Archive for the ‘Value-Based Reimbursement’ Category

Infographic: Healthcare Providers Are Prepared to Increase Risk Model Participation

July 26th, 2019 by Melanie Matthews

Healthcare providers are ready and planning to assume increased levels of risk through commercial payer and Medicare contracting models and Medicare Advantage, according to a new infographic by Navigant, based on an analysis of survey conducted by HFMA.

The infographic examines how providers are partnering on or launching provider-sponsored health plans (PSHPs) as a part of their risk-assumption strategy.

Under CMS’s “Pick Your Pace” choices for Year 1 Quality Payment Program participation, physician practices may opt for the minimum activity necessary to avoid a payment penalty in 2019 by simply submitting some data in 2017.

However, instead of delaying MACRA participation to the later part of this year, physicians should prepare and better position themselves today for MIPS success by analyzing their existing CMS data on their practices’ performance and laying a path now toward performance improvement.

Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance describes the wealth of data analytics available from the CMS Enterprise Portal–Quality Resource Use Reports (QRURs) and other reports providing a window into practice performance under the Merit-Based Incentive Payment System (MIPS). MIPS is one of two MACRA reimbursement paths and the one where most physician practices are expected to align.

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Infographic: Healthcare 2030

July 22nd, 2019 by Melanie Matthews

Ninety percent of incumbents and innovators alike don’t believe healthcare’s status quo will continue. Seventy percent predict value-based care will dominate healthcare by 2030, according to a new infographic by Oliver Wyman.

The infographic examines four possible economic scenarios for healthcare 2030.

2019 Healthcare Benchmarks: Reducing Avoidable Healthcare UtilizationMedicaid expansion programs, newly covered individuals under healthcare insurance exchanges, the rise of big data, and shifts in healthcare delivery models have influenced emergency department and hospital utilization.

2019 Healthcare Benchmarks: Reducing Avoidable Healthcare Utilization is a comprehensive analysis by the Healthcare Intelligence Network of how healthcare organizations define and address avoidable healthcare utilization. The report captures key actionable metrics on reducing avoidable healthcare utilization initiatives, challenges, case studies and innovative programming.

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Infographic: Value-Based Care Results

July 15th, 2019 by Melanie Matthews

Value-based care has shown promising improvements in quality and total cost of care, according to a new infographic by the Blue Cross Blue Shield Association.

The infographic examines the impact of value-based care on site of care decisions, preventative care sought, chronic care management and the cost trend for Blue Cross and Blue Shield members attributed to Total Care providers.

11 Profitable Value-Based Reimbursement Models: Lessons from Early AdoptersCMS’s ambitious agenda for moving Medicare into alternative payment models is driving the U.S. healthcare system toward greater value-based purchasing at a furious rate. Private payors also have pledged to continue to shift payments away from fee for service and into alternative payment models such as accountable care organizations (ACOs). Fortunately, many healthcare organizations are already exploring value-based payments—often a single innovation at a time—testing models that reward providers for meeting Triple Aim goals of improving patient experience and population health while reducing healthcare’s per capita cost.

11 Profitable Value-Based Reimbursement Models: Lessons from Early Adopters encapsulates nearly a dozen such approaches, from Bon Secours’ building of a business case for its multidisciplinary care team to the John C. Lincoln ACO’s deep dive into data analytics to identify and manage the care of high-risk, high-cost ‘VIP’ patients to ‘beat the benchmark’ to WellPoint’s engagement of specialists in care coordination.

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Infographic: The Financial Impact of Value-Based Healthcare Contracts

April 26th, 2019 by Melanie Matthews

As health systems evaluate their ability to transition from fee-for-service medicine toward value-based care, they must understand the financial impact of their strategy, according to a new infographic by Lumeris.

The infographic examines key decision points and outcomes for a health system.

11 Profitable Value-Based Reimbursement Models: Lessons from Early AdoptersCMS’s ambitious agenda for moving Medicare into alternative payment models is driving the U.S. healthcare system toward greater value-based purchasing at a furious rate. Private payors also have pledged to continue to shift payments away from fee for service and into alternative payment models such as accountable care organizations (ACOs). Fortunately, many healthcare organizations are already exploring value-based payments—often a single innovation at a time—testing models that reward providers for meeting Triple Aim goals of improving patient experience and population health while reducing healthcare’s per capita cost.

11 Profitable Value-Based Reimbursement Models: Lessons from Early Adopters encapsulates nearly a dozen such approaches, from Bon Secours’ building of a business case for its multidisciplinary care team to the John C. Lincoln ACO’s deep dive into data analytics to identify and manage the care of high-risk, high-cost ‘VIP’ patients to ‘beat the benchmark’ to WellPoint’s engagement of specialists in care coordination.

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Infographic: 5 Steps to Transform Care Delivery

April 22nd, 2019 by Melanie Matthews

Failures of care delivery accounted for an estimated $102 billion to $154 billion in wasteful spending in 2011, according to a new infographic by Premier.

The infographic provides five steps recommended by Premier to transform care delivery.

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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Infographic: Turning Data into Actionable Value-Based Care Insights

April 19th, 2019 by Melanie Matthews

In today’s healthcare economy, value-based care remains top of mind for payers and providers alike. However, misalignment between payers and providers can hinder their ability to achieve cost and quality goals, according to a new infographic by MedeAnalytics, Inc.

The infographic examines obstacles to alignment, the role of analytics in value-based care and perceived misalignment.

Health Analytics in Accountable Care: Leveraging Data to Transform ACO Performance and Results Between Medicare’s aggressive migration to value-based payment models and MACRA’s 2017 Quality Payment Program rollout, healthcare providers must accept the inevitability of participation in fee-for-quality reimbursement design—as well as cultivating a grounding in health data analytics to enhance success.

As an early adopter of the Medicare Shared Savings Program (MSSP) and the largest sponsor of MSSP accountable care organizations (ACOs), Collaborative Health Systems (CHS) is uniquely positioned to advise providers on the benefits of data analytics and technology, which CHS views as a major driver in its achievements in the MSSP arena. In performance year 2014, nine of CHS’s 24 MSSP ACOs generated savings and received payments of almost $27 million.

Health Analytics in Accountable Care: Leveraging Data to Transform ACO Performance and Results documents the accomplishments of CHS’s 24 ACOs under the MSSP program, the crucial role of data analytics in CHS operations, and the many lessons learned as an early trailblazer in value-based care delivery.

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Infographic: Transitioning to Value-Based Care

April 17th, 2019 by Melanie Matthews

Market and regulatory pressures continue to drive health systems toward value-based payment models. In a survey of leading health systems, half of executives state that the shift to value-based care is happening either quickly or very quickly at their organization. Moreover, respondents indicate that 23 percent of total care delivery in the last quarter of 2018 was value-based, up 5 percent from 2017, according to a new infographic by Lumeris.

The infographic examines the acceleration of the transition to value-based reimbursement.

11 Profitable Value-Based Reimbursement Models: Lessons from Early AdoptersCMS’s ambitious agenda for moving Medicare into alternative payment models is driving the U.S. healthcare system toward greater value-based purchasing at a furious rate. Private payors also have pledged to continue to shift payments away from fee for service and into alternative payment models such as accountable care organizations (ACOs). Fortunately, many healthcare organizations are already exploring value-based payments—often a single innovation at a time—testing models that reward providers for meeting Triple Aim goals of improving patient experience and population health while reducing healthcare’s per capita cost.

11 Profitable Value-Based Reimbursement Models: Lessons from Early Adopters encapsulates nearly a dozen such approaches, from Bon Secours’ building of a business case for its multidisciplinary care team to the John C. Lincoln ACO’s deep dive into data analytics to identify and manage the care of high-risk, high-cost ‘VIP’ patients to ‘beat the benchmark’ to WellPoint’s engagement of specialists in care coordination.

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

Guest Post: Cracking the Care Management Code: How Providers Can Get Paid for Remote Services

February 21st, 2019 by Melanie Matthews

With a successful remote care management model in place, healthcare organizations can increase annual revenues by about $500 per patient.

Healthcare organizations and physician practices are stepping up efforts to reduce avoidable healthcare utilization and ensure patients receive care in lower-cost settings when appropriate.

As part of these efforts, many providers are considering remote care services, such as e-visits, remote health monitoring, secure messaging, and regular check-in calls with patients. These remote interactions can increase patient adherence to treatment plans and lead to faster interventions when problems arise.

While payers have been slow to reimburse for remote care services (despite the clinical benefits), providers today can take advantage of Centers for Medicare and Medicaid Services reimbursement for Chronic Care Management (CCM) services to improve care management for many of their Medicare patients.

To qualify for CCM reimbursement, practitioners must spend at least 20 minutes of non-face-to-face clinical staff time per month on care coordination for CCM patients. To be included in a CCM program, patients must have two or more chronic conditions expected to last at least one year or until death, and those conditions must place patients at significant risk of death, acute exacerbation, or functional decline.

Payments for CCM services, which can be provided by physicians, physician assistants, nurse practitioners, nurse midwives and their clinical staffs, can range from approximately $43 to $141, depending on how complex a patient’s needs are, according to CMS.

When a successful remote care management model is put in place, healthcare organizations can increase annual revenues by about $500 per patient, which translates to $50,000 per year for an organization with 1,000 CCM patients.

Getting Involved

Recent data show that many providers have yet to take advantage of CCM. In fact, as of 2016, the program had touched only 684,000 Medicare patients, according to a 2017 CCM report. That’s less than 2 percent of all Medicare recipients.

One reason is that providers face many barriers when attempting to implement remote care programs. Technology, of course, is one hurdle, but CCM services also take clinical and administrative staff time and resources (such as time spent billing for CCM services and ensuring compliance).

This is why many organizations are turning to outside partners that specialize in remote care management to deliver CCM. These partners can enroll patients into the CCM program (a step that is much harder than most practices anticipate), deliver remote services each month, ensure compliance, and bill for services.

The Wright Center, a safety-net primary care provider in northeastern Pennsylvania, is one provider that sought outside help to achieve its CCM goals. The result of its partnership with a remote services provider included net new revenue within 14 days of partnering with the company, an additional $536 per enrolled patient per year, a 73 percent patient retention rate after two years, lower hospital admission rates, and higher patient satisfaction scores.

Four Key Attributes

Because many providers have found delivering remote services challenging, it’s important to select a partner that has the right model and proven success improving patient engagement and outcomes. Key capabilities to look for in a partner include:

  1. Being staffed with nurses or other clinicians who become a trusted and integral part of the healthcare organization’s team. These clinical staff members should have a strong record of establishing productive relationships with providers in the healthcare organization and with patients remotely.
  2. Working seamlessly with the EHR and population health tools already in place at the healthcare organization. The partnership should not result in an additional burden on IT staff members at the healthcare organization.
  3. Providing a customized program to suit the healthcare organization’s specific needs, goals, and workflows. An organization’s CCM needs will vary depending on the patient population, in-house resources, and technology already in place. The partner should be able to tailor its services accordingly.
  4. Proactively addressing social determinants of health and barriers to care. For example, it should be able to share results that showcase its ability to engage a senior population and address their unique needs.

As value-based reimbursement gains traction, healthcare organizations that don’t start exploring remote healthcare services will fall behind. It’s time to get involved, and CCM is a great way to start.

Drew Kearney

Drew Kearney

About the Author: Drew Kearney has been a healthcare leader since 2010, with expertise in post-ACA market opportunities and experience leading expansion initiatives in multiple markets. In 2015, he co-founded Signallamp Health, a company that offers a unique solution operationalizing population health.

Infographic: Alternative Healthcare Payment Model Trends

February 13th, 2019 by Melanie Matthews

Public and private health plans, managed Medicaid fee-for-service (FFS) states, and Medicare FFS voluntarily participated in a national effort to measure the use of Alternative Payment Models (APMs) as well as progress toward the Health Care Payment Learning & Action Network’s (LAN) goal of tying 30 percent of U.S. healthcare payments to APMs by 2016 and 50 percent by 2018, according to a new infographic by the Health Care Payment LAN.

The infographic examines APM trends for commercial, Medicare Advantage, Medicare fee-for-service and Medicaid populations.

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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Infographic: Precision Outcomes-Based Contracting Driving More Health per Dollar

December 3rd, 2018 by Melanie Matthews

Tying healthcare payments to the achievement of pre-specified goals better aligns healthcare spending with desired clinical outcomes, according to a new infographic by the University of Michigan V-BID Center.

The infographic provides examples of outcomes-based contracts as well as key elements of outcomes-based contracts.

2018 Healthcare Benchmarks: Population Health ManagementAs the healthcare industry’s pace from volume-based to value-based healthcare payment models accelerates so does the demand for more effective management of population health. With the growth of these payment models, healthcare organizations are taking on more risk in terms of shared savings and shared risk arrangements and are investing heavily in programs to support population health. These programs are expanding in both scope of services and health conditions and disease states managed. With the help of advanced technologies in healthcare, this growth will only continue.

2018 Healthcare Benchmarks: Population Health Management is the fourth comprehensive analysis of population health management by the Healthcare Intelligence Network, capturing key metrics such as populations, health conditions and health risk levels targeted by population health management programs; risk stratification criteria; prevalence of value-based payment models supporting population health management programs; population health management processes, tools, workflows and forms; and program outcomes and ROI from responding healthcare organizations. Click here for more information.

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