The symposium is designed for clinicians – physicians, nurses, nurse practitioners, physician assistants, and students – and healthcare executives interested in expanding their scope of knowledge about currently popular health policy topics.
Soraya Ghebleh - Using Financial Incentives to Influence Clinical Decision Ma...Soraya Ghebleh
This slide deck discusses some of the relevant factors that should be considered when designing financial incentives for providers of healthcare services.
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.
Mckesson Payor Solutions Conference Presentation of Case Management, 2004DrFACHE
Presentation by Felix Bradbury, RN, ScD, FACHE for Mckesson entitled
PM-O5 Assessing the Economic Impact of Case Management on Diabetics in a Commercially Insured Population, 2004.
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 Patient-Centered Medical Home Impact on Cost and Quality: An Annual Revie...CHC Connecticut
Dr. Nwando Olayiwola, Associate Director, Center for Excellence in Primary Care, Assistant Professor, University of California, San Francisco addresses the 2014 Weitzman Symposium on The Patient-Centered Medical Home Impact on Cost and Quality: An Annual Review of Evidence
Soraya Ghebleh - Using Financial Incentives to Influence Clinical Decision Ma...Soraya Ghebleh
This slide deck discusses some of the relevant factors that should be considered when designing financial incentives for providers of healthcare services.
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.
Mckesson Payor Solutions Conference Presentation of Case Management, 2004DrFACHE
Presentation by Felix Bradbury, RN, ScD, FACHE for Mckesson entitled
PM-O5 Assessing the Economic Impact of Case Management on Diabetics in a Commercially Insured Population, 2004.
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 Patient-Centered Medical Home Impact on Cost and Quality: An Annual Revie...CHC Connecticut
Dr. Nwando Olayiwola, Associate Director, Center for Excellence in Primary Care, Assistant Professor, University of California, San Francisco addresses the 2014 Weitzman Symposium on The Patient-Centered Medical Home Impact on Cost and Quality: An Annual Review of Evidence
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.
Michigan Hospital Association Governance meetingMary Beth Bolton
Patient centered medical home activities in MI and Nationally and the opportunity to improve quality outcomes by increased access to primary care doctors who outreach members who are missing preventive and chronic care services.
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.
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.
Redefining the role of patient support programs: Shifting the focus towards p...SKIM
Presented by:
Alex Zhu, Manager
Ariel Herrlich, Analyst
The recent shift toward consumerism and patient empowerment is driving companies to reevaluate the role and design of patient support programs. Historically, pharmaceutical manufacturers implemented support programs largely as a way to address patient non-adherence.
These programs were often single-based solutions designed to meet mass market needs. Next generation patient support programs will go beyond simple adherence to address holistic disease management through individualized, patient-centric service offerings.
Using a case study, we illustrated:
- How to evaluate your current patient support program offerings, using a combination of standard and non-standard metrics and exercises
- Re-define what “value” means in a world of patient-centricity and personalized care
- Assess the impact/ROI of potential new service offerings and enhancements
Quality improvement is integral to the practice of medicine. Sometimes, QI strays over into clinical research. This presentation provides an overview of the intersection between QI and research
Key Principles and Approaches to Populaiton Health mManagement - HAS Session 21Health Catalyst
Population Health Management is in its early stages of maturity, suffering from inconsistent definitions and understanding, and is overhyped by vendors and ill-defined by the industry. And yet, many systems are moving forward in innovative pioneering ways to address this growing trend. In this session, you will hear from two very different, successful health systems: a physician-led group and a large integrated delivery system. They will share their best practices, learnings, and different approaches to population health management.
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.
Michigan Hospital Association Governance meetingMary Beth Bolton
Patient centered medical home activities in MI and Nationally and the opportunity to improve quality outcomes by increased access to primary care doctors who outreach members who are missing preventive and chronic care services.
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.
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.
Redefining the role of patient support programs: Shifting the focus towards p...SKIM
Presented by:
Alex Zhu, Manager
Ariel Herrlich, Analyst
The recent shift toward consumerism and patient empowerment is driving companies to reevaluate the role and design of patient support programs. Historically, pharmaceutical manufacturers implemented support programs largely as a way to address patient non-adherence.
These programs were often single-based solutions designed to meet mass market needs. Next generation patient support programs will go beyond simple adherence to address holistic disease management through individualized, patient-centric service offerings.
Using a case study, we illustrated:
- How to evaluate your current patient support program offerings, using a combination of standard and non-standard metrics and exercises
- Re-define what “value” means in a world of patient-centricity and personalized care
- Assess the impact/ROI of potential new service offerings and enhancements
Quality improvement is integral to the practice of medicine. Sometimes, QI strays over into clinical research. This presentation provides an overview of the intersection between QI and research
Key Principles and Approaches to Populaiton Health mManagement - HAS Session 21Health Catalyst
Population Health Management is in its early stages of maturity, suffering from inconsistent definitions and understanding, and is overhyped by vendors and ill-defined by the industry. And yet, many systems are moving forward in innovative pioneering ways to address this growing trend. In this session, you will hear from two very different, successful health systems: a physician-led group and a large integrated delivery system. They will share their best practices, learnings, and different approaches to population health management.
North highland himss_hardwiringclinicalfinancialperformance_041315North Highland
North Highland's Ricardo Martinez and Donna Houlne's presentation on "Hardwiring Clinical and Financial Performance Through Patient-Centered, Physician-Directed Transformation"
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
Sills MR. Overview of the SAFTINet Program. Presented to the Emergency Department Research Committee, Department of Pediatrics, University of Colorado School of Medicine. 6 January 2015.
Pharmacy's Emerging Role in Accountable Care Organizations (ACO)Parata Systems
Your pharmacy is an excellent partner for accountable care organizations. ACOs are formed by doctors, hospitals and other healthcare providers to improve health outcomes and lower overall medical expenses for a targeted patient population. Reimbursements are tied to patient outcomes.
ACOs’ highest-risk and highest-cost patients are those managing chronic illnesses and taking multiple medications a day. When your pharmacy can improve and track adherence – a key driver of readmission prevention and overall health – you are a valuable partner to help ACOs prevent unnecessary medical care.
Jamie Hale serves as the Chief Pharmacy Officer for Cornerstone Health Care where he is responsible for the development and integration of pharmaceutical care services in the Accountable Care Organization. He transitioned to Cornerstone in December 2012 after a 15 year career at Wake Forest Baptist Health, where he last served as Director of Pharmacy.
Download the full audio webinar at http://bit.ly/pharmacyACO.
Two of the New York metro area’s largest provider organizations will share their experiences leveraging HIE as one of many tools to decrease fragmentation of care and improve patients’ experiences across acute and post-acute care settings for patients undergoing elective surgeries. Representatives from NYULMC and VNSNY will summarize their efforts to redesign more personalized specific care pathways and the central role played by the implementation of real-time data exchange to provide a seamless transfer of clinical data between providers caring for the patient at the time of discharge and throughout the post-acute period.
• Kathleen Mullaly - Senior Director for Clinical Operations, Department of Network Integration, NYU Langone Medical Center
• Amy Weiss - Director for Strategic Account Development, Integrated Delivery Systems, Visiting Nurse Service of New York (VNSNY)
New York eHealth Collaborative Digital Health Conference
November 18, 2014
Network physicians, hospitals, and other care continuum providers work collaboratively in active clinical process improvement programs across service lines and specialties to define, establish, implement, monitor, evaluate and periodically update the processes of:
- Evidence-based medicine
- Beneficiary engagement
- Care coordination
- Conservation of healthcare resources
- Clinical data reporting
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
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 24, 2013
Jeff Thompson, Washington State Health Care Authority
David Downs, Engaged Public
David Swieskowski, Mercy ACO Mercy Clinics, Inc.
Lisa Weiss, High Value Healthcare Collaborative
Kate Chenok, Pacific Business Group on Health
Because everyone matters.
IBM Health and Social Programs Summit, October 2014
Craig Rhinehart’s Blog
Insights from NASHP Conference in Atlanta
Trick or Treating for State Healthcare Innovation Treats
http://craigrhinehart.com
NTTAP Webinar Series - April 13, 2023: Quality Improvement Strategies in a Te...CHC Connecticut
Join us for a webinar on quality improvement in team-based care!
Building a quality improvement (QI) infrastructure within team-based care is an organizational strategy that will establish a culture of continuous improvement across departments and improve quality in all domains of performance.
Participants will learn about:
• QI infrastructure
• Facilitating QI committees
• Coach training within health centers
Faculty will also provide an example of how trained coaches use QI tools to test and implement changes within an organization.
Who Knew Health Care Could Be This Complicated?Cedric Dark
A talk I gave to the Spring Branch Democrats (Houston, TX) just as the "Skinny Repeal" was released to the public and hours before it's ultimate failure.
Presentation by Cedric Dark, MD, MPH & Rosalia Guerrero-Luera
for the Third Annual Policy Prescriptions® Symposium
Cedric Dark is the founder and executive editor at Policy Prescriptions® and an assistant professor at Baylor College of Medicine Section of Emergency Medicine
The symposium is designed for clinicians, healthcare workers, and healthcare executives interested in exploring the major themes that will emerge in health policy throughout the year. This year, the symposium will emphasize value in healthcare, health information technology, gun violence, insurance choices, the Affordable Care Act, and the viewpoints of the Presidential candidates on health care.
The Big Bang Theory: Evidence-Based Strategies to Reduce Gun ViolenceCedric Dark
Presentation by Bich-May Nguyen, MD, MPH for the Third Annual Policy Prescriptions® Symposium
Bich-May Nguyen is an assistant professor at Baylor College of Medicine, Department of Family Medicine
The symposium is designed for clinicians, healthcare workers, and healthcare executives interested in exploring the major themes that will emerge in health policy throughout the year. This year, the symposium will emphasize value in healthcare, health information technology, gun violence, insurance choices, the Affordable Care Act, and the viewpoints of the Presidential candidates on health care.
The Affordable Care Act: An Evidence-Based UpdateCedric Dark
Presentation by Seth Trueger, MD, MPH for the Third Annual Policy Prescriptions® Symposium
Seth Trueger is an assistant professor at the University of Chicago, Section of Emergency Medicine.
The symposium is designed for clinicians, healthcare workers, and healthcare executives interested in exploring the major themes that will emerge in health policy throughout the year. This year, the symposium will emphasize value in healthcare, health information technology, gun violence, insurance choices, the Affordable Care Act, and the viewpoints of the Presidential candidates on health care.
Defining Value in Healthcare through Price and Cost TransparencyCedric Dark
Presentation by Laura Medford Davis for the Third Annual Policy Prescriptions® Symposium
Laura Medford-Davis is a Robert Wood Johnson clinical scholar at University of Pennsylvania and a practicing emergency physician.
The symposium is designed for clinicians, healthcare workers, and healthcare executives interested in exploring the major themes that will emerge in health policy throughout the year. This year, the symposium will emphasize value in healthcare, health information technology, gun violence, insurance choices, the Affordable Care Act, and the viewpoints of the Presidential candidates on health care.
Time for a Reality Check on Health InsuranceCedric Dark
Presentation by Elena Marks, JD, MPH for the Third Annual Policy Prescriptions® Symposium
Elena M. Marks is the president and chief executive officer of the Episcopal Health Foundation and a nonresident fellow in Health Policy at Rice University’s Baker Institute for Public Policy.
Marks previously served as the director of Health and Environmental Policy for the City of Houston. Prior to joining the mayor’s staff, Marks practiced trial and appellate law with major law firms, started and directed a successful legal placement firm, and developed strategic, long-range, and operating plans for service lines and system centers at a major health system.
The symposium is designed for clinicians, healthcare workers, and healthcare executives interested in exploring the major themes that will emerge in health policy throughout the year. This year, the symposium will emphasize value in healthcare, health information technology, gun violence, insurance choices, the Affordable Care Act, and the viewpoints of the Presidential candidates on health care.
Presentation by Megan Douglas, JD for the Third Annual Policy Prescriptions® Symposium
She is the associate director of Health Information Technology Policy in the National Center for Primary Care at Morehouse School of Medicine.
The symposium is designed for clinicians, healthcare workers, and healthcare executives interested in exploring the major themes that will emerge in health policy throughout the year. This year, the symposium will emphasize value in healthcare, health information technology, gun violence, insurance choices, the Affordable Care Act, and the viewpoints of the Presidential candidates on health care.
Competition or Collaboration - 2015 Policy Prescriptions® SymposiumCedric Dark
The symposium is designed for clinicians – physicians, nurses, nurse practitioners, physician assistants, and students – and healthcare executives interested in expanding their scope of knowledge about currently popular health policy topics.
How to Cover the Last...Millions - 2015 Policy Prescriptions® SymposiumCedric Dark
The symposium is designed for clinicians – physicians, nurses, nurse practitioners, physician assistants, and students – and healthcare executives interested in expanding their scope of knowledge about currently popular health policy topics.
Leveraging Telemedicine to Improve Health - 2015 Policy Prescriptions Symposium®Cedric Dark
The symposium is designed for clinicians – physicians, nurses, nurse practitioners, physician assistants, and students – and healthcare executives interested in expanding their scope of knowledge about currently popular health policy topics.
Should costs matter in healthcare decision making?- 2015 Policy Prescriptions...
The Near Future of Healthcare Delivery - 2015 Policy Prescriptions® Symposium
1. Kameron Leigh Matthews MD JD
Chief Medical Officer, UI Health Mile Square Health Center
Associate Medical Director, UI Health Plus
Assistant Professor of Clinical Family Medicine
University of Illinois at Chicago
The (Near) Future of
Healthcare Delivery
What are ACOs, PCMHs, and Value-based Performance?
3. Objectives
• To define the “accountable care organization,” its
associated models of payment and care delivery,
and review an example of its implementation.
• To discuss the commonly adopted components of
the Patient-Centered Medical Home and its impact
on the achievement of improved patient outcomes.
• To describe trends in value-based purchasing (pay-
for-performance) models and their impact on
quality and efficiency measures.
4. Accountable Care Organizations
• An ACO is a network of doctors and hospitals that
shares financial and medical responsibility for
providing coordinated care to patients in hopes of
limiting unnecessary spending.
• Formalized under the Affordable Care Act for
Medicare entities
• Now implemented with Medicaid and commercial
sector
• Modeled after Kaiser Permanente and Geisinger
Health System.
7. ACOs - Key Elements
• Provider Led
• Primary Care at the helm
• Hospitals, Community Health Centers, specialists,
urgent care centers
• Accountability for Patient Outcomes
• Care Coordination and case management
• Tied to payment
• Potential for shared savings
• Reduced expenditures for a defined population by
diminishing the link between payments and volume
and intensive of services provided
8. How Does It Work?
• Similarities to HMOs/capitated models?
• Goal of cost savings
• More focus on quality of care and population
health
• Less focus on restrictions to utilization of health
care services
• Larger groups of patients for risk distribution while
also making appropriate clinical decision making.
8
11. Patient-Centered Medical Home
• A health care delivery model that places the patient
at the center of team-based care that is coordinated
and proactively managed.
• Certification by National Committee for Quality
Assurance (NCQA) or Joint Commission
• Standards with specific requirements and levels of
accreditation.
12. PCMH Standards
• Patient-centered access and communication
• Population health management through Patient
tracking and registry function
• Care management and Patient self-management
support
• Coordination including Test tracking and Referral
tracking
• Performance measurement and quality improvement
13. PCMH Critical Factors
• Same day appointments for routine and urgent
care
• Timely clinical advice by telephone.
• Patient care team meetings or other structured
communication process focused on individual
patient care
13
14. PCMH Critical Factors
• Clinical decision support for mental health or
substance use disorders
• Monitoring of total patient population
• Medication reconciliation and tracking
• Registry tracking and “Closing the Loop”
• Lab tests
• Imaging
• Referrals
14
15. Outcomes
• Consistent improvement of quality outcomes
• Hoff, T.,W.Weller, and M. Depuccio. 2012. “The Patient-Centered Medical
Home: A Review of Recent Research.” Medical Care Research and Review 69:
619–44.
• Mixed results for multiple variables
• ED visits
• Inpatient admissions
• Average length of stay
• Costs/Medicare payments
• Utilization of testing
• Patient experience
May 2015
16. Outcomes
• Improvement also associated with higher risk patient
populations
• Chronic conditions
• Coles, ES, et al. Health Affairs. 2015; 34 (1): 87-94.
• Van Hasselt, M. et al. Health Serv Res. 2015 Feb; 50 (1): 253-72
• Minimizes redundant care
• Question remains as to whether a net costs savings is
associated with the model
• Do any improvement in medical expenditures
outweigh the operating costs on the practice side?
• Long term outcomes beyond time-limited studies
17. Herbert PL et al. “Patient-Centered Medical Home Initiative Produced Modest Economic Results
For Veterans Health Administration, 2010-12” Health Affairs, 33, no.6 (2014):980-987
Patient Aligned Care Teams in the Veterans Health Administration
accounted for a discounted investment through FY 2012 was $774
million (primarily for new personnel) and an additional $23 million for
training. The investment was offset by an estimated $596 million in
discounted costs of utilization that was avoided because of PACT, for a
net loss of $178 million.
18. Value-Based Performance
• Payment for achievement of specific quality
outcomes and care coordination goals
• Distinct from a fee-for-service model
• Recommended by the Institute of Medicine
• "Rewarding Provider Performance: Aligning Incentives in Medicare". (2006) The National
Academies Press.
20. Outcomes
• Mixed results for quality outcomes
• Improvement in primary care settings
• Lemak CL et al. “Michigan's Fee-For-Value Physician Incentive Program
Reduces Spending And Improves Quality in Primary Care”. Health Affairs,
34, no.4 (2015):645-652
• Poor evidence in hospitals
• Slower spending increases
• Annual savings
January 2014
21. Disparities in effects on disadvantaged
patient populations
• Provider organizations that serve lower income patient
populations typically have lower average quality
performance and lower average PMPM quality incentive
payments.
• Lower initial capitation payments makes it difficulty for
low-performing providers to initiate the improvement
efforts
• Redistribution of resources away from those organizations
that need them most.
• Recommendation: stronger incentives for higher risk
subgroups of patients.
Damburg CL et al. “Pay-For-Performance Schemes That Use Patient And Provider Categories
Would Reduce Payment Disparities”. Health Affairs, 34, no.1 (2015):134-142
22. Summary
• Innovation in payment models is necessary to
control health care costs
• Traditional models based on services do not impact
quality outcomes
• Primary care plays a critical role to improving
quality.
• Models minimizing the divide between primary care
and specialty care provide continued hope for
achieving the triple aim: improving quality of care,
addressing the patient experience, while decreasing
costs.
22