health IT Advocacy Day Craig Brammer, CEO cbrammer@healthbridge.org @CraigABrammer Challenge #1: Information
More 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 informationPatient-Centered Specialty Practice: Building the Medical Neighborhood
Patient-Centered Specialty Practice: Building the Medical Neighborhood Margaret E. O Kane President, National Committee for Quality Assurance June 6, 2014 1 Overview Central challenge: Creating systems
More information5D QAPI from an Operational Approach. Christine M. Osterberg RN BSN Senior Nursing Consultant Pathway Health Pathway Health 2013
5D QAPI from an Operational Approach Christine M. Osterberg RN BSN Senior Nursing Consultant Pathway Health Objectives Review the post-acute care data agenda. Explain QAPI principles Describe leadership
More informationThe MetroHealth System
The MetroHealth System June 16, 2016 Presentation to Ohio Joint Medicaid Oversight Committee Dr. James Misak, Vice Chair of Community and Population Health, Department of Family Medicine Susan Mego, Executive
More informationSaint Francis Care and Cigna CAC Meeting the Triple Aim Together
Saint Francis Care and Cigna CAC Meeting the Triple Aim Together Christopher M. Dadlez, President and CEO Saint Francis Care Jess Kupec, President and CEO Saint Francis HealthCare Partners 22 nd Annual
More informationBuilding an Ambulatory System of Care: Using Population Health to Combat Secular Trends & Achieve the Triple Aim
Building an Ambulatory System of Care: Using Population Health to Combat Secular Trends & Achieve the Triple Aim Christopher T. Olivia, MD, President June 11, 2014, All Rights Reserved and CONTINUUM HEALTH
More informationInformation for a Healthy Oregon. Statewide Report on Health Care Quality
Information for a Healthy Oregon Statewide Report on Health Care Quality 2014 Welcome Letter from the Board Chair and Executive Director One of our favorite sayings is data flows at the speed of trust.
More informationMaking Cent$ of Health Care Costs
Making Cent$ of Health Care Costs Bob Morrow, MD, MBA Market President, Houston & Southeast Texas Blue Cross and Blue Shield of Texas A Division of Health Care Service Corporation, a Mutual Legal Reserve
More informationTrends in State Medicaid Programs: Emerging Models and Innovations
Trends in State Medicaid Programs: Emerging Models and Innovations Speakers: Barbara Edwards, Principal, Steve Fitton, Principal, Tina Edlund, Managing Principal, Moderator: Annie Melia, Information Services
More informationWashington State T ransparency. Dorothy Teeter, HCA Director March 26, 2014 IHA Pay for Performance Summit
Washington State T ransparency Dorothy Teeter, HCA Director March 26, 2014 IHA Pay for Performance Summit Washington The Evergreen State Progressive, forward thinking Home to: Boeing, Amazon, Expedia,
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 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 informationCAHPS Focus on Improvement The Changing Landscape of Health Care. Ann H. Corba Patient Experience Advisor Press Ganey Associates
CAHPS Focus on Improvement The Changing Landscape of Health Care Ann H. Corba Patient Experience Advisor Press Ganey Associates How we will spend our time together Current CAHPS Surveys New CAHPS Surveys
More informationMedicaid Payment Reform at Scale: The New York State Roadmap
Medicaid Payment Reform at Scale: The New York State Roadmap ASTHO Technical Assistance Call June 22 nd 2015 Greg Allen Policy Director New York State Medicaid Overview Background and Brief History Delivery
More informationSelf-Insured Schools of California: Schools Helping Schools
Schools Helping Schools SISC III SELF-INSURED SCHOOLS OF CALIFORNIA ACCESS+ HMO PLAN Self-Insured Schools of California: Schools Helping Schools 2012 Enrollment Guide 2012 Enrollment Guide Schools Helping
More informationSection IX Special Needs & Case Management
Section IX Special Needs & Case Management Special Needs and Case Management 181 Integrated Health Care Management (IHCM) The Integrated Health Care Management (IHCM) program is a population-based health
More information