Planning Challenges in a Value Based   Purchasing (VBP) Environment       Bonnie Senst, M.S., R.Ph., FASHP             Dir...
DisclosureBonnie Senst reports no relevant financial relationships
Allina Health     Integrated health system in MN and Western WI    Mission: We serve our communities by providingexception...
Objectives Describe Medicare’s Value Based Purchasing (VBP)  program Review VBP clinical and patient experience measures...
Case for Change Health care expenditures Waste in health care cost Poor coordination of care/transitions Harm during c...
CMS Medicare Value Based Pricing Redistributes acute hospital fee-for-service (FFS)  payments between hospitals based on ...
20132014        Weighted Domains and Impact: 2013, 2014 & 2015*            45%                  30%                   25%2...
Process of Care Measures – FY 2013   Measures     Number        Scoring     AMI          X2     HF           X1     PN    ...
Patient Experience – FY 2013           Measure                    Scoring         Overall rating    Nursing communication ...
Outcome Measures – FY 2014/2015                      Measure                AMI 30 day mortality                 HF 30 day...
Measures of success in transformed care Better care for individuals Better health for the community Reduction in the tr...
Changing Paradigms Discipline specific care          Care teams                                    Quality Quality reporti...
Implications Significant pharmacy demand and potential impact Working in current world and new world concurrently Skill...
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Value Based Purchasing ACO Total Cost of Care ASHP 12 12

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Value Based Purchasing ACO Total Cost of Care ASHP 12 12

  1. 1. Planning Challenges in a Value Based Purchasing (VBP) Environment Bonnie Senst, M.S., R.Ph., FASHP Director of Pharmacy Allina Health
  2. 2. DisclosureBonnie Senst reports no relevant financial relationships
  3. 3. 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
  4. 4. 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
  5. 5. Case for Change Health care expenditures Waste in health care cost Poor coordination of care/transitions Harm during care Lack of patient involvement
  6. 6. 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
  7. 7. 20132014 Weighted Domains and Impact: 2013, 2014 & 2015* 45% 30% 25%2015 30% 20% 20% 30% * FY 2015 measures and weights proposed
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. Measures of success in transformed care Better care for individuals Better health for the community Reduction in the trend of health care costs
  12. 12. 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
  13. 13. 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

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