Archive for the ‘Value-Based Reimbursement’ Category

Mounting Pressure from Value-Based Reimbursement Models Drives Clinical Improvement Strategy at Allina Health System

April 17th, 2018 by Melanie Matthews

Value-Based Reimbursement Models Drive Clinical Improvement Strategy

As a greater percentage of hospital payments are through value-based contracts, hospitals that reduce costs while maintaining quality will survive, predicts Pam Rush, cardiovascular clinical service line program director at Allina Health.

“How do we improve outcomes and decrease costs?” Rush asked participants in the March 2018 webinar, Predictive Healthcare Analytics: Four Pillars for Success. “We need to start to look at the world differently.”

How can we be more creative and do things differently? How can we use different members of the healthcare teams in new ways, such as nurse practitioners or advanced practice providers, she added. In addition, “we need to invest in data analytics and data resources and have data analysts who can pull the information for us so we can find the variation. We need to invest in physician and caregiver time to look at the data, to make changes in how they improve care, to monitor and see what is working and what doesn’t work.”

These four pillars…population health management, reducing clinical variation, testing new care processes and new models of payment, and leveraging cutting edge technologies…have been critical to the work at Allina Health System’s Minneapolis Heart Institute Center for Healthcare Delivery Innovation, said Rush.

In population health management, we’re looking at how can we focus on adherence to guidelines, identify where there are gaps in care and partner with people across the system, primary care and specialists, to improve consistency and adherence to guidelines, she explained.

Allina is reducing clinical variation by looking at unnecessary variations in care where there is inconsistent care without an influence on outcomes.

“We’re also looking at new ways of doing things. How can we use our nurse practitioners, how do we care for patients once they’re discharged from the hospital and bring them back in for clinic visits? It’s really looking at the care model and how we can do things differently to reduce total cost of care,” she said.

In cardiology, there are so many new devices, procedures and techniques to monitor, said Rush, but we need to figure out who are the right providers to do that monitoring, who are the right patients to do these expensive procedures on and who achieves the best outcomes, because we can’t afford to do all of this new technology to every single person.

Allina looks at these four pillars across the continuum. Starting in primary care to partner on prevention strategies, moving to who gets referred to cardiology, and when they’re referred to cardiology, what are the set of tests or treatments and guidelines to adhere to along the continuum to subspecialties, emergency services and all the way up through advanced therapies, such as transplant.

During the webinar, Rush along with Dr. Steven Bradley, cardiologist, MHI and associate director, MHI Healthcare Delivery Innovation Center, shared these four pillars of predictive analytics success along with details on creating a culture of quality and innovation, building performance improvement dashboards, as well as several case examples of quality improvement initiatives contributing to these savings and much more.

Listen to Ms. Rush describe how MHI leveraged an enterprise data warehouse to identify care gaps and clinical quality improvement opportunities.

Infographic: Unlocking the Power of Population Health

April 16th, 2018 by Melanie Matthews

Population health management is one of the primary strategies for achieving greater value in healthcare, according to a new infographic by leidos.

The infographic examines how healthcare organizations can create effective and sustainable population health programs.

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS SuccessA laser focus on population health interventions and processes can generate immediate revenue streams for fledgling accountable care organizations that support the hard work of creating a sustainable ACO business model. This population health priority has proven a lucrative strategy for Caravan Health, whose 23 ACO clients saved more than $26 million across approximately 250,000 covered lives in 2016 under the Medicare Shared Savings Program (MSSP).

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success examines Caravan Health’s population health-focused approach for ACOs and its potential for positioning ACOs for success under MSSP and MACRA’s Merit-based Incentive Payment System (MIPS).

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Remote Patient Monitoring Fosters a New Generation of Care Management and Preventive and Value-Based Care

April 5th, 2018 by Melanie Matthews

Remote Patient Monitoring

Moving healthcare out of the brick-and-mortar traditional setting into remote patient monitoring.

As healthcare moves out of the brick-and-mortar traditional setting into patients’ homes and their workplaces, and becomes much more proactive, the University of Pittsburgh Medical Center (UPMC) has been expanding its remote patient monitoring program to foster a new generation of care management, preventive care and value-based care, according to Dr. Ravi Ramani, director of UPMC’s Integrative Heart Failure Program.

The remote patient monitoring program at UPMC has its roots in the heart failure program but has since expanded to additional disease states across the integrated delivery system’s continuum of care.

After achieving reductions in all-cause readmission rates from its remote monitoring of heart failure patients, UPMC knew that the clinical processes were effective and, therefore, was ready to scale the program, said Dr. Ramani during Remote Patient Monitoring at UPMC: Creating Early Warning Systems To Reduce Unplanned Healthcare Utilization, a March 2018 webinar now available for replay.

“To really scale the program and get into the population level management,” said Dr. Ramani, “we really need a vastly reduced cost per unit. The only way to really do this is to leverage what the patients already have, which is ‘Bring Your Own Device.'”

UPMC also focused on refining their operational model so that they select the right patients, put them through an appropriate care pathway, and then integrate all of its other resources to work together, including analytics, operations and finances.

During the webinar, Dr. Ramani shared how UPMC: aligned its various stakeholders for remote patient monitoring success; assessed its hardware needs as patients transitioned through high-risk and low-risk stratifications; leveraged its Enterprise Master Patient Index for remote patient monitoring; and developed its clinical process for bringing new disease states into remote patient monitoring. Dr. Ramani also shared the impact of the program on unplanned care, including ED visits and admissions, and patient satisfaction.

Listen to Dr. Ramani share UPMC’s nine-point vision for a sustainable, scalable remote patient monitoring program.

Infographic: The Pharma Value Chain Is Ripe for Disruption

February 26th, 2018 by Melanie Matthews

Despite today’s healthcare crisis, pharma has maintained a fairly consistent market structure—until now, according to a new infographic by Oliver Wyman.

The infographic examines the factors contributing to pharma’s evolution and disruption as part of the changes in healthcare regulation, transparency and accountability.

Leveraging Pharmacists to Reduce Cost and Improve Medication Adherence in High-Risk PopulationsWhen it comes to medication management for Medicare beneficiaries, there are more than 25 different factors that can complicate proper use of prescribed medicines—from affordability issues, even among the insured, to fear of a drug’s side effects to potential dangers from high-risk medications or health conditions.

Leveraging Pharmacists to Reduce Cost and Improve Medication Adherence in High-Risk Populations examines Novant Health’s deployment of pharmacists as part of its five-pronged strategy to deliver healthcare value through medication management services.

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Infographic: Trends Disrupting the Healthcare Industry

February 19th, 2018 by Melanie Matthews

Value-based healthcare, predictive medicine, digital healthcare and the patient experience are key trends disrupting the healthcare industry, according to a new infographic by EPAM Systems, Inc.

The infographic drills down on each of these trends and their impact on the industry.

Healthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare IndustryHealthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare Industry, HIN’s 14th annual business forecast, is designed to support healthcare C-suite planning as leaders react to presidential priorities and seek new strategies for engaging providers, patients and health plan members in value-based care.

HIN’s highly anticipated annual strategic playbook opens with perspectives from industry thought leader Brian Sanderson, managing principal, healthcare services, Crowe Horwath, who outlines a roadmap to healthcare provider success by examining the key issues, challenges and opportunities facing providers in the year to come. Following Sanderson’s outlook is guidance for healthcare payors from David Buchanan, president, Buchanan Strategies, on navigating seven hot button areas for insurers, from the future of Obamacare to the changing face of telehealth to the surprising role grocery stores might one day play in healthcare delivery. Click here for more information.

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Infographic: Transforming the U.S. Medical Imaging Industry

February 14th, 2018 by Melanie Matthews

The United States medical imaging market is transforming from a “get bigger” approach that emphasizes quantity to a “get better” approach that emphasizes quality, safety, and improvements in workflow efficiency, according to a new infographic by Frost & Sullivan.

The infographic analyzes how stakeholders are looking to new products, technologies and solutions to enhance interoperability and bring about automation and analytics-based solutions to make the industry more process-driven.

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success A laser focus on population health interventions and processes can generate immediate revenue streams for fledgling accountable care organizations that support the hard work of creating a sustainable ACO business model. This population health priority has proven a lucrative strategy for Caravan Health, whose 23 ACO clients saved more than $26 million across approximately 250,000 covered lives in 2016 under the Medicare Shared Savings Program (MSSP).

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success chronicles the evolution of the CHRISTUS RPM pilot, which is framed around a Bluetooth®-enabled monitoring kit sent home with patients at hospital discharge.

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.

Population Health Tactics to Boost an ACO’s Medicare Annual Wellness Visit Rates

February 9th, 2018 by Patricia Donovan

One of the most important revenue opportunities for primary care physicians, and for population health nurses under their direct supervision, is the Medicare Annual Wellness Visit (AWV), advises Tim Gronninger, senior vice president of development and strategy, Caravan Health. The AWV offers an opportunity to check a number of Medicare quality boxes, including preventive check-ins, vaccinations and health screenings, to help make sure that a beneficiary’s medical needs are being met.

Here, Gronninger suggests ways that physician practices can improve all-important AWV rates.

Much of increasing annual wellness visit rates is about how to manage expectations of the practice and of the patient. You’ll be chasing your tail a lot if you are looking at your data and saying, “Well, these 1,000 patients haven’t had an annual wellness visit. I’m going to make a thousand phone calls, and then I’m going to make a thousand follow-up phone calls to try to schedule them all.”

It is very important for a practice to create a process where you have the time, the space and the plan, so that when a patient comes in the door for an Evaluation and Management (E&M) visit, the patient is handed off seamlessly to a nurse coordinator to complete an annual wellness visit at the same time. Obviously, different patients will require different handling. But we have found a very high acceptance rate from that approach among patients of clients that we work with.

It’s something that many patients take for granted, that their clinician knows this about them already. However, many times, the physician in practice doesn’t know whether the patient is up to date on their mammograms or other types of screenings.

Editor’s Note: Caravan Health’s ACOs saved more than $26 million in the Medicare Shared Savings Program (MSSP) and achieved higher than average quality scores and quality reporting scores in 2016.

Source: Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success

ACO population health

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success examines Caravan Health’s population health-focused approach for ACOs and its potential for positioning ACOs for success under MSSP and MACRA’s Merit-based Incentive Payment System (MIPS).

In Successful ACOs, Population Health Focus Paves Way for Shared Savings Payouts

January 25th, 2018 by Patricia Donovan

Physician practices toiling in fledgling ACOs and obsessing over shared savings that have not yet materialized, take heart: population health offers multiple revenue streams for accountable care organizations waiting for the “gravy” of accountable care.

“Gravy” is the way Tim Gronniger, senior vice president of development and strategy for Caravan Health, refers to ACO shared savings payouts, which he says can take considerable time to accrue.

“It is literally two years from the time you jump into an ACO before you have even the chance of a shared savings payout,” Gronniger told participants in Generating Population Health Revenue: ACO Best Practices for Medicare Shared Savings and MIPS Success, a January 2018 webcast now available for replay.

Obsessing over shared savings is one of the biggest mistakes hospitals in ACOs can make, he added.

This delay is one reason Caravan Health urges its ACOs to adopt a population health focus, whether pursuing the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP) Merit-based Incentive Payment System (MIPS) or the Medicare Shared Savings Program (MSSP).

Gronniger’s advice is predicated on his organization’s experience of mentoring 38 ACOs. In 2016, Caravan Health’s ACOs saved more than $26 million in the MSSP program and achieved higher than average quality scores and quality reporting scores, according to recently released CMS data.

Walking attendees through a MACRA primer, Gronniger underscored the challenges of the MIPS program, one of three tracks offered under the Quality Payment Program. “Barring a really exceptional performance on MIPS, you can’t even break even over the next few years on physician compensation,” he said.

In the meantime, ACOs should utilize recently rolled out Medicare billing codes, from the annual wellness visit (AWV) to advanced care planning, to generate wellness revenue. With proper planning, reengineering of staffing and clinical work flows, a practice could generate anywhere from five hundred to one thousand dollars annually per eligible Medicare patient, Gronniger estimates—monies that offset the cost of constructing a sustainable ACO business model.

To back up this population health rationale, Gronniger pointed to data from an ACO client demonstrating the impact of a cohesive PHM approach, including the use of trained population health nurses, on completion rates for preventive screenings. For less top-of-mind screenings like falls assessment and smoking cessation, completion rates rose from negligible to near-universal levels, he said.

“These are recommended sets of screens that are required by CMS, but that also help ACOs with quality measures,” he added.

Gronniger also shared examples of dashboards, scorecards and roadmaps Caravan Health employs to help keep client ACOs on track. An ACO success strategy involves “a lot of dashboarding, checking in, and discussion of problems and barriers, discussion of solutions, and monthly and quarterly measurement and reporting back,” he said.

Beyond coveted shared savings, ACO participation offers significant non-financial benefits, including quality improvements under both MSSP and MIPS standards, availability of ACO-specific waivers, and access to proprietary performance data.

Overall, ACO participation can make providers more attractive both to commercial contractors and to potential patients perusing Physician Compare ratings in greater numbers.

Gronniger ended by weighing in on the recent recommendation by the Medicare Payment Advisory Commission (MedPAC) to repeal and replace the MIPS program.

Assessing MIPS’ Fate: “MedPAC Vote Would Not Affect 2018 Under Any Scenario”

January 18th, 2018 by Patricia Donovan

Tim Gronniger

Tim Gronniger, Senior VP of Development and Strategy, Caravan Health

Amidst healthcare provider outcry over last week’s vote by the Medicare Payment Advisory Commission (MedPAC) to repeal and replace the Merit-based Incentive Payment System (MIPS), an industry thought leader sought to remind physician groups that no change to MIPS is imminent.

“MedPAC is an advisory body, not a legislative one,” said Tim Gronniger, senior vice president of development and strategy for Caravan Health, a provider solutions for healthcare organizations interested in value-based payment models, including accountable care organizations (ACOs).

“Congress would need to adopt MedPAC’s recommendations in order for the changes to go into effect. It is reasonable to expect MIPS to evolve over time, but that evolution will be gradual. [MedPAC’s vote on MIPS] would not affect 2018 under any scenario.”

Gronniger made his comments during Generating Population Health Revenue: ACO Best Practices for Medicare Shared Savings and MIPS Success, a January 2018 webcast sponsored by the Healthcare Intelligence Network and now available for rebroadcast.

Earlier this month, MedPAC voted 14-2 to scrap the MIPS program, describing it in a presentation to members as “burdensome and complex.” According to the advisory commission, “MIPS will not succeed in helping beneficiaries choose clinicians, helping clinicians change practice patterns to improve value, or helping the Medicare program to reward clinicians based on value.”

MedPAC is expected to pass this recommendation along to Congress in coming months, along with a proposed alternative. In MIPS’s place, MedPAC is suggesting a voluntary value program (VVP) in which “group performance will be assessed using uniform population-based measures in the categories of clinical quality, patient experience, and value.”

MGMA’s Anders Gilberg reacts to the MedPAC ruling.

Among the provider groups reacting to MedPAC’s actions was the Medical Group Management Association (MGMA). In a Twitter post, Anders Gilberg, MGMA’s senior vice president for government affairs, called the VVP alternative “a poor replacement,” claiming it “would conscript physician groups into virtual groups and grade them on broad claims-based measures.”

The day prior to the January 11 vote, MGMA had reached out in a letter to Seema Verma, administrator for the Centers for Medicare & Medicaid Services (CMS), requesting CMS to immediately release 2018 Merit-based Incentive Payment System (MIPS) eligibility information, which it called “vital to the complex clinical and administrative coordination necessary to participate in MIPS.”

2018 Success Strategy: Differentiate to Survive Next Wave of Healthcare

January 5th, 2018 by Patricia Donovan

Are supermarkets the next wave of healthcare?

Perhaps not, but if a health insurer can move into the community pharmacy, why not the local grocery store?

On the heels of the recent non-traditional CVS Health-Aetna merger and amidst other swirling consolidation rumors, industry thought leaders are encouraging healthcare organizations to embrace similar partnerships and synergies.

And given the presence of pharmacies inside many supermarkets, “there is potential for greater synergies around what we eat, what we buy and how our healthcare is actually purchased or delivered,” suggests David Buchanan, president of Buchanan Strategies.

“The bonanza [from this merger] might be where data can be shared between CVS’s customers and Aetna’s customers and whether we can steer those CVS customers to Aetna,” he added.

Buchanan and Brian Sanderson, managing principal of healthcare services for Crowe Horwath, sketched a roadmap to help healthcare providers and payors navigate the key trends, challenges and opportunities that beckon in 2018 during Trends Shaping the Healthcare Industry in 2018: A Strategic Planning Session, a December 2017 webinar now available for rebroadcast.

Key guideposts on the road to success: data analytics, consolidation, population health management, patient and member engagement, and telemedicine, among other indicators. Also, organizations shouldn’t hesitate to test-drive new roles in order to differentiate themselves in the marketplace.

“If you are not differentiated, you will not survive in what is a very fluid marketplace,” Sanderson advised.

Honing in on the healthcare provider perspective, Sanderson posed five key questions to help shape physician, hospital and health system strategies, including, “What are the powerful patterns?” Industry mergers, an infusion of private equity money into areas like ambulatory care and emerging value-based payment models fall into this category, he suggested.

These patterns were echoed in four primary trends Sanderson outlined as shaping the direction of the healthcare market, which faces an increasingly “impatient” patient. “I could tell you the market wants care everywhere,” he said. “In the same way we have become impatient with our commoditized goods, so have patients become impatient with accessing care.”

Among these trends are “unclear models of reimbursement,” he noted, adding that after a self-imposed “pause” relative to healthcare reimbursement at the start of a new presidential administration, the industry is ready to “restart with some new sponsors now.”

Notably, Sanderson advised providers to embrace population management. “Don’t think population health, think population management. It’s no longer just the clinical aspects of a patient’s or a population’s health. It’s the overall management of their well-being.”

Following Sanderson’s five winning strategies for healthcare provider success, David Buchanan outlined his list of hot-button items for insurers, which ranged from the future of Obamacare and member engagement to telemedicine, healthcare payment costs and models and trends in Medicare and Medicaid.

Healthcare payors should not underestimate the value of engaging its members, who today possess higher levels of health literacy, he stated. “The member must be an integral part of healthcare transactions, as are the provider, the facility and the insurer. The member must have a greater level of personal responsibility and engagement in the process.”

Offering members wearable health technologies like fitness trackers is one way insurers might engage individuals in their health while creating ‘stickiness’ and member allegiance to the health plan.

Telemedicine, the fastest growing healthcare segment, is another means of extending payors’ reach and increasing profitability, he adds. “Telemedicine is not just for rural health settings anymore, but is finding another subset of adopters among people who can’t fit a doctor’s visit into their busy schedule.”

Payors should expect some competition in this area. “I believe the next wave [of telehealth] will be hospitals expanding into local telehealth services as a lead-in to their local clinics,” Buchanan predicted.

The use of artificial intelligence (AI) and robotics in healthcare is growing, but Buchanan and Sanderson agree that adoption will be slow. On the other hand, expect more collaboration between digital players like Amazon, Google and Apple and larger health plans.

“You will see [synergies] when you can put those two players together: the company that can bring the technology to the table as well as those companies that bring the users to the table,” concluded Buchanan.

Listen to a HIN HealthSounds podcast in which David Buchanan predicts the future of mega mergers in healthcare, the impact of the CVS-Aetna alliance on brand awareness, and the real ‘bonanza’ of the $69 billion partnership, beyond bringing healthcare closer to home for many consumers.