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The Expansion and Acceleration of Value-Based Care


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This presentation highlights the rapid shift to value-based care that's occurring in the healthcare industry and was originally presented at Premier's annual Governance Conference.

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The Expansion and Acceleration of Value-Based Care

  1. 1. The Expansion and Acceleration of Value-Based Care Joe Damore, Service Line Vice President, Population Health, Premier, Inc. PANELISTS: Blair Childs, Senior Vice President of Public Relations Mark Hiller, Vice President of Engagement and Delivery, Innovative Consulting Ariann Polasky, Senior Director of Provider Products MODERATOR:
  2. 2. Agenda • Welcome/Introductions • Overview of Value-Based Care • Understanding MACRA • The expansion of Bundled Payments/CJR • Measurement reporting: preparing for change • Question & answer session 2
  3. 3. Explaining the acceleration to value-based care 3 Federal government commitment to move from volume to value • Secretary Burwell’s announcement (1/26/15) • MACRA bi-partisan approval • CJR bundled program required in 67 markets (approx. 800 hospitals) • Additional MSSPs/Next Gen ACOs National commercial health plans are moving ahead with new value based payment models Early results look promising • Bending the Medicare cost curve • Several states are reporting early success(MD, Oregon) • United Healthcare PCMH “white paper” State Medicaid value based reform is growing • DSRIP (NY, CA, TX, NJ, VA, etc.) • Episode of Care model (AK, TN, OH) • ACO Model (CO, OR, AL)
  4. 4. Medicare Access & CHIP Reauthorization Act of 2015 On 3/26, the House passed H.R. 2 by 392-37 vote. On 4/14, the Senate passed the House bill by a vote of 92-8, and the President signed the bill. “MACRA” Replaces the 1997 SGR formula, which capped Medicare physician per beneficiary spending growth at GDP growth rate • Overwhelming bipartisan support. • Provides new tools in implementing payment reforms. • Applies to MD, DO, PA, NP, Clinical nurse specialist, CRNAs • 2021 includes therapists, psychologists, social workers, audiologists, and dieticians. • Creates clear timetable/benchmarks. • Two options for physicians/providers • Merit Based Incentive Payment system (MIPS) • Alternative Payment Models (APMs)
  5. 5. MACRA reform timeline (Medicare Access and CHIP Reauthorization Act of 2015) 5
  6. 6. Value-based reimbursement across payment silos 6
  7. 7. Track 1: MIPS program and measures weighting 7
  8. 8. 8 Track 2: 5% bonus for qualifying APMs
  9. 9. Nationwide adoption of Bundled Payment 9 Bundled Payment for Care Improvement : 1,618 participants in 4 models Comprehensive Care for Total Joint Replacement: 800 hospitals in 67 MSAs
  10. 10. • Mandatory 5-year program • Begins April 1, 2016 • Focused on hip and knee replacement • Hospital held accountable for quality and cost of care from admission to 90 days post- discharge • Downside financial risk begins in PY2 Comprehensive Care for Joint Replacement (CJR) Model
  11. 11. Succeeding in bundles: What should we be doing now? Program oversight and financial risk elements Cross continuum care pathways / care models Post-acute partnerships Provider engagement Bundled payment analytics, reporting & reconciliation Quality performance measurement Interaction with other payment models (ACO, MSSP, etc)
  12. 12. For more information please contact us: