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 Medicare Aaccess and CHIP Reauthorization Act of 2015 establishes two Quality Payment Programs to transition the U.S. Healthcare System from a Fee-For-Service reimbursement methodology to a Fee-For-Value model. MACRA fundamentally adjusts the Medicare Fee Schedule, forcing healthcare providers to utilize HIT, population health management, and care coordination to receive financial rewards.
Better care at less cost - a 'how to' for commissioners and providers, pop up...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Maximizing Performance Incentives Through Star RatingsCitiusTech
The main aim of this document is to provide a high level understanding of the Star rating quality program of CMS and it’s impact on plans (at contract level) offered by the payers which are in Medicare Advantage line of business
It describes the various measure categories and their weightages, domains and sources required by CMS to assess quality of care and patient experience.
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 Medicare Aaccess and CHIP Reauthorization Act of 2015 establishes two Quality Payment Programs to transition the U.S. Healthcare System from a Fee-For-Service reimbursement methodology to a Fee-For-Value model. MACRA fundamentally adjusts the Medicare Fee Schedule, forcing healthcare providers to utilize HIT, population health management, and care coordination to receive financial rewards.
Better care at less cost - a 'how to' for commissioners and providers, pop up...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Maximizing Performance Incentives Through Star RatingsCitiusTech
The main aim of this document is to provide a high level understanding of the Star rating quality program of CMS and it’s impact on plans (at contract level) offered by the payers which are in Medicare Advantage line of business
It describes the various measure categories and their weightages, domains and sources required by CMS to assess quality of care and patient experience.
Healthcare Reform and Physician Compensation— Presentation Examines What’s in...PYA, P.C.
Among the many questions facing physicians in the wake of healthcare reform—how will they get paid? PYA Principal David McMillan recently addressed this question at the PKF Healthcare Fly-In with “Current Reform Initiatives and Their Impact on Physician Compensation.”
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.
Partnering for Population Health: Strategies to Promote Collaboration Among t...Conifer Health Solutions
A patient-centered approach to care delivery will bring the best health outcomes for individuals, as well as the community. While it is clear that effective population health management is integral to better health, providers can no longer be the sole proprietors of data and information. Improving a population’s health will depend on strong alliances with community stakeholders that generally have not experienced a strong history of collaboration. In the new healthcare landscape, providers, payers and employers must partner to reduce cost, boost quality and improve the health of their shared populations. These new partnerships may start with a few glitches. However a strategic plan, clear objectives and an engaged, informed patient will smooth the path to improved outcomes.
Performance and Reimbursement under MIPS for OrthopedicsWellbe
The 2015 MACRA legislation fundamentally changed the way in which providers are paid for their services. It also provides some relief from the “all or nothing” approach used by Meaningful Use.
This session, a review of the Final Rule published on Oct 14, 2016, conveys a practical approach to maximizing reimbursement under MIPS while reducing burden on clinical staff.
After this session, attendees will have a firm grasp of:
– the major components of the Quality Payment Program
– operational strategies for measure selection
– orthopedic-specific quality measures
About the Speaker:
karenclarkKaren R. Clark is chief information officer for OrthoTennessee, where she has worked since 1998. In that role, she serves on national committees for the Healthcare Information Management Systems Society (HIMSS.) A HIMSS Fellow and Certified Professional in Healthcare Information and Management Systems, her current HIMSS committee is the HIT User Experience, which focuses on clinician experience with health information technology.
She has spoken at the AAOE, AAOS and OrthoForum conferences on both information security and the 2015 MACRA legislation, specifically on the Merit Based Incentive Payment System (MIPS.). She is a member of the College of Healthcare Information Management Executives (CHIME) as well as the CIO/CMIO Council with the American Medical Group Association.
After graduating from American University with a degree in marketing in 1979, she joined Brooks Brothers in New York, where she was a buyer. She earned her MBA in finance from Fordham University in 1984. She moved to Knoxville in 1988 and joined Watson’s as director of planning and distribution when her husband, Brooks, was recruited from Sports Illustrated to Whittle Communications. They have two adult daughters, Isabel, and Olivia.
Healthcare’s Challenging Trio: Quality, Safety, and Complexity Health Catalyst
Dr. John Haughom expands upon the challenges with patient safety and quality in today’s modern healthcare system. First brought to light in the Institute of Medicine’s (IOM) publication of “To Err is Human: Building a Safer Health System”, the situation has only grown more complex since that seminal report. With the total cost of preventable adverse events at as much as $29 billion, preventable readmissions at $17 billion, and preventable medication errors at $16.4 billion, these are all examples of terrible medical waste that must be eliminated.
An actionable summary of the MIPS Merit-Incentive Based Payment System, MACRA (or the Quality Payment Program), and how to approach value-based healthcare.
Mastering MACRA: A Beginner’s Guide to New Reimbursement ModelsCureMD
MACRA is 2 years of work, signed into law in April 2015
Extends the Children’s Health Insurance Program (CHIP) for two more years
Requires Medicare to move away from SSN based Medicare ID numbers
Includes new funding for development and testing of performance measures
Enables new programs and requirements for data sharing
Establishes new federal advisory groups.
(Click the download button for a high-resolution view)
Riding the Rapids of Payment Reform: Downstream Effects of Quality Reporting ...Bill Presley
In this presentation, we highlighted how quality measurement programs impact reimbursement affecting your revenue. The revenue at risk in your organization. We focused on quality programs like Value-Based Purchasing (VBP), Merit-Based Incentive Program (MIPS) and Alternative Payment Models (APM) and their impact on Part A and Part B reimbursements.
It’s no surprise that reimbursement tied to quality performance is quickly becoming a reality for hospitals and physicians. CMS’ aggressive goals aimed at increasing the percentage of Medicare payments associated with quality versus quantity can be achieved through such programs as Value-based Purchasing and MACRA. This session will cover scoring methodologies, reporting requirements, reimbursement impact, infrastructure (and other resource needs), EMR tools and tactics, and workflow modifications.
The Alphabet Soup of Clinical Quality Measures ReportingBill Presley
CMS is transitioning to what the they call "a new and more responsive regulatory framework" for quality reporting and reimbursement. CMS goals are "…electronic health records helping physicians, clinicians, and hospitals to deliver better care, smarter spending, and healthier people". Over the next couple years, we will see a transformation of fee for service into value-based care models driven by the VBP, Quality Payment Program, MACRA, Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APM). Healthcare organizations will no longer be motivated by implementing and meeting Meaningful Use, but instead will be driven by value-based care and risk-based payment models that focus on quality outcomes for reimbursements.
In this Education Session we will review:
• How CMS is aligning clinical quality measures (CQMs) to reduce the reporting burden for healthcare organizations and providers. We will cover the vision and goals for achieving quality alignment for CMS.
• We will dive into the following CMS reporting programs and how they interact with each other: Value-Based Purchasing (VBP), Medicare Access and CHIP Reauthorization Act (MACRA), Merit-based Incentive Payments (MIPS), Hospital Inpatient Quality Reporting (IQR), The Joint Commission (ORYX), Outpatient Quality Reporting (OQR), and Alternative Payment Models (APM).
Revenue at Risk: Understanding Financial Impacts of Quality ReportingBill Presley
Jodi Frei, Northwestern Medical Center Vermont, and I co-presented at the MUSE Executive Institute on Revenue at Risk: Understanding Financial Impacts of Quality Reporting. The Executive Institute featured many amazing CXO's discussing the changing landscape of revenue cycle management and how finance, quality, and IT departments are converging on revenue cycle.
Though pay for performance is the common theme, the logistics of programs including Value Based Purchasing (VBP), Inpatient Quality Reporting (IQR), Hospital Acquired Condition (HAC) Reduction Program, Readmission Reduction, MACRA, MIPS and APMs, are very different. In this session, the specifics of each Quality Program including reporting requirements, scoring methodologies, and associated incentives and penalties will be covered. In addition, tools to track performance and quantify financial risk will be shared.
Reimbursement in this era of health care reform is challenging. We all seek success under this new normal in health care. Optimizing revenue capture in a quality reimbursement model requires acquisition of new knowledge and the use of new tools and strategies. Join us in the conversation; share your strategies; learn from others.
In January 2013, Catholic Health Initiatives began a multi-phase journey to develop a population health management solution across all of its regions. This presentation will describe the strategies the health system pursued for: creating a clinically integrated network as a first step in managing the health of populations and integrating care across the patient experience; aligning hospitals and physician groups to create successful clinical models; creating a data platform to share clinical measures and benchmarks; and ultimately becoming a risk-bearing shared savings ACO. Participants will hear real-world examples of best practices for how to meet FTC regulations, create an effective governance structure to manage performance, and align financial incentives. Learn how one of the nation's largest hospital systems developed a system-wide population health management solution in order to achieve the necessary transformation from fee-for-service to fee-for-value.
The Top 7 Outcomes Measures and 3 Measurement EssentialsHealth Catalyst
Outcomes improvement can’t happen without effective outcomes measurement. Given the healthcare industry’s administrative and regulatory complexities, and the fact that health systems measure and report on hundreds of outcomes annually, this blog adds much-needed clarity by reviewing the top seven outcome measures, including definitions, important nuances, and real-life examples:
Mortality
Readmissions
Safety of care
Effectiveness of care
Patient experience
Timeliness of care
Efficient use of medical imaging
CMS used these exact seven outcome measures to calculate overall hospital quality and arrive at its 2016 hospital star ratings. This blog also reiterates the importance of outcomes measurement, clarifies how outcome measures are defined and prioritized, and recommends three essentials for successful outcomes measurement:
Transparency
Integrated care
Interoperability
Managing Total Joint Replacement Bundled Payment Models: Keys to SuccessWellbe
Speaker: Andrew Duncan, Executive Director for Orthopaedics and Rehabilitation at University of Florida Health
This webinar will describe bundled payments and episode of care based patient management strategies. Attendees can learn to successfully manage total joint replacement bundled payment programs and what clinical service delivery strategies to use to be positioned for success. The importance of collecting and using data to understand costs for the episode of care and to negotiate will also be a focus.
About the Speaker:
Andrew Duncan has been a licensed physical therapist since 1991, when he graduated from the State University of New York at Buffalo with his Bachelor of Science in Physical Therapy. Upon completion of entry-level training, he worked as a physical therapist for two years and then completed his post professional Master’s degree in Human Movement Science and became certified in Athletic Training at the University of North Carolina at Chapel Hill. He then underwent board certification by the American Board of Physical Therapy Specialties and became a Sports Certified Specialist in 2002. While working as a manager at rehabilitation corporations and later at an academic health care center, he developed a passion for the business of health care and went on to complete his MBA from the Simon School of Business at the University of Rochester and has also earned his DPT from Boston University. Since 2012, Duncan serves as the Executive Director for Orthopaedics and Rehabilitation at the University of Florida College of Medicine, Co-Director of the UF Health Orthopaedic and Sports Medicine Institute, and also serves as the Executive Director for Rehabilitation and Radiology Services at UF Health Shands Hospitals. He holds an adjunct clinical lecturer appointment in the University of Florida Department of Physical Therapy providing instruction in the Patient and Families First and Professional Issues courses of the DPT curriculum.
Achieving population health management through more coordinated care is becoming essential as healthcare organizations move away from fee-for-service models and begin operating in the new value-based care environment. One path to succeeding in this new environment and achieving more coordinated care is through formation of a clinically integrated network.
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.
On March 16, 2016, President of Value-Based Care, Megan North and Amanda Skinner, Executive Director of Clinical Integration and Population Health for Yale New Haven Health System (YNHHS), co-presented at the 2016 American College of Healthcare Executives’ Annual Congress on Healthcare Leadership (ACHE Congress). North and Skinner shared “A Step-by-Step Approach to A Clinically Integrated Network,” to provide insights into each step of the clinical integration road map.
The CMS Innovation Center hosted a special webinar featuring Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, on Monday, November 10, 2014 from 10:30am – 11:30 am ET. Dr. Conway will provided an update about the work of the CMS Innovation Center and the models being tested to improve better care for patients, better health for our communities, and lower costs through improvement for our health care system. Opportunities for questions were provided.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Prepping for CCJR: Lessons Learned in Physician Alignment and Bundled PaymentsWellbe
With CMS’ recent announcement of its Comprehensive Care for Joint Replacement (CCJR) payment model and its plan to implement in seventy-five geographic areas, hospitals must be prepared to manage the entire episode of care from the time of surgery through ninety days after discharge. CCJR presents both opportunities and challenges for hospitals. In order to achieve success, organizations must manage their system of care delivery, ensure they are aligned with their physicians and post acute providers, and master the analytics necessary for driving high quality, low cost care.
MedAssets has worked with numerous providers to implement alignment models that bring hospitals and their physicians together, evaluate, identify, and implement changes to the care delivery system to improve quality and decrease cost across the continuum, and employ meaningful analytics for managing an episode of care.
Kevin Lieb, Senior Director for MedAssets’ Physician Alignment Solutions division, will share examples demonstrating how organizations have successfully implemented Episodes of Care. Mr. Lieb will also share examples from both hospital led and specialist led programs and provide lessons learned from these experiences.
This webinar will enable attendees to do the following:
• Identify alignment models within bundled payments and understand their applicability to your organization
• Understand the analytic capabilities necessary for success in a bundled payment environment
• Identify opportunities and strategies for cost reduction and quality improvement
About the Speaker:
Mr. Lieb has more than 20 years of healthcare-related experience focusing on quality improvement, market development and cost reduction initiatives for the hospital provider market. Mr. Lieb has worked for a number of well-known healthcare companies including GE Medical Systems, HCIA and LBA in Denver, Colorado. His responsibilities included healthcare consulting with a focus on process improvement and quality initiatives.
Healthcare Reform and Physician Compensation— Presentation Examines What’s in...PYA, P.C.
Among the many questions facing physicians in the wake of healthcare reform—how will they get paid? PYA Principal David McMillan recently addressed this question at the PKF Healthcare Fly-In with “Current Reform Initiatives and Their Impact on Physician Compensation.”
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.
Partnering for Population Health: Strategies to Promote Collaboration Among t...Conifer Health Solutions
A patient-centered approach to care delivery will bring the best health outcomes for individuals, as well as the community. While it is clear that effective population health management is integral to better health, providers can no longer be the sole proprietors of data and information. Improving a population’s health will depend on strong alliances with community stakeholders that generally have not experienced a strong history of collaboration. In the new healthcare landscape, providers, payers and employers must partner to reduce cost, boost quality and improve the health of their shared populations. These new partnerships may start with a few glitches. However a strategic plan, clear objectives and an engaged, informed patient will smooth the path to improved outcomes.
Performance and Reimbursement under MIPS for OrthopedicsWellbe
The 2015 MACRA legislation fundamentally changed the way in which providers are paid for their services. It also provides some relief from the “all or nothing” approach used by Meaningful Use.
This session, a review of the Final Rule published on Oct 14, 2016, conveys a practical approach to maximizing reimbursement under MIPS while reducing burden on clinical staff.
After this session, attendees will have a firm grasp of:
– the major components of the Quality Payment Program
– operational strategies for measure selection
– orthopedic-specific quality measures
About the Speaker:
karenclarkKaren R. Clark is chief information officer for OrthoTennessee, where she has worked since 1998. In that role, she serves on national committees for the Healthcare Information Management Systems Society (HIMSS.) A HIMSS Fellow and Certified Professional in Healthcare Information and Management Systems, her current HIMSS committee is the HIT User Experience, which focuses on clinician experience with health information technology.
She has spoken at the AAOE, AAOS and OrthoForum conferences on both information security and the 2015 MACRA legislation, specifically on the Merit Based Incentive Payment System (MIPS.). She is a member of the College of Healthcare Information Management Executives (CHIME) as well as the CIO/CMIO Council with the American Medical Group Association.
After graduating from American University with a degree in marketing in 1979, she joined Brooks Brothers in New York, where she was a buyer. She earned her MBA in finance from Fordham University in 1984. She moved to Knoxville in 1988 and joined Watson’s as director of planning and distribution when her husband, Brooks, was recruited from Sports Illustrated to Whittle Communications. They have two adult daughters, Isabel, and Olivia.
Healthcare’s Challenging Trio: Quality, Safety, and Complexity Health Catalyst
Dr. John Haughom expands upon the challenges with patient safety and quality in today’s modern healthcare system. First brought to light in the Institute of Medicine’s (IOM) publication of “To Err is Human: Building a Safer Health System”, the situation has only grown more complex since that seminal report. With the total cost of preventable adverse events at as much as $29 billion, preventable readmissions at $17 billion, and preventable medication errors at $16.4 billion, these are all examples of terrible medical waste that must be eliminated.
An actionable summary of the MIPS Merit-Incentive Based Payment System, MACRA (or the Quality Payment Program), and how to approach value-based healthcare.
Mastering MACRA: A Beginner’s Guide to New Reimbursement ModelsCureMD
MACRA is 2 years of work, signed into law in April 2015
Extends the Children’s Health Insurance Program (CHIP) for two more years
Requires Medicare to move away from SSN based Medicare ID numbers
Includes new funding for development and testing of performance measures
Enables new programs and requirements for data sharing
Establishes new federal advisory groups.
(Click the download button for a high-resolution view)
Riding the Rapids of Payment Reform: Downstream Effects of Quality Reporting ...Bill Presley
In this presentation, we highlighted how quality measurement programs impact reimbursement affecting your revenue. The revenue at risk in your organization. We focused on quality programs like Value-Based Purchasing (VBP), Merit-Based Incentive Program (MIPS) and Alternative Payment Models (APM) and their impact on Part A and Part B reimbursements.
It’s no surprise that reimbursement tied to quality performance is quickly becoming a reality for hospitals and physicians. CMS’ aggressive goals aimed at increasing the percentage of Medicare payments associated with quality versus quantity can be achieved through such programs as Value-based Purchasing and MACRA. This session will cover scoring methodologies, reporting requirements, reimbursement impact, infrastructure (and other resource needs), EMR tools and tactics, and workflow modifications.
The Alphabet Soup of Clinical Quality Measures ReportingBill Presley
CMS is transitioning to what the they call "a new and more responsive regulatory framework" for quality reporting and reimbursement. CMS goals are "…electronic health records helping physicians, clinicians, and hospitals to deliver better care, smarter spending, and healthier people". Over the next couple years, we will see a transformation of fee for service into value-based care models driven by the VBP, Quality Payment Program, MACRA, Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APM). Healthcare organizations will no longer be motivated by implementing and meeting Meaningful Use, but instead will be driven by value-based care and risk-based payment models that focus on quality outcomes for reimbursements.
In this Education Session we will review:
• How CMS is aligning clinical quality measures (CQMs) to reduce the reporting burden for healthcare organizations and providers. We will cover the vision and goals for achieving quality alignment for CMS.
• We will dive into the following CMS reporting programs and how they interact with each other: Value-Based Purchasing (VBP), Medicare Access and CHIP Reauthorization Act (MACRA), Merit-based Incentive Payments (MIPS), Hospital Inpatient Quality Reporting (IQR), The Joint Commission (ORYX), Outpatient Quality Reporting (OQR), and Alternative Payment Models (APM).
Revenue at Risk: Understanding Financial Impacts of Quality ReportingBill Presley
Jodi Frei, Northwestern Medical Center Vermont, and I co-presented at the MUSE Executive Institute on Revenue at Risk: Understanding Financial Impacts of Quality Reporting. The Executive Institute featured many amazing CXO's discussing the changing landscape of revenue cycle management and how finance, quality, and IT departments are converging on revenue cycle.
Though pay for performance is the common theme, the logistics of programs including Value Based Purchasing (VBP), Inpatient Quality Reporting (IQR), Hospital Acquired Condition (HAC) Reduction Program, Readmission Reduction, MACRA, MIPS and APMs, are very different. In this session, the specifics of each Quality Program including reporting requirements, scoring methodologies, and associated incentives and penalties will be covered. In addition, tools to track performance and quantify financial risk will be shared.
Reimbursement in this era of health care reform is challenging. We all seek success under this new normal in health care. Optimizing revenue capture in a quality reimbursement model requires acquisition of new knowledge and the use of new tools and strategies. Join us in the conversation; share your strategies; learn from others.
In January 2013, Catholic Health Initiatives began a multi-phase journey to develop a population health management solution across all of its regions. This presentation will describe the strategies the health system pursued for: creating a clinically integrated network as a first step in managing the health of populations and integrating care across the patient experience; aligning hospitals and physician groups to create successful clinical models; creating a data platform to share clinical measures and benchmarks; and ultimately becoming a risk-bearing shared savings ACO. Participants will hear real-world examples of best practices for how to meet FTC regulations, create an effective governance structure to manage performance, and align financial incentives. Learn how one of the nation's largest hospital systems developed a system-wide population health management solution in order to achieve the necessary transformation from fee-for-service to fee-for-value.
The Top 7 Outcomes Measures and 3 Measurement EssentialsHealth Catalyst
Outcomes improvement can’t happen without effective outcomes measurement. Given the healthcare industry’s administrative and regulatory complexities, and the fact that health systems measure and report on hundreds of outcomes annually, this blog adds much-needed clarity by reviewing the top seven outcome measures, including definitions, important nuances, and real-life examples:
Mortality
Readmissions
Safety of care
Effectiveness of care
Patient experience
Timeliness of care
Efficient use of medical imaging
CMS used these exact seven outcome measures to calculate overall hospital quality and arrive at its 2016 hospital star ratings. This blog also reiterates the importance of outcomes measurement, clarifies how outcome measures are defined and prioritized, and recommends three essentials for successful outcomes measurement:
Transparency
Integrated care
Interoperability
Managing Total Joint Replacement Bundled Payment Models: Keys to SuccessWellbe
Speaker: Andrew Duncan, Executive Director for Orthopaedics and Rehabilitation at University of Florida Health
This webinar will describe bundled payments and episode of care based patient management strategies. Attendees can learn to successfully manage total joint replacement bundled payment programs and what clinical service delivery strategies to use to be positioned for success. The importance of collecting and using data to understand costs for the episode of care and to negotiate will also be a focus.
About the Speaker:
Andrew Duncan has been a licensed physical therapist since 1991, when he graduated from the State University of New York at Buffalo with his Bachelor of Science in Physical Therapy. Upon completion of entry-level training, he worked as a physical therapist for two years and then completed his post professional Master’s degree in Human Movement Science and became certified in Athletic Training at the University of North Carolina at Chapel Hill. He then underwent board certification by the American Board of Physical Therapy Specialties and became a Sports Certified Specialist in 2002. While working as a manager at rehabilitation corporations and later at an academic health care center, he developed a passion for the business of health care and went on to complete his MBA from the Simon School of Business at the University of Rochester and has also earned his DPT from Boston University. Since 2012, Duncan serves as the Executive Director for Orthopaedics and Rehabilitation at the University of Florida College of Medicine, Co-Director of the UF Health Orthopaedic and Sports Medicine Institute, and also serves as the Executive Director for Rehabilitation and Radiology Services at UF Health Shands Hospitals. He holds an adjunct clinical lecturer appointment in the University of Florida Department of Physical Therapy providing instruction in the Patient and Families First and Professional Issues courses of the DPT curriculum.
Achieving population health management through more coordinated care is becoming essential as healthcare organizations move away from fee-for-service models and begin operating in the new value-based care environment. One path to succeeding in this new environment and achieving more coordinated care is through formation of a clinically integrated network.
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.
On March 16, 2016, President of Value-Based Care, Megan North and Amanda Skinner, Executive Director of Clinical Integration and Population Health for Yale New Haven Health System (YNHHS), co-presented at the 2016 American College of Healthcare Executives’ Annual Congress on Healthcare Leadership (ACHE Congress). North and Skinner shared “A Step-by-Step Approach to A Clinically Integrated Network,” to provide insights into each step of the clinical integration road map.
The CMS Innovation Center hosted a special webinar featuring Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, on Monday, November 10, 2014 from 10:30am – 11:30 am ET. Dr. Conway will provided an update about the work of the CMS Innovation Center and the models being tested to improve better care for patients, better health for our communities, and lower costs through improvement for our health care system. Opportunities for questions were provided.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Prepping for CCJR: Lessons Learned in Physician Alignment and Bundled PaymentsWellbe
With CMS’ recent announcement of its Comprehensive Care for Joint Replacement (CCJR) payment model and its plan to implement in seventy-five geographic areas, hospitals must be prepared to manage the entire episode of care from the time of surgery through ninety days after discharge. CCJR presents both opportunities and challenges for hospitals. In order to achieve success, organizations must manage their system of care delivery, ensure they are aligned with their physicians and post acute providers, and master the analytics necessary for driving high quality, low cost care.
MedAssets has worked with numerous providers to implement alignment models that bring hospitals and their physicians together, evaluate, identify, and implement changes to the care delivery system to improve quality and decrease cost across the continuum, and employ meaningful analytics for managing an episode of care.
Kevin Lieb, Senior Director for MedAssets’ Physician Alignment Solutions division, will share examples demonstrating how organizations have successfully implemented Episodes of Care. Mr. Lieb will also share examples from both hospital led and specialist led programs and provide lessons learned from these experiences.
This webinar will enable attendees to do the following:
• Identify alignment models within bundled payments and understand their applicability to your organization
• Understand the analytic capabilities necessary for success in a bundled payment environment
• Identify opportunities and strategies for cost reduction and quality improvement
About the Speaker:
Mr. Lieb has more than 20 years of healthcare-related experience focusing on quality improvement, market development and cost reduction initiatives for the hospital provider market. Mr. Lieb has worked for a number of well-known healthcare companies including GE Medical Systems, HCIA and LBA in Denver, Colorado. His responsibilities included healthcare consulting with a focus on process improvement and quality initiatives.
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
The healthcare transformation from fee for service to fee for outcomes just got an adrenaline shot in the arm April 27th when the Department of Health and Human Services surprised many in the market by announcing a Quality Payment Program, a proposed set of new rules to take effect in 2019 based on key provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
NYU Langone Medical Center’s TJA BPCI Experience: Lessons in How to Maximize ...Wellbe
The Bundled Payments for Care Improvement (BPCI) Initiative began generating data in January of 2013. Dr. Iorio will outline the challenges and benefits of implementing BPCI for Total Joint Arthroplasty at an urban, tertiary, academic medical center with a hybrid compensation model. Early results from the implementation of a Medicare BPCI Model 2 primary TJA program demonstrate cost-savings with an improvement in quality of care metrics and continued cost savings through year 3 of our experience. Changes in patient optimization, care coordination, clinical care pathways, and evidence-based protocols are the key to improving the quality metrics and cost effectiveness within the implementation of the Bundled Payment for Care Initiative, thus bringing increased value to our TJA patients.
Maximizing Value in a Bundled Environment – Keys to Success:
• Evidence based, cost effectiveness analysis
• Standardized protocol adoption
• Transparent data
• Perioperative Patient Optimization
• Care management
• Physician-hospital alignment with Gain sharing
• Enhanced pain relief and rehabilitation protocols
• Blood management and rational VTED prophylaxis
About the Speaker:
Richard Iorio, MD, is the William and Susan Jaffe Professor of Orthopaedic Surgery at New York University Langone Medical Center Hospital for Joint Diseases and Chief of Adult Reconstruction at NYU Langone HJD. He co-founded Labrador Healthcare Consulting Services, Responsive Risk Solutions, and the Value Based Healthcare Consortium in 2015. He is a member of the Board of Directors for LIMA, the Lifetime Initiative for the Management of Arthritis. Dr. Iorio is a national expert in physician and hospital quality and safety and a leader in the implementation of alternate payment paradigms in orthopaedic surgery.
Due to popular demand, the Comprehensive Primary Care Plus (CPC+) team hosted a repeat of the webinar that was originally held on Wednesday, April 27, 2016. During this webinar Model team members provided an overview of the model specifically for interested payers.
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CMS Innovation Center
http://innovation.cms.gov
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Top 3 Strategic Initiatives for Sustainable Results in Healthcare in Middle EastSTELIOS PIGADIOTIS
This research paper offers insights in three areas:
1. Current Challenges in GCC/Middle East Healthcare sector
2. Future Drivers for Healthcare Excellence
3. Future Strategic Initiatives for Sustainable Results
Why Healthcare Costing Matters to Enable Strategy and Financial PerformanceHealth Catalyst
According to Moody’s Investment Service Analysis, not-for-profit hospital margins are at an all-time low of 1.6% while the American Hospital Association has found that 30% of all hospitals have negative margins. Financial pressures are continuing to increase in an environment of rising costs, lower payments, an aging population, higher patient responsibility and changing consumer demands. Now more than ever healthcare providers need to have an accurate picture of their costing information to enable precise, strategic decisions that will improve financial performance.
Activity-based costing has the power to do just that. In this webinar Steve Vance, SVP, Professional Services, Health Catalyst explores different costing methodologies and discusses why activity-based costing is the preferable method to manage margins because it directly ties services to their costs. Many healthcare organizations base their costs on generalized drivers such as relative value units (RVUs) through their chargemaster rather than on specific activities associated with their services, leading to inaccurate assumptions and poor decisions.
View this webinar to learn:
- Why activity-based costing should be your core tool for improving financial performance.
- The differences and implications between costing methodologies.
- How to leverage data from an Electronic Data Warehouse (EDW) and automate processes while improving accuracy.
- Ways that you can make strategic decisions using clinical and operational data when tied to costing data.
- Activity-based costing use cases such as contract negotiations, pricing decisions, population health management (PHM), and process improvement efforts
We hope that you will view the webinar and learn from the depth and breadth of Steve’s extensive financial experience.
ACOs and CINs — Where Did They Start, How Have They Evolved, and Where Are Th...Health Catalyst
As the types and structures of Accountable Care Organizations (ACOs) and Clinically Integrated Networks (CINs) continue to evolve, organizations moving into value-based care face an ever-changing landscape. Alternative payment model arrangements have driven provider organizations to hone in on specific tactics to meet their contractual and strategic objectives.
Please join Health Catalyst Senior Vice President Dr. Amy Flaster and Population Health Management Consultant Jonas Varnum as they discuss the evolution of the ACO and CIN models, what new tools ACOs employ today to promote success, and lessons learned from organizations that have succeeded in alternative payment models. They will dive deep into lessons learned in addition to providing a primer on what has always been and continues to be vitally important to success in value based care. Specifics they will cover include:
- Approaches to simplify quality metric reporting
- Enhanced methodology that zeroes in on identifying high-value opportunities to improve patient populations
- Key tips to expand your business with new contracts
Dr. Flaster and Mr. Varnum’s combined experience make them uniquely qualified to guide you in your ACO or CIN journey. Dr. Flaster comes from a clinical background where she worked as Associate Medical Director at Partners HealthCare - one of the largest ACOs in the country. Mr. Varnum is a professional services strategy leader with demonstrated expertise delivering payment model transformation and helping providers and payers to strategically adjust their operations.
The Next Revolution in Healthcare: Why the New MSSP Revisions Matter Now More...Health Catalyst
Now more than ever, we are entering a period of rapid change catalyzed by the power of data. On December 21, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a final rule for the Medicare Shared Savings Program (MSSP), strengthening the financial incentives for ACOs to drive improved outcomes. The health systems that embrace data to achieve financial success will grow while the rest will struggle to compete. View this webinar for a discussion on how to prepare.
The US healthcare system didn’t develop overnight, rather, it is the culmination of a series of revolutions within wealthy parts of the world. In this webinar, we explore the high points of history that have led us to our current challenges. While care has steadily improved over time, the cost of that care has risen at a much more dramatic rate. CMS created the MSSP to help mitigate the growth of these costs while providing better care for individuals and populations. On a larger scale, the program serves to shift the healthcare industry towards fee-for-value.
Despite general frustration related to legislative involvement, history has proven that regulatory changes precede attitudinal changes and the MSSP (combined with accurate, timely data) may be just the piece of legislation to help make value-based care a reality. By viewing this webinar you will learn:
- How the US healthcare industry reached its current state.
- Why financial imperatives drive cultural change in our economic model.
- Ways that the MSSP can help your organization achieve financial success.
- Ideas for how to utilize data to develop better healthcare delivery systems.
Dr. Will Caldwell is a strong proponent of the use of data analytics to promote good health and save lives. His area of expertise rests in technology-enabled health care delivery models and value-based care platforms. We hope that you will view this webinar and learn from his 17-years of work as a data-informed clinician.
2023 — Focus on the Margin (Vitalware by Health Catalyst)Health Catalyst
In this webinar, we will look at pressures exerted in 2023 on the margin and explore how cost management and complete charge capture can protect and enhance the margin. We will provide details on patient activity costing versus the cost-to-charge ratio (CCR), looking at common themes for lost charges and providing an example of where patient activity cost management was able to provide insight into cost containment and practice patterns of a system provider.
Clinical Integration: The Foundation for Accountable Care - Presentation delivered by Keynote Speaker Marvin O’Quinn, Senior Executive Vice President and Chief Operating Officer, Dignity Health at the National Healthcare CXO Summit held in Las Vegas Oct 19-21, 2014.
Acting as a roadmap through the changes in healthcare and healthcare law that occur almost daily, this presentation uses a case study to illustrate real-world issues and concerns associated with the compensation redesign process, including types of compensation models, service-specific compensation components, legal and contractual issue identification and mitigation, fair market value challenges
During this webinar, a high-level overview of the ACO REACH Model was provided including information on the participation and eligibility requirements, Accountable Care Organization (ACO) types, payment mechanisms, and beneficiary alignment methodology.
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CMS Innovation Center
http://innovation.cms.gov
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Healthcare transition in GCC: Current Painful Realities & Proposed Strategic ...STELIOS PIGADIOTIS
Goals of research effort
1. Hands on analysis of GCC and specifically UAE healthcare market.
2. Proposed 2016 strategies for CEOs in GCC healthcare ecosystem
The Medicare Access and CHIP Reauthorization Act of 2015 is fundamentally transitioning the U.S. Healthcare System from a Fee-For-Service model to a Fee-For-Value reimbursement model. MACRA encourages healthcare providers to utilize HIT, population health management, and care coordination in pursuit of The Triple Aim (Improving individual healthcare quality, improving population health , and reducing cost).
1. Successful Practice
Transformation for the Value-
Based World
Melissa Gerdes, MD, FAAFP
VP and CMO Outpatient Services and ACO
Strategy
Methodist Health System
2. Learning Objectives
• Understand the goals and makeup of value-
based payment scenarios
• Discuss five core competencies required for
early success in the Medicare Shared Savings
Program
• Understand ways to evaluate if an ACO model
is right for a practice
3. Methodist Health System
$1.17 Billion in net revenue in 2014.
Provided more than $135.8 million in
unreimbursed charity care in 2014, 11.6%
of net revenue.
471,376 patient visits.
32 Family Health Centers
1,128 active physicians.
6 hospitals
Overall quality and clinical outcomes rank
in the top quartile in the nation.
4. What is and ACO? MSSP?
What is an Accountable Care Organization
(a/k/a ACO)?
What is the Medicare Shared Savings
Program (MSSP)?
• Healthcare providers agree to be
accountable for quality, cost, and
overall care of a defined
population of patients.
• Similar to patient centered
“medical homes,” which deliver
primary patient centered care via a
coordinated group of providers.
• Payer reimbursement policies will
vary.
• Three year program
• Savings shared between Medicare (50%) and
ACO (50%)
• Savings calculated of all Part A and B spending
• To be eligible for savings, have to meet certain
quality measures criteria.
• Providers continue to bill and be paid from
Medicare as they currently do.
• Patients retain freedom of provider choice
• Specific waivers provided for participating
• Year 1 ACO must successfully submit data for
quality measures
• Year 2 and 3 ACO must successfully submit data
and meet benchmarks for certain quality
measures
• Achieve minimum of 3% savings from
benchmark year
5. MPCACO Success to date
Net $11,492,369
to MHS
$4,063,320 shared
with physician practices
Performance Year One (2012-2013)
$12,717,281 savings
78% aggregate quality score
#13 in the nation
220 providers
13,000 lives
Performance Year Two (2014)
$12,612,997 savings
85.12% aggregate quality score
Highest reported quality in N TX
330 providers
14,700 lives
Year Three Expansion (2015)
38,700 projected lives
392+ providers
Contracts with Cigna,
BCBS
6. HHS 2/15 goals: Better Care. Smarter Spending. Healthier People
o Encourage the integration and coordination of clinical care services
o Improve population health
o Promote patient engagement through shared decision making
Volume to Value
Track 2:
Alternative payment models*
Track 1:
Value-based payments 85% of all Medicare payments 90% of all Medicare payments
30% of all Medicare payments 50% of all Medicare payments
2016 2018
Focus Areas Description
Incentives
Promote value-based payment systems
o Test new alternative payment models
o Increase linkage of Medicaid, Medicare FFS, and other payments to value
Bring proven payment models to scale
Care Delivery
Information
Bring electronic health information to the point of care for meaningful use
Create transparency on cost and quality information
8. Track 2: 5% bonus for qualifying APMs
Inclusion in the APM
program triggers
exclusion from MIPS.
APM participating providers exempt from MIPS;
receive annual 5% bonus (2019-2024)
.75%
update
(2026 )
Track2
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Alternative Payment Models (APM) are defined as:
CMS Innovation
Center model
Medicare ACO
(MSSP)
Demo under section
1866C of SSA
Demo required by
federal law
New programs TBD
Alternative Payment Models (APM) must:
1 | Use certified EHR and MIPS
comparable measures, and
2 | Bear more than “nominal” financial
risk for losses
25%
50%
75%
2019-20
2021-22
2023 +
Medicare only
Medicare* and all-payer
Medicare* and all-payer
Total payments exclude payments made by the Secretaries of Defense/Veterans Affairs and
Medicaid payments in states without medical home programs or Medicaid APMs.
Threshold of payments in an APM
Measurement period
Greater update vs.
Track 1 program
9. Bonus payments for meeting
metrics (e.g., quality, process)
Potential for “box checking” vs.
improving population health/cost
of care
Provider shares savings created if
total cost of care is below target
Creates accountability for
population health management,
even if provider cannot take
on full accountability
Provider shares upside savings,
but pays back some costs above
target
Higher reward potential
Accompanies taking on full
accountability
Providers take on full risk and
manage patients’ costs with a set
global budget
Requires broad set of provider
capabilities
Value Based payment models provide a path to full accountability
Pay for Performance
(P4P) Upside gainsharing
Downside
gainsharing Global payment
10. Structure of Contracting
Negative Performance
Relative to Benchmark
Positive Performance
Relative to Population
Benchmark
$$$$$$$$
Quality Patient Experience Cost Efficiency
11. How to survive? Choose?
• 5 core competencies of an ACO
• Same competencies to evaluate when
considering joining
• What allowed MPCACO to be successful
12. Core Competencies
• Governance structure
• Quality performance support
• Big Data handling
• Post-Acute Strategy
• Population management strategy
14. Physician Governance Participation in
MAP2/MPCACO
ACO Governing
Board
10 physicians
ACO Operations
President
Clinical Executive
Physician
Team Members:
Operations
Clinical
Governance and
Nominating
Committee
4 physicians
Responsible for
nominating new
board and
committee
members
Finance
Committee
12 physicians
Responsible for
approving budget,
capital requests,
earned
distributions
Clinical Oversight
Committee
15 physicians
Responsible for
determining basis
for physician
shared savings
distribution
including quality
measures
Care Coordination
Committee
6 physicians
Post-acute reps
Responsible for
developing and
monitoring
evidence based
practices for the
care continuum
16. New Formation Process
• Data and IT governance
• Peer Review
• Patient Experience
• Hospital Efficiency programs
Committees are
formed upon
request by members
Committees “join” with
existing committees for
synergy
• Credentialing
• Compliance
• Clinical Quality
17. Physician Benefits: Case Study
“The MPCACO has really helped several
of my patients. The nurse navigators were
able to break down barriers to care for
patients, including getting equipment,
ensuring appointment follow-up,
arranging home health services, and
providing health coaching for lung
disease and diabetes. The end result
was happier, healthier patients
who only need to see me a few times
a year to stay that way.”
DARRELL THIGPEN, MD | MPCACO MEMBER
19. Requirements
MSSPs are required to report “completely and accurately” on
quality measures selected by CMS.
Each set of quality metrics has a measure steward(s)
responsible for establishing the numerators and denominators
and defining the parameters for the measure.
CMS selects which beneficiaries and which measures to
collect.
Eight weeks to organize, collect, and enter data into CMS’s
database.
20. The Data Collection Project
A team of RNs, EHR/IT experts, data entry operators, project managers spend 2000+ man-hours
over 8 weeks to collect 8,077 data elements.
THE TEAM
Physician office 1 Physician office 2 Physician office 3
24. Areas for financial focus in MSSP
Expense for
MPCACO
Assigned
Beneficiaries
All MSSP ACOs Impact of 5%
Cost Reduction
Impact of
Reaching MSSP
Average
Total $11,494 $9,824 $7,308,138 $21,236,584
ESRD $69,541 $65,029 $740,612 $961,103
Inpatient $3,550 $3,200 $2,257,328 $4,458,411
Part B Physician $3,318 $3,113 $2,109,638 $2,604,171
Skilled Nursing $1,088 $891 $692,058 $2,509,422
Home Health $1,664 $527 $1,058,028 $14,462,779
Home health alone could generate over 3x the savings as compared to inpatient expenses
NOTE: Costs not severity adjusted
25. Performance Year 1 Financial Results
• Savings in many areas
• 12,260 total beneficiaries as of Q3 2013
27. Sample Format Tracking Metrics: Efficiency
Utilization Metrics June 14-May 15 claims complete
28. Data Sources
• Payer
– Oldest
– Benchmarks
– 3-6 month delay
• Practice coding and billing systems
• Hospital coding and billing systems
– More real-time
– Only a “part” of the picture
• Physicians
– Vital
– Not structured
• Patients
• Business Intelligence Platforms
– $$$$$
– Benchmarks
– Analysis assist
30. Skilled Nursing Facility and Home Health Initiatives
• Quarterly meetings
• Collaborative discussions
• Data review and discussions
• Quality measures
– Lists published 2 x year
– Measures evaluated annually
– Distribution to stakeholders
• Monthly score card survey
• Post Acute Liaison
• Transition medication pilot
31. Skilled Nursing Facilities
Criteria:
• Received four and five star
rating by CMS (CMS star
rating verified)
• Readmissions <30% for
August
• Falls with major injury-state
average*
• New/worse pressure ulcer-
state average*
*Data source: CASPER report
32. Home Health Agencies
Criteria
• Begin patient care within
48 hours at least 88% of
the time
• Wound improvement at
least 84% of the time
• Unplanned return to ER
less than 15%
• Readmission less than
19%
Percentages reflect 2.5-5% of
the state average
33. Rehabilitation Facilities
Criteria
• LOS efficiency
• Discharge to community
• Discharge to Acute
• FIM Change
Facility receives a star if they
1)Report
2) Exceed 5% below national weighted
benchmark
Source of data: eRehab or UDS
34. Performance Year 1 Financial Results
12,260 total beneficiaries as of Q3 2013
37. Why Do Risk Stratified Care Management (RSCM)?
All patients do not need the same amount of help and support
Systems and standardized approaches can be designed which are most appropriate for
the patient’s needs
High risk patients are the ones who are most likely to benefit from intense care
management
High risk patients tend to generate the highest costs for the system and therefore
provide the most opportunity for cost savings
The practice can use valuable time and effort on the patients most likely to benefit
from intense care management
Pro-active care management and tracking of high risk patients keeps them from “falling
through the cracks” or getting lost in the system
38. Population Health Management: Nurse Navigation
Level 6-1% to 3%
Level 5-5% to 7%
Level 3 and 4-40% to 50%
Levels 1 and 2 -The Rest
High
Risk
Group
>400
Active Patient
Panel
13,400
Inpatient/ER census
Crimson risk scores
Physician referrals
Case management
referrals
Individual assessments
PAM score
The rest of the cost
More than 50% of the cost
39. Navigator Program Benefits: Coordinated Patient Care
A team of RNs and care professionals is available to support physicians in coordinating care across the
continuum.
CARE CONTINUUM
CARE RESOURCES
40. Nurse Navigation
• Risk stratification of
entire population
• Nurse navigation
based upon medical
complexity
• Personalized
navigation:
Work collaboratively and maintain
active communication with
physicians, nursing, and other
members of care team to execute
against care plan
Ensures that the plan of care and
services provided are high quality
and cost effective
After hours/complications action
plan
Attend physician visits,
communicate between visits
Phone and in person following
during transitions of locations
Medication reconciliation during
transitions
Advanced directive
Social services
41. Patient Benefits: Case Study
“What the MPCACO
beneficiary care navigators
did for me was to help me
be able to return home
confidently by myself
after a prolonged hospital
stay. I don’t think I would
have been able to do that
without them.”
JUDITH JORDAN | PATIENT
Alternative payment models description: payment is linked to the effective management of a population or an episode of care. Payments still triggered by delivery of services, but opportunities for shared savings or 2-sided risk.
SGR repeal & annual updates
0.5% increase in physician payments for 5 yrs (beginning June 2015); Freeze through 2025
Beyond 2025: physicians in advanced payment models (APMs) receive 1% annual updates, all others receive 0.5% (these out years not pictured in graph)
Time to develop quality measures & clinical improvement activities
Value-Based Performance (VBP) Payment Program
2017, payments adjusted for physicians’ performance in prior period
2018: Consolidate PQRS, VBM & EHR MU into VBP
4% tied to performance in 2019; 5% in 2020; 7% in 2021; 9% in 2022 & beyond. Secretary can increase funding pool in 2021 and beyond to no more than 12%
Maximum upside and downside adjustment equal to funding pool % (e.g. +/- 4% in 2019)
Professionals will be measured on:
Quality
Resource use
Clinical practice improvement activities
EHR MU
Encouraging provider participation in APMs
APM participating providers exempt from VBP; receive annual 5% (2019-2024)
Significant share of revenues must be from APM with 2-sided risk and quality measurement
Reimbursed according to payment arrangements of model
A team of RN’s and care professionals are available to support physicians in coordinating care across the continuum.
CAPABILITIES
• Assigned care coordinator to help manage patient population
• Care navigation across continuum
• Communication with facilities, community resources and physicians to coordinate care decisions
• Post-Acute provider network engagement
BENEFITS TO PHYSICIAN
• Support of Physician-led Care Models
• Team approach to get the “right care at the right time”
• Educational resources to help patients stay healthy
A team of RN’s and care professionals are available to support physicians in coordinating care across the continuum.
CAPABILITIES
• Assigned care coordinator to help manage patient population
• Care navigation across continuum
• Communication with facilities, community resources and physicians to coordinate care decisions
• Post-Acute provider network engagement
BENEFITS TO PHYSICIAN
• Support of Physician-led Care Models
• Team approach to get the “right care at the right time”
• Educational resources to help patients stay healthy
A team of RN’s and care professionals are available to support physicians in coordinating care across the continuum.
CAPABILITIES
• Assigned care coordinator to help manage patient population
• Care navigation across continuum
• Communication with facilities, community resources and physicians to coordinate care decisions
• Post-Acute provider network engagement
BENEFITS TO PHYSICIAN
• Support of Physician-led Care Models
• Team approach to get the “right care at the right time”
• Educational resources to help patients stay healthy
A team of RN’s and care professionals are available to support physicians in coordinating care across the continuum.
CAPABILITIES
• Assigned care coordinator to help manage patient population
• Care navigation across continuum
• Communication with facilities, community resources and physicians to coordinate care decisions
• Post-Acute provider network engagement
BENEFITS TO PHYSICIAN
• Support of Physician-led Care Models
• Team approach to get the “right care at the right time”
• Educational resources to help patients stay healthy
