HEALTHCARE REFORM CARE DELIVERY AND REIMBURSEMENT MODELS. April 10, 2014
|
|
- Delphia Baldwin
- 8 years ago
- Views:
Transcription
1 HEALTHCARE REFORM CARE DELIVERY AND REIMBURSEMENT MODELS April 10,
2 MARKETPLACE UPDATE 2
3 MARKETPLACE - ESSENTIAL HEALTH BENEFITS 3
4 MARKETPLACE - METAL LEVELS 4
5 WHAT IS THE HEALTH INSURANCE MARKETPLACE (CONTINUED)? Effective January 1, 2014, State and Federal Marketplaces were established. 18 States Declared State-based 7 Federal-State partnership 26 State Default to the Federal Goal: Provide health benefit options to the uninsured; Increase consumer choice; Provide Benefit Standardization Premiums will be community-rated and risk-adjusted on only 4 factors (single/family, geography, age, tobacco use) Individual subsidies will be offered 5
6 MARKETPLACE STATS (ILLINOIS) Enrollment Stats by Age: 75% Ages 35 to 64 25%: Ages 18 to 34 77% qualify for Federal Subsidy 138% to 400% of Poverty Level Health Plan Selection: Platinum & Gold 22% Silver 54% Bronze: 24% Tax Penalty: $95 or 1% of Income Source: 6
7 ILLINOIS MEDICAID REFORM 7
8 ILLINOIS MEDICAID GENERAL FACTS Current Medicaid Enrollment: 2.7 Million Current Medicaid Deficit: $2.7 Billion State law requires 50% of Illinois Medicaid recipients move to Managed Care by 2015 Modified eligibility requirement to 138% of Federal Poverty Level Estimated Increase in Medicaid population by 2015: 500,000 Source: 8
9 WHAT IS THE FEDERAL POVERTY LEVEL? Source: 9
10 SENIORS & ADULTS WITH DISABILITIES INNOVATIONS ENROLLMENT & COST 10
11 IL MEDICAID CARE COORDINATION PROGRAMS Integrated Care Program Effective October 1, 2012 Applies to older adults, and adults w/ disabilities Eligible for Medicaid, but not eligible for Medicare. 108,000 eligible members in Chicago region Medicare-Medicaid Alignment Initiative (MMAI) Effective March 1, 2014 Applies to Seniors & Persons with Disabilities eligible for Medicare and Medicaid 118,000 eligible members in Chicago region Children, Families and NEWLY ELIGBLE Adults Effective July 1, 2014 Eligibility: Below 138% of the National Poverty Level (NPL) 11
12 REIMBURSEMENT REFORM 12
13 CONTINUUM OF PAYMENT MODELS 13
14 REIMBURSEMENT MODELS Fee-For Service Episodic Reactionary Medicine Lacks Care Coordination, Case Management Reimbursement Method: Per Service Focus: Quantity of Care Increased Utilization: Length of Stay Admissions Clinic Visits Specialty services 14
15 REIMBURSEMENT MODELS 3 Pay For Performance (P4P) Value-Based Purchasing Rewards providers Performance Measures based on Quality and Efficiency Disincentives, eliminating payments for negative outcomes Never Events Readmissions Modest improvements in outcomes Little cost savings due to added administrative requirements Validity of quality measurements 15
16 REIMBURSEMENT MODELS 2 Capitation Preventative Proactive Medicine Population Based Medicine Evidence Based Medicine Focus: Quality of Care Requires Care Coordination: Community Outreach Case Management Utilization Management Care Setting: Community based (Schools, Churches, Work, Home (Telemedicine) Reimbursement Methodology: Per Member Per Month 16
17 CARE MODEL GOALS 17
18 REFORM BASED CARE MODELS GOAL Maximized health outcomes Avoid unnecessary duplication of services & prevent error Delivering high-quality care Spending health care dollars more wisely Providers share in the Savings Accountable Care Organizations (ACO) Groups of doctors, hospitals, and other health care providers Care Coordination Reimbursement :Fixed Per Member Per Month (PMPM) Patient Centered Medical Homes (PCMH) Team based health care delivery (Primary Care, Specialists, Hospital, Ancillary) Care Coordination Emphasis on Primary Care Population Based Health Care Reimbursement :Fixed Per Member Per Month (PMPM) 18
19 REFORM BASED CARE MODELS - ILLINOIS Coordinated Care Entities (CCE) Collaboration of providers and community agencies Governed by a lead entity Provide Care Coordination Managed Care Coordinated Entities (MCCN) Owned, operated, or governed by providers Provides or arranges primary, secondary and tertiary services Provide Care Coordination Accountable Care Entities (ACE) Formed to coordinate network of Medicaid services Large enough to handle 40,000 members in Cook County Provides PCP, Specialty, Hospital and Mental Health services Provide Care Coordination, Utilization Management, Case Management 19
20 REFORM BASED CARE MODELS 2 Health Maintenance Organizations (HMO) Members must select a Primary Care Physician (PCP) PCP acts as Gatekeeper PCP collaborates with specialists to provide medical services - referrals Requires Care Coordination, utilization management, case management Per Member Per Month (PMPM) Capitation 20
21 EXAMPLE OF AN ACCOUNTABLE CARE ORGANIZATION 21
22 MODEL OF AN ACCOUNTABLE CARE ENTITY 22
23 HEALTHCARE FINANCE
24 Income Statement Full Risk Model *PMPM Values are arbitrary and meant for illustration purposes only
25 SUMMARY 25
26 WHAT DOES THE FUTURE HOLD Newly Insured - Marketplace and Medicaid Reform Population / Evidence Based Medicine Investment in Organizational Infrastructure Increased Care Coordination Tighter Control on Utilization Management Payer: Narrower Provider Networks Provider: Market Consolidation 26
27 INFORMATION SOURCES Get Covered Illinois Federal website Illinois Department of Healthcare and Family Services ation.html U.S. Department of Health and Human Services Blue Cross Blue Shield of Illinois. 27
28 QUESTIONS? 28
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 informationInsights AdvocateCare Health Insurance Exchanges
Insights AdvocateCare Physician Edition April 16, 2013 Executive Summary (HIX, also called Health Insurance Marketplace) a key provision of The Patient Protection and Affordable Care Act (ACA, Affordable
More informationAccountable Care Platform
The shift toward increased collaboration, outcome-based payment and new benefit design is transforming how we pay for health care and how health care is delivered. UnitedHealthcare is taking an industry
More informationHEALTH POLICY AFFORDABLE CARE ACT AND STATE MEDICAID CHANGES. NEW Members Conference of the Illinois General Assembly November 27-28, 2012
HEALTH POLICY AFFORDABLE CARE ACT AND STATE MEDICAID CHANGES NEW Members Conference of the Illinois General Assembly November 27-28, 2012 Robert Kaestner, PhD Institute of Government and Public Affairs,
More informationillinois health insurance marketplace
illinois health insurance marketplace healthcare reform is coming. find answers here. healthcarereform.illinois.gov The Affordable Care Act. What it means for you. In March of 2010, the Affordable Care
More informationWhat 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 informationAs of January 1, 2014, most individuals must have some form of health coverage, or pay a penalty to the federal government.
Consumer Alert Health Insurance for 2014: What You Need to Know Before You Enroll (Individuals) As of January 1, 2014, most individuals must have some form of health coverage, or pay a penalty to the federal
More informationWho We Are We re a coalition of concerned Kentuckians, over 250 organizations and individuals, who believe that the best health care solutions are found when everyone works together to build them. Right
More informationHealthcare Reform: Preparing Your Practice For Implementation of the. HMWC Healthcare Education Leadership Program. Affordable Care Act (ACA)
Healthcare Reform: Preparing Your Practice For Implementation of the HMWC Healthcare Education Leadership Program Affordable Care Act (ACA) September 12, 2013 Main Provisions Signed into law on March 23,
More informationHealth Care Reform Basics
Health Care Reform Basics You may be asking yourself what health care reform is all about. Don t worry, you re not alone many people are asking the same question! This booklet will give you the basics
More informationTABLE OF CONTENTS. Claims Processing & Provider Compensation
TABLE OF CONTENTS Claims Address... 2 Claim Submission... 2 Claim Payment... 2 Claim Payment Adjustments.... 2 Claim Disputes... 2 Recovery of Overpayments... 3 Balance Billing... 3 Annual Health Assessment
More informationHealthy Business Chat 07/10/2014
Healthy Business Chat 07/10/2014 1 What Is An Insurance Exchange? An Insurance Exchange is an organized marketplace for insurance plans to compete and offer services efficiently in the small group and
More informationPopulation-based health care: can you get there from here?
Population-based health care: can you get there from here? by David Howe SORH Contracted Rural Writer Hospitals and insurance companies are acquiring other hospitals and insurance companies. Other hospitals
More informationNational Healthcare Reform: Implications for Nursing Education and Practice
National Healthcare Reform: Implications for Nursing Education and Practice UMass Graduate School of Nursing Alumni Association Program June 4, 2010 Katharine London 2 Goals for Today s Presentation Explain
More informationPresentation for Licensed Producers The Affordable Care Act
Presentation for Licensed Producers The Affordable Care Act Bruce Donaldson, CHC Producer & Stakeholder Specialist Arkansas Insurance Department Affordable Care Act The ACA was passed by Congress and signed
More informationUnderstanding Health Insurance. Your Guide to the Affordable Care Act
Understanding Health Insurance Your Guide to the Affordable Care Act Summary Health insurance may seem like a luxury if you are on a tight budget. But protecting your health and your family is one of the
More informationor vertical applications)
or vertical applications) Health care reform is on many of our minds. After all, the Affordable Care Act (ACA), will be in full swing by January 2014. But many people still have questions about what the
More informationACO 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 informationHEALTH CARE REFORM CHECKLIST
HEALTH CARE REFORM CHECKLIST As a small employer, you need to be aware of the new regulations tied to the Affordable Care Act. Refer to this checklist to ensure you understand each one and that you re
More informationThe meeting was called to order at 5:27 by the Chairman of the Executive Committee, Joseph Szot, M.D.
Minutes Carver College of Medicine Fall Faculty Forum: Health Care Reform Legislation - Its Implementation and Impact on UI Health Care Tuesday, October 26, 2010 Presenters: Vice-President Jean Robillard,
More informationE. Christopher Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences
Accountable Care Organizations and You E. Christopher Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences CEO, OSU Faculty Group Practice Chair, Department of Surgery Ohio State University
More informationHospitals and the Affordable Care Act (ACA)
Hospitals and the Affordable Care Act (ACA) General Housekeeping If you experience any technical difficulties during the webinar, please contact GoToMeeting.com Corporate Account Customer Support at: 1-888-259-8414
More informationHealth Insurance Marketplace in Illinois Plan Comparison Charts
2015 Independent Authorized Agent for An Independent Licensee of the Blue Cross Blue Shield Association Health Insurance Marketplace in Illinois Plan Comparison Charts preventive services and maternity
More informationUnderstanding the ObamaCare Health Insurance Plans in North Carolina Understanding Insurance and Affordable Care Act Terminology: ACA- Marketplace
Understanding the ObamaCare Health Insurance Plans in North Carolina As a result of the Affordable Care Act (a.k.a. ObamaCare) the following provisions are now in place for health insurance policies with
More informationValue-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 informationAccountable 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 informationHealth Insurance Shopper s Guide 3 steps to choosing the right health plan for you and your family.
Health Insurance Shopper s Guide 3 steps to choosing the right health plan for you and your family. Ready to get started? We re here for you online, on the phone or in person. Visit for a quick and free
More informationLEARN. Your guide to health insurance. How to choose the best plan for you and your family
LEARN Your guide to health insurance How to choose the best plan for you and your family Table of Contents Understanding health insurance...1 Health care law and you...2 Health insurance basics...4 Why
More informationPremium Tax Credits: Answers to Frequently Asked Questions
Updated July 2013 Premium Tax Credits: Answers to Frequently Asked Questions Beginning in 2014, millions of Americans will become eligible for a new premium tax credit that will help them pay for health
More informationHow Health Reform Will Affect Health Care Quality and the Delivery of Services
Fact Sheet AARP Public Policy Institute How Health Reform Will Affect Health Care Quality and the Delivery of Services The recently enacted Affordable Care Act contains provisions to improve health care
More informationInsurance Terms 101. Patient Access Specialists I
Access Management Insurance Terms 101 University of Mississippi Medical Center Patient Access Specialists I As a Patient Access Specialist Your job is to collect ACCURATE patient information during registration.
More informationShopping for a health care plan can be confusing. Let us help.
We re here to help Shopping for a health care plan can be confusing. Let us help. Thank you for trusting Anthem Blue Cross and Blue Shield for your health coverage. We re here to protect you from the high
More informationHealth Insurance Exchange & Network Management Solutions
Health Insurance Exchange & Network Management Solutions Mike Flanagan AVP, Product Management June 19, 2013 Today s Presenter Mike Flanagan Associate Vice President of Product Management McKesson Health
More informationCare Coordination and Contracting Entities: The CHC Perspective on IPAs and ACOs. Today s Discussion
Care Coordination and Contracting Entities: The CHC Perspective on IPAs and ACOs Ohio Association of Community Health Centers June 2014 Contact Us Andrew Principe PO Box 410221, Cambridge, MA 02141 P.
More informationHealth insurance Marketplace. What to expect in 2014
Health insurance Marketplace What to expect in 2014 Overview The Affordable Care Act (ACA) includes several provisions geared to extend greater access to health insurance benefits to more people. Beginning
More informationINDIVIDUAL HEALTH INSURANCE GUIDE. Introduction. What is the Health Insurance Marketplace?
INDIVIDUAL HEALTH INSURANCE GUIDE Introduction On November 15th, 2014, the second annual Open Enrollment Period for Individual Health Insurance begins. The Affordable Care Act (ACA) requires all US citizens
More informationThe Patient Protection & Affordable Care Act: Next Steps in Maine. February 8, 2013 1
The Patient Protection & Affordable Care Act: Next Steps in Maine February 8, 2013 1 Maine Medical Association Voluntary membership association of over 3,600 Maine physicians, residents, and medical students
More informationLEARN. Your guide to health insurance
LEARN Your guide to health insurance Table of Contents Why health insurance is important...1 How the Affordable Care Act affects you...2 See if you may qualify for a subsidy...4 Types of health plans...6
More informationHealth 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 informationMedicaid Managed Care is Coming to Illinois WHAT YOU NEED TO KNOW. March Case Manager Webinar Series
Medicaid Managed Care is Coming to Illinois WHAT YOU NEED TO KNOW March Case Manager Webinar Series Welcome! Welcome to our webinar series on Medicaid managed care for people with HIV in Illinois. Last
More informationNew provider networks will support health plans sold on and off the Health Insurance Marketplace
Health Insurance Exchange October 2013 New provider networks will support health plans sold on and off the Health Insurance Marketplace Anthem Blue Cross and Blue Shield and our subsidiary HMO Nevada (Anthem)
More informationGetting Ready for 2014: The Big Year for Healthcare Reform Anne Arundel County SHRM. David Johnson jdjohnson@rcmd.com November 15, 2012
Getting Ready for 2014: The Big Year for Healthcare Reform Anne Arundel County SHRM David Johnson jdjohnson@rcmd.com November 15, 2012 0 Topics for Discussion 1. Recap of Supreme Court Decision on Affordable
More informationCountdown to 2014: HEALTH CARE REFORM WHAT YOU NEED TO KNOW
Countdown to 2014: HEALTH CARE REFORM WHAT YOU NEED TO KNOW Coordinated by: -The Affordable Care Act- -Employer Notification- Monday, September 9, 2013 Registration 8:15 a.m. 8:45 a.m. Welcome 8:45 a.m.
More informationEssentialCare. PLAN HIGHLIGHTS. $0 co-pay for preventive care, screenings, and immunizations. No referral needed to see specialist.
EssentialCare. PLAN HIGHLIGHTS $0 co-pay for preventive care, screenings, and immunizations. No referral needed to see specialist. ADDITIONAL OFFERINGS Free access to Stat DoctorsTM, a telemedicine service
More informationHealthcare IT Angel Investor Intro Presenter: Saul Richter. sponsored by
Healthcare IT Angel Investor Intro Presenter: Saul Richter sponsored by August 2015 Agenda What is the problem in healthcare? Why is it so hard to solve? Overview of healthcare change Healthcare spending
More informationHealth Insurance for PLTS Students. KAREN MARRINER, MBA Licensed Insurance Agent KM Consulting
Health Insurance for PLTS Students KAREN MARRINER, MBA Licensed Insurance Agent KM Consulting True or False? Individuals can be charged more for their health insurance for having medical conditions. All
More informationAffordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion
Affordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion Table of Contents Expanded Coverage... 2 Health Insurance Exchanges... 3 Medicaid Expansion... 8 Novartis Pharmaceuticals Corporation
More informationAccountability 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 informationTHE AFFORDABLE CARE ACT IMPACT ON YOUR MEDICAL PRACTICE
THE AFFORDABLE CARE ACT IMPACT ON YOUR MEDICAL PRACTICE Dennis Olmstead, MPA Vice President Practice Economics & Payer Relations Pennsylvania Medical Society Kaiser Health Tracking Poll Poll (March 2013)
More informationVALUE 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 informationHealth Insurance Marketplace. vhealth insurance exchanges. What to expect in 2014. What to expect in 2014
vhealth insurance exchanges Health Insurance Marketplace What to expect in 2014 What to expect in 2014 The basics of exchanges As part of the Affordable Care Act (ACA or health care reform law), starting
More informationChoosing the Best Plan for You: A Tool for Purchasing Coverage in the Health Insurance Exchange
Choosing the Best Plan for You: A Tool for Purchasing Coverage in the Health Insurance Exchange The Affordable Care Act (ACA) makes health insurance available to nearly all Americans and the law requires
More informationINTRO 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 informationThe Affordable Care Act: Is Healthcare Becoming More Affordable?
The Affordable Care Act: Is Healthcare Becoming More Affordable? Houston Economics Club Federal Reserve Bank of Dallas, Houston Branch November 17, 2014 Vivian Ho, PhD James A. Baker III Institute Chair
More informationHealth Insurance Buyers Guide. What You Need to Know to Get Started
Health Insurance Buyers Guide What You Need to Know to Get Started Time to Enroll The Affordable Care Act has changed the way that many people get health insurance. You may have more options and more ways
More informationHealth Care Reform & The Health Insurance Marketplace. Presented by Mikal A Jeffries, CEBS Account Manager
Health Care Reform & The Health Insurance Marketplace Presented by Mikal A Jeffries, CEBS Account Manager 1 Health Care Reform Review Goals of Health Care Reform Increase number of Americans with health
More informationPushing the Boundaries of Population Health Management: How University Hospitals Launched Three ACOs July 26, 2013 American Hospital Association
Pushing the Boundaries of Population Health Management: How University Hospitals Launched Three ACOs July 26, 2013 American Hospital Association Eric J. Bieber, M.D. Chief Medical Officer, University Hospitals
More informationThe Affordable Care Act
The Affordable Care Act What does it mean for internists? Joshua Becker MD 10/14/2015 VII. 2015 Reforms and Beyond Payment Penalties under Medicare s Pay-for-Reporting Program Value-Based Payment Modifier
More informationBanner 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 informationManaged Care in Illinois
Managed Care in Illinois This profile reflects state managed care program information as of August 2014, and only includes information on active federal operating authorities, and as such, the program
More informationIssue 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 informationList of Insurance Terms and Definitions for Uniform Translation
Term actuarial value Affordable Care Act allowed charge Definition The percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70%,
More information3M s unique solution for value-based health care
A quick guide to 3M s unique solution for value-based health care Volume-based health care Part 1: Helping your organization navigate the journey from volume- to value-based health care. Value-based health
More informationSpecial Needs Plans. A Platform and Strategy for Quality and Control Provider Sponsored
A Platform and Strategy for Quality and Control Provider Sponsored Special Needs Plans Alicia Heazlitt, VP, Signature HealthCARE Will Saunders, CEO, AllyAlign Health Agenda Agenda Items Introductions The
More information2016 HIV Pre-Exposure Prophylaxis (PrEP) Health Insurance Assessment
2016 HIV Pre-Exposure Prophylaxis (PrEP) Health Insurance Assessment December 2015 Report produced by: Cesar Egurrola Clinical Coordinator Petersen Clinics Shannon Smith Director, Special Projects Department
More informationExchanges go live: Early trends in exchange dynamics
Exchanges go live: Early trends in exchange dynamics After three and a half years of forecasting, data is now emerging from the individual exchanges that can inform the likely impact of the Affordable
More informationPayment Models Workgroup July 13, 2015
Payment Models Workgroup July 13, 2015 Alternative Payment Models: WHAT Are Other SIM States Doing? 2 State Innovation Models (SIM) Initiative Evaluation - Model Test CMS contracted with RTI to develop
More informationTHE AFFORDABLE CARE ACT: THE AFFORDABLE COVERAGE OPTIONS AND CONSIDERATIONS IN 2014 THE NEW HEALTH INSURANCE: MARKETPLACE AND MEDICAID
THE AFFORDABLE CARE ACT: THE AFFORDABLE COVERAGE OPTIONS AND CONSIDERATIONS IN 2014 THE NEW HEALTH INSURANCE: MARKETPLACE AND MEDICAID Deloris Summers Deaf In-Person Counselor Navigator Jacksonville Area
More informationHelping You Achieve Better Clinical and Financial Health
McKesson Business Performance Services Accountable Care Services Helping You Achieve Better Clinical and Financial Health 1 We recognized that fee-for-service would decrease and value-based care would
More informationHealth Care Reform: Policy Implications for the Future
Health Care Reform: Policy Implications for the Future Michigan Primary Care Association Douglas M. Paterson, MPA Director of State Policy Promoting, supporting, and developing comprehensive, accessible,
More informationBCBSM 2015-2016 PG5 P4P Program Population Health Management Champion Measure
BCBSM 2015-2016 PG5 P4P Program Population Health Management Champion Measure Blue Cross Blue Shield of Michigan Hospital Incentive Programs May 15, 2015 Kristen Frey kfrey@bcbsm.com Mark Huizenga mhuizenga@bcbsm.com
More informationSteven E. Ramsland, Ed.D., Senior Associate, OPEN MINDS The 2015 OPEN MINDS Performance Management Institute February 13, 2015 10:15am 11:30am
Steven E. Ramsland, Ed.D., Senior Associate, OPEN MINDS The 2015 OPEN MINDS Performance Management Institute February 13, 2015 10:15am 11:30am The execution or accomplishment of work, acts, or feats The
More informationTHE IMPACT OF HEALTH CARE REFORM ON NONPROFIT ORGANIZATIONS. By Tom Webber
THE IMPACT OF HEALTH CARE REFORM ON NONPROFIT ORGANIZATIONS By Tom Webber Agenda Why Reform? Tax Subsidies for Nonprofit Organizations Timeline of Changes MNA Resources Why Reform? The Uninsured More than
More informationMassachusetts Health Care Reform and Cancer Care. Therese Mulvey, MD Southcoast Centers for Cancer Care February 2010
Massachusetts Health Care Reform and Cancer Care Therese Mulvey, MD Southcoast Centers for Cancer Care February 2010 Southcoast Health System in Massachusetts Southcoast Primary and Secondary Markets An
More informationWhile health care reform has its foundation and framework at
CENTER FOR HEALTHCARE RESEARCH & TRANSFORMATION Policy Brief June 2010 The Patient Protection and Affordable Care Act at the State and Local Level While health care reform has its foundation and framework
More informationApplying 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 informationACCEPTED INSURANCE PLANS
ACCEPTED INSURANCE PLANS The University of Chicago Medicine currently participates in the health insurance products listed below. Patients are advised to contact their insurance company to confirm the
More informationThe Affordable Care Act: Its Impact on People with Serious Chronic Diseases
The Affordable Care Act: Its Impact on People with Serious Chronic Diseases PSC Partners Annual Conference Victoria Veltri, JD, LLM State Healthcare Advocate April 26, 2013 Discussion Areas What is the
More informationA,B,C s of Obama Care What do you need to know? How will it affect you and your family?
Elephant in the Room A,B,C s of Obama Care What do you need to know? How will it affect you and your family? Confused? What will you learn in this webinar? O What is Obamacare? O What has it done so far?
More informationHealthcare Reform: An Analysis of the Impact on Healthcare Providers
Healthcare Reform: An Analysis of the Impact on Healthcare Providers Background The financial impact from the Affordable Care Act on providers from changes in Medicare reimbursement have been well documented
More informationThemes from the Accountable Care Organization (ACO) Payment Reformers Consultation December 4, 2014
Themes from the Accountable Care Organization (ACO) Payment Reformers Consultation December 4, 2014 The Payment Reformers Project Community convened for a group consultation session to discuss the development
More informationKey Design Feature Scope of services Governance Payment Measurement & Evaluation
Figure 2: Domains of State Activity Name of Initiative Key Design Feature Scope of services Governance Payment Measurement & Evaluation Support for Infrastructure Alabama Regional Organizations (RCOs)
More informationColorado Legislative Council Staff
Colorado Legislative Council Staff Room 029 State Capitol, Denver, CO 80203-1784 (303) 866-3521 FAX: 866-3855 TDD: 866-3472 MEMORANDUM October 29, 2012 TO: Interested Persons FROM: Bill Zepernick, Fiscal
More informationDRAFT Health Home Concept Paper
DRAFT Health Home Concept Paper 1. How are health home services provided? Illinois Medicaid has been primarily a fee-for-service system, involving thousands of healthcare providers who have provided invaluable
More informationWashington Health Benefit Exchange. Leading Age 2014 Annual Conference. Phil Dyer Board Member
Washington Health Benefit Exchange Leading Age 2014 Annual Conference Phil Dyer Board Member DISCLAIMER; The views and information expressed are my personal opinions and perspectives and do not represent
More informationHealth Care Reform PPACA. General Assembly Greensboro, NC 2013
Health Care Reform PPACA General Assembly Greensboro, NC 2013 Near-term Provisions 1 These fees apply to both insured and self-insured plans. Additional Coming Changes PPACA Patient Protection and Affordable
More informationHEALTH INSURANCE MARKETPLACES FACT SHEET
HEALTH INSURANCE MARKETPLACES FACT SHEET INFORMED ON REFORM Overview A Health Insurance Marketplace, also known as a Health Insurance Exchange, is available in every state as a public option for individuals
More informationInsure Tennessee. What is Insure Tennessee?
Coverage for Tennessee s uninsured that is market-based, promotes personal responsibility, addresses cost, and is a big step towards real healthcare reform in Tennessee. What is Insure Tennessee? 2 What
More informationMAKING 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 informationAccountable Care Organizations: An old idea with new potential. Stephen E. Whitney, MD, MBA Testimony to Senate State Affairs September 22, 2010
Accountable Care Organizations: An old idea with new potential Stephen E. Whitney, MD, MBA Testimony to Senate State Affairs September 22, 2010 Impetus for ACO Formation Increased health care cost From
More informationExchanges and the ACA What You Need to Know for 2014
Exchanges and the ACA What You Need to Know for 2014 How the Affordable Care Act affects the Individual Health Insurance Market This presentation is for informational purposes only and does not constitute
More informationValue-Based Programs. Blue Plans Improving Healthcare Quality and Affordability through Innovative Partnerships with Clinicians
Value-Based Programs Blue Plans Improving Healthcare Quality and Affordability through Innovative Partnerships with Clinicians Issue: U.S. healthcare spending exceeds $2.8 trillion annually. 1 With studies
More informationAffordable Care Act and Adolescents and Young Adults
Affordable Care Act and Adolescents and Young Adults Overview of Summit Welcome and Introductions Affordable Care Act 101 Affordable Care Act and Impact on Adolescents and Young Adults Federal Update on
More informationHow To Get A Dental Plan On The Marketplace
2014 Delaware Qualified Health Plans Individual Market Overview October 8, 2013 www.pcghealth.com Topics Overview of QHPs in the Individual Market QHP Issuers Plan Summary Premium Rates and Cost-Sharing
More informationACOs: Six Things Specialty Practices Should Know
ACOs: Six Things Specialty Practices Should Know =TOS Newsletter, July/August 2014= Authors: John P. Schmitt, Ph.D. and J. Garrett Schmitt, MBA, PCMH CCE INTRODUCTION Do you remember the analogy of four
More informationThe Vermont Health Benefit Exchange: An Update
The Vermont Health Benefit Exchange: An Update Today s Discussion Health Reform Goals & Timeline Overview of Health Care Reform What is the Exchange? What Does the Exchange Look Like? Plan Design Enrollment
More informationEXPLORING NEW YORK S SHOP MARKETPLACE. An Overview for Small Groups
EXPLORING NEW YORK S SHOP MARKETPLACE An Overview for Small Groups TABLE OF CONTENTS Why SHOP... 1 Who Can Enroll...2 How to Enroll...3 Choosing Plans...4 Our SHOP Offerings...5 SHOP Plan Comparison...6-7
More informationThe Large Business Guide to Health Care Law
The Large Business Guide to Health Care Law How the new changes in health care law will affect you and your employees Table of contents Introduction 3 Part I: A general overview of the health care law
More informationHEALTH INSURANCE CONSULTING FEBRUARY 21, 2013
1 HEALTH INSURANCE CONSULTING FEBRUARY 21, 2013 2 INSURANCE BROKER TOOLKIT Medical Dental Life Disability Vision Employee Assistance Program (EAP) Supplemental (AFLAC) Flexible Spending Account (FSA) Health
More informationQ. My company already offers employee health coverage, how does the law impact me?
Frequently Asked Questions Q. Will my business be required to provide employee health insurance under the health care law? A. The law does not mandate employers provide employees health care coverage.
More information