Posts Tagged ‘Value-Based Reimbursement’

Mounting Pressure from Value-Based Reimbursement Models Drives Clinical Improvement Strategy at Allina Health System

April 17th, 2018 by Melanie Matthews

Value-Based Reimbursement Models Drive Clinical Improvement Strategy

As a greater percentage of hospital payments are through value-based contracts, hospitals that reduce costs while maintaining quality will survive, predicts Pam Rush, cardiovascular clinical service line program director at Allina Health.

“How do we improve outcomes and decrease costs?” Rush asked participants in the March 2018 webinar, Predictive Healthcare Analytics: Four Pillars for Success. “We need to start to look at the world differently.”

How can we be more creative and do things differently? How can we use different members of the healthcare teams in new ways, such as nurse practitioners or advanced practice providers, she added. In addition, “we need to invest in data analytics and data resources and have data analysts who can pull the information for us so we can find the variation. We need to invest in physician and caregiver time to look at the data, to make changes in how they improve care, to monitor and see what is working and what doesn’t work.”

These four pillars…population health management, reducing clinical variation, testing new care processes and new models of payment, and leveraging cutting edge technologies…have been critical to the work at Allina Health System’s Minneapolis Heart Institute Center for Healthcare Delivery Innovation, said Rush.

In population health management, we’re looking at how can we focus on adherence to guidelines, identify where there are gaps in care and partner with people across the system, primary care and specialists, to improve consistency and adherence to guidelines, she explained.

Allina is reducing clinical variation by looking at unnecessary variations in care where there is inconsistent care without an influence on outcomes.

“We’re also looking at new ways of doing things. How can we use our nurse practitioners, how do we care for patients once they’re discharged from the hospital and bring them back in for clinic visits? It’s really looking at the care model and how we can do things differently to reduce total cost of care,” she said.

In cardiology, there are so many new devices, procedures and techniques to monitor, said Rush, but we need to figure out who are the right providers to do that monitoring, who are the right patients to do these expensive procedures on and who achieves the best outcomes, because we can’t afford to do all of this new technology to every single person.

Allina looks at these four pillars across the continuum. Starting in primary care to partner on prevention strategies, moving to who gets referred to cardiology, and when they’re referred to cardiology, what are the set of tests or treatments and guidelines to adhere to along the continuum to subspecialties, emergency services and all the way up through advanced therapies, such as transplant.

During the webinar, Rush along with Dr. Steven Bradley, cardiologist, MHI and associate director, MHI Healthcare Delivery Innovation Center, shared these four pillars of predictive analytics success along with details on creating a culture of quality and innovation, building performance improvement dashboards, as well as several case examples of quality improvement initiatives contributing to these savings and much more.

Listen to Ms. Rush describe how MHI leveraged an enterprise data warehouse to identify care gaps and clinical quality improvement opportunities.

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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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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Infographic: Industry Perspectives on Value-Based Payment

October 4th, 2017 by Melanie Matthews

The shift to value-based payment is a slow one, with most health plans not yet making the transition to risk, according to a new infographic by HealthScape Advisors.

The infographic examines the percentage of plans in upside and downside risk contracts, the impact of health plan sponsor on risk contracts, cost and quality impacts for risk contracts, value-based payment enablers and recommendations for success in value-based contracts.

The accountable care organization, or ACO, has become a cornerstone of healthcare delivery system and payment reform by raising the bar on healthcare quality and reducing unnecessary costs. There are now more than 700 ACOs in existence today, by a 2017 SK&A estimate.

2017 Healthcare Benchmarks: Accountable Care Organizations, HIN’s fifth compendium of metrics on ACOs, captures ACO operation in today’s value- and quality-focused healthcare environment.

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Infographic: Payer-Provider Partnership Trends

May 3rd, 2017 by Melanie Matthews

Partnered-products are gaining favor with payers and providers, and the value-based environment is pushing players to explore new ways to control total cost of care, according to a new infographic by Oliver Wyman.

The infographic provides an up-to-date look at market-wide and nationwide trends in payer-provider partnerships.

Positioning for Value-Based Reimbursement: Leveraging Care Management for Clinical and Financial OutcomesWhile others wait for the healthcare industry to complete its transition to value-based reimbursement, Bon Secours Medical Group has already aligned itself with payment reform, leveraging its care team and providers and automating workflows to enjoy immediate rewards from its patient-centered approach.

Positioning for Value-Based Reimbursement: Leveraging Care Management for Clinical and Financial Outcomes describes how this 600-provider medical group has primed its providers to employ a broad mix of team-based care, technology and retooled care delivery systems to maximize quality and clinical outcomes and reduce spend associated with its managed patients.

Click here for more information.

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Infographic: Obstacles to Value-Based Healthcare

December 19th, 2016 by Melanie Matthews

Obstacles to Value-Based Healthcare
Multispecialty medical groups and integrated systems of care that deliver care to one in three Americans—reported that the transition away from fee-for-service medicine continues, but at a slower pace than anticipated, according to new infographic by AMGA.

The infographic examines the barriers to value-based care for these organizations.

A 2015 adopter of Medicare’s Chronic Care Management (CCM) reimbursement program, The Center for Primary Care (CPC) quickly expanded its CCM initiative to qualifying Medicare beneficiaries at its nine locations. Today, with a detailed profile of its CCM population and the health improvements and revenue that resulted, the CPC is leveraging this Chronic Care Management experience for participation in MACRA.

Physician Chronic Care Management Reimbursement: Roadmap to MIPS Success Under MACRA describes how early adoption of Medicare’s CCM Reimbursement program enhanced the Center’s MACRA-readiness, laying the foundation for success under the Merit-based Incentive Payment System (MIPS) path.

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Infographic: Alternative Payment Model Trends

November 30th, 2016 by Melanie Matthews

Alternative Payment Model Trends

Public and private health plans voluntarily participated in a national effort to measure the use of alternative payment models (APMs) as well as progress toward the goal of tying 30% of U.S. healthcare payments to APMs by 2016 and 50% by 2018, the results of which are depicted in a new infographic by the Health Care Payment Learning and Action Network (LAN).

The infographic drills down on the number of covered lives and market share participating in APMs, as well as the amount of healthcare dollars spent in APMs.

Physician Chronic Care Management Reimbursement: Roadmap to MIPS Success Under MACRAA 2015 adopter of Medicare’s Chronic Care Management (CCM) reimbursement program, The Center for Primary Care (CPC) quickly expanded its CCM initiative to qualifying Medicare beneficiaries at its nine locations. Today, with a detailed profile of its CCM population and the health improvements and revenue that resulted, the CPC is leveraging this Chronic Care Management experience for participation in MACRA.

Physician Chronic Care Management Reimbursement: Roadmap to MIPS Success Under MACRA describes how early adoption of Medicare’s CCM Reimbursement program enhanced the Center’s MACRA-readiness, laying the foundation for success under the Merit-based Incentive Payment System (MIPS) path.

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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.

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.

Infographic: Path Toward Value-Based Care

August 22nd, 2016 by Melanie Matthews

UnitedHealthcare recently recognized more than 1,900 care providers who earned more than $148 million in quality of care bonus payments for achieving performance metrics in the UnitedHealthcare PATH Excellence in Patient Service Awards for their commitment to improving health outcomes for people enrolled in its Medicare Advantage plans, according to a new infographic by UnitedHealthcare.

The infographic examines the components of the PATH program and some of the quality performance measurements and their impact.

A profitable by-product of CMS’s aggressive pursuit of value-based healthcare delivery is a menu of revenue opportunities associated with care management of the Medicare population.

Physician Reimbursement in 2016: 4 Billable Medicare Events to Maximize Care Management Revenue and Results details the ways in which Bon Secours Medical Group (BSMG) leverages a team-based care approach, expanded care access and technology to capitalize on four Medicare billing events: transitional care management, chronic care management, Medicare annual wellness visits and advance care planning.

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