Archive for the ‘Medicare’ Category

4 Ways CMS 2018 Quality Payment Program Supports ‘Patients Over Paperwork’ Pledge

November 6th, 2017 by Patricia Donovan

“Patients Over Paperwork” is committed to removing regulatory obstacles that get in the way of providers spending time with patients.

Year 2 of the CMS Quality Payment Program promises continued flexibility and reduced provider burden, according to the program’s final rule with comment issued by the Centers for Medicare and Medicaid Services (CMS) last week.

The Quality Payment Program (QPP), established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), is a quality payment incentive program for physicians and other eligible clinicians that rewards value and outcomes in one of two ways: through the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

A QPP Year 2 fact sheet issued by CMS highlights 2018 changes for providers under the QPP’s MIPS and APM tracks. The Year 2 fact sheet noted that stakeholder feedback helped to shape policies for QPP Year 2, and that  “CMS is continuing many of its transition year policies while introducing modest changes.”

In keeping with the federal payor’s recently launched “Patients Over Paperwork” initiative, QPP Year 2 reflects the following changes:

    • More options for small practices (groups of 15 or fewer clinicians). Options include exclusions for individual MIPS-eligible clinicians or groups with less than or equal to $90,000 in Part B allowed charges or less than or equal to 200 Part B beneficiaries, opportunities to earn additional points, and the choice to form or join a virtual group.
    • Addresses extreme and uncontrollable circumstances, such as hurricanes and other natural disasters, for both the 2017 transition year and the 2018 MIPS performance period, by offering hardship exception applications and limited exemptions.
    • Includes virtual groups as another participation option for Year 2. A virtual group is a combination of two more taxpayer identification numbers (TINs) made up of solo practitioners and groups of 10 or fewer eligible clinicians who come together ‘virtually’ (no matter specialty or location) to participate in MIPS for a performance period of a year. A CMS Virtual Groups Toolkit provides more information, including the election process to become a virtual group.
    • Makes it easier for clinicians to qualify for incentive payments by participating in Advanced APMs that begin or end in the middle of a year. Updated QPP policies for 2018 further encourage and reward participation in APMs in Medicare.
  • CMS describes its Patients Over Paperwork effort as “a cross-cutting, collaborative process that evaluates and streamlines regulations with a goal to reduce unnecessary burden, increase efficiencies and improve the beneficiary experience. This effort emphasizes a commitment to removing regulatory obstacles that get in the way of providers spending time with patients.”

    2016 ACO Results: Majority of Next Generation and Pioneer ACOs Earn Shared Savings

    October 20th, 2017 by Patricia Donovan

    Six of eight Pioneer ACOs and eleven of eighteen Next Generation ACOs earned shared savings in separate initiatives in 2016, according to newly released quality and financial data from the Centers for Medicare and Medicaid Services (CMS).

    In 2016 Performance Year Five of the Pioneer ACO program, one of several new accountable care organization (ACO) payment and service delivery models introduced by CMS to serve a range of provider organizations, only Monarch HealthCare and Partners HealthCare were not among shared savings earners.

    Banner Health Network emerged as the top 2016 Pioneer ACO performer, earning nearly $11 million in shared savings based on care provided to its more than 42,000 beneficiaries.

    In order to receive savings or owe losses in a given year, Pioneer ACO expenditures must be outside a minimum corridor set by the ACO’s minimum savings rate (MSR) and minimum loss rate (MLR).

    The Pioneer ACO model is designed for healthcare organizations and providers already experienced in coordinating care for patients across care settings. It allowed these provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with but separate from the Medicare Shared Savings Program (MSSP).

    The Pioneer ACO Model began with 32 ACOs in 2012 and concluded December 31, 2016 with eight ACOs participating.

    Meanwhile, at the conclusion of 2016 Performance Year One of the Next Generation ACO model, Baroma, Triad and Iowa Health topped the list of ACO earners in this program, with each organization accumulating more than $10 million shared savings.

    Building upon experience from the Pioneer ACO Model and the Medicare Shared Savings Program, CMS’s Next Generation ACO Model sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care.

    According to a CMS fact sheet, 18 ACOs participated in the Next Generation ACO Model for the 2016 performance year, and 28 ACOs are joining the Model for 2017, bringing the total number of Next Generation ACOs to 45. The Next Generation ACO Model will consist of three initial performance years and two optional one-year extensions.

    CMS’s ACO models are one of seven Innovation categories designed to incentivize healthcare providers to become accountable for a patient population and to invest in infrastructure and redesigned care processes that provide for coordinated care, high quality and efficient service delivery.

    Cityblock Health to Open First ‘Neighborhood Health Hub’ for Underserved Urban Populations in NYC

    October 6th, 2017 by Patricia Donovan

    Cityblock Health neighborhood health hubs for underserved urban populations: “Where health and community converge.”

    Cityblock Health expects to open its first community-based clinic for underserved urban populations, known as a neighborhood health hub, in New York City in 2018, according to a Medium post this week by Cityblock Health Co-Founder and CEO Iyah Romm.

    Cityblock Health is a spinout of Sidewalk Labs focused on the root causes of health for underserved urban populations. Sidewalk Labs is an Alphabet company focused on accelerating urban innovation.

    The neighborhood health hub, where members can connect with care teams and access services, is one of several key member benefits outlined on the Cityblock Health web site. Other advantages include a personalized care team available 24/7, a personalized technology-supported Member Action Plan (MAP), and a designated Community Health Partner to help members navigate all aspects of their care.

    According to Romm, who brings a decade of healthcare experience to the initiative, the neighborhood hubs will be designed as visible, physical meeting spaces where health and community converge. Caregivers, members, and local organizations will use the hubs to engage with each other and address the many factors that affect health at the local level, Romm said.

    For example, Cityblock Health states it will offer members rides to the hub if needed. Transportation, care access, and finances are among multiple social determinants of health that drive health outcomes, particularly for populations in urban areas.

    Where possible, the hubs will be built within existing, trusted spaces operated by its partners and staffed with local hires, he added. Cityblock envisions offering a range health, educational, and social events, including support groups and fitness classes.

    The hubs are part of Cityblock Health’s larger vision to provide Medicaid and lower-income Medicare beneficiaries access to high-value, readily available personalized health services in a collaborative, team-based model, Romm explained in his post. The organization will partner with community-based organizations, health plans, and provider organizations to reconfigure the delivery of health and social services and apply “leading-edge care models that fully integrate primary care, behavioral health, and social services.”

    Three key health inequities related to underserved urban populations motivated the formation of Cityblock Health: disproportionately poor health outcomes, interventions coming much later in the care continuum, and the significantly higher cost of interventions in urban areas as compared to other populations.

    Cityblock Health will use its custom-built technology to enhance strong relationships between members and care teams, while simultaneously empowering and incentivizing the health system to do better, he added.

    18 Success Strategies from Seasoned Healthcare Case Managers for New Hires

    September 14th, 2017 by Patricia Donovan

    Advice from case management trenches: “Don’t do more work for your patient than they are willing to do for themselves.”

    What does it take to succeed as a healthcare case manager? For starters, patience, flexibility and mastery of motivational interviewing, say veterans from case management trenches.

    As part of its 2017 Healthcare Benchmarks Survey on Case Management, the Healthcare Intelligence Network asked experienced case managers what guidance they would offer to new hires in the field. Respondents were thoughtful and generous with their advice, highlights of which are shared here.

    It’s important to note that in total, a half dozen veterans identified motivational interviewing as an essential case management skill.

    We hope you find these tips useful. We invite all experienced case managers to add your tips in the Comments below.

    • “It’s hard work but satisfying. It takes a good year to get all resources and process, so don’t give up.”
    • “Learn the integrated case management model and get ongoing coaching in motivational interviewing.”
    • “Listen, think, develop, coordinate, adhere to plan benefits, and be honest.”
    • “Communicating and developing a relationship with members are key.”
    • “Be aware of and utilize telemedicine.”
    • “Be prepared to help patients with non-medical matters. Develop a trust bond, almost as a family member, and your medical-focused concerns will be that much easier to handle.”
    • “Always remain flexible. Listen and meet the patient where they are at in their disease and life process.”
    • “Understand both the clinical and financial impacts of healthcare on the patient.”
    • “Establish a good working relationship with your manager. Ensure you understand job expectations and identify a mentor.”
    • “Time management is crucial.”
    • “Stay visible within the practice; interact regularly with the care team; share examples of success stories.”
    • “Compassion and empathy are a must.”
    • “Don’t become overwhelmed by all that needs to be learned. Strive for sure and steady progress in gaining the knowledge needed.”
    • “Don’t let a fear of the unknown hold you back. Learn all that you can.”
    • “Get a good understanding of the population of patients you are working with. Study motivational interviewing and harm reduction.”
    • “This is a wide body of knowledge. Each case is different. It takes six months to a year to be fully comfortable in the practice.”
    • “Establish boundaries with your patients, and don’t do more work for your patient than they are willing to do for themselves.”
    • “Earn the trust of your patients and providers. LISTEN to your patients.”

    One respondent geared her advice to case management hiring managers:

    • “Hire for coaching mentality and chronic disease experience.”

    Excerpted From: 2017 Healthcare Benchmarks: Case Management

    2017 case management benchmarks

    2017 Healthcare Benchmarks: Case Management provides actionable information from 78 healthcare organizations on the role of case management in the healthcare continuum, from targeted populations and conditions to the advantages and challenges of embedded case management to CM hiring and evaluation standards. Assessment of case management ROI and impact on key care components are also provided.

    SDOH Video: Tackling the Social, Economic and Environmental Factors That Shape Health

    September 7th, 2017 by Patricia Donovan

    Initiatives such as CMS’ Accountable Health Communities Model and other population health platforms encourage healthcare organizations to tackle the broad range of social, economic and environmental factors known as social determinants of health (SDOH) that shape an individual’s health.

    This video from the Healthcare Intelligence Network highlights how healthcare organizations address SDOH factors, based on benchmarks from HIN’s 2017 Social Determinants of Health Survey.

     

     

    Source: 2017 Healthcare Benchmarks: Social Determinants of Health

    SDOH benchmarks

    2017 Healthcare Benchmarks: Social Determinants of Health documents the efforts of more than 140 healthcare organizations to assess social, economic and environmental factors in patients and to begin to redesign care management to account for these factors. These metrics are compiled from responses to the February 2017 Social Determinants of Health survey by the Healthcare Intelligence Network.

    Infographic: Medicare Advantage Member Satisfaction Rankings

    August 23rd, 2017 by Melanie Matthews

    Kaiser Permanente ranks highest in Medicare Advantage member satisfaction for the third consecutive year. Kaiser outperforms all other plans across five of the six factors that comprise the overall satisfaction index, according to a new infographic by J.D. Power.

    The study, now in its third year, measures member satisfaction with Medicare Advantage plans—also called Medicare Part C or Part D—based on six factors (in order of importance): coverage and benefits (25%); customer service (19%); claims processing (15%); cost (14%); provider choice (14%); and information and communication (12%).

    The infographic examines satisfaction indexes for Kaiser and nine additional Medicare Advantage plans.

    Medicare is now reimbursing physician practices for select Chronic Care Management (CCM) services not previously eligible for reimbursement, underscoring the vital role of care management in primary care.

    Physician Reimbursement for Chronic Care Management: Identifying New Practice Revenue Opportunities offers practical guidance to prepare physician practices to maximize CCM reimbursement in the year ahead.

    Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

    Have an infographic you’d like featured on our site? Click here for submission guidelines.

    Montefiore SDOH Screenings Leverage Learnings from Existing Pilots

    August 3rd, 2017 by Patricia Donovan

    Montefiore Health Systems screens patients for social determinants of health, which drive 85 percent of a person’s well-being.

    Montefiore Health System’s two-tiered assessment screening program to measure social determinants of health (SDOH) positivity in its predominantly high-risk, government-insured population is inspired by existing initiatives within its own organization. Here, Amanda Parsons, MD, MBA, vice president of community and population health at Montefiore Health System, describes the planning that preceded Montefiore’s SDOH screening rollout.

    I’d like to explain how we came to implement the social determinants of health screening. Many of us in New York State participate in the delivery system or full-on incentive program. It is that program that has enabled us to step back and think about using Medicaid waiver dollars to invest in the things that make a difference.

    I need not tell anybody in this industry: many studies have looked at what contributes to health. We know that clinical health in and of itself contributes somewhere between 10 to 15 percent of a person’s well-being; however, so much more of their health and well-being is driven by other factors, like their environment and patient behaviors. And yet, we had not had a chance in the healthcare system to really think about what we wanted to do about that. It was really the Delivery System Reform Incentive Payment (DSRIP) program that has allowed us to start exploring these new areas and think about how we want to collectively address them in our practices.

    The way we structured our program was quite simple. We said, “If we’re going to do something about social determinants of health, let’s recognize that they are important and must be addressed, and that we have many different community-based organizations that surround or are embedded in our community that stand poised and ready to help our patients. We’re just not doing a very good job of connecting them to those organizations, so let’s backtrack and say, ‘First, we have to screen our patients using a validated survey instrument.’”

    There were different sites at Montefiore that had already launched various pilots. We said, “Let’s make sure we leverage the experience and the learnings from these pilots. Then let’s think about who’s going to deal with those patients, which means we have to triage them.” For example, if somebody screens positive for domestic violence that is occurring in their home right now in the presence of children, that might require a different response from us than someone who says, “I have some difficulty paying my utilities.”

    Source: Assessing Social Determinants of Health: Screening Tools, Triage and Workflows to Link High-Risk Patients to Community Services

    sdoh high risk patients

    Assessing Social Determinants of Health: Screening Tools, Triage and Workflows to Link High-Risk Patients to Community Services outlines Montefiore’s approach to identifying SDOH markers such as housing, finances, healthcare access and violence that drive 85 percent of patients’ well-being, and then connecting high-need individuals to community-based services.

    In Montefiore Social Determinants of Health Screening, Patients’ Needs Shape SDOH Workflow

    July 11th, 2017 by Patricia Donovan
     Clinical factors drive 15 percent of a patient's well-being; social determinants of health like finances drive the rest.


    Clinical factors drive 15 percent of a patient’s well-being; social determinants of health like finances drive the rest.

    In Dr. Amanda Parsons’ twenty-something years in healthcare, she has never implemented a program as widely embraced as Montefiore Health System’s Social Determinants of Health (SDOH) screening.

    “It was one of the few times in my career that I didn’t encounter physician resistance,” said Dr. Parsons, Montefiore’s vice president of community and population health. The health system’s screening assesses patients for a host of SDOH factors that drive 85 percent of their well-being, including housing, food security, access to care or medications, finances, transportation and violence.

    Following assessment, the goal is to connect individuals who screen positively for SDOHs with assistance from the area’s robust network of community organizations.

    Dr. Parsons outlined her organization’s SDOH screening process, findings, challenges, and future plans during Assessing Social Determinants of Health: Collecting and Responding to Data in the Primary Care Setting, a June 2017 webcast by the Healthcare Intelligence Network now available for rebroadcast.

    To get started, Montefiore piggybacked on the efforts of a few provider sites already screening for SDOHs. It then offered providers a choice of two validated screening tools, the first developed at a fifth-grade reading level, the second a more sophisticated “stressor” screen. Thirdly, it built a two-tiered triage system that leveraged social workers for individuals with very high SDOH needs, and community health workers to assist with lower-level needs.

    Referrals would come from existing data banks or a host of new online referral tools, many of which Dr. Parsons mentioned during the webcast.

    Interestingly, while Montefiore is fully live on an EPIC® electronic health record, SDOH screenings are currently conducted on paper, noted Dr. Parsons. This decision was one of multiple considerations in workflow creation, including respect for patient privacy.

    For the time being, each Montefiore provider site selects a unique population to screen—or opts not to screen at all, if staffing is lacking. For example, one site screens all patients scheduled for annual physicals, while another screens patients recently discharged from the hospital.

    In an initial readout of both screens, SDOH positivity was highest for housing and finances.

    By the end of 2017, Montefiore expects to have completed more than 10,000 screenings. The health system, which serves some 700,000 patients, also plans to boost its ranks of community health workers, broadening its referral network.

    Looking ahead, Montefiore will address a number of key administrative and emotional barriers. Some patient issues, like overcoming the stigma of seeing a social worker, can be minimized with a simple scripting change. Others, like alleviating an individual’s financial pain or putting a roof over a family’s head, are much more complicated.

    Also needed is a process to confirm a patient has “gone that last mile” and obtained the recommended support, Dr. Parsons added.

    As it expands SDOH screening, Montefiore is banking on that swell of engaged providers. As part of its mission to provide comprehensive, ‘cradle-to-grave’ care for its mostly Medicaid and otherwise government-insured population, Montefiore “intervenes even when there is no payment structure for that work,” said Dr. Parsons.

    Falling into that category is SDOH screening. “Much of the Social Determinants of Health work is not very billable in the traditional paper service model, but it is incredibly important to do, regardless.”

    Listen to an interview with Dr. Parsons on adapting SDOH screenings for different populations.
    TW_Montefiore_SDOH_webinar0617

    Shared SNF Patients, Common Readmissions Goals Unify Three Competing Health Systems

    June 15th, 2017 by Patricia Donovan

    A common desire to reduce SNF readmissions resulted in the formation of Michigan's Tri-County SNF Collaborative.

    A common desire to reduce SNF readmissions resulted in the formation of Michigan’s Tri-County SNF Collaborative.

    Concerned about escalating hospital readmissions from skilled nursing facilities (SNFs) and the accompanying pinch of Medicare readmissions penalties, three Michigan healthcare organizations decided to set competition aside to collaborate and reduce rehospitalizations from SNFs. Here, Susan Craft, director of care coordination, family caregiver program, Office of Clinical Quality & Safety at Henry Ford Health System, describes the origins of Michigan’s Tri-County SNF Collaborative, of which her organization is a founding member.

    I want to talk about the formation of the Tri-County SNF Collaborative between Henry Ford Health System, Detroit Medical Center, and St. John Providence Health System. As quality and care transition leaders from each of the health systems, we see each other frequently at various meetings. After some good conversation, we learned that each of us was partnering with our SNFs to improve quality and reduce readmissions.

    We all required that they submit data to us that was very similar in nature but not exactly the same, which created a lot of burden for our SNFs to conform to multiple reporting requirements. We knew we were working with the same facilities because geographically, we are all very close to each other. We recognized that this was really a community problem, and not an individual hospital problem. Although we are all competing healthcare systems, those of us with very similar roles in the organization had very little risk from working together. And because we had so much in common, it just made sense that we create this collaborative.

    We also worked with our MPRO (Michigan Quality Improvement Organization) and reviewed data that showed that about 30 percent of our patient population was shared between our three health systems. We decided it made sense to move forward. We created a partnership that was based on collaboration and transparency, even within our health systems. We identified common metrics to be used by all of our organizations and agreed upon operational definitions for each of those. We all reached out to our SNF partners to tell them about the collaborative and invite them to join, and then engaged MPRO as our objective third party. We created a charter to solidify that cooperation and collaboration.

    Source: A Collaborative Blueprint for Reducing SNF Readmissions: Driving Results with Quality Reporting and Performance Metrics

    reducing SNF readmissions

    A Collaborative Blueprint for Reducing SNF Readmissions: Driving Results with Quality Reporting and Performance Metrics examines the evolution of the Tri-County SNF Collaborative, as well as the set of clinical and quality targets and metrics with which it operates.

    HINfographic: During Annual Wellness Visit, Screen for Social Health Determinants

    June 12th, 2017 by Melanie Matthews

    Seventy percent of health outcomes are determined by social determinants of health­—areas that involve an individual’s social and environmental condition as well as experiences that directly impact health and health status, according to the Pew Research Center in its report, Chronic Disease and the Internet.

    A new infographic by HIN examines the impact of SDOH on health status, why the Medicare annual visit is an ideal time to screen for SDOH and the correlation between technology and social isolation.

    The move from fee-for-service to value-based healthcare is driving the need for increased capabilities in population health management, including addressing all of the areas that may impact a person’s health. There is growing recognition that a broad range of social, economic and environmental factors shape an individual’s health, according to the New England Journal of Medicine. In fact, 60 percent of premature deaths are due to either individual behaviors or social and environmental factors. Healthcare providers who adopt value-based reimbursement models have an economic interest in all of the factors that impact a person’s health and providers must develop new skills and data gathering capabilities and forge community partnerships to understand and impact these factors.

    During Social Determinants and Population Health: Moving Beyond Clinical Data in a Value-Based Healthcare System, a December 8th webinar, now available for replay, Dr. Randall Williams, chief executive officer, Pharos Innovations, shares his insight on the opportunity available to providers to impact population health beyond traditional clinical factors.

    Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

    Have an infographic you’d like featured on our site? Click here for submission guidelines.