Deconstructing Health Reform: 3 Reasons Medicare and Pioneer ACOs May Not Survive

Given changing reimbursement incentives and collaborative models for physicians and hospitals, Greg Mertz, managing director of Physician Strategies Group, LLC, discusses why the Congressional proposal “Better Care, Lower Cost Act” of 2014 is financially more attractive to providers than ACO models and whether he thinks it will be passed. He also deconstructs CMS’ recently reported financial results for such health reform delivery initiatives as Medicare ACOs, Pioneer ACOs, and the Physician Group Practice demonstration, and weighs in on which, if any, model he considers the most sustainable.

Greg Mertz helped healthcare organizations assess which value-based healthcare delivery model is right for their organization during Physician Alignment: Which Model Is Right for You?, a February 19th, 2014 workshop at 1:30 p.m. Eastern.


Length: 5:58 minutes

3 Key Benefits to Prudent Sharing of Physician Performance Data

There are three key benefits to prudent sharing of performance data among physicians, notes Cynthia Kilroy, senior vice president of provider strategy and business development at Optum, who suggests a four-step systematic approach for data dissemination that moves companies away from simply creating “metrics in a box.” Besides the electronic health record, she recommends three other data sources to mine for provider performance metrics.

Cynthia Kilroy explored the key structure, issues and challenges in these evolving reimbursement models during a January 29, 2014 webinar, Accountable Care Reimbursement Models: Moving from Productivity to Population-Based Incentives, a 45-minute program sponsored by The Healthcare Intelligence Network.


Length: 6:04 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

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 Pay for Performance: Refining the Bonus Structure to Meet Market Realities

In its 15-year existence, Highmark’s Quality Blue physician pay for performance program has evolved from one strictly based on clinical measures to a payment model shaped by practices’ needs, explains Julie Hobson, Highmark’s manager of provider engagement, performance and partnership. Hobson describes how feedback from physicians resulted in its Best Practice quality improvement project, what CMS’s recently announced stage 2 proposal for meaningful EHR use means for Quality Blue, and some lessons Highmark has learned about engaging physicians in pay for performance.

Julie Hobson presented during Physician Pay-for-Performance: Refining the Bonus Structure To Meet Market Realities, a 45-minute webinar on March 22, 2012, during which Hobson described how Highmark’s Quality Blue physician pay for performance program has evolved to meet today’s healthcare market realities. Hobson will share new developments slated for 2012 to reflect meaningful use requirements; the bonus scoring algorithm currently in place that rewards physicians across the measure set and how this algorithm will change in 2012 to reflect market developments; and much more.


Length: 6:05 minutes

Healthcare Performance Improvement: Exceeding Core Measure Targets for Value-Based Reimbursement

The establishment of good core measure performance is good patient care, emphasizes Dr. Steve Berkowitz, president of SMB Consulting and former chief medical officer at St. David’s HealthCare, which boasts a mortality index and CMS core measure ratings that are among the best in the nation. Dr. Berkowitz shares his formula for achieving 100 percent performance, describes an incentive program for drivers of the quality measures and weighs in on the need for an EHR to achieve core measure excellence.

Dr. Berkowitz shared practical strategies for improving core measures, as well as modeling techniques to illustrate the impact of a hospital’s failure to meet the measures during Healthcare Performance Improvement: Exceeding Core Measure Targets for Value-Based Reimbursement, a 45-minute webinar on July 20, 2011, now available for replay, sponsored by The Healthcare Intelligence Network.


Length: 5:21 minutes

Physician Quality Reporting Initiative in 2009: How To Avoid Submission Errors and Improve Reimbursement


According to Dr. Bruce Bagley, the cornerstone of PQRI is quality improvement, and any bonus payments physicians receive for reporting efforts are just that — by-products of the process. Dr. Bagley, medical director of quality improvement for the American Academy of Family Physicians, also shares his views on the value of patient registries and other healthcare IT for PQRI, and advises physicians who may be frustrated by their PQRI experiences.

Dr. Bagley, along with Betsy Nicoletti, consultant, Medical Practice Consulting, LLC, described how PQRI can provide physician practices with a great start on registries and measurement and reporting and provided practical hands-on PQRI coding and auditing strategies during a March 18, 2009 webinar, Physician Quality Reporting Initiative in 2009: How To Avoid Submission Errors and Improve Reimbursement.


Length: 5:05 minutes