Moving Forward with Payment Bundling

Since the idea of payment bundling was first introduced 10 years ago, justification for the episode-based reimbursement model has shifted from quality and innovation gains to its proven ability to reduce the total cost of healthcare, notes Jay Sultan, associate vice president and chief product portfolio architect for TriZetto®. Healthcare entities testing bundled payments should keep two key factors in mind when trying to engage physicians in the model, Sultan adds, describing the type of message most likely to foster provider support. And finally, Sultan also identifies the major decision primary care must make now that CMS has introduced bundled payments for care coordination tasks.

Sultan provided perspectives on the emerging bundled payment trend during a March 13, 2013 webinar, Moving Forward with Payment Bundling, a 45-minute program sponsored by The Healthcare Intelligence Network.


Length: 14:26 minutes

Physician Hospital Organizations: Developing a Collaborative Structure for Shared Savings Agreements

Physician-hospital organizations have been around before, but it’s the emphasis on quality that sets today’s PHO apart from the 80’s version. In PHO 2.0, where healthcare value is favored over volume, clinical integration of participating physicians is a prerequisite, agree Greg Mertz, director of Healthcare Strategy Group, and Travis Ansel, its manager of strategic services. In this interview, they talk about the essential first steps of PHO creation and the perennial challenges of physician engagement and clinical leadership in this emerging collaborative model.

Greg Mertz and Travis Ansel explored the key contractual elements to consider when creating a PHO during a January 23, 2013 webinar, Physician Hospital Organizations: Developing a Collaborative Structure for Shared Savings Agreements, a 45-minute program sponsored by The Healthcare Intelligence Network.

Greg Mertz and Travis Ansel



Length: 8:02 minutes

Bending the Cost Curve with a Commercial Value-Based Payment Contract: A Case Study from Advocate Physician Partners

A value-based contract between Advocate Physician Partners (APP) and Blue Cross Blue Shield of Illinois (BCBSIL) has reduced inpatient admissions and emergency room visits and has bent the cost curve after its first year. In this interview, Dr. Carrie Nelson, APP’s medical director for special projects, describes how APP’s eight-year clinical integration of 4,000 physicians and 10 hospitals has laid the groundwork for this value-based contract.

Dr. Carrie Nelson presented during Bending the Cost Curve with a Commercial Value-Based Payment Contract: A Case Study from Advocate Physician Partners, a 45-minute webinar on July 18, 2012, now available for replay, during which she shared lessons learned from the first year of implementing the value-based contract between APP and BCBSIL. APP’s clinical integration program is described in detail in Case Study in Clinical Integration: The Advocate Physician Partners Experience.


Length: 4:14 minutes

Mapping the Way to ICD-10 Readiness: Blue Cross Blue Shield of Michigan’s Approach

The mapping between ICD-9 and ICD-10 code sets will have two major impacts on healthcare, predicts Dennis Winkler, ICD-10 technical program director for Blue Cross Blue Shield of Michigan, which has created a roadmap for the transition that it is sharing with the industry. Winkler describes where health plans should be on the ICD-10 timeline at the start of 2012, and defines the two major challenges the health plan expects to face as it enters the testing phase of the transition.

Dennis Winkler presented during, Mapping the Way to ICD-10 Readiness: Blue Cross Blue Shield of Michigan’s Approach, a 45-minute webinar, during which he will share BCBS of Michigan’s mapping strategy along with other organizational readiness tactics for ICD-10. Winkler will address: BCBSM’s six dimensions of neutrality and how the BCBSM plan incorporates these aspects into ICD-10 readiness; working with external vendors and constituents; ICD-10 systems testing and training; and more.


Length: 7:40 minutes

Evaluating CMS’ Bundled Payment Initiative: Operational, Financial and Clinical Considerations

CMS learned a few things from its first foray into bundled payments, explains Jim Reilly, managing partner with TRG Health Care Solutions. Having worked with all five participants in the Acute Care Episode (ACE) pilot a few years back, Reilly is ideally positioned to identify the three key benefits of participation in the upcoming CMS bundled payment initiative. But in order for episodic payments, bundled pricing and other alternative payment methodologies to be implemented successfully a key organizational process must take place, Reilly notes.

Reilly examined the key distinctions between each of CMS’ four bundled payment models and the organizational criteria that is most effective in bundled payment programs during an October 19, 2011 webinar, Evaluating CMS’ Bundled Payment Initiative: Operational, Financial and Clinical Considerations.


Length: 6:04 minutes

Redesigning the Physician Practice for Improved Efficiency and Increased Revenue

In the face of healthcare reform and new models of care delivery such as the patient-centered medical home, primary care physicians don’t have to fly solo anymore, advises Dr. David Eitrheim, a family physician with the Mayo Clinic Health System in Wisconsin. Dr. Eitrheim described how his practice’s team-based approach has changed the nature of the patient visit as well as the nurses’ workload, and provides the secret to a productive patient visit.

Dr Eitrheim shared how his practice made the transformation from a traditional practice to a team-based approach during Redesigning the Physician Practice for Improved Efficiency and Increased Revenue, a 45-minute webinar on December 15, 2010.




Length: 4:25 minutes

Health Plan Rate Setting: Balancing Premium Increases Against Regulatory Oversight

In an atmosphere of increased state and federal oversight of health plan rates, healthcare organizations need a sound strategy for determining premium rate increases that meet regulatory approval. HealthScape Advisors managing directors Steve Young and John Steele describe the challenges of setting rates in this environment and the essential experience that can best prepare health plans for dealing with commercial plans.

Young and Steele shared how health plans can develop a sound policy for premium rate increases that will meet with regulatory approval during Health Plan Rate Setting: Balancing Premium Increases Against Regulatory Oversight, a 45-minute webinar on December 8, 2010.

 




Length: 3:39 minutes

The Emerging Role of Nurse Practitioners in Expanding Access, Enhancing Revenue

Nurse practitioners constitute a workforce already grounded in patient-centered care, explains Linda Lindeke, Ph.D., an RN and a nurse practitioner herself since 1978. Lindeke, who is also associate professor for the School of Nursing and Department of Pediatrics and director of Graduate Studies for the School of Nursing at the University of Minnesota, describes the demographics where a nurse practitioner’s contributions might need clarification, explains why there’s not much mention of the medical home in nursing literature and assesses the impact of the Affordable Care Act’s $15 million allocation to fund 10 nurse practitioner-led clinics that will provide primary care services to the medically underserved.

Lindeke examined how nurse practitioners are being utilized in the physician practice, hospital and clinic settings to increase access to care and coordinate care for patients with chronic conditions during The Emerging Role of Nurse Practitioners in Expanding Access, Enhancing Revenue, a 45-minute webinar on July 28, 2010.




Length: 6:21 minutes

Improving Patient Collections in an Unhealthy Economy: Technologies and Processes to Speed Payments

With a revenue cycle that is measured by claims denials, collaborative data mining by billing and IT can identify origins of financial “bleeding” and turn these problems into actionable items, explain Beacon Partner experts Kevin Burchill, director; Sean McDonagh, practice director; and Ben Tobin, management consultant. Patient-friendly IT can also improve the patient experience on the front end while obtaining data to improve collections on the back end. This is a practice frequently employed by more financially robust providers. The three experts also debate the merits of offering patient discounts for prompt payment and placing patient credit reports in providers’ hands.

Burchill, McDonagh and Tobin, along with Beacon senior consultant Greg Adams and principal Phil Villacci, provided practical strategies, techniques and tools to improve patient collections without alienating patients during Improving Patient Collections in an Unhealthy Economy: Technologies and Processes to Speed Payments.


Kevin Burchill, Sean McDonagh and Ben Tobin
Length: 13:50 minutes