Posts Tagged ‘value-based payment’

Infographic: Four Key Considerations in Pacing the Transition to Value-Based Payments

September 14th, 2016 by Melanie Matthews

There are four key considerations for healthcare organizations to pace their transition to value-based payments, according to a new infographic by PYA.

The infographic outlines these four considerations to determine how quickly healthcare organizations should move toward value-based reimbursement.

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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Majority Back Medicare Timeline for Value-Based Reimbursement

January 29th, 2015 by Patricia Donovan

For the first time in Medicare history, HHS has set explicit goals for alternative payment models and value-based payments.

The healthcare industry took notice earlier this week of Medicare’s ambitious timeline for moving Medicare payments from volume- to value-based models—an agenda validated by the majority of respondents to HIN’s eleventh annual Healthcare Trends and Forecasts survey.

Ninety-two percent of respondents to the December 2014 survey endorsed healthcare’s transition to rewarding healthcare value and quality over volume of services, noting the trend has boosted accountability and revenues.

In a related data point, 26 percent view the adoption of value-based reimbursement and rewards as the most promising area of healthcare.

The HHS timeline will tie 30 percent of traditional or fee-for-service (FFS) Medicare payments to quality or value through alternative payment models by the end of 2016. Alternative payment formulas include accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and bundled payment arrangements for episodes of care, which CMS has tested in a range of pilots in recent years.

The HHS said it will tie 50 percent of payments to these models by the end of 2018. In 2011, Medicare made almost no payments to providers through alternative payment models, but today such payments represent approximately 20 percent of Medicare payments.

With views toward value-based reimbursement mostly favorable, 2015 Trends survey respondents shared some spoils of a value-over-volume approach:

  • „„“Higher levels of accountability in order to be well positioned to execute in a value environment.”
  • „„“As a high quality provider, shift to rewarding this behavior has increased revenue.”
  • „„“Not as much direct impact as implied and perceived focus on quality and reporting.”
  • „„“We built a provider network upon this principle.”

In other trends documented by the survey, declining reimbursement and cost constraints posed considerable challenges for respondents in the last 12 months, while interventions to tighten transitions in care, reduce hospital readmissions and integrate care via the patient-centered medical home (PCMH) model—all value-based initiatives—were among business successes recounted by this year’s participants.

Infographic: Aetna’s Approach to Value-Based Healthcare

September 15th, 2014 by Melanie Matthews

With a new focus on quality of healthcare over quantity, Aetna is reporting improvements in outcome-based measures and reduced costs. In its new infographic, Aetna details its value-based healthcare options and results its achieving.

Quality over Quantity

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.

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.

5 Market Trends Impacting Value-Based Reimbursement: “It’s Not Just About Volume”

July 31st, 2014 by Cheryl Miller

Accompanying the move to value-based care and reimbursement is the need to align economic and practice incentives to create accountability, says Cynthia Kilroy, senior vice president of provider strategy and business development, Optum. It is not just about volume, but about managing populations, and investing in capabilities and tools to manage populations.

We are seeing five trends in the industry, with implications for each of them.

First, there is a consolidation of the provider community that physicians are organizing, and then hospital systems or large integrated delivery networks (IDNs) are purchasing physicians. We are seeing both an affiliated and an employed model in the market right now.

Another trend is system affordability. Premiums have been increasing significantly — more than 30 percent over the last five years. The challenge that CMS and some payors are focusing on is how to make healthcare more affordable to the community at large.

A third trending area is value-based care, and aligning the economic and the practice incentives to create accountability. It is not just about volume, but about managing populations. This leads into the fourth trend, which is that provider organizations are investing in capabilities and tools to manage populations. Then the incentive models are moving more around that population care, which is more challenging to measure.

Finally, there is a significant amount of interest in finding performance metrics. There is HCAHPS®. Every other payor is asking for different performance metrics from organizations; how do we focus that into the right incentive, especially from an incentive program for physicians? Each organization will be trying to achieve something different; each market is very different. I may see one provider organization focus in particular areas and disease states around quality. In other markets there might be something completely different. It is based on what is going on in that particular market and practice.

Excerpted from 6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability.

Q&A: How Clinical Integration Creates Framework for Value-Based Payment Contract

August 8th, 2012 by Jessica Fornarotto

Advocate Physician Partners is proud of its infrastructure of success in shared savings, built on a foundation of clinical integration.

“To describe how valuable our clinical integration program is at Advocate Physician Partners, two areas need to be highlighted,” says Dr. Carrie Nelson, medical director for special projects with Advocate Physician Partners (APP).

Dr. Carrie Nelson, Medical Director for Special Projects


Prior to her presentation on Bending the Cost Curve with a Commercial Value-Based Payment Contract: A Case Study from Advocate Physician Partners, Dr. Nelson discussed in depth APP’s clinical integration program that helped to set the framework for their value-based payment contract with Blue Cross Blue Shield of Illinois (BCBSIL). This payor-provider agreement has reduced inpatient admissions and ER visits, and has bent the cost curve after its first year of implementation. APP’s clinical integration program is described in detail in
Case Study in Clinical Integration: The Advocate Physician Partners Experience.

HIN: How has APP’s clinical integration of more than 4,000 physicians and 10 hospitals over the last few years helped to lay the groundwork for your value-based payment contract?

(Dr. Carrie Nelson): We feel very fortunate that we have a strong clinical integration program in place. It has created a strong foundation for the work that we’re doing with shared savings. There are two major areas that demonstrate how valuable that foundation has been to us.

First, it is a culture of delivering that value that we have established here over the last eight years or so since we’ve been deeply involved in this clinical integration program. That has been a tremendous spirit to build upon with movement toward shared savings and value-based contracting. Physicians in our network have a strong understanding of the importance of delivering that value and achieving quality metrics and not just a fee-for-service volume-based approach to care.

The second would be the framework that it has laid for us in how we can continue to incentivize the physicians to achieve the goals associated with shared savings. We have been able to build a number of our key priorities into the clinical integration program, such as decreasing ER utilization, length of stay, and admissions for ambulatory care-sensitive conditions. Many of those things have rolled into our clinical integration program and have helped physicians to be energized to help achieve these shared goals.

We feel very fortunate that we had this program in place in many cases before it was truly rewarded. It has also provided this cultural basis and framework for building upon the successes that we’ve already seen. The last thing to remember is this: all that needs to be accomplished in shared savings can be overwhelming. Clinical integration and the measurements that we’ve been involved in for many years are some of those things.

It’s nice to be able to focus on some alternative areas to show our infrastructure of success in shared savings, instead of having to focus explicitly on just the measures that are brought along.

Are Payment Tides Turning for Primary Care?

July 16th, 2012 by Patricia Donovan
Primary Care Pay

Value-Based Payments

Several indicators this month point to more dollars flowing into primary care offices, either in the form of higher provider salaries, increased reimbursement, or both. And new market data finds physicians leading the majority of accountable care organizations (ACO).

A study released last week by Medical Group Management Association found that median pay for primary care physicians (PCPs) grew 5 percent last year to $212,840, capping a five-year increase of 16.7 percent from 2007 to 2011. While an actual PCP paycheck pales next to a specialist’s, of note is MGMA’s finding that PCP compensation grew at a faster rate than specialist pay over the last five years.

The reimbursement stage is being set for patient-centered care delivery models like the patient-centered medical home and the ACO that put a premium on care coordination, with many payors offering a combination of traditional fee for service (FFS) payment topped off with a care coordination fee, with possibly a little shared savings thrown in to sweeten the payment pot.

Sixty-one percent of respondents to the sixth annual HIN 2012 Patient-Centered Medical Home survey reported they operate under an FFS plus care coordination fee model.

And earlier this month, CMS proposed payment increases for family physicians of approximately 7 percent and for other practitioners providing primary care services of between 3 and 5 percent. As it has in other initiatives resulting from healthcare reform, the proposed rule offers additional financial incentives for care coordinated during critical transitions in care, such as when a patient is discharged from the hospital:

For 2013, CMS is proposing for the first time to explicitly pay for the care required to help a patient transition back to the community following a discharge from a hospital or nursing facility. The proposals calls for CMS to make a separate payment to a patient’s community physician or practitioner to coordinate the patient’s care in the 30 days following a hospital or skilled nursing facility stay.

Dr. Carrie Nelson, medical director of special projects for Advocate Physician Partners (APP), lauds CMS’s proposal. “It’s a long time coming that that kind of recognition has translated into reimbursement for primary care physicians,” notes Dr. Nelson, a family physician herself. “I know first-hand the amount of work that goes into making sure your patients aren’t falling through the cracks and getting the care they need in an efficient manner, especially after a hospitalization or major clinical situation.”

However, it’s critical that those dollars given to primary care for care coordination actually go toward that function, Dr. Nelson cautioned, and that quality measures are established in parallel with this funding. “There’s a risk that these funds could be seen as ‘new money,’ she said. “I think primary care feels undervalued and underpaid, and there is some validity to that. But at the same time, reimbursement for care coordination may not translate into actual care coordination unless there are some quality measures associated with that in order to make sure that the dollars go toward the purpose for which they were intended.”

With eight years of clinical integration (CI) under its belt, involving more than 4,000 physicians and 10 hospitals, APP can speak from experience. Its nationally recognized CI effort has achieved record performance in almost all measured areas, resulting in improved patient outcomes and significant cost savings. The CI program laid the groundwork for a value-based payment contract between APP and Blue Cross Blue Shield of Illinois. Dr. Nelson will share lessons learned from contract implementation during a July 18, 2012 webinar, Bending the Cost Curve with a Commercial Value-Based Payment Contract.