Archive for the ‘Value-Based Reimbursement’ Category

Infographic: Payer-Provider Partnerships Continue to Deepen

December 11th, 2017 by Melanie Matthews

Payer-provider partnerships continue to deepen, with 68 percent of partnerships launched in 2017 being joint venture or fully co-branded insurance products, according to a new infographic by Oliver Wyman.

The infographic tracks the growth of partnerships since 2013 and how these partnerships support value-based healthcare models.

2017 Healthcare Benchmarks: Community Health PartnershipsIncreasingly, healthcare organizations are forging community partnerships to bridge care gaps and improve population health status. This alignment of care and resources ranges from providing transportation to doctors’ appointments to scheduling EMT visits to visit the homebound elderly following their hospitalization. Working in tandem with community groups addresses social determinants of health (SDOH) and produces clinical and financial benefits that are recognized and rewarded by today’s value-based healthcare reimbursement models.

2017 Healthcare Benchmarks: Community Health Partnerships documents the efforts of 81 healthcare organizations to align clinical interventions with neighborhood collaborations to improve health, wellness and socioeconomic factors in the populations they serve. These metrics are compiled from responses to the October 2017 Community Health Partnerships survey by the Healthcare Intelligence Network. Click here for more information.

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Infographic: Economic Investment and the Journey to Value-Based Healthcare

December 1st, 2017 by Melanie Matthews

Value-based payment and care has left a powerful and indelible footprint on the U.S. healthcare system. Widescale provider and payer investment in IT infrastructure and personnel to support alternative payment models, an infusion of venture capital support into new technology-based third-party partners, and innovative employer arrangements with providers, are tangibly shifting the axis of healthcare spending, according to a new infographic by the Health Care Transformation Task Force.

The infographic examines how value-based healthcare impacts patients, providers, payers and purchasers.

Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and MethodologyIf one trend has transformed the healthcare industry post-ACA more than any other, it is the market’s new business model rewarding value over volume.

Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and Methodology provides a framework for healthcare’s new value proposition, with advice from thought leaders steeped in the delivery and reimbursement of value-based care. Click here for more information.

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LVHN Portal Places Healthcare Control in Patients’ Hands, Liberates Staff

November 30th, 2017 by Patricia Donovan

patient portal rolloutConsumers accustomed to communicating, shopping, banking and booking travel online increasingly expect those same conveniences from their healthcare providers.

And as Lehigh Valley Health Network (LVHN) has learned, despite the myriad of benefits a patient portal offers, the most important reason to incorporate this interactive tool into a physician practice is because patients want it.

“As much as we emphasize the marketing aspect of [the portal], having a nice, functional technology that we get in other aspects of our life has really been an enabler,” notes Michael Sheinberg, M.D., medical director, medical informatics, Epic transformation at LVHN. Many LVHN patients found the portal on their own, independent of the tool’s formal introduction, he adds. “Patients really wanted this. Our patients want to be engaged, they want to have access, and they want to own their medical information.”

Dr. Sheinberg and Lindsay Altimare, director of operations for Lehigh Valley Physician Group at LVHN, walked through the rollout of the LVHN portal to its ambulatory care providers during Patient Portal Roll-Out Strategy: Activating and Engaging Patients in Self-Care and Population Health, a November 2017 webinar now available for rebroadcast.

The 2015 launch of LVHN’s patient portal and its continued user growth has earned it the distinction of being the fastest growing patient portal on the Epic® platform.

As Ms. Altimare explained, LVHN first launched its portal with limited functionality in February 2015 as part of the Epic electronic health record that had gone live two years earlier. But even given the portal’s limited feature set, LVHN quickly recognized the tool’s potential to enhance efficiency, education, communication and revenue outside of traditional doctor’s office visits.

At its providers’ request, however, LVHN first piloted the portal within 14 of its 160+ physician practices, using feedback from providers in the two-month trial to further tweak the portal before next rolling it out to its remaining clinicians, and finally to patients.

LVHN supported each rollout phase with targeted marketing and education materials.

Today, LVHN patients and staff embrace the functionality of the portal, which offers an experience similar to that of an online airline check-in. Via the portal, LVHN patients can self-schedule appointments, complete medical questionnaires and forms, even participate in select e-visits with physicians—all in the comfort and privacy of their own homes.

Not only are about 45 percent of LVHN’s 420,000 patients enrolled in the portal, but self-scheduling doubled in the first six months of use. Additionally, upon examining a segment of portal participants over 12 months, LVHN identified a steady rise in portal utilization for common tasks like medication renewals and medical history completion.

The portal “liberates our patients from the need to access our providers in the traditional way,” says Dr. Sheinberg. Appreciation of this freedom is reflected in improved patient experience scores, he adds.

“The portal is a patient satisfier, and certainly a staff satisfier, because it reduces patient ‘no-shows’ and liberates our staff from more manual processes, putting them in the hands of our patients.”


Community Health Partnerships Can Change the Culture of Poverty: 2017 Benchmarks

November 28th, 2017 by Patricia Donovan

Community health partnerships address unmet needs, providing services related to transportation, housing, nutrition and behavioral health.

For residents of some locales, community health partnerships (CHP) —alliances between healthcare providers and local organizations to address unmet needs—can mean the difference between surviving and thriving, according to new CHP metrics from the Healthcare Intelligence Network (HIN).

“We could not survive without community partnerships. Our patients thrive because of them. They are critical to help change the culture of poverty that remains in our community,” noted a respondent to HIN’s 2017 survey on Community Health Partnerships.

Partnerships can also mean the difference between housing and homelessness. According to the survey, more than a quarter of community health partnerships (26 percent) address environmental and social determinants of health (SDOH) like housing and transportation that can have a deleterious effect on population health.

“To date, we have housed 49 families/individuals who were formally homeless or near homelessness,” added another respondent.

“Social health determinants are more important than ever to managing care,” said another. “Community health partnerships make a big impact when it comes to rounding out care.”

Motivated to improve population health, healthcare providers are joining forces with community groups such food banks, schools and faith-based organizations to bridge care gaps and deliver needed services. The majority of community health partnerships are designed to improve access to healthcare, say 70 percent of survey respondents.

Eighty-one organizations shared details on community health partnerships, which range from collaborating with a local food bank to educate food pantries on diabetes to the planting of community gardens to launching an asthma population health management program for students.

Seventy-one percent conduct a community health needs assessment (CHNA) to identify potential areas for local health partnerships. Priority candidates for 36 percent of these partnerships are high-risk populations, defined as those having two or more chronic medical conditions.

Overall, the survey found that 95 percent of respondents have initiated community health partnerships, with half of those remaining preparing to launch partnerships in the coming year.

Other community health partnership metrics identified by the 2017 survey include the following:

  • Local organizations such as food banks top the list of community health partners, say 79 percent.
  • The population health manager typically has primary responsibility for community health partnerships forged by 30 percent of respondents.
  • Foundations are the chief funding source for services offered through community health partnerships, say 23 percent. However, funding remains the chief barrier to community health partnerships, say 41 percent.
  • Forty-five percent have forged community health partnerships to enhance behavioral health services.
  • Two-thirds attributed increases in clinical outcomes and quality of care to community health partnerships.
  • Forty-four percent reported a drop in hospital ER visits after launching community health partnerships.

Download an executive summary of results from the 2017 Community Health Partnerships survey.

Guest Post: Value-Based Care is Dying—But Longitudinal Patient Data Can Revive It

November 16th, 2017 by William D. Kirsh, DO, MPH, CMO at Sentry Data Systems

In 2013, Harvard Business Review (HBR) called value-based care “the strategy that will fix healthcare.” And the concept goes back even further than that—Michael Porter and Elizabeth Teisberg introduced the value agenda in their book, Redefining Health Care, in 2006, accord to HBR. Yet years later, value-based care is still struggling to survive, still in limbo, not quite breathing on its own. At this point, you might say it’s in critical condition.

More than a decade after Porter and Teisberg’s book, the industry is still talking about the “transition” to value-based care. In January of this year, CMS and HHS’ Office of the National Coordinator for Health IT (ONC) issued a vision for the continued shift to value-based care. In April, CEOs from Kaiser Permanente, Medtronic, Novartis and others, along with the Netherlands’ health minister, the head of England’s National Health Service, and Harvard economics professor Michael Porter (author of the 2006 book mentioned above) called for a new approach that would embrace patient-centered care and focus on outcomes.

Also in April, the World Economic Forum, in collaboration with The Boston Consulting Group, released a report, Value in Healthcare: Laying the Foundation for Health-System Transformation. Why are we still seeing words like “a new approach” and “laying the foundation” after all the time we’ve had, as an industry, to embrace value-based care?

After much wandering, it’s apparently a destination we still haven’t found on the map.

Resisting Change

According to a report from professional services organization EY (Ernst & Young) in July, about a fourth of 700 respondents (chief medical officers, clinical quality executives and chief financial officers at U.S.-based healthcare providers with annual revenue of $100 million and higher) polled said they had no value-based reimbursement initiatives planned for 2017. And that’s despite figures stating that healthcare spending in the United States “has now risen to 17.8 percent of GDP,” as the EY report says. So, what’s stopping physicians and hospitals from acting on value-based care?

As Modern Healthcare notes, the EY report points to “the escalating cost of care, a lack of standardization in how quality is defined, a disengaged workforce that leads to more medical errors, and a lack of trust and transparency between providers, payers and regulators,“ as some of the barriers. A 2016 article from Deloitte Insights adds that physician compensation may be part of the problem, stating, “Currently, there is little focus on value in physician compensation, and physicians are generally reluctant to bear financial risk for care delivery…86 percent of physicians reported being compensated under fee-for-service (FFS) or salary arrangements.” Deloitte recommends, “At least 20 percent of a physician’s compensation should be tied to performance goals. Current financial incentive levels for physicians are not adequate.”

But financial incentives alone are not enough. “Regardless of financial incentives to reduce costs and improve care quality, physicians would have a difficult time meeting these goals if they lack data-driven tools,” Deloitte says. “These tools can give them insight on cost and quality metrics, and can help them make care decisions that are consistent with effective clinical practice.”

Achieving Quality Outcomes

The EY report seems to come to the same conclusion as Deloitte about the lack of metrics and data. “Clinical outcomes and healthcare quality are often measured inconsistently by healthcare providers — if they are measured at all,” EY says. One way for hospitals to change that—a vital step in the value-based payment model—is through access to and analysis of longitudinal patient data, which is data that tracks the same patients over multiple episodes of care over the course of many years.

The problem is that hospitals and physicians often do not see the outcomes of particular treatment protocols (prescriptions, diagnostic tests, surgeries, etc.) for a long time, and capturing clinical data with this level of accuracy has historically been the industry’s blind spot. Without having a comparison population, each institution can only compare its data to real-world experience within their own data depository. A critical need is to use a de-identified real-world census population to compare protocols, best practices or specific utilization by National Drug Codes to help identify patterns of interventions that create value consistently across multiple systems, physicians, and patients. To truly answer these challenging questions about value in a meaningful way, hospitals need a comparison longitudinal patient data set.

There are countless questions about patient cohorts that physicians might want answered as they seek to make the best treatment decisions: What treatment protocol will result in the highest quality outcomes for a 50-year-old female diabetic patient with kidney failure? Which medications most effectively keep children with asthma from repeat visits to the ER? What comorbidities and symptoms are seen among patients with acute myelocytic leukemia (AML) in their earliest visits to the ER, and how can that information result in earlier diagnosis or different treatment options down the line? Quality historical longitudinal patient data may answer all these questions.

“Market forces are moving the industry toward a new paradigm; one in which delivering the highest value is an organization’s defining goal,” notes the EY report. “Optimizing patient experiences across the continuum of care while industrializing quality requires more than episodic effort.” This is the crux of value-based care. The only way to bring all stakeholders together and keep value-based care alive is by leveraging real-world, longitudinal patient data and using that information to make actionable treatment and prescribing decisions that lead to overall wellness and financial value, instead of focusing on just acute-care treatment.

William D. Kirsh, DO, MPH, CMO at Sentry Data Systems

About the Author: William D. Kirsh, DO, MPH, is chief medical officer at Sentry Data Systems and a practicing physician, clinically certified in family practice, geriatrics, hospice and palliative medicine. Sentry Data Systems, a pioneer in automated pharmacy procurement, utilization management and 340B compliance, is leading the healthcare industry in turning real-time data into real-world evidence through Comparative Rapid Cycle Analytics™ to reduce total cost of care, improve quality, and provide better results for all.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

Infographic: A State-by-State Value-Based Reimbursement Comparison

November 15th, 2017 by Melanie Matthews

There is a range of value-based reimbursement approaches and significant variation in the scope, leadership commitment, and resources devoted to the transition from fee-for-service to value-based reimbursement across the United States, according to a new infographic by Change Healthcare.

The infographic provides an aggregated look at which strategies states have adopted, whether they have chosen to set value-based payment (VBP) targets, the scope of their initiative (Medicaid or multi-payer), and the approximate year that the VBP initiative was implemented.

Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and MethodologyIf one trend has transformed the healthcare industry post-ACA more than any other, it is the market’s new business model rewarding value over volume.

Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and Methodology provides a framework for healthcare’s new value proposition, with advice from thought leaders steeped in the delivery and reimbursement of value-based care. Click here for more information.

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

Infographic: Healthcare Payment Model Reform

November 3rd, 2017 by Melanie Matthews

As the 79 million baby boomers turn 65, they will grow the
Medicare-eligible cohort from 13.1 percent to 20.3 percent in 2030, according to a new infographic by HORNE Healthcare.

The infographic provides advice for providers to prepare for success in the ever-changing healthcare reimbursement environment.

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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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.

Infographic: Precision Medicine Meets Precision Benefit Design

October 18th, 2017 by Melanie Matthews

Advances in precision medicine may specify immediate use targeted therapies, nullifying recommendations for use of standard first line treatment, according to a new infographic by the University of Michigan Center for Value-Based Insurance Design.

The infographic examines how precision medicine benefit design removes administrative barriers and lowers cost-sharing to improve access to clinically indicated therapies.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry Not in recent history has the outcome of a U.S. presidential election portended so much for the healthcare industry. Will the Trump administration repeal or replace the Affordable Care Act (ACA)? What will be the fate of MACRA? Will Medicare and Medicaid survive?

These and other uncertainties compound an already daunting landscape that is steering healthcare organizations toward value-based care and alternative payment models and challenging them to up their quality game.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry, HIN’s 13th annual business forecast, is designed to support healthcare C-suite planning during this historic transition as leaders prepare for both a new year and new presidential leadership.

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Infographic: Banking the Upside from Value-Based Reimbursement

October 11th, 2017 by Melanie Matthews

As healthcare reimbursement shifts toward paying for value, there’s significant revenue at stake for physician practices, according to a new infographic by athenahealth, Inc.

The infographic examines five different types of physician practices and how participation in value-based reimbursement models would impact practice revenue.

No matter which level of participation physician practices choose for the first Quality Payment Program performance period beginning January 1, 2017, CMS’s “Pick Your Pace” announcement means practices should proactively prepare for the impact of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) on physician quality reporting and reimbursement.

MACRA Physician Quality Reporting: Positioning Your Practice for the MIPS Merit-Based Incentive Payment System delivers a veritable MACRA toolkit for physician practices, with dozens of tips and strategies that lay the groundwork for reimbursement under Medicare’s Merit-based Incentive Payment System (MIPS), expected to begin in 2017 and one of two payment paths Medicare will offer to practices.

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