Archive for the ‘Healthcare Quality Ratings’ Category

5 Market Trends Affecting Value-Based Reimbursement

March 25th, 2014 by Patricia Donovan

physician compensation

A new economy is reshaping healthcare delivery, measurement and funding.

Changes in the way healthcare is delivered, evaluated and funded are having a serious impact as the industry gradually shifts from productivity- to population-focused compensation, according to Cynthia Kilroy, senior vice president of provider strategy and business development at Optum.

We are seeing five trends in the healthcare industry that are affecting value-based reimbursement, with implications for each.

First, there is a consolidation of the provider community: physicians are organizing, and hospital systems or large integrated delivery networks (IDNs) are actually purchasing physicians. We’re seeing both affiliated and employed models going on in the market right now.

Another influential trend is system affordability. We’ve talked about this a lot, but premiums have been increasing significantly— more than 30 percent over the last five years. A lot of the challenges and what CMS and some payors are trying to focus on is, how can we make healthcare more affordable to the community at large?

A third area of trends is the value-based care models, or the alignment of economic and practice incentives to create accountability. This does not just relate to volume, but also to how to manage populations. Which leads into the next trend, which is the investment of provider organizations in capabilities and tools to manage populations. The result is that the incentive models are moving more toward that population-based care, which is much more challenging to measure.

And then finally, we have a lot of interest in performance metrics—HCAHPS,® for example. With just about every other payor asking for different performance metrics from organizations, how do we really focus, especially from an incentive program for physicians, into the right incentive? More than likely, each organization is going to be different about what they’re trying to achieve; each market is very different.

Excerpted from: 6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability

Infographic: The Failure of U.S. Healthcare Spending

March 5th, 2014 by Jackie Lyons

The average cost of a hospital stay in the United States is $15,734, according to a new infographic from BestNursingMasters.com. This is just one area of expense that contributes to the United States' healthcare spending in comparison to other countries.

This infographic shows life expectancy versus healthcare spending, spending per capita, cost of developing new drugs, health risks that affect the United States and more.

You may also be interested in this related resource: 57 Population Health Management Metrics: Assessing Risk to Maximize Reimbursement. How can your healthcare organization provide the best care while maximizing reimbursement? This 65-page desktop resource delivers performance benchmarks in six key areas of population health management, based on feedback by hundreds of healthcare organizations.


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Infographic: 7 Reasons to Engage With Patients Before Their Appointments

February 26th, 2014 by Jackie Lyons

The need to engage patients by preparing them before their appointments is rapidly growing. Positives include efficiency and increased patient satisfaction due to less manual data entry and shorter patient wait times among other benefits, according to a new infographic from Leading Reach.

This infographic provides the top seven reasons to engage with patients before their appointments and 10 examples of information that can be sent to patients before their appointment to ensure satisfaction.

You may also be interested in this related resource: Healthcare Innovation in Action: 19 Transformative Trends. Need more ways to increase patient satisfaction? This 40-page resource examines a set of pioneering efforts supporting the industry's seismic shift from a volume-based culture to one rewarding value and patient-centeredness.


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Which Value-Based Reimbursement Model Will Ultimately Align Physicians?

February 24th, 2014 by Patricia Donovan


Move over, ACO: a new payment model in town "has an excellent chance of coalescing value around a single model," according to Greg Mertz, MBA, FACMPE, managing director of Physician Strategies Group, LLC.

It's not yet law, but the federal Better Care, Lower Cost Act introduced last month circumvents the ACO's attribution model, which Mertz describes as "loosey-goosey," and targets the sickest and highest cost patients, who are also eligible for financial incentives if they play by the act's health management rules. In Mertz's eyes, the ACO has a limited life span.

Touching briefly on the proposed legislation, Mertz all but left the accountable care organization off his list of six value-based physician compensation models explored during Physician Alignment: Which Model Is Right for You? workshop sponsored by the Healthcare Intelligence Network — except as a footnote under Population Management, a model Mertz described as still evolving.

And while three-quarters of healthcare leaders agree that quality is driving the need for alignment around a preferred reimbursement model, the simple presence of physicians in a hospital does not translate to alignment.

Instead, the financial catnip of incentives will draw physicians to collaborative efforts, he said. Mertz moved workshop participants along a "collaborative continuum" of alignment from an environment of "mutual toleration"—the state of many two- to four-doctor practices today where planning can be challenging—to Population Management, a model he termed "the least defined, most questionable of the value models right now."

In all, Mertz explored the following six models:

  • Process Improvement
  • Physician-Hospital Organization (PHO)
  • Shared Savings
  • Case Pricing/Bundled Payments
  • Co-Management
  • Population Management

Engaging physicians in process improvement efforts is a first step toward much larger things, Mertz noted. "If you can't get doctors to collaborate over something like standard orders, surgical trays or discharge orders, you're going to be hard-pressed to move up the continuum toward any other kind of value models."

Shared savings, a term nearly synonymous with kickbacks until a few years ago, now aligns with the government's goal of reducing costs, Mertz noted, although it can be complex to implement. High cost service lines like orthopedics are good contenders, he added.

Case pricing and bundled payment models have great potential, while population management requires large numbers of physicians and patients. Many questions still surround population management, including the idea model to employ (Medicare's ACO or a commercial payor's), the best quality metrics to measure, and the likely short- and long-term benefits.

To guide workshop participants, Mertz presented examples of a small rural hospital, a competitive community hospital, and a large health system, outlining the challenges, likely realities and possible reimbursement models for each.

Regardless of an organization's size, to foster alignment, healthcare companies should focus on education, engagement and fostering good citizenship among physicians, Mertz said, defining this last concept as being an active participant in organizational efforts.

"Help [physicians] develop the skills and ability to interact with their peers. Just because they have an MD or a DO after their name, doesn't mean they know how to do that."

Those efforts will pay dividends, he notes—including the kind that could eventually end up in physicians' pockets.

Click here for an extended interview with Greg Mertz on the future of accountable care organizations.

Infographic: The Healthcare Transparency Revolution

December 31st, 2013 by Jackie Lyons

'Healthcare transparency' is defined as an effort to provide consumers with tools and information needed to choose providers and treatment options in an informed, convenient and value-driven way, according to HealthSparq. Seventy percent of executives say healthcare transparency is 'very important,' illustrated in a new HealthSparq infographic.

This infographic captures key findings from HealthSparq and The Cicero Group during a recent survey of more than 100 health plan executives about their healthcare transparency views and plans. The infographic includes benefits, tools and best practices for healthcare transparency.

ACA Mandate Just Around the Corner

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You may also be interested in this related resource: The Patient-Centered Payoff: Driving Practice Growth Through Image, Culture, and Patient Experience.

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Infographic: U.S. Adults Are More Likely to Skip Care and Struggle with Medical Bills Than Adults in Peer Countries

December 5th, 2013 by Jackie Lyons

In the past year, 37 percent of U.S. adults skipped care, according to a new infographic from the Commonwealth Fund, which summarizes the results of a survey of adults in 11 countries.

The infographic also outlines additional struggles in care, including out-of-pocket expenses and more.

U.S. Adults Are More Likely to Skip Care and Struggle with Medical Bills Than Adults in Peer Countries

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You may also be interested in this related resource: Futurescan 2013: Healthcare Trends and Implications 2013-2018.

Infographic: Pick Your Provider Before You Pick Your Plan

November 21st, 2013 by Jackie Lyons

As millions of Americans begin choosing a health plan under the Affordable Care Act (ACA), it is important to know how a patient’s health can be impacted by hospital selection.

If all hospitals performed similarly to the quality of 5-star hospitals from 2010 to 2012, 234,252 lives could potentially be saved, according to a new infographic from Healthgrades. The infographic shows the American attitude toward healthcare, percentage of Americans who gather information before making a care decision, examples from the 2014 Healthgrades American Hospital Quality Report, and the extent of healthcare spending.

Pick Your Provider Before You Pick Your Plan

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You may also be interested in this related resource: The Patient-Centered Payoff: Driving Practice Growth Through Image, Culture, and Patient Experience.

Infographic: The High Cost of Low HCAHPS Scores

November 12th, 2013 by Jackie Lyons

Approximately $850 million value-based incentives depend on HCAHPS scores, according to a new infographic from Voalte. Therefore, it is a crucial tool for hospitals to consider.

Furthermore, noise is the number one patient complaint on the HCAHPS survey. This infographic includes sample questions from the survey, other common patient complaints and specific ways for hospitals to improve their HCAHPS scores.

Caring for Veterans' Healthcare Needs

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You may also be interested in this related resource: 33 Metrics for Care Transition Management.

Pioneer ACO to Specialists: If the Care Coordination Role Fits, Wear It

September 24th, 2013 by Patricia Donovan

Monarch HealthCare took top honors in quality performance in year one of the CMS Pioneer ACO program.


As far as Medicare beneficiaries are concerned, it's time for healthcare to acknowledge specialists as principal caregivers of the chronically ill, advises Monarch HealthCare, a top-performing CMS Pioneer ACO.

Monarch came to this realization in year one of participation in CMS's Pioneer ACO program, when it discovered that 70 to 80 percent of office visits by its 14,000 accountable care organization (ACO) patients were to specialists.

"We have to start treating [specialists] like a primary care provider (PCP), especially for those patients that are chronically ill, where it is actually appropriate that a cardiologist is the primary care giver for a patient with CHF and coronary artery disease (CAD)," said Colin LeClair, Monarch HealthCare's executive director of ACO.

Engaging and incentivizing specialists in its ACO are two key facets of Monarch's year three performance strategy, noted LeClair during a recent webinar on Medicare Pioneer ACO Year One: Lessons from a Top-Performer. Going forward, Monarch plans to tap patient data from specialist encounters to enhance its care management and quality improvement efforts.

Despite its regret at not engaging specialists earlier, Monarch's Pioneer ACO has plenty to be pleased about at the outset of year two, in which the number of ACO-attributed patients has swelled to 22,000 patients.

In terms of quality performance, Monarch, the largest IPA in Orange County, Calif., was year one's top scorer in several patient-centered metrics in the Pioneer ACO program, and the second highest performer in the area of medical cost reduction — a result largely driven by reductions in hospital and skilled nursing facility (SNF) utilization and unit costs, noted LeClair.

Monarch is one of 32 originally selected CMS Pioneer ACOs. Today, 23 remain in the program.

During the 45-minute program, LeClair outlined Monarch's six-step ACO implementation strategy, a patient-centered approach built around risk stratification, ACO team-building, and care management. Trial and error during the first year yielded some interesting findings, such as the optimal time to engage a patient, he said.

Among the four success drivers LeClair shared was a coterie of Web-based population health management tools Monarch developed for its ACO team, he said, that are supported with Web and face-to-face training.

One such tool is the annual senior health risk assessment (ASHA) reviewed by the patient and doctor during the Medicare Annual Wellness Visit. The free annual well visit provides an opportunity to identify key risk factors, perform screenings and reconcile medications.

Unfortunately, the new CMS benefit is largely unfamiliar to patients, LeClair added.

Another year one lesson learned was the value of the office staff in ACO rollout. As Monarch tweaks its ACO architecture, it is considering incentivizing the office staff as well. "Too often, incentives are focused on the physicians, and the office staff actually drives most of the work to support the ACO population," said LeClair.

In closing, LeClair said Monarch remains committed to the ACO model, and as it looks ahead to year three, it hopes to identify mini-networks of physicians, explore episodic or bundled payments, and partner with hospitals, SNFs and ancillary vendors to reduce avoidable utilization.

Click here to listen to an interview with Colin LeClair.

Infographic: U.S. Healthcare vs. the World

September 20th, 2013 by Jackie Lyons

The United States spends more than two and a half times more on healthcare per person than most developed nations in the world, according to the World Health Organization.

The United States spends the most per capita on health at $8,233 compared to the lowest health expenditure, which is in Afghanistan at $44 per capita. This infographic shows how U.S. healthcare compares to 16 other countries around the globe in terms of health expenditure, life expectancy, health service availability, risk factors, health systems and more.

U.S. Healthcare vs. the World

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You may also be interested in this related resource: 101 Tools for Improving Health Care Performance.