Volume to Value Based Healthcare Dr. Thilo Koepfer, VP International, 3M Health Information Systems
Learning Objectives 1. Explain the Triple Aim as developed by the Institute of Healthcare Improvement 2. Understand the differences between volume vs. value based reimbursement in the healthcare setting 3. Discuss examples of healthcare systems using value based components of reimbursement and their impact on outcomes
Introduction 3M Health Information Systems 30 years of Global Experience Implementing & Supporting Patient Classifications Classification Development & Maintenance USA CANADA UK AUSTRALIA HONG-KONG GERMANY Support for DRG Introduction BELGIUM CHILE GERMANY HONG-KONG QATAR SINGAPORE SPAIN UAE Computation of Relative Weights GERMANY ITALY PORTUGAL SINGAPORE SPAIN Reimbursement and Fee Schedule Development GERMANY QATAR USA Quality and Value-Based Initiatives GERMANY SPAIN USA Population-Based Initiatives CANADA ITALY SPAIN USA
Healthcare System in the U.S. today
Institute for Healthcare Improvement Improving the patient experience of care (including quality and satisfaction) Improving the health of populations Reducing the per capita cost of health care
Better Health, Better Care, Lower Cost Alignment of cost, quality, performance Define quality from the perspective of an individual member of a defined population IHI Triple Aim Health care Public health Social services Individuals and families Definition of primary care Integration Per capita cost reduction System-level metrics Source: Institute for Healthcare Improvement, 2012 Prevention and health promotion
The IHI Approach Identify target populations Define system aims and measures Develop a portfolio of project work, sufficiently strong to move system-level results Rapid testing and scale up, adapted to local needs and conditions
Making the Transition to Value-based Care Volume-based health care One problem with the volume-based model is the incentives between providers, insurers and patients are misaligned. Fee-for-service and volume are about individual services: The more services you provide, the more you get paid. Value-based health care In a value-based system, the core measurement is no longer units of service, but population count. Providers will be paid according to how healthy their patients are, held accountable for cost and quality, and measured on performance.
The Benefits of Population Health Management
3M Tools Enable Transparency and Help Contain Costs Expert Driven, Enabling Advanced Variability Analysis Inpatient & Outpatient Risk Adjusted, Linking Clinical Patterns to Cost Population Health Patient Centered Risk Adjusted Data, Quality & Patient Safety Measures, Total Cost of Care APR DRGs All Patient Refined Diagnosis Related Groups EAPGs Enhanced Ambulatory Patient Groups IR-DRGs International Refined Diagnosis Related Groups CRGs Clinical Risk Groups PPCs Potentially Preventable Complications PPRs Potentially Preventable Readmission s PFEs Patient Focused Episodes PFPs Population Focused Preventables Inpatient Grouper Severity and Risk of Mortality Outpatient Grouper International Grouper In & Outpatient Health status Grouper Identify preventable complications Value Index Score Identify preventable readmissions PPV Potentially Preventable ED Visits Defines 700+ patient episodes PPA Potentially Preventable Initial Admissions PPS Potentially Preventable Services
Maryland Quality-Based Reimbursement Program MARYLAND PROGRAM RULES 2009 2011 RESULTS MEDICARE OPPORTUNITY Extrapolated from 2-year Maryland s 6% inpatient cost savings to Medicare s Fee-for-Service national program
Minnesota Reducing Avoidable Readmissions Effectively (RARE Campaign) THE CAMPAIGN THE RESULTS RECOGNITION
Colorado Accountable Care Collaborative
Colorado Accountable Care Collaborative
Conclusions Population health management is not a one and done endeavor. Measuring outcomes against expected targets is an ongoing component that is vital to overall success.
REFERENCES 1. Stiefel M, Nolan K. A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2012. 2. http://www.ihi.org/engage/initiatives/tripleaim/pages/default.aspx 3. Sule Calikoglu, Robert Murray and Dianne Feeney Hospital Pay-For-Performance Programs In Maryland Produced Strong Results, Including Reduced Hospital-Acquired Conditions, Health Affairs 31, no.12 (2012):2649-2658 doi: 10.1377/hlthaff.2012.0357 4. www.rarereadmissions.org; Patient Safety Monitor Journal, Volume 15, Issue 5: pp1, May 2014. 5. www.colorado.gov/pacific/hcpf/accountable-care-collaborative; Creating a Culture of Change, Annual report 2014 6. 3M Health Information Systems, Inc., www.3mhis.com
Questions?
Thank You!