DRIVING VALUE IN HEALTHCARE: PERSPECTIVES FROM TWO ACO EXECUTIVES, PART I
|
|
- Darrell Wilkerson
- 8 years ago
- Views:
Transcription
1 DRIVING VALUE IN HEALTHCARE: PERSPECTIVES FROM TWO ACO EXECUTIVES, PART I A firm understanding of the key components and drivers of healthcare reform is increasingly important within the pharmaceutical, biotech, and medical device industries. Manufacturers are typically not identified as one of the key stakeholders (Payers, Providers and Patients) within healthcare reform, yet play a critical role in improving the health of patients as they strive to identify and bring new and innovative products to the market. In this two-part paper, we explore the evolving role of accountable care organizations (ACOs) as a core element of the Affordable Care Act and healthcare reimbursement redesign. Moderated by Thomas M. Richardson, PhD, MBA, PA-C Sr. Vice President, Strategic Consulting, KJT Group, Inc.
2 MEET THE PANEL Thomas M. Richardson, PhD, MBA, PA-C Sr. Vice President, Strategic Consulting KJT Group, Inc. Joseph S. Vasile, MD, MBA President/CEO Greater Rochester Independent Practice Association Rochester General Health System (RGHS) ACO Joel Port Chief Operating Officer Delaware Valley ACO; An ACO jointly owned by Jefferson University and Hospitals, Main Line Health System, Holy Redeemer Health System, Doylestown Health, and Magee Rehabilitation Hospital. Disclaimer: The views of both Dr. Vasile and Mr. Port are their own and do not represent the views of their organizations. KJT Group, Inc. July
3 BACKGROUND Driving Value In Healthcare: As part of our ongoing efforts at KJT Group, Inc. to maintain a deep understanding of the evolution of ACOs as part of the larger healthcare reform ecosystem, we conducted an interview with two ACO executives in their second year of operation as both a Medicare Shared Savings Program (MSSP) and a commercial ACO. Our goal was to gather their perspectives and insights into how ACOs are working with providers and healthcare systems to drive value within a reimbursement and delivery system focused on improving patient outcomes and controlling healthcare expenditures. In the interview, we explore ten topics. Interview Topics Part I: Part II: Defining an ACO and its Role Bundled and Episodic Payments Post-Acute Care Controlling Costs Care Management Pharmacy Medical Devices & Technology Assessment Desired Outcomes Pharma & Medical Device Manufacturers Price and Quality Transparency INTRODUCTION BY DR. TOM RICHARDSON (MODERATOR) Dr. Vasile, Joel, on behalf of KJT Group, we appreciate you taking the time today to share your insights on ACOs and the role that ACOs play within our quickly evolving healthcare delivery system. We have ten topics that we are interested in exploring with you both and I am not seeking to gain consensus but rather explore your individual perspectives based on your experiences leading your ACOs. With that, let s get to our discussion. KJT Group, Inc. July
4 DEFINING AN ACO AND ITS ROLE Moderator: The first question we should start with is, What is the primary role of an ACO? Driving Value In Healthcare: Joel: Our role is to figure out ways, tactics, and strategies to increase the quality of care while reducing the cost of care. We focus on the inefficiencies of the healthcare system, including poor handoffs in care, transitions in care, and we focus on the total cost of care. The healthcare system at times can be so fragmented and we re trying to look at the entire picture. Moderator: Joe, do you agree? Joe: I absolutely agree. And I d go a step further to say that part of the goal of an ACO is to align the incentives of patients (and engage them in their care), hospitals, providers, and insurance companies. Technically, when we talk about an ACO, we re really talking about a defined population that we ve agreed to care for. But, as this takes hold throughout the country, this defined population is only growing and will represent a change in how overall care is delivered. Moderator: Great. What are key success factors? Joe: You need some governance model that brings the stakeholders together so they can begin to have these dialogues. The next critical piece is having access to data and the ability to look at data and manipulate the data in a way that supports quality. Then, you really need some care management services, although those don t necessarily have to exist strictly within the ACO. Moderator: Joel, anything to add to that? Joel: I d add that, for us, it really starts at having very engaged primary care providers. I d also emphasize the role of care coordinators or care management teams. We also bring to the table what we call practice transformation coaches. These are people that work with the primary care practices trying to maximize the use of their electronic medical record and improve their local operations. Moderator: Are there any differences between running a Medicare and a commercial ACO? Joel: I think the fundamentals are the same but you re going to have different challenges. For example, in a younger population, when you focus on chronic care, you might be more focused on patients with diabetes. In Medicare, you are likely to be more focused on patients with COPD and heart failure, in addition to diabetes. Joe: You want physicians and health systems to perfect one way of operating, one workflow. We re trying to accomplish one workflow for all our patients so the physicians know what to expect and what they re being measured on. You don t want to have to build 10 different systems for 10 different insurance plans. KJT Group, Inc. July
5 Moderator: You both mentioned the importance of engagement with providers and health systems executives. Joe, can you tell me how you work with hospital administrators and providers? Joe: Well, the challenge is that we are still in a world where the incentives are not fully aligned. So, we have to find those areas where we can align the incentives. A good example would be things like in-system utilization, sometimes known as leakage out of your system. If we can create systems around how we care for patients in a single health system, the patients win, our specialists win and the system itself wins. So, you try to find areas where you can all agree. Certainly the quality metrics, which are patient focused, are areas that we can agree on and build programs to improve. Also, many large health systems have their own employee-based self-funded medical plans. If you can use that as an incubator or pilot as you roll out these population health programs, the system wins because it s essentially the payer for that population. If you re able to demonstrate that you can actually reduce costs and improve quality, that allows you to have more conversations with other payers about expanding the program. Moderator: And, Joel, are there any specific ways in which you work with the hospital administrators and providers? Joel: One of the ways is through our ACO governance. We have five member health systems that support our ACO and each of those CEOs sit on the board. At the governance level, they understand what our goals are, our business plan, and they embrace it. But, as Joe stated, there can be conflicting priorities. Hospitals still get paid, for the most part, on the number of patients in beds, so they still get paid on a volume basis. The shift for value-based care has started for hospitals too. For example, Medicare offers a bundled payment program, where a hospital or health system can get paid for the whole course of care from pre-hospitalization to post-hospitalization. This is the type of program that incents hospitals on value versus volume. Health System CEOs recognize the world is changing. The leading CEOs, some of whom we work with at our ACO, realize they have an opportunity to move their organizations to a different place that rewards high quality and low cost, and when the healthcare world switches overnight, they ll be ready for it. BUNDLED PAYMENTS Moderator: You mentioned bundled payments, what is the future of bundled payments and what do they mean for ACOs, hospitals, and providers? Joe: When I think of bundled payments, they re a tool to get us to move, to understand risks and manage the cost of care. A bundled payment starts with a very discrete episode of care or disease. So, it s really a step towards taking on more risk. It s a way that a health system can begin to align its work in the area of quality improvement while reducing overall cost. Moderator: Joel, anything to add? Joel: Well, I think the biggest challenge is getting good data upfront. The big surprise in the bundled payment program has been the amount of cost once the patient leaves the hospital. Current cost estimates show that up to 60% of the cost of a bundle occur outside the confines of a hospital. KJT Group, Inc. July
6 Moderator: How quickly do you see bundled payments and episodic payment mechanisms replacing FFS? What conditions or specialties are they being used for or most suited for going forward? Joel: While it is always difficult to estimate these transitions, CMS has made a commitment that by 2018, 50% of all payments will be based on alternative payment models as opposed to FFS. Also, a larger coalition of providers, payers and purchasers have pledged that by 2020, 75% of all contracts will be value based. Based on these organizations, one can realistically see a shift towards bundled payments and episodic payments within the next five years. Today, there are already a number of hospitals around the country participating in the CMS bundled payment program, often times focused on orthopedic and cardiovascular procedures. POST-ACUTE CARE Moderator: Joel, you mentioned transitions in care and the role of providers outside the hospital. What are your thoughts on the future of integration with post-acute care service providers such as skilled nursing facilities, rehab, and home care? Joel: Well, today those areas don t connect very well and don t communicate as well as they could. Some health systems are trying to figure out who their post-acute partners are partners with good communication, good handoffs, progressing to maybe a bundled payment program and even sharing in the incentives and disincentives. So, to me, that s a tremendous opportunity as we move ahead together to reduce readmission and improve the transitions from acute to post-acute care. Joe: I would agree. We re currently in the process of evaluating the nursing homes and the long term care facilities that we work with. We re looking for partners that have similar incentives, similar capabilities and have the same commitment to patient satisfaction and quality. We want to work with a select group of partners. We re going to try to create a common dashboard so we can look at what our post-acute partners are doing and how they re performing. Are they sending people to the ED? Are they taking people back from the health systems in a timely way? What kind of medical services do they have within the nursing home so they can assess and keep people at that level of care? Moderator: Great. And Joel, do you feel more hospitals are going to purchase SNFs and home care agencies or will they continue to have an arm s length relationship? Joel: That s a very good question. I think you re going to continue to see what we see now, which is all types, from direct hospital ownership of SNFs, to contracts and service agreements. One problem that hospitals have regarding the outright buying of nursing homes is the limit on capital. While it is always easier to align a service that you own, it may not be the time to invest their capital in long-term care when a hospital or health system could possibly get the same level of service just from having a very strong contractual relationship that includes service expectations. Moderator: To that point, there is consolidation within the long-term care arena itself, separate from the hospital consolidation that we re seeing. Do you think that s setting things up for success, in that hospitals can partner with a larger chain of providers rather than several smaller individual entities? Joel: I agree with that. It s a lot easier to deal with one company that owns/manages multiple long-term facilities and agrees on specific levels of service and quality, than try to contract with 25 different providers. While it may depend on the local market, it s important to work with all of our post-acute providers and hopefully share a similar vision and goals. KJT Group, Inc. July
7 Joe: I would agree on both counts. One is that I don t think you necessarily have to own the nursing homes, although many health systems do own post-acute care facilities. I think that you re able to partner, but you have to align the goals and be open about what you re trying to accomplish. And I would also agree that, like many areas of medicine, scale is going to have increased importance. You re going to see consolidation in that area like you are in just about every other area of medicine. CONTROLLING COSTS Moderator: Okay. Let s talk a little bit about some of the most pressing issues that ACOs and health systems face in regard to cost containment. Can you elaborate on where the focus is to help control costs and improve outcomes? Joe: We are looking at readmissions or admissions or the site where care is delivered. Specifically, we are also focusing on the high-cost, high-risk patients and actively and aggressively care managing these patients. It s also not a surprise that things like high cost imaging, CT scans and MRIs, are on the list of things that we re looking at. Certainly, pharmacy is on this list as well. Moderator: Joel, anything to add to that? Joel: The only thing I would add is the use of skilled nursing facilities. We just happen to have high post-acute costs as compared to national averages. We believe it reflects that there aren t enough alternatives in the post-acute spectrum, including having the right services to get people back to their home. In our marketplace, there are opportunities to do more within the home and get people back home quicker. Moderator: And what does this mean for home care providers? Joel: First, I think there s tremendous opportunities for home care. However, the reimbursement for home care services can get in the way as they don t have incentives focused on the total cost of care. There are some excellent experimental programs out there where when a patient goes home, they re accompanied by a nurse or some type of clinical worker. They check out the home, make sure they re minimizing the chance for falls, make sure that the refrigerator has food in it and address basic activities of daily living. We have a lot of seniors living alone, and the caregiver resources vary from home to home. You may not know if the patient has money to fill the prescriptions they come home with. Also, we would like to ensure that all patients going home by themselves have the right support so they don t return back to the hospital inappropriately. At times, the caregiver system often isn t in place to support them at home. Joe: I agree with all that was mentioned and suggest that we need to develop and align incentives, a dashboard, and we ll continue to evaluate the different agencies and those that provide the best value and service. Moderator: And will bundled payment force collaboration in this area and the integration of these social aspects with medical care? Joel: I m not sure force is the right word, but at least it provides the right incentives to have the multiple providers work together to achieve common goals. Moderator: Joe, anything to add? Joe: I agree a bundle is a tool. It begins to align our incentives and gives us experience in this area. Ten or 15 years from now I don t know if we re going to be using bundled payments in the same way that we use them now, but it s one step in a direction where we begin to change how we do business. KJT Group, Inc. July
8 CARE MANAGEMENT Driving Value In Healthcare: Moderator: Okay, good. I want to move to the topic of care management. What are the barriers to achieving effective care management? Joel: Well, to me, the first one is being able to identify the patient. As Joe mentioned earlier, we need good data and good analytics to support that data and then be able to risk-stratify the population and identify those patients that truly need complex care management resources. Also, since our physicians are our first line of communication, we need to get them engaged upfront. When they are engaged, we are able to address the specific concerns of their patients together, and coordinate the resources so we can offer optimal care for their patients. Moderator: Joe, what specific conditions or patients are at the top of your list for care management? And, if you have more than one chronic disease, do you end up with more than one care manager? Joe: Well, let me take that question in a couple of parts. The first is, yes, we re using care management for specific diseases. Those diseases would be things like COPD, coronary artery disease and diabetes. Although, ironically in terms of those patients that are driving risk, if you will, we re trying to push much of the work in those populations to our primary care physicians, which doesn t necessarily mean to them personally, but working with their practices to develop ways that we can engage those patients. As those patients get sicker, we re able to assess which of those patients are more at risk or at immediate risk. That s where our care management team goes to work, really, with the highest risk, the highest cost patients. And, again, those are identified through the use of data, through algorithms for which patients are most at risk. Some of the algorithms are fairly intuitive. Are you over 65? Have you had a number of hospitalizations in the past year? Do you have a diagnosis of three or more conditions? Are you on three or more medications? Etcetera, etcetera. So then, when those patients are identified, our care management team will take an active role in engaging those patients. So, again, the approach is almost two-fold. One, it s looking at the whole population and trying to prevent illness, but then engaging the highest risk, highest cost patients. KJT Group, Inc. July
9 KJT Group is an evidence-based research and consulting firm focused on guiding life science clients to uncover insights that enhance their strategies and execution. Our mission is to help our client organizations deliver superior value to their customers and constituents by enabling evidence-based decision making. Our consultants are experts in research design, survey methods, advanced analytic techniques, health services research, epidemiology, health policy, economics, and marketing and strategy development. KJT Group, Inc. July
Accountable Care Organizations New Healthcare Opportunities for Employers
Accountable Care Organizations New Healthcare Opportunities for Employers The ACO and Employer Opportunities Since the passage of the Patient Protection and Affordable Care Act (PPACA) in 2009, the marketplace
More informationChallenging Chronic Disease Through Telehealth
CMMI Innovation Advisor Erin Denholm, Centura Health at Home: Challenging Chronic Disease Through Telehealth Erin Denholm, of Centura Health at Home, joins the Alliance for a discussion of her work with
More informationThe ABCs of Population Health Management Jennifer Houlihan, MSP Director of CIN Strategy, Integration and Population Health
The ABCs of Population Health Management Jennifer Houlihan, MSP Director of CIN Strategy, Integration and Population Health A view from the marketplace Employers seek Other health Systems for Clinically
More informationHOW CARE MANAGEMENT EVOLVES WITH POPULATION MANAGEMENT
Reform and rising costs continue to push the importance of care management systems to the forefront. With the growing prominence of population health for provider organizations, provider-based care management
More informationProven Innovations in Primary Care Practice
Proven Innovations in Primary Care Practice October 14, 2014 The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA. 2014 Society for Healthcare
More informationHow Health Reform Will Affect Health Care Quality and the Delivery of Services
Fact Sheet AARP Public Policy Institute How Health Reform Will Affect Health Care Quality and the Delivery of Services The recently enacted Affordable Care Act contains provisions to improve health care
More informationIntegrating Post-Acute Providers with Health System Strategies
Integrating Post-Acute Providers with Health System Strategies Bridging the Acute and Post-Acute Worlds The opinions expressed are those of the presenter and do not necessarily state or reflect the views
More informationAnalytic-Driven Quality Keys Success in Risk-Based Contracts. Ross Gustafson, Vice President Allina Performance Resources, Health Catalyst
Analytic-Driven Quality Keys Success in Risk-Based Contracts March 2 nd, 2016 Ross Gustafson, Vice President Allina Performance Resources, Health Catalyst Brian Rice, Vice President Network/ACO Integration,
More informationBenefit Design and ACOs: How Will Private Employers and Health Plans Proceed?
Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed? Accountable Care Organizations: Implications for Consumers October 14, 2010 Washington, DC Sam Nussbaum, M.D. Executive Vice
More informationQ. What is your reaction to the U.S. Supreme Court decision on healthcare reform?
Contact: Gail Rosenberg Carolinas HealthCare System 704-355-3800 (office) 704-400-3959 (cell) gail.rosenberg@carolinashealthcare.org An Interview with Carolinas HealthCare System President & Chief Operating
More informationTRANSFORMING HEALTHCARE
TRANSFORMING HEALTHCARE FROM REACTIVE TREATMENT TO PROACTIVE HEALTH MANAGEMENT CRITICAL THInKInG AT THE CRITICAL TIME 1 Looking Forward Transforming Healthcare from Reactive Treatment to Proactive Health
More informationEarly Lessons learned from strong revenue cycle performers
Healthcare Informatics June 2012 Accountable Care Organizations Early Lessons learned from strong revenue cycle performers Healthcare Informatics Accountable Care Organizations Early Lessons learned from
More informationIs Your System Ready for Population Health Management? By Dale J. Block, MD, CPE
Population Health Is Your System Ready for Population Health Management? By Dale J. Block, MD, CPE In this article Health care organizations will need to migrate to population health management sooner
More informationCare Management Strategies Require Better Tools
Care Management Strategies Require Better Tools The ripple effect of healthcare reform is beginning to impact care delivery strategies as care management now falls increasingly to providers. According
More informationPremier ACO Collaboratives Driving to a Patient-Centered Health System
Premier ACO Collaboratives Driving to a Patient-Centered Health System As a nation we all must work to rein in spiraling U.S. healthcare costs, expand access, promote wellness and improve the consistency
More informationCare Delivery Transformation in Academic Health Centers
Care Delivery Transformation in Academic Health Centers William B. Borden, MD Associate Professor of Medicine Director of Healthcare Delivery Transformation George Washington University Chest pain 67 year
More informationE. Christopher Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences
Accountable Care Organizations and You E. Christopher Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences CEO, OSU Faculty Group Practice Chair, Department of Surgery Ohio State University
More informationPopulation Health Management Helps Utica Park Clinic Ease the Transition to Value-Based Care
CASE STUDY Utica Park Clinic Population Health Management Helps Utica Park Clinic Ease the Transition to Value-Based Care The transition from fee-for-service to value-based reimbursement has been a challenge
More informationDATA ACROSS THE CARE CONTINUUM
FierceHealthIT Sponsored by: A FierceHealthIT Executive Summary share: DATA ACROSS THE CARE CONTINUUM Health IT execs share challenges, rewards of data analytics at live event in Chicago By Gienna Shaw
More informationSystems in the Act, Trying Out ACOs
A L O O K A H E A D Systems in the Act, Trying Out ACOs BY MARK CRAWFORD Catholic health care leaders are experimenting with accountable care organizations (ACOs) as a method of delivering higher quality
More informationACCOUNTABLE CARE ANALYTICS: DEVELOPING A TRUSTED 360 DEGREE VIEW OF THE PATIENT
ACCOUNTABLE CARE ANALYTICS: DEVELOPING A TRUSTED 360 DEGREE VIEW OF THE PATIENT Accountable Care Analytics: Developing a Trusted 360 Degree View of the Patient Introduction Recent federal regulations have
More informationIdentifying High-Risk Medicare Beneficiaries with Predictive Analytics
Identifying High-Risk Medicare Beneficiaries with Predictive Analytics September 2014 Until recently, with the passage of the Affordable Care Act (ACA), Medicare Fee-for-Service (FFS) providers had little
More informationAccountable Care Platform
The shift toward increased collaboration, outcome-based payment and new benefit design is transforming how we pay for health care and how health care is delivered. UnitedHealthcare is taking an industry
More informationImproving Quality And Bending the Cost Curve: Strategies That Work
Improving Quality And Bending the Cost Curve: Strategies That Work Lewis G. Sandy MD SVP, Clinical Advancement, UnitedHealth Group UnitedHealth Center for Health Reform and Modernization AcademyHealth
More informationBUNDLING ARE INPATIENT REHABILITATION FACILITIES PREPARED FOR THIS PAYMENT REFORM?
BUNDLING ARE INPATIENT REHABILITATION FACILITIES PREPARED FOR THIS PAYMENT REFORM? Uniform Data System for Medical Rehabilitation Annual Conference August 10, 2012 Presented by: Donna Cameron Rich Bajner
More informationNuts and Bolts Accountable Care Organizations: A New Care Delivery Model for New Expectations
Nuts and Bolts Accountable Care Organizations: A New Care Delivery Model for New Expectations Presented to The American College of Cardiology October 27, 2012 1 Franciscan Alliance Overview Franciscan
More informationMeasuring and Assigning Accountability for Healthcare Spending
Measuring and Assigning Accountability for Healthcare Spending Fair and Effective Ways to Analyze the Drivers of Healthcare Costs and Transition to Value-Based Payment Harold D. Miller CONTENTS EXECUTIVE
More informationTerry McGeeney, MD MBA, President, CEO of TransforMED
Terry McGeeney, MD MBA, President, CEO of TransforMED Terry McGeeney, MD MBA, President, CEO of TransforMED According to the Future of Family Medicine Report: unless there are changes in the broader healthcare
More informationCreating Strategic Alliances for Post-Acute Coordination of Care
Creating Strategic Alliances for Post-Acute Coordination of Care Kathleen Yosko, PhD President/CEO Wheaton Franciscan Health Care Sole Illinois property Free-standing facility 101 IRF beds 27 SNF beds
More informationACOs: Impacting the Past, Present and Future State of Healthcare
ACOs: Impacting the Past, Present and Future State of Healthcare Article By Alan Cudney, RN, CPHQ, PMP, FACHE, Executive Consultant October 2012 What are Accountable Care Organizations? Can they help us
More informationMedicare Savings and Reductions in Rehospitalizations Associated with Home Health Use
Medicare Savings and Reductions in Rehospitalizations Associated with Home Health Use June 23, 2011 Avalere Health LLC Avalere Health LLC The intersection of business strategy and public policy Table of
More informationPlenary Session 1. Health Dimensions Group. 2010 Health Dimensions Group
Plenary Session 1 Kathleen M. Griffin, PhD Health Dimensions Group March 31, 2011 Hospital, Post Acute and Long-Term Care Collaboration in Health Care Reform: Critical Success Factors National Summit:
More informationAnatomy of an ACO. Through the Eyes of a Physician-owned IPA. Genesis Accountable Care Organization
Anatomy of an ACO Through the Eyes of a Physician-owned IPA Genesis: IPA by the Numbers 1,400 Physicians PCPs 500 900 SCPs 700 Practices 400 Square miles in North Texas Genesis: Challenges for Change Pressure
More information10 Key Concepts for Higher Sales into ACOs
By Michelle O Connor President and CEO By Michelle O Connor President and CEO CMR Institute Healthcare providers are under significant pressure from government payers, commercial health plans, and patients
More informationAllina Health System. Accountable Care thoughts from an ACO Pioneer
Allina Health System Accountable Care thoughts from an ACO Pioneer Care Integration and Payment Reform Workgroup Elmer Anderson Human Services Building St.Paul, MN February 6, 2012 Objectives for Today
More informationThe Accountable Care Organization: An Introduction
January 2011 The Accountable Care Organization: An Introduction The healthcare reform discussion introduced new terms and ideas and reintroduced many concepts explored in the past: value-based healthcare,
More informationHealthcare Reform Update Conference Call VI
Healthcare Reform Update Conference Call VI Sponsored by the Healthcare Reform Educational Task Force October 9, 2009 2:00-2:45 2:45 pm Eastern Healthcare Delivery System Reform Provisions in America s
More informationSTRATEGIC INNOVATIONS FOR AFFORDABLE, SUSTAINABLE HEALTH CARE:
January 2011 STRATEGIC INNOVATIONS FOR AFFORDABLE, SUSTAINABLE HEALTH CARE: A Model for Health System Reform Environmental Scan Accountable Care Organizations Table of Contents ACCOUNTABLE CARE ORGANIZATIONS...
More informationPerformance Measurement in CMS Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS
Performance Measurement in CMS Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS Mind the Gap: Improving Quality Measures in Accountable Care Systems October
More informationACCOUNTABLE CARE ORGANIZATION (ACO): SUPPLYING DATA AND ANALYTICS TO DRIVE CARE COORDINATION, ACCOUNTABILITY AND CONSUMER ENGAGEMENT
ACCOUNTABLE CARE ORGANIZATION (ACO): SUPPLYING DATA AND ANALYTICS TO DRIVE CARE COORDINATION, ACCOUNTABILITY AND CONSUMER ENGAGEMENT MESC 2013 STEPHEN B. WALKER, M.D. CHIEF MEDICAL OFFICER METRICS-DRIVEN
More informationHow To Track Spending On A Copay
Accountable Care Organizations & Other Reimbursement Reforms: The Impact on Physician Practices Martin Bienstock, Esq. Wilson Elser Martin.Bienstock@WilsonElser.com The New York Times Take... For the first
More informationAccountable Care and Workers Compensation: Are They Compatible?
By Jacob Lazarovic, MD, FAAFP Senior Vice President and Chief Medical Officer Broadspire Accountable Care and Workers Compensation: Are They Compatible? First let s review the acronym glossary. Accountable
More informationJohns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases
Johns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases Epidemiology Over 145 million people ( nearly half the population) - suffer from asthma, depression and other chronic
More informationPopulation health management:
3M Health Information Systems Population health management: A bridge between fee for service and value-based care Balancing multiple payment models Although 85 percent of healthcare reimbursement is currently
More informationDelivery System Innovation
Healthcare Transformation Concepts and Definitions Our healthcare transformation process is invigorated by many stakeholders with differing backgrounds. To help them with new terms and all of us to use
More informationPopulation Health Management: Advancing Your Position in the Journey to Value-Based Care
Population Health Management: Advancing Your Position in the Journey to Value-Based Care Webcast Session One: An Integrated Approach to Population Health Management 11 August 2015 Welcome & Introductions
More informationProposed Rule: Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations (CMS-1461-P)
Via online submission to http://www.regulations.gov February 6, 2015 Sylvia M. Burwell Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS 1461
More informationRealizing ACO Success with ICW Solutions
Realizing ACO Success with ICW Solutions A Pathway to Collaborative Care Coordination and Care Management Decrease Healthcare Costs Improve Population Health Enhance Care for the Individual connect. manage.
More informationJuly 23, 2015. Page 1
Testimony of Paul Black, Before the Senate Committee on Health Education Labor and Pensions Achieving the Promise of Health Information Technology: Information Blocking and Potential Solutions July 23,
More informationAccountable Care Fundamentals for Medical Practice Executives
Accountable Care Fundamentals for Medical Practice Executives Nathan Anspach, FACMPE Senior Vice President and Chief Executive Officer John C. Lincoln Accountable Care Organization and John C. Lincoln
More informationPopulation health management:
GE Healthcare Population health management: Navigating successfully from volume to value In the new world of value-based care and risk-sharing compensation, success will depend on how well provider organizations
More informationToward a Single Source of Patient Truth: Predictive Analytics for Accountable Care
Toward a Single Source of Patient Truth: Predictive Analytics for Accountable Care Driven by new and emerging models of accountable care, healthcare organizations must determine how to use data to address
More information3M s unique solution for value-based health care
A quick guide to 3M s unique solution for value-based health care Part 2: The era of and Current trends industry changes Volume-based health care Value-based health care ICD-9 ICD-10 Inpatient care Outpatient
More informationESSENTIA HEALTH AS AN ACO (ACCOUNTABLE CARE ORGANIZATION)
ESSENTIA HEALTH AS AN ACO (ACCOUNTABLE CARE ORGANIZATION) Hello and welcome. Thank you for taking part in this presentation entitled "Essentia Health as an ACO or Accountable Care Organization -- What
More informationThe 4 Pillars of Clinical Integration: A Flexible Model for Hospital- Physician Collaboration
The 4 Pillars of Clinical Integration: A Flexible Model for Hospital- Physician Collaboration Written by Daniel J. Marino, President & CEO, Health Directions November 14, 2012 Originally published by Becker
More informationPopulation-based health care: can you get there from here?
Population-based health care: can you get there from here? by David Howe SORH Contracted Rural Writer Hospitals and insurance companies are acquiring other hospitals and insurance companies. Other hospitals
More informationGuide to Population Health Management
Guide to Population Health Management presented by the Healthcare Intelligence Network Note: This is an authorized excerpt from the Guide to Population Health Management. To download the entire guide,
More informationAutomating Workforce Management in Healthcare
Automating Workforce Management in Healthcare Have you considered the benefits of workforce management automation for patient care, employee engagement, and productivity? Automation of workforce management
More informationEmployee Population Health Management:
Employee Population Health Management: a stepping stone for accountable care Richard Boehler, MD, MBA, FACPE President and Chief Executive Officer St. Joseph Hospital, Nashua N.H. Learning to Manage Populations
More informationHealthPartners: Triple Aim Approach to ACO Development
HealthPartners: Triple Aim Approach to ACO Development Brian Rank, MD Medical Director, HealthPartners Medical Group October 27, 2010 HealthPartners Integrated Care and Financing System 10,300 employees
More informationACOs: Six Things Specialty Practices Should Know
ACOs: Six Things Specialty Practices Should Know =TOS Newsletter, July/August 2014= Authors: John P. Schmitt, Ph.D. and J. Garrett Schmitt, MBA, PCMH CCE INTRODUCTION Do you remember the analogy of four
More informationOctober 18, 2013. Articulating the Value Proposition of Innovative Medical Technologies in the Healthcare Reform Landscape
October 18, 2013 Articulating the Value Proposition of Innovative Medical Technologies in the Healthcare Reform Landscape Outline The Changing Landscape Evolving Care Delivery and Incentive Models Provider
More informationTransitions of Care: The need for collaboration across entire care continuum
H O T T O P I C S I N H E A L T H C A R E, I S S U E # 2 Transitions of Care: The need for collaboration across entire care continuum Safe, quality Transitions Effective C o l l a b o r a t i v e S u c
More informationFinancial and Population Analytics for Accountable Care Organizations SEPTEMBER 20, 2012
Financial and Population Analytics for Accountable Care Organizations Valence Biographies Lori Fox Ward is Senior Vice President of Clinical Integration for Valence Health where her primary role involves
More informationEnterprise Analytics Strategic Planning
Enterprise Analytics Strategic Planning June 5, 2013 1 "The first question a data driven organization needs to ask itself is not "what do we think?" but rather "what do we know? Big Data: The Management
More informationPopulation Health Management Systems
Population Health Management Systems What are they and how can they help public health? August 18, 1:00 p.m. 2:30 p.m. EDT Presented by the Public Health Informatics Working Group Webinar sponsored by
More informationThe Evolving Nature of Accountable Care. Results from the 2015 ACO Survey
The Evolving Nature of Accountable Care Results from the 2015 ACO Survey BACKGROUND Accountable care organizations (ACOs) are voluntary networks of healthcare providers that have agreed to work together
More informationA Foundation for Health Care Reform Legislation
A Foundation for Health Care Reform Legislation Mayo Clinic s Point of View Mayo Clinic believes that U.S. health care urgently needs reform to ensure access to quality, affordable patient care. Each major
More informationHelping You Achieve Better Clinical and Financial Health
McKesson Business Performance Services Accountable Care Services Helping You Achieve Better Clinical and Financial Health 1 We recognized that fee-for-service would decrease and value-based care would
More informationPrimary Care, ACOs, and Payment Reform
Primary Care, ACOs, and Payment Reform Mark McClellan, MD, PhD Director, Initiatives on Value and Innovation in Health Care Engelberg Center for Healthcare Reform Senior Fellow, Economic Studies The Brookings
More informationRE: CMS 1461-P; Medicare Shared Savings Program: Accountable Care Organizations
221 MAIN STREET, SUITE 1500 SAN FRANCISCO, CA 94105 PBGH.ORG OFFICE 415.281.8660 FACSIMILE 415.520.0927 February 6, 2015 Marilyn Tavenner Administrator Centers for Medicare and Medicaid Services 7500 Security
More informationA VISION TO TRANSFORM U.S. HEALTH CARE. The programs to make it a reality.
A VISION TO TRANSFORM U.S. HEALTH CARE. The programs to make it a reality. HCI 3 IMPROVING HEALTH CARE QUALITY AND VALUE with evidence-based incentive programs and a fair and powerful model for payment
More informationTransforming traditional case management through local provider partnerships
Transforming traditional case management through local provider partnerships Introduction The dramatic changes sweeping the health care industry are driving a strong interest in engaging patients at the
More informationTHE ACCOUNTABLE CARE ORGANIZATION (ACO) TRAIN IS LEAVING THE STATION: ARE YOU ON BOARD?
UNDER THE MICROSCOPE NOVEMBER 5, 2013 THE ACCOUNTABLE CARE ORGANIZATION (ACO) TRAIN IS LEAVING THE STATION: ARE YOU ON BOARD? ISSUE. A 2006 Institute of Medicine report ( Performance measurement: Accelerating
More informationINTEGRATION STRATEGIES FOR A NEW HEALTH CARE ECONOMY
INTEGRATION STRATEGIES FOR A NEW HEALTH CARE ECONOMY Thomas William Baker Baker Donelson Bearman Caldwell & Berkowitz, P.C. Atlanta, Georgia (404) 221-6510 tbaker@bakerdonelson.com Prepared for East Georgia
More informationPopulation Health Management (PHM) January 29, 2014
Population Health Management (PHM) January 29, 2014 1 Agenda What is PHM? What is triggering the need for PHM? Why Now? What are 5 steps to a reasonable PHM strategy? What s a Physician s perspective of
More informationAccountable Care Organizations. Rick Shinto, MD Aveta Health Inc. July 20, 2010
Accountable Care Organizations Rick Shinto, MD Aveta Health Inc. July 20, 2010 1 Health Care Reform- New Models of Care Patient Protection and Affordable care Act (PPACA 2010) controlling costs and improving
More informationFive Myths Surrounding the Business of Population Health Management
Five Myths Surrounding the Business of Population Health Management Joan Moss, RN, MSN Robert Sehring Chief Nursing Officer and Chief Ministry Services Officer, Senior Vice President, Sg2 OSF HealthCare
More informationPost-care Networks and LTACs: Finding Your Place in an ACO Model
Post-care Networks and LTACs: Finding Your Place in an ACO Model Accountable Care Organizations (ACOs) are more than just a fad. Post-care providers and LTACS in particular, will need to give careful thought
More information3 Easy Ways to Increase Your Medical Practice Revenue by 25%
3 Easy Ways to Increase Your Medical Practice Revenue by 25% 3 Easy Ways to Increase Your Medical Practice Revenue by 25% There are a hundred ways to streamline workflow and improve revenue in a medical
More informationCMS Quality Measurement and Value Based Purchasing Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS
CMS Quality Measurement and Value Based Purchasing Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS American Urological Association Quality Improvement Summit
More informationMedicare Shared Savings Program (ASN) and the kidney Disease Prevention Project
December 3, 2010 Donald Berwick, MD Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building 200 Independence Avenue, SW
More informationLeveraging EHR to Improve Patient Safety: A Davies Story
Leveraging EHR to Improve Patient Safety: A Davies Story Claudia Colgan, Vice President of Quality Initiatives Bruce Darrow, MD, PhD, Interim Chief Medical Information Officer Jill Kalman, MD, Director
More informationMEDICAID MANAGED CARE PROGRAM MANAGEMENT: THE NEXT GENERATION ANNE JACOBS, MANAGING DIRECTOR NAVIGANT HEALTHCARE
MEDICAID MANAGED CARE PROGRAM MANAGEMENT: THE NEXT GENERATION ANNE JACOBS, MANAGING DIRECTOR NAVIGANT HEALTHCARE Page 1 WHAT S EXPECTED OF MEDICAID HEALTH PLANS? Some might ask, if the delivery system
More informationUpdates from CMS: Value-Based Purchasing, ACOs, and Other Initiatives The Seventh National Pay for Performance Summit March 19, 2012
Updates from CMS: Value-Based Purchasing, ACOs, and Other Initiatives The Seventh National Pay for Performance Summit March 19, 2012 Presenters David Sayen, CMS Regional Administrator Betsy L. Thompson,
More informationKey Strategic and Tactical Steps to Excel as Community Hospital May 2011
Key Strategic and Tactical Steps to Excel as Community Hospital May 2011 1 2 3 Pillars of Excellence 4 Transformation from Hospital-Centric to Community-Centric with Triple Aim as Framework 5 Objectives
More informationCare Transformation and the Journey to Population Health Management
Care Transformation and the Journey to Population Health Management Richard A Bankowitz, MD MBA FACP Chief Medical Officer, Premier healthcare alliance AMGA Institute for Quality September 26, 2013 Premier:
More informationPopulation Health Management: Leveraging Data and Analytics to Achieve Value. White Paper. A Special Report
Authors Carol Cassell CTG Health Solutions John Kontor, MD Clinovations Lisa Shah, MD, MAPP Clinovations Contributors Marla Roberts, DrPH, RN CTG Health Solutions Katie Stevenson Clinovations : Leveraging
More information5/13/2011. ACO Partnerships A Case Study. Contents: The Strategic Imperative for Accountable Care
ACO Partnerships A Case Study Bob Edmondson, MPH Vice President, Innovation West Penn Allegheny Health System Pittsburgh, PA 1 Contents: 1. The Strategic Imperative for Accountable Care 2. Population Health
More informationValue-Based Programs. Blue Plans Improving Healthcare Quality and Affordability through Innovative Partnerships with Clinicians
Value-Based Programs Blue Plans Improving Healthcare Quality and Affordability through Innovative Partnerships with Clinicians Issue: U.S. healthcare spending exceeds $2.8 trillion annually. 1 With studies
More informationAccountable Care: Implications for Managing Health Information. Quality Healthcare Through Quality Information
Accountable Care: Implications for Managing Health Information Quality Healthcare Through Quality Information Introduction Healthcare is currently experiencing a critical shift: away from the current the
More informationAccountable Care Organizations
Accountable Care Organizations Myth, Reality, Facts Why =System Failure Low Quality - IOM report High Cost Quality Cost disconnect Low Value Problems Disconnect between Quality and Cost Care is fragmented
More informationManaging Population Health: Equity through Person- Centered Care
Managing Population Health: Equity through Person- Centered Care Linda Alexander, RN, MBA, CCM Total Health Care Chief Clinical Officer Plante Moran Healthcare Consulting Detroit Medical Center - Clinical
More informationWill Your Accountable Care Organization Pilot Succeed? Predict Success with Just Four Numbers.
White Paper Will Your Accountable Care Organization Pilot Succeed? Predict Success with Just Four Numbers. Bob Kelley Senior Vice President, Healthcare Analytics Truven Health Analytics SM February 2012
More informationA New Payer Model For Medical Management Execution
A New Payer Model For Medical Management Execution To combat rising costs and inefficient use of resources, payers can streamline utilization management and optimize care management through medical management
More informationLeveraging Population Health to Meet Value-Based Care Goals. 19 out of 25 Organizations view population health as a high priority today.
Leveraging Population Health to Meet Value-Based Care Goals Value-based reimbursement is no longer a futuristic concept. It s a reality that healthcare organizations need to face today. 19 out of 25 Organizations
More informationPhysician Compensation Models: A Difficult Era. Submitted to: AAOE e-newsletter. Parts I and II. Tom Ealey
Physician Compensation Models: A Difficult Era Submitted to: AAOE e-newsletter Parts I and II Tom Ealey Tom Ealey, professor of business administration at Alma College (Michigan) has extensive experience
More informationTelehealth Solutions Enhance Health Outcomes and Reduce Healthcare Costs
Text for a pull out can go heretext for a pull out can go heretext for a pull out can go Text for a pull out can go here Text for a pull out can go here Telehealth Solutions Enhance Health Outcomes and
More informationCPCA California Primary Care Association
CPCA California Primary Care Association Accountable Care Organizations: Next Generation Systems for Community Health Centers? CPCA Annual Conference Sacramento, California October 10, 2014 Larry Garcia,
More informationAccountable Care Organizations (ACOs): Potential to Foster Quality While Reducing Costs
Accountable Care Organizations (ACOs): Potential to Foster Quality While Reducing Costs Debra Ness Co-Chair, Consumer-Purchaser Disclosure Project President, National Partnership for Women & Families David
More information