Edifecs: Demonstrating who you are in CJREdifecs Inc
A hands-on approaches for hospitals to strategically align orthopedic surgeons and post-acute providers under CJR. This Presentation focuses on tools that providers can use to help manage their performance to be successful under the new value-based environment.
The role of real world data and evidence in building a sustainable & efficien...Office of Health Economics
This presentation defines RWD and RWE in the context of digital health, and looks at potential uses for RWD and RWE. It briefly sets out the current landscape in Malaysia and looks at the challenges in using RWE. In particular, the issues of access, governance and ensuring good quality are considered.
The Imperative of Linking Clinical and Financial Data to Improve Outcomes - H...Health Catalyst
Quality and cost improvements require the intelligent use of financial and clinical data coupled with education for multi-disciplinary teams who are driving process improvements. Once a data warehouse is established, healthcare organizations need to set up multi-disciplinary clinical, financial, and IT specialist teams to make the best use of the data. Sometimes, financial involvement is minimized or even excluded for a number of reasons that can turn out to be counterproductive. However, including financial measurements and participation up front can help enhance the recognized value and sustainability of quality improvement or waste reduction efforts. the In this session you will learn keys to success and real-life examples of linking clinical, financial and patient satisfaction data via multi-disciplinary teams that produce impressive results.
Best Practices for Enabling HIE and Incorporating Capabilities into EHR Workf...Justin Campbell
Health Information Exchange (HIE) allows health care providers to access and share a patient’s medical information securely and electronically, providing a unified view of patient data across health care organizations. HIE enhances clinicians’ workflow and their ability to connect, coordinate, and collaborate on patient care quickly and easily. However, health care organizations frequently struggle with last-mile connectivity from their clinical system of record to the receiving system and incorporating HIE capabilities into EHR workflows. This session will provide a framework for successful HIE onboarding including data access, conformance testing & validation, as well as share strategies for implementing HIE capabilities at the point of care. This session will also introduce the concept of Patient Centered Data Home and illustrate how the exchange of information utilizing the PCDH model is a cost-effective, scalable solution to assuring real-time clinical data is available whenever and wherever care occurs to improve the quality of care.
Edifecs: Demonstrating who you are in CJREdifecs Inc
A hands-on approaches for hospitals to strategically align orthopedic surgeons and post-acute providers under CJR. This Presentation focuses on tools that providers can use to help manage their performance to be successful under the new value-based environment.
The role of real world data and evidence in building a sustainable & efficien...Office of Health Economics
This presentation defines RWD and RWE in the context of digital health, and looks at potential uses for RWD and RWE. It briefly sets out the current landscape in Malaysia and looks at the challenges in using RWE. In particular, the issues of access, governance and ensuring good quality are considered.
The Imperative of Linking Clinical and Financial Data to Improve Outcomes - H...Health Catalyst
Quality and cost improvements require the intelligent use of financial and clinical data coupled with education for multi-disciplinary teams who are driving process improvements. Once a data warehouse is established, healthcare organizations need to set up multi-disciplinary clinical, financial, and IT specialist teams to make the best use of the data. Sometimes, financial involvement is minimized or even excluded for a number of reasons that can turn out to be counterproductive. However, including financial measurements and participation up front can help enhance the recognized value and sustainability of quality improvement or waste reduction efforts. the In this session you will learn keys to success and real-life examples of linking clinical, financial and patient satisfaction data via multi-disciplinary teams that produce impressive results.
Best Practices for Enabling HIE and Incorporating Capabilities into EHR Workf...Justin Campbell
Health Information Exchange (HIE) allows health care providers to access and share a patient’s medical information securely and electronically, providing a unified view of patient data across health care organizations. HIE enhances clinicians’ workflow and their ability to connect, coordinate, and collaborate on patient care quickly and easily. However, health care organizations frequently struggle with last-mile connectivity from their clinical system of record to the receiving system and incorporating HIE capabilities into EHR workflows. This session will provide a framework for successful HIE onboarding including data access, conformance testing & validation, as well as share strategies for implementing HIE capabilities at the point of care. This session will also introduce the concept of Patient Centered Data Home and illustrate how the exchange of information utilizing the PCDH model is a cost-effective, scalable solution to assuring real-time clinical data is available whenever and wherever care occurs to improve the quality of care.
Population Health Management: Where are YOU?Phytel
This presentation explains how population health is fundamental to value-based delivery models, including key principles and definitions of PHM, as well as how to assess your organization’s “population health readiness.”
To lower health costs, physician networks and medical homes must employ a closed loop population management program that focus on patient SOH stratification, chronic disease management, care coordination and incentive management. This approach will enable them to consistently reduce ER and inpatient admissions, which are the greatest expenditures in health care today.
Population Health Management PHM MLCSU huddleMatthew Grek
Andi Orlowski (Director of The Health Economics Unit) give an overview of Population Health Management (PHM) to the Midlands and Lancashire Commissioning Support Unit Huddle, on 25 March 2021
Rising Importance of Health Economics & Outcomes ResearchCitiusTech
Health Economics & Outcomes Research (HE&OR) guides stakeholders to make informed decisions regarding patient access to drugs and services. This document highlights specific use cases for healthcare information technology that add value to HE&OR.
March 02, 2018
Value-based health care is one of the most pressing topics in health care finance and policy today. Value-based payment structures are widely touted as critical to controlling runaway health care costs, but are often difficult for health care entities to incorporate into their existing infrastructures. Because value-based health care initiatives have bipartisan support, it is likely that these programs will continue to play a major role in both the public and private health insurance systems. As such, there is a pressing need to evaluate the implementation of these initiatives thus far and to discuss the direction that American health care financing will take in the coming years.
To explore this important issue, the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School collaborated with Ropes & Gray LLP to host a one-day conference on value-based health care. This event brought together scholars, health law practitioners, and health care entities to evaluate the impact of value-based health care on the American health care system.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/will-value-based-care-save-the-health-care-system
Transforming Clinical Practice InitiativeCitiusTech
The Transforming Clinical Practice Initiative (TCPI) is designed to help small practices and clinicians achieve large-scale health transformation. The initiative is designed to support more than 140,000 clinician practices over four years duration in sharing, adapting and further developing their comprehensive quality improvement strategies. The TCPI is one part of a unique strategy advanced by the Affordable Care Act to strengthen the quality of patient care and manage health care expenditures, ultimately saving the taxpayer from substantial costs. This document describes the initiative in detail with the type of participants, eligibility and reporting requirements of the participants. Understanding the implementation of this initiative not only helps clinicians, but opens up a huge market for Healthcare IT companies offering the products and services like EHR implementation, Integration, EHR/ Data Migration, Implementation of HIE etc.
Rethinking Value Based Healthcare
Around the world healthcare providers are busy exploring how value-based healthcare can both improve the efficiency and effectiveness of healthcare delivery and seed new opportunities for innovation. Continuing our collaboration with Denmark, we are very pleased to release a new perspective on how VBHC can have greater impact in practice. Based on insights from a recent event hosted by DTU Executive Business Education and undertaken in partnership with Rethink Value, this point of view looks at the key issues for patients, physicals, providers and payers.
It explores some of the associated implications for healthcare systems worldwide, highlights several leading early examples of VBHC in practice and looks at how it can have impact at scale. Recommendations focus on the structure of care, key metrics, moving beyond pilots, changes in reimbursement models and the need for greater insight sharing and deeper collaboration.
For related Future Agenda research see www.futureofpatientdata.org
Top seven healthcare outcome measures of healthJosephMtonga1
The seven healthcare outcome measures are meant to understand the quality of health systems and how they could be measured and how quality care could be provided to clients.
The transformation towards more integrated and accountable healthcare delivery systems is aligning physicians, outpatient care, hospitals and ultimately payers in unprecedented numbers. Yet creating a successful clinically integrated network can be a daunting and complicated undertaking.
Yale New Haven Health System (YNHHS), a nonprofit academic medical center, is following a seven-phase plan to achieve a regional, clinically integrated network with the ultimate goal of population health management.
Conifer Health President of Value-Based Care, Megan North and Gayle Capozzalo, FACHE Executive Vice President/Chief Strategy Officer, Yale New Haven Health System (YNHHS), co-presented at the the Becker’s Hospital Review 7th Annual Meeting in Chicago. North and Capozzalo shared “A Seven-Step Approach to a Clinically Integrated Network,” to provide insights into each step of the clinical integration road map.
Adding Value to the EMR: A Clinical PerspectiveHealth Catalyst
Known for leading large-scale healthcare improvement using data and analytics to drive positive change, Dr. Charles Macias speaks to creating greater value in the EMR through analytics. This approach has done more to increase value than many other cost-reduction efforts.
In this webinar you will 1) Explore each component of the value equation, 2) learn how TCH has increased the value of its healthcare using data to drive quality an ever more important need of those facing capitated or value–based care reimbursements and 3) consider a new ROI equation for systems who have invested heavily in their EMRs
Mirabegron US Commercial Persistence poster AUGS 2014Todd Berner MD
EArly Experience with Mirabegron: Comparative Persistence of Mirabegron and Tolterodine Extended release in Patients with Overactive Bladder AUGS poster 2014
Population Health Management: Where are YOU?Phytel
This presentation explains how population health is fundamental to value-based delivery models, including key principles and definitions of PHM, as well as how to assess your organization’s “population health readiness.”
To lower health costs, physician networks and medical homes must employ a closed loop population management program that focus on patient SOH stratification, chronic disease management, care coordination and incentive management. This approach will enable them to consistently reduce ER and inpatient admissions, which are the greatest expenditures in health care today.
Population Health Management PHM MLCSU huddleMatthew Grek
Andi Orlowski (Director of The Health Economics Unit) give an overview of Population Health Management (PHM) to the Midlands and Lancashire Commissioning Support Unit Huddle, on 25 March 2021
Rising Importance of Health Economics & Outcomes ResearchCitiusTech
Health Economics & Outcomes Research (HE&OR) guides stakeholders to make informed decisions regarding patient access to drugs and services. This document highlights specific use cases for healthcare information technology that add value to HE&OR.
March 02, 2018
Value-based health care is one of the most pressing topics in health care finance and policy today. Value-based payment structures are widely touted as critical to controlling runaway health care costs, but are often difficult for health care entities to incorporate into their existing infrastructures. Because value-based health care initiatives have bipartisan support, it is likely that these programs will continue to play a major role in both the public and private health insurance systems. As such, there is a pressing need to evaluate the implementation of these initiatives thus far and to discuss the direction that American health care financing will take in the coming years.
To explore this important issue, the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School collaborated with Ropes & Gray LLP to host a one-day conference on value-based health care. This event brought together scholars, health law practitioners, and health care entities to evaluate the impact of value-based health care on the American health care system.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/will-value-based-care-save-the-health-care-system
Transforming Clinical Practice InitiativeCitiusTech
The Transforming Clinical Practice Initiative (TCPI) is designed to help small practices and clinicians achieve large-scale health transformation. The initiative is designed to support more than 140,000 clinician practices over four years duration in sharing, adapting and further developing their comprehensive quality improvement strategies. The TCPI is one part of a unique strategy advanced by the Affordable Care Act to strengthen the quality of patient care and manage health care expenditures, ultimately saving the taxpayer from substantial costs. This document describes the initiative in detail with the type of participants, eligibility and reporting requirements of the participants. Understanding the implementation of this initiative not only helps clinicians, but opens up a huge market for Healthcare IT companies offering the products and services like EHR implementation, Integration, EHR/ Data Migration, Implementation of HIE etc.
Rethinking Value Based Healthcare
Around the world healthcare providers are busy exploring how value-based healthcare can both improve the efficiency and effectiveness of healthcare delivery and seed new opportunities for innovation. Continuing our collaboration with Denmark, we are very pleased to release a new perspective on how VBHC can have greater impact in practice. Based on insights from a recent event hosted by DTU Executive Business Education and undertaken in partnership with Rethink Value, this point of view looks at the key issues for patients, physicals, providers and payers.
It explores some of the associated implications for healthcare systems worldwide, highlights several leading early examples of VBHC in practice and looks at how it can have impact at scale. Recommendations focus on the structure of care, key metrics, moving beyond pilots, changes in reimbursement models and the need for greater insight sharing and deeper collaboration.
For related Future Agenda research see www.futureofpatientdata.org
Top seven healthcare outcome measures of healthJosephMtonga1
The seven healthcare outcome measures are meant to understand the quality of health systems and how they could be measured and how quality care could be provided to clients.
The transformation towards more integrated and accountable healthcare delivery systems is aligning physicians, outpatient care, hospitals and ultimately payers in unprecedented numbers. Yet creating a successful clinically integrated network can be a daunting and complicated undertaking.
Yale New Haven Health System (YNHHS), a nonprofit academic medical center, is following a seven-phase plan to achieve a regional, clinically integrated network with the ultimate goal of population health management.
Conifer Health President of Value-Based Care, Megan North and Gayle Capozzalo, FACHE Executive Vice President/Chief Strategy Officer, Yale New Haven Health System (YNHHS), co-presented at the the Becker’s Hospital Review 7th Annual Meeting in Chicago. North and Capozzalo shared “A Seven-Step Approach to a Clinically Integrated Network,” to provide insights into each step of the clinical integration road map.
Adding Value to the EMR: A Clinical PerspectiveHealth Catalyst
Known for leading large-scale healthcare improvement using data and analytics to drive positive change, Dr. Charles Macias speaks to creating greater value in the EMR through analytics. This approach has done more to increase value than many other cost-reduction efforts.
In this webinar you will 1) Explore each component of the value equation, 2) learn how TCH has increased the value of its healthcare using data to drive quality an ever more important need of those facing capitated or value–based care reimbursements and 3) consider a new ROI equation for systems who have invested heavily in their EMRs
Mirabegron US Commercial Persistence poster AUGS 2014Todd Berner MD
EArly Experience with Mirabegron: Comparative Persistence of Mirabegron and Tolterodine Extended release in Patients with Overactive Bladder AUGS poster 2014
Go Big or Go Home—The Data Boon in HealthcareTodd Berner MD
Big Data has the potential to give us insights into our own physical conditions more than ever before. Read about some of the best applications for this new trend.
The CRISPR Controversy—The Debate Over Genetic ManipulationTodd Berner MD
Todd Berner gives a rundown of recent news and developments on CRISPR, a genetic manipulation tool creating a buzz in the scientific community for its potential applications and debatable ownership.
Imagine a healthcare system where people live long, healthy lives, receiving quality, affordable care, with clinicians nationwide collaborating to improve outcomes. That's Accountable Care! Learn the benefits of becoming an ACO in this insightful eBook.
Population Health Management: Enabling Accountable Care in Collaborative Prov...Salus One Ed
This document provides the reader information about population health management (PMH), how it relates to incentive payments for healthcare providers and their health insurance partners (commercial and government). See details about required transformation of care delivery methods, typical accountable care payment models, how to achieve incentives, partnerships between state government (public health) and community shared services needs and necessary technology and data to achieve it.
mHealth Israel_US Health Insurance Overview- An Insider's PerspectiveLevi Shapiro
Presentation about the US Health Insurance Sector by Lori Rund, VP, Product Management and Market Intelligence at Health Alliance Plan, a managed care organization owned by the Henry Ford Health System, with 650,000 lives. Lori is responsible for the identification, concept building, researching and business case developments for new products, services and markets. She develops and leads comprehensive market intelligence functions to help the organization better understand industry trends and identify business opportunities.
Prior to joining Health Alliance Plan, Lori was Director of Product Development and Market Intelligence at Health Alliance Medical Plans in Illinois and Director of Market Research and Strategy at Carle Clinic Association, also in Illinois.
Building Clinical Integration as a Foundation to Become a Successful ACOPhytel
More and more healthcare organizations are recognizing that clinical integration of providers is a prerequisite to care coordination, population health management, and accountable care organizations. They also know that patient centered medical homes—the building blocks of ACOs—can thrive only in patient-centered medical neighborhoods where specialists collaborate with primary care physicians. For this cooperation to be truly effective, all of these providers must be clinically integrated. This paper explains the components of clinical integration and summarizes the kinds of information technology required for its implementation. Case studies of organizations that are building the necessary infrastructure are also included.
A Clinically Integrated Network (CIN) is a selective partnership of physicians collaborating with
hospital(s) and other providers to deliver evidence-based care, improve quality and efficiency,
manage populations and demonstrate value to the market. Once these objectives are met, the network may contract on behalf of participants
Providers know that successful care coordination is key to enhancing patient outcomes and better personalizing their experience. At its root, care coordination starts with effective communication, and healthcare organizations are increasingly turning to innovative technology solutions to solve their needs. To improve their care teams’ communication, coordination, and data capture capabilities, two of New York City’s leading healthcare organizations worked with two cutting edge tech solutions providers to design and implement innovative pilots as a part of the New York Digital Health Accelerator program. Utilizing real-life case studies, the panelists will discuss the design and implementation of the pilots, and lessons learned from their participation in the program.
• Anuj Desai - Vice President of Market Development, New York eHealth Collaborative
• Joseph Mayer, MD - Founder & CEO, Cureatr Inc.
• Patricia Meisner, MS, MBA - CEO & Co-Founder, ActualMeds
• Ken Ong, MD, MPH - Chief Medical Informatics Officer, New York Hospital Queens
• Victoria Tiase, MSN, RN - Director, Informatics Strategy, NewYork-Presbyterian Hospital
New York eHealth Collaborative Digital Health Conference
November 17, 2014
Healthcare Consumerism and Cost: Dispelling the Myth of Price TransparencyHealth Catalyst
The world of healthcare costs is confusing and messy for both patients and providers. Many providers don’t fully understand their costs and therefore struggle to meet the increasing pressure for greater price transparency for consumers. With price transparency rules finalized and implementation looming, many providers are racing against the clock to adapt business practices to meet regulations and communicate the implications to consumers. And each organization’s financial health depends on transparency, as uncertainty about costs keeps many patients from seeking care.
Deb Gordon, seasoned healthcare executive and author of the book, “The Health Care Consumer’s Manifesto: How to Get the Most for Your Money,” and Pat Rocap, Director of Cost Management Services at Health Catalyst, examine the relationship between cost and pricing as the path to transparency for consumers. Deb and Pat provide expert analysis and practical advice to help you become a savvier provider and consumer when it comes to healthcare pricing and spending.
- The implications of federal price transparency regulations.
- The connection between healthcare costing and pricing.
- How to start your organization’s journey to understand costs and why it matters.
- Why price transparency is important to both patients and providers.
Chapter 16: Managing
Information
Chapter Objectives
• Appreciate the interconnected nature of
computerized devices in hospitals and other
organizations.
• Be able to define and explain the elements of an
electronic health record system.
• Appreciate the growing use of information systems
in support of public health activities.
• Understand that many health care providers and
members of the public do not share the same
enthusiasm for information systems that managers
have.
Outline
• Electronic Health Records
• Managing Public Health Information
• Managing Inventory
• Managing Human Resources
Definitions
• Health Information and Data
• Result Management
• Order Management
• Decision Support
• Electronic Communication and Connectivity
• Patient Support
• Administrative Processes
• Reporting
Health Information and Data
• Provide immediate access to information such
as individual diagnosis, medications, allergies,
and laboratory test results to improve the
ability or service to make sound clinical
decisions in a timely manner.
Result Management
• Provide access to new and past test results,
thus allowing all participating providers to
make more informed decisions about the
effectiveness of treatment regimens and
patient safety.
Order Management
• Ensure that providers have the ability to enter
and store orders for prescriptions, tests, and
other services. This capability is intended to
improve legibility, reduce duplication, and
allow orders to be completed in a timely
manner.
Decision Support
• Provide reminders, prompts, and alerts to
facilitate diagnoses and treatments by
improving compliance with best clinical
practices, promoting regular screenings and
other preventive practices, and identifying
possible drug interactions.
Electronic Communication and
Connectivity
• Promote secure, open, and readily accessible
channels of communication among providers
and patients to improve the continuity of care,
increase the timeliness of diagnoses and
treatments, and reduce the frequency of
adverse events.
Patient Support
• Provide tools that give individuals access to
their health records, provide interactive
education on relevant health topics, and
protocols to help people conduct home-
monitoring and self-testing activities to
improve control of chronic conditions such as
diabetes and hypertension.
Administrative Processes
• Include computerized administrative tools,
such as scheduling and record-keeping
systems; such equipment should greatly
improve the efficiency and performance of
hospitals and clinics, allowing them to provide
more timely services to patients and other
clientele.
Reporting
• Provide sufficient supportive equipment
(software, hardware, and memory capacity)
that meets uniform data standards and
enables health care organizations to respond
more quickly to federal, state, and private
reporting requirements, including those .
Similar to Berner T Health Economics Research Collaborating with ACOs to Improve Patient Data EXL 3rd Partnering with ACOs Summit 3.18.2014 (20)
In need of an update, existing healthcare infrastructure has been revamped during COVID-19, while telehealth has become a priority for many organizations.
Tips For A Great Telehealth Patient ExperienceTodd Berner MD
In the face of a global pandemic, healthcare organizations have been forced to adjust their approach to telehealth. Here's how any healthcare professional can remotely connect with their patients.
Staying Productive in the Face of Clinician BurnoutTodd Berner MD
Clinician burnout is driving many to early retirement or to leave the healthcare industry. Hospitals should approach this issue as a long-term investment and plan to support their doctors.
For hospitals and other healthcare facilities, it's important to realize that delivering a great service is more important than ever in the face of consumers comparison shopping.
Though patient portals have enjoyed widespread adoption among healthcare professionals, patients have been much more apathetic. How can organizations listen to patients and make these tools more palatable?
Patient Engagement Is Not One Size Fits AllTodd Berner MD
Patient engagement shouldn't be all about technology. Rather, care providers owe it to their patients to determine the best ways to get them involved in their health and ensure the best outcomes for them.
Patient advocacy is especially important for those living with rare diseases. As the potential to cure some of these conditions rises with the advent of gene therapy, advocacy groups will need to ensure ethical testing and implementation of new solutions.
Todd Berner talks about the growing potential for gene therapy methods to treat rare diseases that previously would have been difficult to effectively address.
Pharmaceutical companies are reevaluating the way they help patients. From better production and distribution of medicine to improvements in patient engagement, the future looks highly dependent on innovative technology and better communication.
Virtual reality has become a popular technology for entertainment in recent years, but it has other applications as well. Learn about how VR can be used to prepare aspiring doctors and surgeons for working with patients.
Patient Engagement in Health Economic and Outcomes Research: Current and Future ISPOR Initiatives, presentation from the ISPOR 20th International meeting Philadelphia, May 2015, by the Patient Centered Special Interest Group
Berner T Health Economics Research Collaborating with ACOs to Improve Patient Data EXL 3rd Partnering with ACOs Summit 3.18.2014
1. Health Economics Research:
Collaborating with ACOs to Improve Patient Data
Todd Berner MD
Director, Health Economics & Clinical Outcomes Research
Astellas Scientific and Medical Affairs
3rd
Partnering with ACOs Summit
March 18, 2014
2. “Todd Berner is a paid employee of Astellas. The opinions stated in this
presentation do not necessarily reflect those of Astellas.”
4. NAACOS Survey of 35 ACOs
First year start-up experience:
“What were your most vexing problems?”
• Meeting implementation schedules
• Finding suitable software
• Delays in getting claims data
• Developing new skill sets to analyze data
• Obtaining addresses of assignees
• Slow stand-up of IT systems
• Data inconsistency from CMS
• Translating data into actionable information for care
managers and providers
NATIONAL ACO SURVEY CONDUCTED NOVEMBER 2013
www.naacos.com accessed 3.12.2014
The typical ACO is risking $3.5
million, plus feasibility and
pre-application costs, until it
can get “cash flow relief”
from possible savings
At least one-third of the ACOs
took out legal debt to finance
their venture
So many are certainly
banking on recouping
investment costs
5. Estimated Number of Lives Covered by ACO Contracts
Leavitt Partners Center for Accountable Care Intelligence in Muhlestein Health Affairs Blog Oct 13,2013
6. Total ACOs Over Time
Leavitt Partners Center for Accountable Care Intelligence in Muhlestein Health Affairs Blog Oct 13,2013
7. Physician Led ACOs:
Physician practices have the potential to encourage hospitals to compete
on price and quality for the allegiance of physician sponsored ACOs
8. Reasons for Slowing in Growth of ACOs
• Reason 1: Tapped Out Market for Trailblazers
• Reason 2: No Proven Model to Follow
• Reason 3: Payer Delays
Leavitt Partners Center for Accountable Care Intelligence in Muhlestein Health Affairs Blog Oct 13,2013
9. Providers
Assuming
Risk:
• Nationwide, about 120 provider-
sponsored health plans are owned by
hospitals or health systems or are in the
process of applying for license to own
health plans
• Few provider-owned health plans will
participate in exchanges
• About 15% of hospitals had PPOs, 13%
HMOs and 5% fee-for-service products
in 2011, with percentages relatively flat
over a decade, according to AHA’s latest
data
Health Plan Week August 19, 2013 Volume 23 Issue 28
There are limitations for smaller provider
organizations in taking full risk and
becoming an insurance plan, “because
you need large numbers in terms of how
capitated rates are set.”
10. • North Shore-LIJ began a health plan for its 50,000-some
employees and their families about four years ago
• North Shore is the primary network and UnitedHealthcare
the plan’s administrator, provides the “wrap” network
• More than 85% of inpatient services occur at North Shore-
LIJ facilities
• Benefit design encourages employee base to use their
health system and lowers costs
• The Plan’s experience, coupled with market changes under
the reform law and interest from employers and unions,
allowed the move into fully insured products and to
become an insurance company
Health Plan Week August 19, 2013 Volume 23 Issue 28
North Shore-LIJ:
Started With Own
Workforce
North Shore-Long Island Jewish (LIJ) Health System is marketing an array of commercial products under North Shore-LIJ CareConnect
It will sell individual and small-group options on the exchange and individual and group products off the exchange
The delivery vehicle is an exclusive provider organization (EPO) offering only in-network benefits falling on the low end of 2014 pricing
ranges for various metal levels
11. Catholic Health Initiatives
(CHI)
• Colorado-based CHI, a nonprofit system, operates in 18 states and includes 86 hospitals; 40
long-term care, assisted- and residential-living facilities; two academic medical centers; and
home health agencies
• CHI has been developing its strategic plan for how it should participate in risk-based
relationships with the payer community
• CHI sponsors health benefits for as many as 70,000 workers, so they are at risk for their own
employees
• CHI purchased Soundpath Health, Inc., a Medicare Advantage (MA) plan in Washington state,
for $24 million in 2012
• CHI also is involved in bundled pricing, the Medicare Shared Savings Program, a couple of
ACOs, and a managed Medicaid globally capitated program in Nebraska
• The health system is involved in a growing number of “value-based relationships” with
insurers —offering financial underwriting gains if CHI demonstrates that it meets certain
quality, cost and service measures
• In 2014 and 2015, CHI will make a significant investment in electronic health records and
informatics for better evaluation of patient data and claims, taking active opportunities to
learn about the populations they’re serving, and how to better manage their care and costs
at the same time
Health Plan Week August 19, 2013 Volume 23 Issue 28
12.
13. • Anchored by the system's two flagship academic medical centers, with referral volume generated
by a large group of employed and aligned physicians and by multiple community hospitals within
the Partners system.
• Largest non-university based research enterprise in the United States with over $1.6 billion in
research revenue
• Research revenue provides a meaningful source of revenue diversification and contributes to
Partners' ability to recruit physicians
• The system is affiliated with Harvard University for medical training.
• There is significant consolidation and merger and acquisition activity among Boston area hospitals
resulting in the emergence of networks of physicians and hospitals with overlapping geographies
that are competing for similar patient populations
• Multiple academic medical centers in Boston are pursuing similar strategies.
• Partners acquired a moderately sized healthcare insurance company (Neighborhood Health Plan)
in 2013
NHP generated a 1.0% margin in FY13
Two thirds of NHP's business is Medicaid managed care, exposing the system to rates dictated by the state
Focus on cost control has lead to increased government regulation in Massachusetts
Growth of health insurance products that provide financial incentives for cost control could limit
patient care revenue growth in future years
Moody’s Investors Service Jan 27,2014
14. Innovation Health Plans:
Inova Health System + Aetna
“Streamlining the process”
• Jointly owned health plan serving Northern Virginia
Inova provides care to more than 1.1 million Northern Virginia residents annually
Aetna provides health care benefits to approximately 570,000 members in Virginia
• Aetna
Health benefits administration and care management capabilities
Inova
Health care delivery
• The partnership will promote clinical integration of the health care community
Health system will engage community physicians to focus on promoting wellness
Improve patient outcomes through better care coordination
Streamline access to patient information
Aetna will support Inova with technology that makes it easier for physicians to exchange information
and track their patients’ care across all settings.
• Commercial and Medicare Advantage HMO and PPO products will be offered in Northern
Virginia as part of the joint venture
The new products will give employers and consumers access to less expensive, more coordinated
and integrated health care fostered by the partnership and engagement with community physicians.
“Both Inova and Aetna believe that shared
accountability translates into a powerful new value
proposition for consumers,”
Mark T. Bertolini, Aetna chairman, CEO and president
20. Real World Evidence:
Efficacy vs. Effectiveness
Example-
• RCT data
• Extremely high placebo response rates
• Difficult to show efficacy for drug compared to placebo
• It is essentially all non-pharmacologic therapy compared to
non-pharmacologic therapy + drug
• Real World data
• All of the behavioral, non-pharmacologic intervention
associated with the RCT moves over to the drug side of the
ledger
• This becomes a comparison of activated, engaged Rx
recipients vs. those with just an Rx
21. Winning under reform:
Critical success factors
High quality; reduce costs
Ability to aggregate clinical capabilities and deliver
evidence-based care
Access to capital
Ability to aggregate lives
Physician / Hospital alignment
Ability to aggregate and analyze data
Ability to engage consumers
Manage transition with one foot in FFS and stepping
into risk-based contracting
Ability to manage risk
Understand benefit design
22. Opportunities for ACOs to Better
Manage Costs
• Consider distinctions among medications
• Acquisition costs
• Utilization
• Overall medical costs
• Identify interventions
• Utilization management strategies
• Drug formulations
• Best practices for risk management
• Care coordination
24. The Imperative to Remain Relevant
• Forging new types of relationships to answer
questions of relevance to ACOs
• Developing a “Change Package”
25.
26. Sample Research Project #1:
Primary Nonadherence to Medication within a Health System
• Phase 1
Retrospective database analysis that will help evaluate the treatment patterns and health care resource
utilization amongst our population of interest. This will build the foundation to understanding the adherence
rates, discontinuation rates and switching rates within this population. This will quantify the burden of both
primary and secondary nonadherence. We will also identify patient and prescriber characteristics for this
population, and evaluate the factors associated with patients being non adherent or discontinuing. Stratification
between age will be conducted to evaluate the Medicare population versus non-Medicare (>=65 y/o versus <65
y/o). We will assess factors associated with the nonadherence or discontinuation of the various therapies. It
would be ideal to evaluate patients newly initiated on therapy and possibly prevalent users. Both primary and
secondary nonadherence will be evaluated. Newly initiating therapy patients will be defined as no prior
history of therapy in the prior 12 months.
• Phase 2
Study focusing patients newly initiated on therapy. Once we define discontinuation, primary non adherence,
secondary non adherence, we will send them a survey to ask the reasons. This will help examine the real world
reasons for why patients are non adherent or discontinuing. Survey will be designed or a prior validated survey
could be used. We may use an existing instrument since this may be easy for operational purposes.
• Phase 3
Intervention built from the findings from Phase 1 and Phase 2. Explore which types of interventions would
be needed to help improve care and overall adherence in this population. Phase 1 and Phase 2 findings will be
evaluated with Clinical Leadership to figure out ways to intervene and what the Health System can do as next
steps.
27.
28. Sample Research Project #2:
Performance Improvement within a Health System with Significant
‘leakage’ of patient care outside the system
• In order to assess treatment approaches, project will explore a number of measures:
Compare the number of visits during which condition was:
was in the problem list
listed as a diagnosis
drug was prescribed for the condition
Examine appropriateness of referral patterns:
For purposes of this project, a primary care provider should try at least one drug for this
condition– but only one – before referring to a specialist
Referrals made without trying any drug or after prescribing more than one will be classified
as potentially inappropriate or suboptimal
We will also distinguish between referrals from the Health System’s primary care
clinic system vs others
Examine the use of diagnostic testing and imaging
Examine the use and documentation of validated symptom assessment tools.
Compare the use of different treatment options among those that we can identify via the EHR
29. Sample Research Project #2:
Performance Improvement within a Health System with Significant
‘leakage’ of patient care
# Condition specific
Rx’s
# Condition specific
medication classes
Referrals
Use of diagnostic
tools
Treatment Options
Patient Characteristics
Age
<65
65+
Race
Wh
Other
Sex
M
F
Insurance Status
Medicare
Medicaid
Commercial
Provider Characteristics
Primary care physician
Other primary care provider
Specialist
Hospital #1
Hospital #2
30. Sample Research Project #3:
EHR Based Condition Specific Prompts and HCP Decision Support
National Quality Strategy--The Future of Quality Measurement
ONC, AHRQ, CMS Presentation. September 14, 2012
31. Sample Research Project #3:
EHR Based Condition Specific Prompts and HCP Decision Support
• Clinical Decision Support (CDS)
− Detect potential safety and quality problems and help prevent them
− Detect inappropriate utilization of services, medications, and supplies
− Foster the greater use of evidence-based medicine principles and guidelines
− Organize, optimize and help operationalize the details of a plan of care
− Help gather and present data needed to execute this plan
− Ensure that the best clinical knowledge and recommendations are utilized to
improve health management decisions by clinicians and patients
Osheroff JA, Pifer EA, Teich JM, et al. Improving Outcomes with Clinical Decision Support: An Implementers' Guide
Chicago: HIMSS; 2005.
32. “Knowing is not enough; we must apply.
Willing is not enough; we must do.”
-Johann Wolfgang von Goethe
Editor's Notes
Hill Physicians, based out of California, reported $11.8 million in net income on $491 million in revenue this past year, up from $11.6 million in net income and $480 million in revenue the year before. CEO Darryl Cardoza stated: “We kept pace with a rapidly changing healthcare environment. Our three, commercial ACO arrangements have led to improvements in overall performance, while also reducing the cost of care for the population as a whole, saving money for employers and consumers. It’s clear that alignment works.” While still achieving cost savings, Hill Physicians also paid over $44 million in bonuses to physicians for improving quality and efficiency metrics. - See more at: http://leavittpartners.com/2013/12/case-physician-led-acos/#sthash.vFFmB4RY.dpuf