Accountable Care Platform

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Accountable Care Platform"

Transcription

1 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 leading approach to this transformation by leveraging years of experience with value-based contracting models. Through the expansion of our existing programs and the creation of new innovative programs, we are rewarding care providers for delivering improvements in quality (as defined by evidence-based guidelines) and cost efficiency. Our accountable care platform charts the path to superior performance, making health care more affordable and helping people live healthier lives. We are paying for value through outcome-based payment models. } We have implemented a suite of innovative value-based contract models that reward care providers for improvements in quality and cost efficiency. Nearly $28 billion dollars of our total network health care spend flows through the programs in our Accountable Care Platform. } We recognize that care providers are at various stages of readiness to move towards a risk-based contract where they are accountable for cost and quality outcomes. Therefore, we developed a modular suite of value-based incentive programs that can be leveraged across the accountable care continuum. } Nearly $28 billion dollars of our network health care spend, across Commercial, Medicare and Medicaid lines of business, is currently tied to value-based contracts. } We currently have value-based contracts in place with more than 600 hospitals, 1,150 medical groups & 80,000 physicians. Accountable Care Platform/Accountability Continuum Our modular set of value-based payment models are deployed across the continuum. We are able to align our value-based payment models with a care provider s risk readiness. Capitation + PBC Level of Financial Risk Fee-for- Service Primary Care Incentives Performancebased Contracts (PBC) Performance-based Condition or Service Line Bundles & Episodes Service Line Shared Savings Shared Risk Accountable Care Degree of Provider Integration and Accountability

2 UnitedHealthcare We are transforming the delivery system to be more accountable for cost, quality and experience outcomes. } We are collaborating with care providers and delivery systems and supporting them with tools, actionable data and clinical consultation as they become more integrated and accountable for outcomes. } Our Performance-based reward care providers for improvements in quality and cost-efficiency. } Our Centers of Excellence (COEs) leverage competition to drive enhanced quality and costefficiency in managing health conditions. } Our Accountable Care couple value-based payment models with proactive population health management strategies to drive increased quality, lower cost and improved consumer experience. Nearly $28 Billion of Network Spend is Tied to our Accountable Care Platform. 1 Performance-based Condition or Service Line Accountable Care Achieving specific METRICS Managing a specific CONDITION or SEVICE LINE Managing entire POPULATION HEALTH Primary Care Incentives, Performance-based Contracts Bundle/episode payments Service Specific Shared Savings, Shared Risk, Capitation (including ACO, PCMH) 32,000+ Physicians 900+ Medical Groups 575+ Hospitals 2,300+ physicians 25+ ancillary providers 160+ hospitals 70,000+ Physicians 550+ Medical Groups 90+ Hospitals Increasing level of integration, financial risk and accountability Value-based engagement with more than 600 hospitals, 1,150 medical groups and 80,000 physicians participating in our Accountable Care Platform. 2 1 Estimated national network medical expenditures across all lines of business. 2 Deployment statistics for executed contracts as of July, 2013 net of program overlap. 2

3 We are aligning network, product and clinical innovations to maximize value. } Our high-performance networks leverage a variety of aligned, flexible and targeted network, product and clinical strategies to drive optimal value. } Our suite of value-based benefit designs incent consumers to select higher performing care providers, resulting in savings opportunities for consumers and employers. } Our care management programs support better health outcomes for consumers and deliver value across the entire health system. } Our innovative pharmacy programs promote transparency and synchronize with our medical and wellness programs to drive value through total cost management. } Our performance measurement transparency programs activate and inform consumers, maximize affordability for employers and support care providers with actionable information. We are leveraging transparency to improve quality and lower cost. } Currently there are over 293,000 physicians in 148 markets across 41 states that are evaluated for the UnitedHealth Premium Designation program. } UnitedHealth Premium is evolving to an integrated system with consistent measurement and reporting across multiple programs to reinforce performance improvement and shared accountability. } The Health Care Cost Estimator (myhce) tool provides cutting edge information to compare both cost and quality in order to assist consumers in choosing the best care for their specific health care need. } Care provider portals, such as View360, provide network physicians and their practice staff with valuable information supporting proactive consumer outreach to drive increased consumer compliance. Our Accountable Care Platform delivers meaningful value. Our Goal: Shared Value Consumer } Lower out-of-pocket costs } Improved quality of care } Increased satisfaction with experience } Entire system working for their best outcome Employers/Plan Sponsor } Lower cost of care } Improved quality outcomes } Increased satisfaction with experience Care Provider } Financial benefit from incentives } Infrastructure support for delivering evidence-based high-quality care } Practice pattern transformation to improve accountability readiness } Increased market share } Our Accountable Care Platform is not a pilot it is our foundation. } Our extensive experience with value-based contracting enables us to demonstrate the meaningful value our programs have already delivered. 3

4 UnitedHealthcare Accountable Care Platform Impact Proven Results Performance-based } $50M savings in last 12 months } 3.6% readmit reduction } 9% reduction in inpatient length of stay Reduction in the use of non-participating laboratory services Reduction in the use of non-tier 1 prescriptions Centers of Excellence } 25% decrease in the average length of hospital stays for transplants } Improved transplant survival rates at Centers of Excellence 3% reduction in one-year mortality for liver transplants 5% reduction in one-year mortality for heart transplants } 16% reduction in the incidence of transplants through application of evidence-based appropriateness criteria Patient Centered Medical Home Accountable Care 1 } 1.5%-3.5% lower medical cost trend than expected } 4:1 ROI Westmed ACO } 3% reduction in medical cost } 5% reduction in acute hospital admissions Improved 9 key quality metrics 1 Patient Centered Medical Home results based on 4 states and 1 Commercial ACO. 4

5 Our Value Agenda The UnitedHealthcare Difference. } Our modular suite of value-based programs enables us to customize our accountable care approach with care providers across all stages of the risk continuum and support them as they become more accountable for cost, quality and experience outcomes. } Our broad national network of more than 676,000 doctors and health professionals, 64,000 pharmacies, 5,100 hospitals and 1,000 convenient care clinics enables us to implement our valuebased programs in many different markets with a variety of different types of care providers. } We are unique in the marketplace because we are an industry leader not only for private, commercial insurance but also for Medicare Advantage and Medicaid programs. We have the opportunity to partner with care providers in proactively managing the health of a variety of populations. } We offer comprehensive data and reporting, innovative mechanisms to distribute funds based on performance and access to cutting edge health information technology. We are supporting care providers in this transformation by supplying them with the tools they need to be successful. } We believe our strategy uniquely maximizes value by aligning incentives across consumers, care providers and payers to achieve the Triple Aim of better health, better care and lower costs. } Our Accountable Care Platform delivers distinctive value through delivery system transformation. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. 1/ United HealthCare Services, Inc. UHCEW

ACCOUNTABLE CARE PLATFORM

ACCOUNTABLE CARE PLATFORM ACCOUNTABLE CARE PLATFORM Delivering distinctive value to those we serve North Carolina State Health Plan March 28, 2014 Network Strategy Delivering Distinctive Value Transforming the Delivery System Paying

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

MODERNIZE YOUR HEALTH PLAN BY INCREASING INDIVIDUAL HEALTH OWNERSHIP

MODERNIZE YOUR HEALTH PLAN BY INCREASING INDIVIDUAL HEALTH OWNERSHIP MODERNIZE YOUR HEALTH PLAN BY INCREASING INDIVIDUAL HEALTH OWNERSHIP Lancaster County Business Group on Health, Forecast Breakfast, September 25, 2014 Impact of ACA & Pharmacy on UHC Clients Financial:

More information

HEALTHCARE REFORM CARE DELIVERY AND REIMBURSEMENT MODELS. April 10, 2014

HEALTHCARE REFORM CARE DELIVERY AND REIMBURSEMENT MODELS. April 10, 2014 HEALTHCARE REFORM CARE DELIVERY AND REIMBURSEMENT MODELS April 10, 2014 1 MARKETPLACE UPDATE 2 MARKETPLACE - ESSENTIAL HEALTH BENEFITS 3 MARKETPLACE - METAL LEVELS 4 WHAT IS THE HEALTH INSURANCE MARKETPLACE

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

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

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

Issue Brief. Raising the Bar. Standards for Accountable Care Organizations to Truly Improve Health Care Quality and Affordability in the United States

Issue Brief. Raising the Bar. Standards for Accountable Care Organizations to Truly Improve Health Care Quality and Affordability in the United States Raising the Bar Standards for Accountable Care Organizations to Truly Improve Health Care Quality and Affordability in the United States Issue Brief Introduction Health care costs continue to rise at an

More information

Helping You Achieve Better Clinical and Financial Health

Helping 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 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

Your guide to UnitedHealthcare

Your guide to UnitedHealthcare Your guide to UnitedHealthcare Face the future with confidence The benefits environment remains challenging. Uncertainty reigns as a wave of new regulation sweeps across the industry. Costs continue to

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

LARGE SCALE NETWORKS NEXT WAVE OF CLINICAL INTEGRATION

LARGE SCALE NETWORKS NEXT WAVE OF CLINICAL INTEGRATION CENTER FOR INDUSTRY TRANSFORMATION MAY 2015 LARGE SCALE NETWORKS NEXT WAVE OF CLINICAL INTEGRATION Authors Michael Strilesky Principal, DHG Healthcare michael.strilesky@dhgllp.com DHG HEALTHCARE CENTER

More information

6/12/2015. Dignity Health Population Health Management and Compliance Programs. Moving Towards Accountable Care. Dignity Health Poised for Innovation

6/12/2015. Dignity Health Population Health Management and Compliance Programs. Moving Towards Accountable Care. Dignity Health Poised for Innovation Dignity Health Population Health Management and Compliance Programs Julie Bietsch, VP Population Health Management Dawnese Kindelt, Senior Compliance Director, Clinical Integration June 8, 2015 Moving

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

Incorporating New Payment Models Into a Managed Care Environment

Incorporating New Payment Models Into a Managed Care Environment Incorporating New Payment Models Into a Managed Care Environment Association of Community Affiliated Health Plans CEO Summit, Washington DC, July 13, 2011 Topics for our conversation today An experience

More information

Applying ACO Principles to a Pediatric Population UH Rainbow Care Connection: Transforming Pediatric Ambulatory Care with a Physician Extension Team

Applying ACO Principles to a Pediatric Population UH Rainbow Care Connection: Transforming Pediatric Ambulatory Care with a Physician Extension Team Applying ACO Principles to a Pediatric Population UH Rainbow Care Connection: Transforming Pediatric Ambulatory Care with a Physician Extension Team Ethan Chernin, MBA Director 1 Objectives Understand

More information

Analytic-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. 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 information

Making the Transition into Risk-Based Payment Why Children s Hospitals Need to Accept Value-Based Care Strategies

Making the Transition into Risk-Based Payment Why Children s Hospitals Need to Accept Value-Based Care Strategies Making the Transition into Risk-Based Payment Why Children s Hospitals Need to Accept Value-Based Care Strategies Substantial changes within the Medicaid marketplace are driving U.S. children s hospitals

More information

Clinical Integration: A Road Map to Accountable Care

Clinical Integration: A Road Map to Accountable Care Clinical Integration: A Road Map to Accountable Care Jacqueline Matthews, RN, MS Senior Healthcare Transformation Director IBM Watson Health May 12, 2016 Housekeeping 1. Using the control panel - Use the

More information

ANALYTIC-DRIVEN QUALITY KEYS SUCCESS IN RISK-BASED CONTRACTS DATE APRIL 27, 2016

ANALYTIC-DRIVEN QUALITY KEYS SUCCESS IN RISK-BASED CONTRACTS DATE APRIL 27, 2016 ANALYTIC-DRIVEN QUALITY KEYS SUCCESS IN RISK-BASED CONTRACTS DATE APRIL 27, 2016 Ross Gustafson, Vice President Allina Performance Resources, Health Catalyst Brian Rice, Vice President Network/ACO Integration,

More information

INTRO TO THE MICHIGAN PIONEER ACO 101: THE BASICS. Karen Unholz, RN, BSN

INTRO TO THE MICHIGAN PIONEER ACO 101: THE BASICS. Karen Unholz, RN, BSN INTRO TO THE MICHIGAN PIONEER ACO 101: THE BASICS Karen Unholz, RN, BSN Origins of the Accountable Care Organization ACOs originated from the Patient Protection and Affordable Care Act (Healthcare Reform)

More information

3M s unique solution for value-based health care

3M 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 information

MAKING THE TRANSITION TO POPULATION HEALTH MANAGEMENT

MAKING THE TRANSITION TO POPULATION HEALTH MANAGEMENT MAKING THE TRANSITION TO POPULATION HEALTH MANAGEMENT H O W T O E F F E C T I V E L Y N E G O T I A T E V A L U E - B A S E D C O N T R A C T S I N T H E N E W R E T A I L M A R K E T P I O N E E R I N

More information

The Accountable Care Organization: An Introduction

The 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 information

The Cornerstones of Accountable Care ACO

The Cornerstones of Accountable Care ACO The Cornerstones of Accountable Care Clinical Integration Care Coordination ACO Information Technology Financial Management The Accountable Care Organization is emerging as an important care delivery and

More information

PRINCIPAL DEPUTY ADMINISTRATOR, DEPUTY ADMINISTRATOR FOR INNOVATION AND QUALITY, AND CHIEF MEDICAL OFFICER, CENTERS FOR MEDICARE & MEDICAID SERVICES

PRINCIPAL DEPUTY ADMINISTRATOR, DEPUTY ADMINISTRATOR FOR INNOVATION AND QUALITY, AND CHIEF MEDICAL OFFICER, CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF PATRICK CONWAY, MD, MSc ACTING PRINCIPAL DEPUTY ADMINISTRATOR, DEPUTY ADMINISTRATOR FOR INNOVATION AND QUALITY, AND CHIEF MEDICAL OFFICER, CENTERS FOR MEDICARE & MEDICAID SERVICES ON EXAMINING

More information

01/22/2010 1. Program Objectives. Quality and Poor Care Coordination

01/22/2010 1. Program Objectives. Quality and Poor Care Coordination Building Community Engagement in Indiana Communities: The Conduit to Transforming Healthcare Empowerment 34 th Annual InAHQ Conference on Healthcare Quality The Triple Crown of Healthcare Quality Nancy

More information

Premier ACO Collaboratives Driving to a Patient-Centered Health System

Premier 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 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

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

Key Features of the Affordable Care Act, By Year

Key Features of the Affordable Care Act, By Year Page 1 of 10 Key Features of the Affordable Care Act, By Year On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place comprehensive health insurance reforms that will roll

More information

The Rising Tide of Pharmacy Benefit Cost and Complexity: A health plans roadmap to optimizing pharmacy services relationships

The Rising Tide of Pharmacy Benefit Cost and Complexity: A health plans roadmap to optimizing pharmacy services relationships The Rising Tide of Pharmacy Benefit Cost and Complexity: A health plans roadmap to optimizing pharmacy services relationships New pharmacy benefit challenges After several years of manageable pharmacy

More information

33rd Annual J.P. Morgan Healthcare Conference

33rd Annual J.P. Morgan Healthcare Conference 33rd Annual J.P. Morgan Healthcare Conference January 12, 2015 Disclosures / Forward-looking Statements This presentation includes forward-looking statements. Such forward-looking statements are based

More information

Accountable Care: Clinical Integration is the Foundation

Accountable Care: Clinical Integration is the Foundation Solutions for Value-Based Care Accountable Care: Clinical Integration is the Foundation Clinical Integration Care CoordinatioN ACO Information Technology Financial Management The Accountable Care Organization

More information

Hospitals and Health Systems:

Hospitals and Health Systems: Hospitals and Health Systems: An Inside Look at Employee Health Plan Strategies To Control Costs and Provide Access to Healthcare August 2010 Highlights Because of their dual role as benefit plan sponsor

More information

HFMA Region 9 Webinar Are You on the Right Path to Value?

HFMA Region 9 Webinar Are You on the Right Path to Value? HFMA Region 9 Webinar Are You on the Right Path to Value? March 21, 2016 P. Todd DeWeese, MBA Vice President The Affordable Care Act s Path to Payment Reform and Corresponding Impact on the Health Care

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

Health Care Financing: ACC/ ACO s, beyond the hype hope. Brian Seppi, MD, President, Washington State Medical Assn.

Health Care Financing: ACC/ ACO s, beyond the hype hope. Brian Seppi, MD, President, Washington State Medical Assn. : ACC/ ACO s, beyond the hype hope Brian Seppi, MD, President, Washington State Medical Assn. Washington State Medical Association Health Care Financing Our vision Make Washington the best place to practice

More information

NCQA Health Plan Accreditation. Rigorous. Flexible. Superior.

NCQA Health Plan Accreditation. Rigorous. Flexible. Superior. NCQA Health Plan Accreditation Rigorous. Flexible. Superior. Health Plan Accreditation Rigorous. Flexible. Superior. Health plans operate in a competitive marketplace, often vying for business with local,

More information

Top 10 Issues for Health Plans - Strategic & Operational Priorities

Top 10 Issues for Health Plans - Strategic & Operational Priorities Top 10 Issues for Health Plans - Strategic & Operational Priorities Thomas Carleton, Sr. Director, Health IT & Analytics Mosaic Health Solutions (BCBS NC) Nancy Wise, SVP, Strategic & Regulatory Consulting

More information

Center for Medicare & Medicaid Innovation Request for Information on Health Plan Innovation Initiatives at CMS

Center for Medicare & Medicaid Innovation Request for Information on Health Plan Innovation Initiatives at CMS Center for Medicare & Medicaid Innovation Request for Information on Health Plan Innovation Initiatives at CMS Agency/Office: Type of Notice: Department of Health and Human Services Centers for Medicare

More information

Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed?

Benefit 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 information

Early Lessons learned from strong revenue cycle performers

Early 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 information

The Impact of Accountable Care Organizations on the Healthcare Industry. Dale Maxwell Senior Vice President & CFO Presbyterian Healthcare Services

The Impact of Accountable Care Organizations on the Healthcare Industry. Dale Maxwell Senior Vice President & CFO Presbyterian Healthcare Services The Impact of Accountable Care Organizations on the Healthcare Industry Dale Maxwell Senior Vice President & CFO Presbyterian Healthcare Services Agenda The Case for Change A New Idea, The ACO Characteristics

More information

Signature Leadership Series. Metrics for the Second Curve of Health Care

Signature Leadership Series. Metrics for the Second Curve of Health Care Signature Leadership Series Metrics for the Second Curve of Health Care April 2013 Metrics for the Second Curve of Health Care Resources: For information related to health care delivery transformation,

More information

ACOs: Impacting the Past, Present and Future State of Healthcare

ACOs: 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 information

Investing in a Medical Home. By Robin Mancuso Managing Director Healthcare Practice

Investing in a Medical Home. By Robin Mancuso Managing Director Healthcare Practice By Robin Mancuso Managing Director Healthcare Practice A medical home needs to gather, interpret and distribute information about its patients in real time. Several marketplace factors and economic forces

More information

Population Health: Tales from the Front

Population Health: Tales from the Front Population Health: Tales from the Front Integrated Design and Case Study from Northwest Arkansas Objectives 1 2 3 4 Discuss current Population Health trends and approaches in the market Determine the strategies

More information

VALUE BASED PURCHASING

VALUE BASED PURCHASING HEALTH WEALTH CAREER VALUE BASED PURCHASING EMPLOYEE BENEFITS PLANNING ASSOCIATION MARY KAY O NEILL, MD, MBA FEBRUARY 25, 2016 WHAT ARE THE GOALS OF ACOS AND VBCS? A fundamental shift in how health care

More information

Transitioning to a Sub-Capitation (At Risk) Model

Transitioning to a Sub-Capitation (At Risk) Model Transitioning to a Sub-Capitation (At Risk) Model Presentation Overview Understanding the Changing Environment Understanding Changing Payment Models Network Management Keys For Success Shifting Mindsets

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

OHIO CONSUMERS FOR HEALTH COVERAGE POLICY PRIORITIES FY 2012-13. Medicaid Make Improvements to Improve Care and Lower Costs

OHIO CONSUMERS FOR HEALTH COVERAGE POLICY PRIORITIES FY 2012-13. Medicaid Make Improvements to Improve Care and Lower Costs OHIO CONSUMERS FOR HEALTH COVERAGE POLICY PRIORITIES FY 2012-13 Ohio Consumers for Health Coverage supports robust implementation of the Patient Protection and Affordable Care Act (ACA) in Ohio, making

More information

Accountable Care Organizations (ACOs): Potential to Foster Quality While Reducing Costs

Accountable 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

The UnitedHealthcare Diabetes Health Plan Better information. Better decisions. Better results. Agenda

The UnitedHealthcare Diabetes Health Plan Better information. Better decisions. Better results. Agenda The UnitedHealthcare Better information. Better decisions. Better results. 1 Agenda Market Health Trends- declining health status and increase disease prevalence Optimal Decisions and Opportunity for Improvement

More information

Author: Mallory M. Johnson, MHA, Senior Consultant. A push towards pay-for-performance

Author: Mallory M. Johnson, MHA, Senior Consultant. A push towards pay-for-performance Author: Mallory M. Johnson, MHA, Senior Consultant A push towards pay-for-performance The term pay-for-performance (P4P) has matured in healthcare over the last decade from concept to reality as healthcare

More information

CPAs & ADVISORS PHYSICIAN ALIGNMENT STRATEGIES. experience clarity // Moving Forward in the Health Reform Era

CPAs & ADVISORS PHYSICIAN ALIGNMENT STRATEGIES. experience clarity // Moving Forward in the Health Reform Era CPAs & ADVISORS experience clarity // PHYSICIAN ALIGNMENT STRATEGIES Moving Forward in the Health Reform Era OVERVIEW Physician alignment is a key in achieving Triple Aim -type outcomes Alignment opportunities

More information

Timeline: Key Feature Implementations of the Affordable Care Act

Timeline: Key Feature Implementations of the Affordable Care Act Timeline: Key Feature Implementations of the Affordable Care Act The Affordable Care Act, signed on March 23, 2010, puts in place health insurance reforms that will roll out incrementally over the next

More information

/10/2015. Perspective. Payer Common Themes. MACRA Payment Reform. MIPS or APM? Summary

/10/2015. Perspective. Payer Common Themes. MACRA Payment Reform. MIPS or APM? Summary Looking Ahead: Value Based Reimbursement Considerations for the Medical Practice Kentucky MGMA Doral Jacobsen Senior Manager DHG Healthcare Kathy Rhodes Manager DHG Healthcare 1 Agenda 1. 2. 3. 4. 5. Perspective

More information

10 Key Concepts for Higher Sales into ACOs

10 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 information

Alternative Payment Models Impacting Care Delivery Across the Care Continuum

Alternative Payment Models Impacting Care Delivery Across the Care Continuum Alternative Payment Models Impacting Care Delivery Across the Care Continuum AT A GLANCE Contributing Tenant Partners The recent announcement by HHS and CMS accelerates the movement away from FFS and provides

More information

myhealthcare Cost Estimator Member guide Your personalized online tool that will empower you to make more informed health care decisions.

myhealthcare Cost Estimator Member guide Your personalized online tool that will empower you to make more informed health care decisions. SM myhealthcare Cost Estimator Member guide Your personalized online tool that will empower you to make more informed health care decisions. Say yes to know. Get to know myuhc.com. Get to know myuhc.com,

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

Best Practices and Strategies to Engage ACOs, Incentive Programs and Emerging Payment Models JUSTIN T. BARNES

Best Practices and Strategies to Engage ACOs, Incentive Programs and Emerging Payment Models JUSTIN T. BARNES Best Practices and Strategies to Engage ACOs, Incentive Programs and Emerging Payment Models JUSTIN T. BARNES CHAIRMAN EMERITUS, EHR ASSOCIATION CO-CHAIR, ACCOUNTABLE CARE COMMUNITY OF PRACTICE About Justin

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

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

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

Healthcare Facilities Accreditation Program

Healthcare Facilities Accreditation Program 1 Healthcare Facilities 2 Moving Accreditation from Standards to Quality and Safety Based Lessons from the Healthcare Facilities Richard Snow DO, MPH Healthcare Facilities Advisory Board Medical Director

More information

After years of intense discussion and little action, outcome-based healthcare has arrived with a boom.

After years of intense discussion and little action, outcome-based healthcare has arrived with a boom. September 2013 After years of intense discussion and little action, outcome-based healthcare has arrived with a boom. It s as if that twinkling little star went supernova. In fact, are driving the new

More information

The Need to Embrace Profit Cycle Management in Healthcare

The Need to Embrace Profit Cycle Management in Healthcare GE Healthcare The Need to Embrace Profit Cycle Management in Healthcare Justin Steinman General Manager GE Healthcare IT Top 5 Takeaways 1. Healthcare leaders need to start analyzing and controlling costs

More information

Health Research Institute 2014 June. Medical cost trend: Behind the numbers 2015 Chart pack

Health Research Institute 2014 June. Medical cost trend: Behind the numbers 2015 Chart pack Health Research Institute 2014 June Medical cost trend: Behind the numbers 2015 Chart pack HRI projects 2015 s medical cost trend to be 6.8% a modest increase over our 2014 projection of 6.5%. As more

More information

PHOTO HERE. Monarch Pioneer ACO. Current State and Future Outlook January 12, 2015

PHOTO HERE. Monarch Pioneer ACO. Current State and Future Outlook January 12, 2015 PHOTO HERE Monarch Pioneer ACO Current State and Future Outlook January 12, 2015 Questions 1. Are ACOs meeting their full potential? 2. What changes should be made to achieve the Triple Aim? 2 Monarch

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

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

Physician Discovery Services Provide a Full Range of Physician Practice Solutions

Physician Discovery Services Provide a Full Range of Physician Practice Solutions Physician Discovery Services OUR SOLUTION Truven Health Physician Discovery Services experts provide insights into a hospital or health system s physician enterprise. With experience in physician assessment,

More information

Clinical Integration Concepts for Successful Population Health

Clinical Integration Concepts for Successful Population Health Annual Conference November 12, 2015 Presented by: Jane Jerzak, RN, CPA, Partner Clinical Integration Concepts for Agenda Population Health and the Movement Toward Clinical Integration Consumerism Patient

More information

Healthcare Payment Reform: Transition from Volume-Based to Value-Based Payments. October 6, 2014

Healthcare Payment Reform: Transition from Volume-Based to Value-Based Payments. October 6, 2014 Healthcare Payment Reform: Transition from Volume-Based to Value-Based Payments October 6, 2014 1 Healthcare Payment Reform: From Volume to Value-Based Payments Healthcare Reform Overview National Trends

More information

Health Care Reform. Jim Smith American Continental Group 900 19 th Street, NW, #800 Washington, DC 20006 202-327-8100

Health Care Reform. Jim Smith American Continental Group 900 19 th Street, NW, #800 Washington, DC 20006 202-327-8100 Health Care Reform Jim Smith American Continental Group 900 19 th Street, NW, #800 Washington, DC 20006 202-327-8100 *Tobacco-related disease *Poor diet *Lack of exercise *Excessive use of alcohol *American

More information

Urgent Care Industry Overview

Urgent Care Industry Overview Urgent Care Industry Overview September 2013 Investment banking services are provided by Harris Williams LLC, a registered broker-dealer and member of FINRA and SIPC, and Harris Williams & Co. Ltd, which

More information

How-To Guide: Accountable Care Organizations

How-To Guide: Accountable Care Organizations How-To Guide: Accountable Care Organizations How to Use this Guide The information in this guide is intended to be used primarily by self-funded purchasers of health care who are interested in understanding

More information

9/3/2013. Understanding Data: How to improve quality and affordability. Disclosure Information. Overview

9/3/2013. Understanding Data: How to improve quality and affordability. Disclosure Information. Overview Understanding Data: How to improve quality and affordability MGMA 2013 Annual Conference October 8, 2013 Robert A. Greene, MD National VP, Clinical Analytics Final Disclosure Information Meeting: Speaker:

More information

Post-Acute/Long- Term Care Planning for Accountable Care Organizations

Post-Acute/Long- Term Care Planning for Accountable Care Organizations White Paper Post-Acute/Long- Term Care Planning for Accountable Care Organizations SCORE A Model for Using Incremental Strategic Positioning as a Planning Tool for Participation in Future Healthcare Integrated

More information

Accountable Care Organizations & Other Reimbursement Reforms: The Impact on Physician Practices

Accountable Care Organizations & Other Reimbursement Reforms: The Impact on Physician Practices 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 information

2014 New York Small Group (1-50) Health Plan Portfolio (Oxford Product Offerings) Robust Benefits, Broad Network, Innovative Online Tools

2014 New York Small Group (1-50) Health Plan Portfolio (Oxford Product Offerings) Robust Benefits, Broad Network, Innovative Online Tools 2014 New York Small Group (1-50) Health Plan Portfolio ( Product Offerings) Robust Benefits, Broad Network, Innovative Online Tools Offering a variety of plan designs, ranging from open access to primary

More information

Accountable Care Organizations New Healthcare Opportunities for Employers

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 information

Unlocking the Value of Healthcare s Big Data with Predictive Analytics

Unlocking the Value of Healthcare s Big Data with Predictive Analytics Unlocking the Value of Healthcare s Big Data with Predictive Analytics Background The volume of electronic data in the healthcare industry continues to grow. Adoption of electronic solutions and increased

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

The Personalized Patient-Centered Healthcare Transformation

The Personalized Patient-Centered Healthcare Transformation The Personalized Patient-Centered Healthcare Transformation From Volume to Value A Connected Approach to Patient Care WHITE PAPER Contents EXECUTIVE SUMMARY A Case for the Patient-Centric Provider How

More information

Pay for Performance and Accountable Care

Pay for Performance and Accountable Care Pay for Performance and Accountable Care Mark McClellan, MD, PhD Director, Engelberg Center for Health Care Reform Senior Fellow, Economic Studies Leonard D. Schaeffer Chair in Health Policy Studies Brookings

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

HAI LEADERSHIP PARTNERING FOR ACCOUNTABLE CARE

HAI LEADERSHIP PARTNERING FOR ACCOUNTABLE CARE HAI LEADERSHIP PARTNERING FOR ACCOUNTABLE CARE Cepheid s Government Affairs Department Advocating for Patient Access to Molecular Diagnostics in the Era of Healthcare Reform A TEAM APPROACH Legislative

More information

HEALTHCARE CHANGES AFFECTING YOUR PRACTICE. Vinay Kumar MD, FACS, ABVM Endovascular options Dallas, Texas

HEALTHCARE CHANGES AFFECTING YOUR PRACTICE. Vinay Kumar MD, FACS, ABVM Endovascular options Dallas, Texas HEALTHCARE CHANGES AFFECTING YOUR PRACTICE Vinay Kumar MD, FACS, ABVM Endovascular options Dallas, Texas HEALTH CARE CHANGES 1 st Major overhaul of health care system since WWII introduction of 3 rd party

More information

Beyond the Math of Bundles: Redesigning Care: Establishing Convention and Consistency

Beyond the Math of Bundles: Redesigning Care: Establishing Convention and Consistency Beyond the Math of Bundles: Redesigning Care: Establishing Convention and Consistency Your Presenters Ray Herschman President and COO, xg Health Francois de Brantes Executive Director, HCI3 Kathryn Hayes-Hallowell

More information

Value-based reimbursement models call for innovative payment administration

Value-based reimbursement models call for innovative payment administration Value-based reimbursement models call for innovative payment administration Expert presenters Mark Anderson, Vice President, General Manager, Value Based Care s health care transitions away from traditional

More information

The Impact Of Employer Contribution Policy On Premium Rate Setting. Group-Specific Experience: Financial And Utilization Performance

The Impact Of Employer Contribution Policy On Premium Rate Setting. Group-Specific Experience: Financial And Utilization Performance Premiums: HMO Premium Rate Calculations Setting Group Renewal Premium Rates The Impact Of Employer Contribution Policy On Premium Rate Setting Group-Specific Experience: Financial And Utilization Performance

More information

MANAGEMENT S DISCUSSION CONDITION AND RESULTS OF OPERATIONS FOR ASCENSION AS OF AND FOR THE SEPTEMBER 30, 2014 AND 2013 AND ANALYSIS OF FINANCIAL

MANAGEMENT S DISCUSSION CONDITION AND RESULTS OF OPERATIONS FOR ASCENSION AS OF AND FOR THE SEPTEMBER 30, 2014 AND 2013 AND ANALYSIS OF FINANCIAL MANAGEMENT S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS FOR ASCENSION AS OF AND FOR THE THREE MONTHS ENDED SEPTEMBER 30, 2014 AND 2013 The following information should be

More information

Population Health Management Innovation Payer and Provider Collaboration. Population Health Management Innovation Payer and Provider Collaboration

Population Health Management Innovation Payer and Provider Collaboration. Population Health Management Innovation Payer and Provider Collaboration Population Health Management Innovation Payer and Provider Collaboration Population Health Management Innovation Payer and Provider Collaboration Agenda Strategic Context Population Health Journey Key

More information

MEDICAID 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 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 information

A STRATIFIED APPROACH TO PATIENT SAFETY THROUGH HEALTH INFORMATION TECHNOLOGY

A STRATIFIED APPROACH TO PATIENT SAFETY THROUGH HEALTH INFORMATION TECHNOLOGY A STRATIFIED APPROACH TO PATIENT SAFETY THROUGH HEALTH INFORMATION TECHNOLOGY Table of Contents I. Introduction... 2 II. Background... 2 III. Patient Safety... 3 IV. A Comprehensive Approach to Reducing

More information

Accountable Care Communities 101. Jennifer M. Flynn, Esq. Senior Director, State Affairs Premier healthcare alliance January 30, 2014

Accountable Care Communities 101. Jennifer M. Flynn, Esq. Senior Director, State Affairs Premier healthcare alliance January 30, 2014 Accountable Care Communities 101 Jennifer M. Flynn, Esq. Senior Director, State Affairs Premier healthcare alliance January 30, 2014 Premier is the largest healthcare alliance in the U.S. Our Mission:

More information