Value Based Purchasing ACO Total Cost of Care ASHP 12 12
Planning Challenges in a Value Based Purchasing (VBP) Environment Bonnie Senst, M.S., R.Ph., FASHP Director of Pharmacy Allina Health
DisclosureBonnie Senst reports no relevant financial relationships
Allina Health Integrated health system in MN and Western WI Mission: We serve our communities by providingexceptional care, as we prevent illness, restore health and provide comfort to all who entrust us with their care. 11 hospitals Allina home and 24 hospital based clinics community services • Hospice, care 60 physician clinics management, home care, 5 ambulatory care home oxygen and medical centers equipment, senior care transitions 15 community pharmacy sites
Objectives Describe Medicare’s Value Based Purchasing (VBP) program Review VBP clinical and patient experience measures and timelines Discuss paradigm changes resulting from VBP and Accountable Care Organization (ACO) models Identify implications for pharmacy of VBP and ACOs
Case for Change Health care expenditures Waste in health care cost Poor coordination of care/transitions Harm during care Lack of patient involvement
CMS Medicare Value Based Pricing Redistributes acute hospital fee-for-service (FFS) payments between hospitals based on quality performance scores Hospital funding reduced by 1% in FY 2013. Rises to 2% by FY 2017. Hospital incentives to achieve clinical and patient experience care quality measures Yearly reset of clock
Process of Care Measures – FY 2013 Measures Number Scoring AMI X2 HF X1 PN X2 Achievement X5 and SCIP (one 2014) Improvement SCIP VTE X 2 SCIP CARD
Patient Experience – FY 2013 Measure Scoring Overall rating Nursing communication Physician communication 8 Measure ScoresCommunication about medications and Staff responsiveness Consistency Environment Pain management Discharge instructions
Outcome Measures – FY 2014/2015 Measure AMI 30 day mortality HF 30 day mortality PN 30 day mortality AHRQ PSI Central Line Infection Efficiency – FY 2015 Measure Total Medicare spending per beneficiary
Measures of success in transformed care Better care for individuals Better health for the community Reduction in the trend of health care costs
Changing Paradigms Discipline specific care Care teams Quality Quality reporting and mandates, consistency, rel improvement iability Selective reporting Data transparency Pay for quality outcomes Pay for volume and value Alignment across Silos of care continuumReimbursement pressure Total cost of care
Implications Significant pharmacy demand and potential impact Working in current world and new world concurrently Skills and technical support systems required for TCOC Coordination of care beyond walls and health systems Placement of resources at optimal points in care continuum Compete and collaborate simultaneously Actively engage patients in their care
Gostou de algum slide específico?
Recortar slides é uma maneira fácil de colecionar informações para acessar mais tarde.