Healthcare Trends & Forecasts in 2014: Expect Surge in Commercial ACOs to Continue

Despite the migration of some Pioneer ACOs to CMS’s Medicare Shared Savings Program (MSSP), expect the surge in commercial accountable care organizations to continue in 2014, predicts Steven Valentine, president, The Camden Group. In this audio interview, Valentine suggests improvements to patient handoffs, an area in which ACOs have disappointed, in Valentine’s view, as well as expectations for the other much-modeled care delivery platform, the patient-centered medical home (PCMH).

In both the ACO and the PCMH, Valentine anticipates specialists will be critical parts of the solution, especially when it comes to emerging payment models, quality and performance.

Steven Valentine and Catherine Sreckovich, managing director, healthcare, Navigant, provided a roadmap to the key issues, challenges and opportunities for healthcare providers and payors in 2014 during an October 30, 2013 webinar, Healthcare Trends & Forecasts in 2014: A Strategic Planning Session.


Length: 8:13 minutes

Healthcare Trends & Forecasts in 2014: 7 Payor Strategies That Will Reshape Primary Care

From partnering with non-traditional providers like retail clinics to targeting larger physician practices to achieve savings and boost health outcomes, watch for health plans to continue to reshape primary care delivery over the coming year, predicts Catherine Sreckovich, managing director, healthcare, Navigant. Ms. Sreckovich outlines seven ways in which payors will influence primary care, advocates for big data for both payors and providers, and comments on the longevity of the bundled or episodic payment trend in this HealthSounds interview.

Catherine Sreckovich and Steven Valentine, president of The Camden Group, provided a roadmap to the key issues, challenges and opportunities for healthcare providers and payors in 2014 during an October 30, 2013 webinar, Healthcare Trends & Forecasts in 2014: A Strategic Planning Session.


Length: 7:37 minutes

Aligning Value-Based Reimbursement with Physician Practice Transformation

In its quest to transform 70 to 80 percent of its physician practices to a patient-centered medical home (PCMH) over the next three years, WellPoint has adopted a “meet the practices where they are” philosophy, reports Julie Schilz, director of care delivery transformation for WellPoint. Each practice is at a different place in the transformation effort and requires specialized supports, she adds.

Smoothing the transformation rollout is the simultaneous participation of 500 WellPoint practices in CMS’s Comprehensive Primary Care (CPC) program, whose goals dovetail with key PCMH principles — as though WellPoint had another partner in its transformation initiative, Schilz notes.

Just as important as practice support is transparency with health plan members, Schilz adds, especially when it comes to explaining the concept of the medical home neighborhood — where care coordination is a collaboration between primary care and the specialist.

Ms. Schilz shared the key features of WellPoint’s transformation initiative, including results from its pilot program that have led to a system-wide rollout, during an October 24, 2013 webinar, Aligning Value-Based Reimbursement with Physician Practice Transformation.


Length: 5:29 minutes

Improving Population Health with Embedded Case Managers in an Open, Multi-Payor Community

There’s education, there’s experience, and then there’s the ‘right stuff’ — the indefinable personality traits that earmark an individual as a change agent, collaborator and ambassador of case management, says Annette Watson, senior vice president of community transformation for Taconic IPA (TIPA), of TIPA’s requirements for the RN case managers it hires for its advanced patient-centered medical homes.

Then there are the not insignificant contributions of the RN case manager to accountable and patient-centered care, which Ms. Watson describes in this interview.

While staff-buy-in and communication continue to challenge the embedded case manager model, the participant in CMS Innovation Center’s Comprehensive Primary Care (CPC) initiative says reimbursement for embedded case management is less of an obstacle today than in the past, due to funding-friendly care models and pilots descending from healthcare reform.

Ms. Watson shared how TIPA has successfully embedded case managers in an open, multi-payor community during an October 9, 2013 webinar, Improving Population Health with Embedded Case Managers in an Open, Multi-Payor Community.


Length: 8:36 minutes