BCBSM PG5 P4P Program Population Health Management Champion Measure

Transcription

1 BCBSM PG5 P4P Program Population Health Management Champion Measure Blue Cross Blue Shield of Michigan Hospital Incentive Programs May 15, 2015 Kristen Frey Mark Huizenga 1

2 Why Population Health Management? Half of traditional Medicare payments in alternative payment models by 2018³ Fee-for-Service Linked to Quality: Hospital Value-Based Purchasing (VBP) Physician Value-Based Modifier Readmission Reduction Program Hospital Acquired Condition Reduction Program MBQIP and MU Stage 2 Alternative Payment Models: Accountable Care Organizations (ACO) Bundled Payments Primary Care Medical Homes (PCMH) Percentage of Medicare payments in 2018, by payment model³ How Michigan s rural health providers can fit into this value equation: PGIP Program and PCMH Primary Care Organized Systems of Care (ACO concept) Population Insights Reports: Hospital-Physician Alignment Hospital Incentives: Hospital Pay-for-Performance (P4P) MBQIP Care Transitions ³ Rajkumar R, Conway PH, Tavenner M. CMS Engaging Multiple Payers in Payment Reform. JAMA. 2014;311(19):

3 Linking to IHI Triple Aim Population Health Gaining an understanding of: - Who is my population? - Where do they seek healthcare? - What types of healthcare do they require? Experience of Care - Better continuity of care across primary and acute care settings (rural and urban) - Engagement of all healthcare providers Per Capita Cost Improved coordination resulting in: - Decreased duplication of services (PMPM) - Unnecessary utilization (think ED use) 3

4 BCBSM Population Profiling Tool 4

5 Health of the Community Population Health Management (10%) Program Year Hospitals required to complete a Population Health Management Attestation form by June 1, 2015 Form asked hospitals to: 1. Review each of the population-health management reports provided by BCBSM 2. Briefly comment on how CAH was partnering (or planning to partner) with the PGIP-participating physician organizations or other acute care hospital providers in their communities OK to note if there aren t currently collaborative activities between providers Full credit for reporting only (10% of program incentive) Program Year Builds upon requirements from previous year by asking hospitals to designate a Population Health Champion Champion responsible for: 1. Being the point of contact for all population-health management activities 2. Attending informational webinar in Summer 2015 to learn more about BCBSM s population health management approach and reports available 3. Engage with other health care providers in the community and work towards increased collaboration Hospitals will receive credit for champion designation and attendance at informational webinar (10%) Future Program Years Continue work with hospital champions to further engage with partnering primary and acute care providers Identify areas of opportunity to improve population-based utilization (ED visits, imaging, etc) Consider health information exchange between primary and acute care providers to facilitate improved care transitions 5

6 Population Health Champion Form ( ) Similar format as the population health management attestation form Champion is expected to complete the form after attending the webinar and reviewing the Population Insights Report and Population Profiling Tool Submission by June 1 st, 2016 to receive full credit Champion should seek to collaborate with PO partners to address an opportunity for improvement, however, it is not necessary for receiving program credit in

7 Population Insights Webinar Information Next release of BCBSM s Population Insights Reporting targeted for June 15 th, 2015 Measurement Period: 2014 CY Reports sent via to hospital CEO, CFO, and P4P Representatives Population Health Webinars to review updated reporting will be held throughout Summer 2015: Upper Peninsula: Tuesday, July 14, 10am 11:30am Northern Lower Peninsula: Tuesday, July 21, 10am 11:30am Thumb: Monday, July 27, 1pm 2:30pm Southern Lower Peninsula: Thursday, July 30, 10am 11:30am Champions are strongly encouraged to attend the webinar scheduled for their region However, not a requirement attend any webinar you are able to 7