Posts Tagged ‘payment models’

Infographic: How Academic Medical Centers and Health Systems Are Meeting Innovation Challenges

April 25th, 2018 by Melanie Matthews

Healthcare policy is increasingly designed to incentivize healthcare delivery transformation and payment model reform, according to a new infographic by Russell Reynolds Associates.

The infographic examines organizational innovation at health systems across institutions.

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: Trends in Healthcare Payments

July 17th, 2017 by Melanie Matthews

As consumers become responsible for a greater portion of healthcare costs, they are paying more attention to the price of healthcare services…with 92 percent of consumers asking for their payment responsibility prior to a provider visit, according to a new infographic by InstaMed.

The infographic examines how consumer payment trends are impacting the healthcare industry.

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: Population Health and Children’s Hospitals

June 15th, 2016 by Melanie Matthews

More than two-thirds of children’s hospitals consider population health a top priority, according to a new survey by the Children’s Hospital Association (CHA).

A new infographic by CHA examines the defined populations for which hospitals have aligned payment models for population health management, funding sources for population health programs, the percent of organizations with risk-based contracts and the need for reliable data for population health management.

2016 Healthcare Benchmarks: Population Health ManagementPopulation health management remains a top-ranked healthcare development opportunity, according to 2016 industry trends data from The Healthcare Intelligence Network, with many organizations deriving clinical and financial gains from population health’s data-driven, risk-stratified care management approach.

2016 Healthcare Benchmarks: Population Health Management drills down on the latest population health management (PHM) trends, including the prevalence of PHM initiatives, program components, targeted conditions, PHM care team members, challenges and ROI.

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Infographic: New Models of Care

January 22nd, 2016 by Melanie Matthews

In response to healthcare industry trends, healthcare organizations are turning to social media, mobility, analytics and cloud computing to stay relevant in the digital landscape, according to a new infographic by CSC.

The infographic examines the industry trends driving these changes and how healthcare organizations are responding.

2015 Healthcare Benchmarks: Chronic Care ManagementThe desire to improve health outcomes for individuals with serious illness coupled with opportunities to generate additional revenue have prompted healthcare providers to step up chronic care management initiatives. The Centers for Medicare and Medicaid Services now reimburses physician practices for select chronic care management (CCM) services for Medicare beneficiaries, with more private payors likely to follow suit.

2015 Healthcare Benchmarks: Chronic Care Management captures tools, practices and lessons learned by the healthcare industry related to the management of chronic disease. Click here for more information.

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Q&A: Predicting 2013 Healthcare Trends

January 29th, 2013 by Jessica Fornarotto

“There will be a significant investment in EHRs in 2013,” predicts Dennis Eder, managing director of Strategic Health Group. Eder also expects there will be more physician-run ACOs in 2013 compared to 2012.

Prior to their presentations during an October webinar on Healthcare Trends & Forecasts in 2013: A Strategic Planning Session, Eder, along with Hank Osowski, managing director of Strategic Health Group, and Steven Valentine, president of The Camden Group, shared the changes they see coming in 2013 for the healthcare industry, including future payment models, ACO administration, and demands for services.

HIN: Physician payment models are getting a lot of retooling — from the addition of pay for performance incentives for hitting quality metrics to care coordination payments for patients and members in medical homes. Is this going to change much in 2013? Are we going to see a shift toward shared savings or another payment model in the coming year?

(Hank Osowksi): Watching the trends over the last year or two and many of the innovations that are being tried, the industry is moving toward value-based purchasing and population risk-based purchasing. We think this is going to accelerate as we look at 2013, 2014 and beyond.

(Dennis Eder): I would agree with Hank. We believe with the events of 2012 and the significant interest in ACO participation, it will mature and continue into the future.

HIN: In comparing some results from our 2011 and 2012 surveys on accountable care organizations, we noticed a sizeable shift in ACO administration from hospital-run to physician-administered. Why do you think so many hospitals backed away from this role when the ACO model seemed so promising?

(Dennis Eder): One of the reasons we think this may be occurring is that hospitals administering ACOs is not part of their core competency. Many of the characteristics of an ACO are a health plan or a management service organization (MSO). And this is not what hospitals do, for the most part. In addition, hospital margins are thin, and have even become thinner, so any overhead that they can offload is a good thing. Physician organizations do this and they’re the ones who are responsible for the medical management and other care management in an ACO. I think it makes logical sense to have the physician organization take on more of an administrative role for an ACO.

(Hank Osowski): I think the point Dennis made is critically important. It is the physician organization that is controlling the array of services that the beneficiary is receiving. It makes sense for them to take a lead in running an ACO. They are the ones who best understand how all the pieces fit together and where the opportunities are to get efficiencies to improve quality and reduce the costs of care.

HIN: The IOM has recommended better and shared use of health data, particularly at the point of care, where key health decisions are made. What will be the technology to invest in or embrace in 2013 to improve data analytics for population health management?

(Dennis Eder): We’re going to continue to see a significant investment in EHRs. We know that it’s an important tool in some health plans. Kaiser, for example, is gaining significant market share. We see further investments in that particular area.

(Hank Osowski): It’s also important to take a self-examination of us as an industry. We have mountains of data. We have very little intelligence about where the value is in our system. Where can we leverage the most efficient of the care providers and change some of the things that are inefficient, that don’t contribute to high quality care and that drive up the costs? It’s digging into that mountain of data and pulling out the real healthcare intelligence that we as a system, and as an industry, can use to provide better care to patients.

HIN: What’s ahead for population health management?

(Steven Valentine): We will begin to see more fierce competition, if you will, around population health management. People are going to try to concur and grab more populations to work with in their delivery systems. We’re expecting that we should have slightly soft demands for services. We would find that even with the population getting older, and with these new delivery systems and lower utilization rates, we don’t expect to see an uptick in volume — stable to a slight decline — which means you have to reduce your expenses and go after an additional market share population.