Accountable Care Organizations and Patient-Centered Medical Homes

Size: px
Start display at page:

Download "Accountable Care Organizations and Patient-Centered Medical Homes"

Transcription

1 Emerging Topics in Healthcare Reform Accountable Care Organizations and Patient-Centered Medical Homes Janssen Pharmaceuticals, Inc.

2 Accountable Care Organizations and Patient-Centered Medical Homes The Patient Protection and Affordable Care Act (ACA) encourages greater coordination of care among primary care physicians, specialists, and hospitals. Two related care models gaining popularity accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) are designed to reduce costs by minimizing treatment fragmentation, avoiding hospital readmissions, and encouraging smooth transitions of care. 1,2 Medicare payment reforms compel hospitals to improve quality of care. In that sense, hospitals, ACOs, and PCMHs all share incentives to enable one another s success. Accountable care organizations An ACO is a network of physicians and hospitals that share responsibility for providing high-quality, efficient care to a defined population. 3 Medicare-approved ACOs agree to manage the healthcare needs of 5000 or more beneficiaries for 3 years. 3 In integrated markets, hospitals have formed ACOs 4 ; in other areas, physicians in large group practices form the ACOs and contract with hospitals. 5 Importance of care coordination to ACOs An ACO develops its own standards to ensure that patient care consistently meets best practices. 1 Hospitals and health systems that form ACOs will not only seek shared savings, but also have additional incentives to reduce readmissions 6 and meet Centers for Medicare and Medicaid Services (CMS) standards for value-based purchasing. 7 This heightens the importance of coordinating the care of patients as they move from one setting to another. How ACOs are paid ACOs are paid on a fee-for-service basis, but they receive bonus payments for keeping costs down. 8 These shared savings bonuses are based on an ACO s performance on 33 quality measures that CMS has determined can reduce Medicare spending. 8,9 ACOs are exempt from Medicare s Value-Based Payment Modifier (VBPM) program. 10 Patient-centered medical homes A PCMH is typically a primary care driven affiliation of healthcare providers. Each patient s care is coordinated by a primary care physician who leads a team of specialists, pharmacists, and institutions. 11 Medicare s VBPM program is separate from PCMHs, but physicians who participate in a PCMH and who also enroll in a VBPM may benefit from CMS s reports on quality measures. VBPM offers incentive payments to physicians who meet quality-performance standards. 12 VBPM is being phased in between now and fiscal year How ACOs and PCMHs differ Whereas an ACO is responsible for the care of a population, a PCMH focuses on the individual patient. A PCMH emphasizes care coordination among providers as a patient moves through sites of service. 13 Multiple Medicare demonstration projects are testing PCMH reimbursement structures to determine the most cost-efficient ways to provide coordinated, high-quality care. 14 In the private sector, several PCMH models have demonstrated cost savings through reductions in emergency room use and hospitalizations. 1 How hospitals and PCMHs interact CMS payment incentives should motivate hospitals to work with PCMHs to prevent readmissions. Coordination between a hospital and a PCMH can reduce drug errors and other pitfalls of care transition that can lead to rehospitalization. 15 Think of ACOs and PCMHs as an extended hospital medical staff organization whose goals are aligned with those of the hospital 2 3

3 ACOs, PCMHs, and the Role of Drug Therapy ACOs and PCMHs have financial incentives to reduce unnecessary ER utilization and readmissions. Their ability to achieve this depends on several factors unique to each model, but both models have 3 success factors in common and each is relevant to drug therapy. ACO and PCMH success factors Formularies and ACOs For ACOs formed around institutional entities like a hospital or an integrated delivery system (IDS), it is critical to manage transitions of care through clear communication between the hospital and postacute providers. A hospital or IDS will have its own formularies and protocols in place intended to influence physician behavior. 16 Ensuring that outpatient providers in the network adhere to these protocols increases the likelihood that patients receive consistent treatment as they move from one site of care to another. During care transitions, a patient s drug regimen might be changed. Studies show that about a quarter of patients discharged from hospitals experience an adverse event within 30 days. Most of these events are drug-related, many are preventable, and about 20% result in ER visits or readmissions. 15 In small and midsize ACOs whose governance is not dominated by a large hospital or IDS, physicians will be motivated to construct formularies that emphasize best practices with demonstrated proven outcomes. Shared savings are based on cost reductions in Medicare Part A and Part B, so these ACOs will seek population-specific data on outcomes for self-administered medications. 16 Pharmacists play an important role in these ACOs. With their experience in coordinating medication therapy with physicians, nurses, and case managers, pharmacists can help ACOs with the selection of appropriate therapies for formularies. 8 Formularies and PCMHs The PCMH will also have a formulary. To maximize the success of a PCMH, formularies should be focused on outcomes rather than financial incentives. With this focus on evidence-based drug therapy, a PCMH formulary decision maker will need information that is applicable to individual patients, such as patient-specific outcomes, contraindications, and pharmacogenomic data. 17 Developing an evidence-based formulary is in keeping with the PCMH mission of coordinating care among primary care physicians, specialists, care managers, and caregivers; providing high-quality care; and reducing unnecessary hospital utilization. 4 5

4 Information: the Foundation of Success for ACOs and PCMHs When considering anticoagulation therapies, ACO and PCMH formulary committees face many considerations, including a product s efficacy, safety, and ability to foster successful transitions of care. 18 Novel oral anticoagulants offer potential ease-of-management and dosing advantages over warfarin, as well as the ability to tailor therapy to a patient s specific needs and abilities to follow a therapeutic regimen. 19 After a new anticoagulant is added to a formulary, its status will be reviewed regularly. An ACO or PCMH pharmacy and therapeutics committee and its subcommittees will seek periodic updates on the anticoagulant s ability to improve outcomes and quality of care within their population. 18 Many of the quality measures that ACOs must meet including reporting outcomes from the use of antithrombotics in patients with ischemic vascular disease 9 rely on the ability to track real-world outcomes through electronic medical records. 8 Similarly, PCMHs rely on health information technology applications to manage outcomes and transitions of care in real time. 15 A collaborative approach Given their need for information that enables optimal management of their populations, ACOs and PCMHs can build partnerships with drug manufacturers to focus on meeting quality-improvement goals. If you are a hospital or an IDS, talk with your Janssen representative about evidence-based guidelines, adherence and compliance programs, and tools for case managers that ensure consistency of care throughout the network. If you are an independent practice association or a multigroup specialty ACO, talk with your Janssen representative about matching anticoagulation therapies with specific populations. Your representative can discuss medication outcomes for specific patient populations. If you are a PCMH, consider where the literature gives clear evidence to recommend specific anticoagulation therapies. Your Janssen representative can supply outcomes data to inform your coordination-of-care protocols for specific populations. Let Janssen Partner With You Your Janssen representative can offer support tools to help ACO and PCMH providers, case managers, and hospitals provide high-quality care, ensure smooth transitions across care settings, and help patients understand their self-care. Ask your representative for: Resources for PCMHs and case managers: Care-coordination flow charts Information on managing transitions of care and helping patients stay adherent to therapy Postoperative follow-up care brochures Resources for ACOs and hospital discharge planners: Fact sheets on assessing and managing disease risk and postdischarge complications Clinical practice guidelines Resources for patients: Materials explaining postoperative follow-up and care Patient self-care is an important part of ensuring positive outcomes. Sometimes, patients need help understanding their medications, managing side effects, and sticking to a medication regimen. CarePath by Janssen can help patients by providing: Product information Medication reminders Access and reimbursement assistance programs Means for providing feedback to physicians Tips on recovery and rehabilitation Visit JanssenCareCoordination.com and CarePathbyJanssen.com for more information 6 7

5 References 1. Longworth DL. Accountable care organizations, the patient-centered medical home, and healthcare reform: what does it all mean? Cleve Clin J Med. 2011;78: Department of Health and Human Services. More Doctors, Hospitals Partner to Coordinate Care for People with Medicare. Published January 10, Accessed January 15, Department of Health and Human Services. Summary of Final Rule Provisions for Accountable Care Organizations Under the Medicare Shared Savings Program. Downloads/ACO_Summary_Factsheet_ICN pdf. Published November Accessed January 31, Centers for Medicare and Medicaid Services. CMS Names 88 New Medicare Shared Savings Accountable Care Organizations. July 9, &srchtype=1&numdays=3500&srchopt=0&srchdata=&keywordtype=all&chknewstype=6&intpage=&showall=&pyear=&year= &desc=&cboorder=date. Accessed March 31, Gold J. ACO is the hottest three-letter word in healthcare. Kaiser Health News website /January/13/ACO-accountable-care-organization-FAQ.aspx?p=1. Published October 21, Accessed January 15, Centers for Medicare and Medicaid Services. Readmissions Reduction Program. Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html. Updated August 1, Accessed January 15, Centers for Medicare and Medicaid Services. Frequently Asked Questions Hospital Value-Based Purchasing Program. Program-Frequently-Asked-Questions-about-Hospital-VBP pdf. Updated March 9, Accessed January 15, Yeung W, Burns H III, Loiacono D. Are ACOs the answer to high-value healthcare? Am Health Drug Benefits. 2011;4(7): Accountable Care Organization 2012 Program Analysis. Quality Performance Standards Narrative Measure Specifications Final Report. Centers for Medicare and Medicaid Services website. sharedsavingsprogram/downloads/aco_qualitymeasures.pdf. Published December 12, Accessed January 15, Centers for Medicare and Medicaid Services. Physician Value-Based Payment Modifier under the Medicare Physician Fee Schedule 2013 Final Rule. Accessed April 29, National Committee for Quality Assurance. NCQA Patient-Centered Medical Home website. PCMH2011%20withCAHPSInsert.pdf. Accessed Feburary 1, Centers for Medicare and Medicaid Services. Medicare FFS Physician Feedback Program/Value Based Payment Modifier Background. Accessed April 29, Meyers D, Peikes D, Genevro J, et al. The Roles of Patient-Centered Medical Homes and Accountable Care Organizations in Coordinating Patient Care. AHRQ Publication No. 11-M005-EF. Rockville, MD: Agency for Healthcare Research and Quality. December Patient-Centered Primary Care Collaborative Payment Reform Task Force. Payment Reform to Support High-Performing Practice. Medscape.com website. Published October 26, Accessed January 15, Smith MA, Nigro SC. The Patient-Centered Medical Home. In: Science and Practice of Pharmacotherapy I and II PSAP-VII, Book 8. American College of Clinical Pharmacy; 2011: Cherry M, Pankey-Dooley B. Pharma has free ride with Medicare ACOs, but for how long? HealthLeaders InterStudy website. Published August 8, Accessed January 15, Academy of Managed Care Pharmacy. The Patient-Centered Medical Home. How Does Managed Care Pharmacy Add Value? Accessed January 15, Merli GJ. The new oral anticoagulants: a challenge for hospital formularies. Hosp Pract. 2012;40(3): Eikelboom JW, Weitz JI. New anticoagulants. Circulation. 2010;121: Janssen Pharmaceuticals, Inc May 2013 K02X13106B Janssen Pharmaceuticals, Inc.

Value-Based Purchasing

Value-Based Purchasing Emerging Topics in Healthcare Reform Value-Based Purchasing Janssen Pharmaceuticals, Inc. Value-Based Purchasing The Patient Protection and Affordable Care Act (ACA) established the Hospital Value-Based

More information

Preventing Readmissions

Preventing Readmissions Emerging Topics in Healthcare Reform Preventing Readmissions Janssen Pharmaceuticals, Inc. Preventing Readmissions The Patient Protection and Affordable Care Act (ACA) contains several provisions intended

More information

How Health Reform Will Affect Health Care Quality and the Delivery of Services

How 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 information

Nuts 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 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 information

Idaho Health Home State Plan Amendment Matrix: Summary Overview. Overview of Approved Health Home SPAs

Idaho Health Home State Plan Amendment Matrix: Summary Overview. Overview of Approved Health Home SPAs Idaho Health Home State Plan Amendment Matrix: Summary Overview This matrix outlines key program design features from health home State Plan Amendments (SPAs) approved by the Centers for Medicare & Medicaid

More information

TRENDS IN DIABETES QUALITY MEASUREMENT. Manage patients entire healthcare experience with a more comprehensive approach

TRENDS IN DIABETES QUALITY MEASUREMENT. Manage patients entire healthcare experience with a more comprehensive approach TRENDS IN DIABETES QUALITY MEASUREMENT Manage patients entire healthcare experience with a more comprehensive approach Type 2 diabetes is a complex disease that requires a multifaceted treatment approach

More information

Proven Innovations in Primary Care Practice

Proven 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 information

Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION

Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION At the end of this session, you will be able to: Identify ways RT skills can be utilized for

More information

AGENCY-SPECIFIC PLAN FOR THE NATIONAL QUALITY STRATEGY

AGENCY-SPECIFIC PLAN FOR THE NATIONAL QUALITY STRATEGY AGENCY-SPECIFIC PLAN FOR THE NATIONAL QUALITY STRATEGY Adult Medicaid Quality Grants Program The Adult Medicaid Quality Grants Program is a 2-year funding opportunity designed to support grantee Medicaid

More information

A white paper. Collaborative Accountable Care. CIGNA s Approach to Accountable Care Organizations. 841282 a 11/11

A white paper. Collaborative Accountable Care. CIGNA s Approach to Accountable Care Organizations. 841282 a 11/11 A white paper Collaborative Accountable Care CIGNA s Approach to Accountable Care Organizations 841282 a 11/11 Transforming the Health Care System Successfully transforming the U.S. health care system

More information

THE AFFORDABLE CARE ACT: KEY POINTS FOR PHARMACISTS. Sarah M. Smith, Pharm.D., BCACP Douglas H. Kay Symposium June 11, 2014

THE AFFORDABLE CARE ACT: KEY POINTS FOR PHARMACISTS. Sarah M. Smith, Pharm.D., BCACP Douglas H. Kay Symposium June 11, 2014 THE AFFORDABLE CARE ACT: KEY POINTS FOR PHARMACISTS Sarah M. Smith, Pharm.D., BCACP Douglas H. Kay Symposium June 11, 2014 Objectives 1. Summarize the major changes the Affordable Care Act (ACA) will have

More information

How Independent Pharmacies Can Use Medicare Star Ratings to Improve Their Businesses

How Independent Pharmacies Can Use Medicare Star Ratings to Improve Their Businesses How Independent Pharmacies Can Use Medicare Star Ratings to Improve Their Businesses We are in a new, changing healthcare environment that is affecting every stakeholder in the market hospitals, doctors,

More information

Post-acute care providers: Shortcomings in Medicare s fee-for-service highlight the need for broad reforms

Post-acute care providers: Shortcomings in Medicare s fee-for-service highlight the need for broad reforms C h a p t e r7 Post-acute care providers: Shortcomings in Medicare s fee-for-service highlight the need for broad reforms C H A P T E R 7 Post-acute care providers: Shortcomings in Medicare s fee-for-service

More information

Hitting a Home Run: The Patient Centered Medical Home and Home Care

Hitting a Home Run: The Patient Centered Medical Home and Home Care Hitting a Home Run: The Patient Centered Medical Home and Home Care This paper has been prepared by the Home Care Alliance of Massachusetts to support home health agencies seeking to align with community

More information

LTC Division Webinar Accountable Care Organizations and LTC Pharmacy - The New Era in Health Care Delivery

LTC Division Webinar Accountable Care Organizations and LTC Pharmacy - The New Era in Health Care Delivery LTC Division Webinar Accountable Care Organizations and LTC Pharmacy - The New Era in Health Care Delivery 1 The Pioneer ACO Model James Vasquenza Jr. Vice President, Preferred Provider Network, Innovatix

More information

Accountable Care Organizations: What Are They and Why Should I Care?

Accountable Care Organizations: What Are They and Why Should I Care? Accountable Care Organizations: What Are They and Why Should I Care? Adrienne Green, MD Associate Chief Medical Officer, UCSF Medical Center Ami Parekh, MD, JD Med. Director, Health System Innovation,

More information

Accountable Care Organizations and Future Healthcare Delivery

Accountable Care Organizations and Future Healthcare Delivery Accountable Care Organizations and Future Healthcare Delivery Introduction Accountable care organizations (ACOs) are a key component of healthcare reform. This module covers the establishment of accountable

More information

Accountable Care Organizations: Reality or Myth?

Accountable Care Organizations: Reality or Myth? Written by: Ty Meyer Accountable Care Organizations: Reality or Myth? Introduction According to Steven Gerst, VP of Medical Affairs at MedCurrent Corporation, The Patient Protection and Affordable Care

More information

Mar. 31, 2011 (202) 690-6145. Summary of proposed rule provisions for Accountable Care Organizations under the Medicare Shared Savings Program

Mar. 31, 2011 (202) 690-6145. Summary of proposed rule provisions for Accountable Care Organizations under the Medicare Shared Savings Program DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 Office of Media Affairs MEDICARE FACT SHEET FOR IMMEDIATE RELEASE

More information

CARE COORDINATION IN PATIENTS WITH TYPE 2 DIABETES

CARE COORDINATION IN PATIENTS WITH TYPE 2 DIABETES CARE COORDINATION IN PATIENTS WITH TYPE 2 DIABETES An Overview for Healthcare Providers INTRODUCTION As you may know, patient-centered care and care coordination of patients with complex conditions have

More information

The Patient-Centered Medical Home How Does Managed Care Pharmacy Add Value?

The Patient-Centered Medical Home How Does Managed Care Pharmacy Add Value? The Patient-Centered Medical Home How Does Managed Care Pharmacy Add Value? With heath care reform now being implemented, it is important that managed care pharmacy understand how to provide value for

More information

Re: CMS-1345-P; Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations; Proposed Rule

Re: CMS-1345-P; Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations; Proposed Rule Department of Health and Human Services Attention: CMS 1345 P P.O. Box 8013, Baltimore, MD 21244 8013 Re: CMS-1345-P; Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations;

More information

Medicaid Health Plans: Adding Value for Beneficiaries and States

Medicaid Health Plans: Adding Value for Beneficiaries and States Medicaid Health Plans: Adding Value for Beneficiaries and States Medicaid is a program with numerous challenges, both for its beneficiaries and the state and federal government. In comparison to the general

More information

Population-based health care: can you get there from here?

Population-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 information

CHAPTER 535 HEALTH HOMES. Background... 2. Policy... 2. 535.1 Member Eligibility and Enrollment... 2. 535.2 Health Home Required Functions...

CHAPTER 535 HEALTH HOMES. Background... 2. Policy... 2. 535.1 Member Eligibility and Enrollment... 2. 535.2 Health Home Required Functions... TABLE OF CONTENTS SECTION PAGE NUMBER Background... 2 Policy... 2 535.1 Member Eligibility and Enrollment... 2 535.2 Health Home Required Functions... 3 535.3 Health Home Coordination Role... 4 535.4 Health

More information

10/7/2015. Orthopedics in the Value-Based Environment. Financiers of Health Care are Becoming More Active. ACOs and Beyond.

10/7/2015. Orthopedics in the Value-Based Environment. Financiers of Health Care are Becoming More Active. ACOs and Beyond. Orthopedics in the Value-Based Environment ACOs and Beyond October 9, 2015 Accountable Care Solutions from Aetna Aetna Inc. Financiers of Health Care are Becoming More Active 2 Instead of payment that

More information

Atrius Health ACO Initiative. Agenda

Atrius Health ACO Initiative. Agenda Atrius Health ACO Initiative November 9, 2012 Mark Yurkofsky MD Mark_yurkofsky@vmed.org 11/13/2012 1 Agenda Why the interest in the Pioneer ACO? What actually is Pioneer ACO anyway? What is Atrius Health?

More information

Accountability and Innovation in Care Delivery Models

Accountability and Innovation in Care Delivery Models Accountability and Innovation in Care Delivery Models Lisa McDonnel Senior Vice President, Network Strategy & Innovation, United Healthcare November 6, 2015 Today s discussion topics Vision Our strategic

More information

Identifying High-Risk Medicare Beneficiaries with Predictive Analytics

Identifying 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 information

What is an Accountable Care Organization. Amit Rastogi, MD President/CEO PriMed

What is an Accountable Care Organization. Amit Rastogi, MD President/CEO PriMed What is an Accountable Care Organization Amit Rastogi, MD President/CEO PriMed Goals Why is U.S. healthcare undergoing dramatic change How reimbursement structures are likely to change What is the timeline

More information

The Impact of Healthcare Reform on Pharmacy Practice. Disclosure

The Impact of Healthcare Reform on Pharmacy Practice. Disclosure The Impact of Healthcare Reform on Pharmacy Practice Thomas Buckley, MPH, RPh Assistant Clinical Professor University of Connecticut School of Pharmacy Disclosure Thomas Buckley has nothing to disclose

More information

Readmissions as an Enterprise Priority. Presenters 4/17/2014

Readmissions as an Enterprise Priority. Presenters 4/17/2014 Readmissions as an Enterprise Priority April 24, 2014 Presenters Vincent A. Maniscalco, MPA, LNHA Administrator Middletown Park Rehabilitation and Health Care Center Vmaniscalco@parkmanorrehab.com Eileen

More information

STATEMENT OF TIM GRONNIGER DIRECTOR OF DELIVERY SYSTEM REFORM CENTERS FOR MEDICARE & MEDICAID SERVICES

STATEMENT OF TIM GRONNIGER DIRECTOR OF DELIVERY SYSTEM REFORM CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF TIM GRONNIGER DIRECTOR OF DELIVERY SYSTEM REFORM CENTERS FOR MEDICARE & MEDICAID SERVICES ON EXAMINING THE MEDICARE PART D MEDICATION THERAPY MANAGEMENT PROGRAM BEFORE THE U.S. HOUSE COMMITTEE

More information

Alternatives to Fee-for-Service Payments in Health Care

Alternatives to Fee-for-Service Payments in Health Care AP PHOTO/M. SPENCER GREEN Alternatives to Fee-for-Service Payments in Health Care Moving from Volume to Value Maura Calsyn and Emily Oshima Lee September 2012 W W W.AMERICANPROGRESS.ORG Alternatives to

More information

Proposed Rule: Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations (CMS-1461-P)

Proposed 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 information

The Future of Home Health Care Project MAY 2014

The Future of Home Health Care Project MAY 2014 The Alliance for Home Health Quality & Innovation The Future of Home Health Care Project MAY 2014 About the Alliance The Alliance for Home Health Quality & Innovation is a 501(c)(3) foundation with a mission

More information

Federal Health Care Reform: Implications for Hospital and Physician partnerships. Walter Kopp Medical Management Services

Federal Health Care Reform: Implications for Hospital and Physician partnerships. Walter Kopp Medical Management Services Federal Health Care Reform: Implications for Hospital and Physician partnerships Walter Kopp Medical Management Services Outline Overview of federal health reform legislation Implications for Care delivery

More information

Medicare Value Partners

Medicare Value Partners Medicare Value Partners Medicare Shared Savings ACO Program Frequently Asked Questions (FAQ) Q: What exactly is a Medicare Shared Savings Program ACO? A: Medicare Shared Savings Program accountable care

More information

LEARNING WHAT WORKS AND INCREASING KNOWLEDGE

LEARNING WHAT WORKS AND INCREASING KNOWLEDGE About This Series In February 2010, the George Washington University School of Public Health and Health Services, Department of Health Policy released Changing po 2 licy: The Elements for Improving Childhood

More information

Accountable Care Organizations (ACOs)

Accountable Care Organizations (ACOs) Accountable Care Organizations (ACOs) Pantea Ghasemi, USC Pharm.D. Candidate 2015 Sarkis Kavarian, UOP Pharm.D. Candidate 2015 Preceptor Dr. Craig Stern Pro Pharma Pharmaceutical Consultants, Inc. April

More information

ACCOUNTABLE 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 Accountable Care Analytics: Developing a Trusted 360 Degree View of the Patient Introduction Recent federal regulations have

More information

Preparing for Online Communication with Your Patients

Preparing for Online Communication with Your Patients Preparing for Online Communication with Your Patients A Guide for Providers This easy-to-use, time-saving guide is designed to help medical practices and community clinics prepare for communicating with

More information

Value-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 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 information

NCQA Patient-Centered Medical Home. Improving experiences for patients, providers and practice staff

NCQA Patient-Centered Medical Home. Improving experiences for patients, providers and practice staff NCQA Patient-Centered Medical Home Improving experiences for patients, providers and practice staff PCMH Recognition The patient-centered medical home is a model of care that emphasizes care coordination

More information

Title Slide: Healthcare Reform and Multilevel Interventions and Research: Big Changes Go Hand-in-Hand with Big Science

Title Slide: Healthcare Reform and Multilevel Interventions and Research: Big Changes Go Hand-in-Hand with Big Science Title Slide: Healthcare Reform and Multilevel Interventions and Research: Big Changes Go Hand-in-Hand with Big Science Presented by Kelly J. Devers Prepared for the N C I Conference on Multilevel Interventions

More information

Accountable Care Organizations

Accountable 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 information

Medweb Telemedicine 667 Folsom Street, San Francisco, CA 94107 Phone: 415.541.9980 Fax: 415.541.9984 www.medweb.com

Medweb Telemedicine 667 Folsom Street, San Francisco, CA 94107 Phone: 415.541.9980 Fax: 415.541.9984 www.medweb.com Medweb Telemedicine 667 Folsom Street, San Francisco, CA 94107 Phone: 415.541.9980 Fax: 415.541.9984 www.medweb.com Meaningful Use On July 16 2009, the ONC Policy Committee unanimously approved a revised

More information

CMS QCDR (Qualified Clinical Data Registry) and Other Ways PPRNet Can Help with Value-Based Payment

CMS QCDR (Qualified Clinical Data Registry) and Other Ways PPRNet Can Help with Value-Based Payment CMS QCDR (Qualified Clinical Data Registry) and Other Ways PPRNet Can Help with Value-Based Payment Cara Litvin MD, MS Assistant Professor MUSC Department of Medicine Agenda Provide an update of the current

More information

Reforming and restructuring the health care delivery system

Reforming and restructuring the health care delivery system Reforming and restructuring the health care delivery system Are Accountable Care Organizations and bundling the solution? Prepared by: Dan Head, Principal, RSM US LLP dan.head@rsmus.com, +1 703 336 6536

More information

Formulary Management

Formulary Management Formulary Management Formulary management is an integrated patient care process which enables physicians, pharmacists and other health care professionals to work together to promote clinically sound, cost-effective

More information

UNIVERSITY OF WISCONSIN HOSPITAL AND CLINICS DEPARTMENT OF PHARMACY SCOPE OF PATIENT CARE SERVICES FY 2014 October 1 st, 2014

UNIVERSITY OF WISCONSIN HOSPITAL AND CLINICS DEPARTMENT OF PHARMACY SCOPE OF PATIENT CARE SERVICES FY 2014 October 1 st, 2014 UNIVERSITY OF WISCONSIN HOSPITAL AND CLINICS DEPARTMENT OF PHARMACY SCOPE OF PATIENT CARE SERVICES FY 2014 October 1 st, 2014 Department Name: Department of Pharmacy Department Director: Steve Rough, MS,

More information

Accountable Care Organization Workgroup Glossary

Accountable Care Organization Workgroup Glossary Accountable Care Organization Workgroup Glossary Accountable care organization (ACO) a group of coordinated health care providers that care for all or some of the health care needs of a defined population.

More information

Pediatric Alliance: A New Solution Built on Familiar Values. Empowering physicians with an innovative pediatric Accountable Care Organization

Pediatric Alliance: A New Solution Built on Familiar Values. Empowering physicians with an innovative pediatric Accountable Care Organization Pediatric Alliance: A New Solution Built on Familiar Values Empowering physicians with an innovative pediatric Accountable Care Organization BEYOND THE TRADITIONAL MODEL OF CARE Children s Health SM Pediatric

More information

MERCY-CR/UI HEALTH CARE ACCOUNTABLE CARE ORGANIZATION Dan Fick, M.D. Timothy Quinn, M.D.

MERCY-CR/UI HEALTH CARE ACCOUNTABLE CARE ORGANIZATION Dan Fick, M.D. Timothy Quinn, M.D. MERCY-CR/UI HEALTH CARE ACCOUNTABLE CARE ORGANIZATION Dan Fick, M.D. Timothy Quinn, M.D. November, 2012 Accountable Care Organization An ACO is a group of health care providers who agree to take on a shared

More information

1900 K St. NW Washington, DC 20006 c/o McKenna Long

1900 K St. NW Washington, DC 20006 c/o McKenna Long 1900 K St. NW Washington, DC 20006 c/o McKenna Long Centers for Medicare & Medicaid Services U. S. Department of Health and Human Services Attention CMS 1345 P P.O. Box 8013, Baltimore, MD 21244 8013 Re:

More information

Accountable Care Organizations and Behavioral Health. Indiana Council of Community Mental Health Centers October 11, 2012

Accountable Care Organizations and Behavioral Health. Indiana Council of Community Mental Health Centers October 11, 2012 Accountable Care Organizations and Behavioral Health Indiana Council of Community Mental Health Centers October 11, 2012 What is an ACO? An accountable care organization is a group of providers or suppliers

More information

Summary of Final Rule Provisions for Accountable Care Organizations under the Medicare Shared Savings Program

Summary of Final Rule Provisions for Accountable Care Organizations under the Medicare Shared Savings Program DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Summary of Final Rule Provisions for Accountable Care Overview The Centers for Medicare & Medicaid Services (CMS), an agency

More information

Using Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare

Using Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare December 2010 Using Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare CONTENTS Background... 2 Problems with the Shared Savings Model... 2 How

More information

RE: Medicare Program; Request for Information Regarding Accountable Care Organizations and the Medicare Shared Saving Program

RE: Medicare Program; Request for Information Regarding Accountable Care Organizations and the Medicare Shared Saving Program Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS 1345 NC P.O. Box 8013 Baltimore, MD 21244 8013 RE: Medicare Program; Request for Information Regarding Accountable

More information

- New Models: Community Pharmacy s Role in an ACO!

- New Models: Community Pharmacy s Role in an ACO! - New Models: Community Pharmacy s Role in an ACO! - Bruce Thompson, RPh, MS" - Director of Health System Pharmacy Services" - Hennepin County Medical Center" 1 Objectives q Realize the benefits Pharmacy

More information

July 20, 2015. Dear Colleague:

July 20, 2015. Dear Colleague: July 20, 2015 Dear Colleague: On May 29, 2015, the Department of Human Services released a request for information (RFI) to help guide us as we plan for the release of a new procurement for the provision

More information

Alternative Payment Models in Oncology

Alternative Payment Models in Oncology Alternative Payment Models in Oncology Prepared for Pharmaceutical Research and Manufacturers of America by Covance Market Access Services Inc. April 2014 1 Agenda Introduction to Alternative Healthcare

More information

Building a Post Acute Network: Care Management and ACOs

Building a Post Acute Network: Care Management and ACOs Building a Post Acute Network: Care Management and ACOs A high level summary of proposed rules for ACOs and the shared savings program most relevant to post acute providers. Prepared By: Kathleen M. Griffin,

More information

CPCA California Primary Care Association

CPCA 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 information

Technician Learning Objectives 3/25/2014. Pharmacy Practice Changes in ACA Accountable Care Organizations

Technician Learning Objectives 3/25/2014. Pharmacy Practice Changes in ACA Accountable Care Organizations Pharmacy Practice Changes in ACA Accountable Care Organizations Avani S. Desai, PharmD & Emory S. Martin PharmD Sunday, April 12, 2014 9:05 10:05 am Pharmacist Learning Objectives At the conclusion of

More information

Value-Based Purchasing Literature Survey August 2012

Value-Based Purchasing Literature Survey August 2012 Value-Based Purchasing Literature Survey August 2012 This document highlights a selection of briefs, reports, and commentaries on value-based purchasing payment reform methods as well as how payment reforms

More information

The 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 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 information

Accountable Care Platform

Accountable 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 information

Getting to value in high-value health care

Getting to value in high-value health care + Getting to value in high-value health care Ashish K. Jha, MD, MPH December 4 th, 2015 @ashishkjha + We have a value problem 1 + Value= Quality Costs + Quality is suboptimal 1 in 4 seniors injured during

More information

The Value Quadrant of Healthcare Reform. 2008 Pharos Innovations, LLC. All Rights Reserved.

The Value Quadrant of Healthcare Reform. 2008 Pharos Innovations, LLC. All Rights Reserved. The Value Quadrant of Healthcare Reform ACOs in PPACA Provider Organizations or networked groups Accountable for quality, cost and overall care of defined population of Medicare FFS benes Key metrics to

More information

Multiple sclerosis and health insurance: How to choose a plan that is right for you

Multiple sclerosis and health insurance: How to choose a plan that is right for you Multiple sclerosis and health insurance: How to choose a plan that is right for you What are the different types of health insurance? Choosing a health insurance plan is important, especially if you have

More information

UNDERSTANDING THE CONTENT OUTLINE/CLASSIFICATION SYSTEM

UNDERSTANDING THE CONTENT OUTLINE/CLASSIFICATION SYSTEM BOARD OF PHARMACY SPECIALTIES PHARMACOTHERAPY SPECIALIST CERTIFICATION CONTENT OUTLINE/CLASSIFICATION SYSTEM FINALIZED SEPTEMBER 2015/FOR USE ON FALL 2016 EXAMINATION AND FORWARD UNDERSTANDING THE CONTENT

More information

The Promise of Care Coordination:

The Promise of Care Coordination: THE NUTS AND BOLTS THE NUTS AND BOLTS HEALTH SYSTEM REFORM The Promise of Care Coordination: Transforming Health Care Delivery There are many different definitions of care coordination, but all of them

More information

Value Based Care and Healthcare Reform

Value Based Care and Healthcare Reform Value Based Care and Healthcare Reform Dimensions in Cardiac Care November, 2014 Jacqueline Matthews, RN, MS Senior Director, Quality Reporting & Reform Quality and Patient Safety Institute Cleveland Clinic

More information

Care Definition, Practice Foundations, and Ability-Based Outcomes Updated May 23, 2013

Care Definition, Practice Foundations, and Ability-Based Outcomes Updated May 23, 2013 University of Washington School of Pharmacy Care Definition, Practice Foundations, and Ability-Based Outcomes The pharmacist graduating from the University of Washington School of Pharmacy promotes the

More information

Senate Special Committee on Aging

Senate Special Committee on Aging Senate Special Committee on Aging Field Hearing July 31, 2015 Five Star Senior Center, St. Louis, Missouri Testimony Delivered by Sandra Van Trease Group President, BJC HealthCare Introduction Members

More information

caresy caresync Chronic Care Management

caresy caresync Chronic Care Management caresy Chronic Care Management THE PROBLEM Chronic diseases and conditions, including heart disease, diabetes, COPD and obesity, are among the most common, expensive, and preventable health problems in

More information

Banner Health Network Pioneer ACO - Physician Toolkit

Banner Health Network Pioneer ACO - Physician Toolkit & The Banner Health Network, an AIP and Banner Health partnership, present the Banner Health Network Pioneer ACO - Physician Toolkit This BHN Pioneer ACO Physician Toolkit has been developed to provide

More information

House Committee on Healthcare. CMS Evaluation of the Multi-Payer Advanced Primary Care Practice Demonstration

House Committee on Healthcare. CMS Evaluation of the Multi-Payer Advanced Primary Care Practice Demonstration House Committee on Healthcare CMS Evaluation of the Multi-Payer Advanced Primary Care Practice Demonstration HUD and ASPE Evaluation of Vermont s Support & Services at Home Program February 25, 2015 2008Q3

More information

ACO s as Private Label Insurance Products

ACO s as Private Label Insurance Products ACO s as Private Label Insurance Products Creating Value for Plan Sponsors Continuing Education: November 19, 2013 Clarence Williams Vice President Client Strategy Accountable Care Solutions Today s discussion

More information

Guidelines for the Practice and Documentation of Comprehensive Medication Management in the Patient-Centered Medical Home

Guidelines for the Practice and Documentation of Comprehensive Medication Management in the Patient-Centered Medical Home APPENDIX A: Guidelines Guidelines for the Practice and Documentation of Comprehensive Medication Management in the Patient-Centered Medical Home Based on Information Contained in the PCPCC Resource Guide:

More information

Healthcare Reform Update Conference Call VI

Healthcare 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 information

Enterprise Analytics Strategic Planning

Enterprise 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 information

January 3, 2012. RE: Comments submitted at http://www.regulations.gov.

January 3, 2012. RE: Comments submitted at http://www.regulations.gov. January 3, 2012 RE: Comments submitted at http://www.regulations.gov. Marilyn Tavenner, Acting Administrator U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services Attention:

More information

CMS Initiatives Involving Patient Experience Surveying FAQs

CMS Initiatives Involving Patient Experience Surveying FAQs CMS Initiatives Involving Patient Experience Surveying FAQs Updated October 2013 Prepared by: DSS Research CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). The

More information

Broad Issues in Quality Measurement: the CMS perspective

Broad Issues in Quality Measurement: the CMS perspective Broad Issues in Quality Measurement: the CMS perspective Shari M. Ling, MD Deputy Chief Medical Officer Centers for Medicare & Medicaid Services Workshop on Quality Measurement Developing Evidence-Based

More information

Andrew C. Bledsoe, MBA, CHPA, PCMH CCE Executive Director. Northeast KY Regional Health Information Organization. www.nekyrhio.org

Andrew C. Bledsoe, MBA, CHPA, PCMH CCE Executive Director. Northeast KY Regional Health Information Organization. www.nekyrhio.org Andrew C. Bledsoe, MBA, CHPA, PCMH CCE Executive Director Northeast KY Regional Health Information Organization www.nekyrhio.org NCQA Program Setup Standards Six Standards Outline Program Elements Six

More information

The Health Care Transformation Glossary

The Health Care Transformation Glossary The Health Care Transformation Glossary which was compiled using a variety of sources helps to educate your staff, governance and community about the new language associated with transformation. Using

More information

Primary Care, ACOs, and Payment Reform

Primary 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 information

What is Home Care Case Management?

What is Home Care Case Management? What is Home Care Case Management? Printed in USA Arcadia Home Care & Staffing www.arcadiahomecare.com Case Management: What is it why is it important? While different approaches to healthcare today are

More information

Value-based Incentive Programs. Frequently Asked Questions for self-funded customers

Value-based Incentive Programs. Frequently Asked Questions for self-funded customers Value-based Incentive Programs Frequently Asked Questions for self-funded customers December 2013 1 Table of Contents Transitioning to Value-based Incentive Programs Value-based Program Overview 1. What

More information

Improving Quality And Bending the Cost Curve: Strategies That Work

Improving 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 information

Health Care Reform: Seizing the Opportunity to Transform the Care Delivery System for Our Elders

Health Care Reform: Seizing the Opportunity to Transform the Care Delivery System for Our Elders May 5, 2011 Health Care Reform: Seizing the Opportunity to Transform the Care Delivery System for Our Elders WAHSA 2011 Spring Conference & Annual Business Meeting: New Thoughts, New Directions Kathleen

More information

PIONEER ACO PARTICIPATION WAIVER DISCLOSURES

PIONEER ACO PARTICIPATION WAIVER DISCLOSURES SICN has developed an Electronic Health Record Program Agreement that it intends to enter into with medical groups participating in the SICN Pioneer ACO that are primarily comprised of primary care physicians

More information

Re: Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations (CMS-1345-P)

Re: Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations (CMS-1345-P) Donald M. Berwick, MD Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-1503-FC Mail Stop C4-26-05 7500 Security Boulevard Baltimore, MD 21244-1850

More information

Leveraging the Patient Centered Medical Home Model to Improve Member Engagement

Leveraging the Patient Centered Medical Home Model to Improve Member Engagement Leveraging the Patient Centered Medical Home Model to Improve Member Engagement AHIP Medicare Conference 2014 THE NOLAN COMPANY September 30, 2014 Presented to: Presented by: Lisa Winternheimer Principal

More information

Clinically Integrated Networks and Accountable Care Organizations

Clinically Integrated Networks and Accountable Care Organizations Clinically Integrated Networks and Accountable Care Organizations 1 Do Nothing 2 Become Someone s Employee 3 Join a Network Provider The wake up call is for POPULATION health management managing clinical

More information

October 15, 2010. Re: National Health Care Quality Strategy and Plan. Dear Dr. Wilson,

October 15, 2010. Re: National Health Care Quality Strategy and Plan. Dear Dr. Wilson, October 15, 2010 Dr. Nancy Wilson, R.N., M.D., M.P.H. Senior Advisor to the Director Agency for Healthcare Research and Quality (AHRQ) 540 Gaither Road Room 3216 Rockville, MD 20850 Re: National Health

More information

Patient Centered Medical Homes

Patient Centered Medical Homes Patient Centered Medical Homes Paul Kleeberg, MD, FAAFP, FHIMSS CMIO Stratis Health North Dakota e-health Summit November 20, 2013 REACH - Achieving - Achieving meaningful meaningful use of your use EHR

More information