Posts Tagged ‘value-based healthcare’

Infographic: The Impact of a Changing Reimbursement Landscape

June 18th, 2018 by Melanie Matthews

Most healthcare providers revealed that they wouldn’t drop a contract with a payer even if they knew they were underpaid, according to a new infographic by BillingParadise.

The infographic details recent trends in the reimbursement climate and industry changes that are having an impact on how providers are reimbursed.

Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM RevenueSince the January 2015 rollout by CMS of new chronic care management (CCM) codes, many physician practices have been slow to engage in CCM.

Arcturus Healthcare, however, rapidly grasped the potential of CCM to improve patient outcomes while generating care coordination revenue, estimating it could earn up to $100,000 monthly for qualified patients treated in its four physician practices—or $1 million a year.

Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM Revenue traces the incorporation of CCM into Arcturus Healthcare’s existing care management efforts for high-risk patients, as well as the bonus that resulted from CCM code adoption: increased engagement and improved relationships with CCM patients.

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Infographic: The Healthcare Value Initiative

June 11th, 2018 by Melanie Matthews

Hospitals are taking the lead in addressing healthcare affordability, according to a new infographic by the American Hospital Association.

The infographic examines how hospitals and health systems have been able to hold price increases to under 2 percent in each of the last four years.

Predictive Healthcare Analytics: Four Pillars for SuccessWith an increasing percentage of at-risk healthcare payments, the Allina Health System’s Minneapolis Heart Institute began to drill down on the reasons for clinical variations among its cardiovascular patients. The Heart Institute’s Center for Healthcare Delivery Innovation, charged with analyzing and reducing unnecessary clinical variation, has saved over $155 million by reducing this unnecessary clinical variation through its predictive analytics programs.

During Predictive Healthcare Analytics: Four Pillars for Success, a 45-minute webinar in March 2018, now available for replay, Pam Rush, cardiovascular clinical service line program director at Allina Health, and Dr. Steven Bradley, cardiologist, Minneapolis Heart Institute (MHI) and associate director, MHI Healthcare Delivery Innovation Center, shared their organization’s four pillars of predictive analytics success…addressing population health issues, reducing clinical variation, testing new processes and leveraging an enterprise data warehouse. Click here for more information.

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Guest Post: Is the Future of Value-based Healthcare Payments at Risk?

May 31st, 2018 by Erin Weber

CAQH CORE report highlights how value-based payment may encounter the challenges fee-for-service faced 20 years ago.

There is an old adage that anyone who doesn’t learn from the past is doomed to repeat it. For those of us in healthcare, it is time to review our history, so we can avoid repeating some of the operational headaches that emerged almost two decades ago.

Beginning in the 1990s, when electronic transactions were first being implemented to administer fee-for-service payment models, organizations began using many different, often proprietary approaches. Although HIPAA standards were in place, there were no agreed-upon expectations for exchanging data, and the content of transactions varied from one organization to another. This slowed automation and resulted in an inefficient, costly and frustrating experience for all parties.

If wireless companies, for example, did not use common approaches for exchanging data, you would need to carry different phones to call people on other networks. This is what health systems started to face with fee-for-service models. Instead of having to connect with four or five different carriers, however, they had to exchange electronic data with every health plan with which they contracted, often a dozen or more.

To help address this challenge, stakeholders across healthcare came together to form CAQH CORE®, a nonprofit collaboration of health plans, health systems, and vendors. Members worked together to develop common rules, many of which have been codified as part of the Affordable Care Act.

Because of these and other industry efforts, more fee-for-service administrative information flows electronically and securely today. Health plans, providers, and clearinghouses have sharply reduced the use of costlier manual phone, fax, and mail processes.

CAQH CORE is starting to see signs that value-based payment operations are following a similar path. Today, as adoption of value-based payment is growing, health plans and providers are developing new approaches to measure, manage, and pay for care. While innovation is needed, a common foundation for basic administrative operations is lacking. Absent this foundation, value-based payment is being managed, in part, using approaches designed for fee-for-service. This is not likely to yield the fluid, reliable, and trusted exchanges of data needed for long-term value-based payment model success.

Given that experience, CAQH CORE began to study the matter in depth by interviewing stakeholders and reviewing the literature. Last month, CAQH CORE published these findings in a report, All Together Now: Applying the Lessons of Fee-for-Service to Streamline Adoption of Value-Based Payments. In it, they identified five areas where greater uniformity can help the value-based healthcare economy thrive: data quality, interoperability, patient risk stratification, provider attribution, and quality measurement. The report also details specific strategies to address each of these areas.

For example, today there are many issues with data quality, particularly involving provider identification. In the value-based payment world, inaccurate information about the provider can yield a cascading series of problems, such as misplaced accountability, erroneous risk-based payments, inappropriate referrals, and higher patient costs. The report recommends more universal and consistent use of the National Provider Identifier as one way to improve data quality and mitigate many of these problems.

This is just one example, but it highlights how acting now, before operational variances can become entrenched in value-based payment models, will help avoid needless costs, inefficiencies, and frustration. Others in the industry are looking at these challenges as well. By working together to apply the lessons learned during the fee-for-service transition, CAQH CORE hopes to energize an effort to ease the pain points in value-based payment and avoid reliving challenges of the past.

Erin Weber

Erin Weber

About the Author:

Erin Weber is director of CAQH CORE, a nonprofit collaboration of over 130 public and private health plans, hospitals and health systems, vendors and others that helps stakeholders uniformly adopt electronic transactions and exchange data efficiently.

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 remains with them. The company accepts no liability for any errors, omissions or representations.

Infographic: Hospital Adoption of Alternative Payment and Delivery Models

May 18th, 2018 by Melanie Matthews

Hospitals and health systems continue to test and adopt alternative payment and delivery models, such as ACOs, medical homes, and performance-based payment, according to a new infographic by the American Hospital Association.

The infographic examines market trends for value-based payment and delivery models.

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: 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: 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.

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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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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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