Posts Tagged ‘Value-Based Reimbursement’

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.

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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.

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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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Infographic: Tracking Patient Status for Bundled Payments

August 10th, 2016 by Melanie Matthews

The Centers for Medicare and Medicaid Services is targeting the wide variations in quality and cost of hip and knee replacements (lower extremity joint replacement [LEJR]) through its LEJR bundled payment program launched in April, according to a new infographic by Caradigm.

The infographic examines these quality and cost variations as well as the sites of care where patients typically recover from these surgeries.

Bundled Payments for Post-Acute Care: Profiting from Alternative Payments and Clinical Redesign A desire to position itself at the forefront of healthcare payment reform and be a catalyst for clinical redesign are two factors driving Brooks Rehabilitation's participation in Model 3 of CMS's Bundled Payments for Care Improvement (BPCI) initiative.

Today, having completed more than 1,000 bundled episodes for total hip replacements, total knee replacements and hip fractures, Brooks has reduced cost by 19 percent per episode, lowered readmissions to about 15 percent across its 60-day time frame, registered a patient satisfaction level of 94 percent and documented significant functional improvement.

Bundled Payments for Post-Acute Care: Profiting from Alternative Payments and Clinical Redesign examines the four domains of success of Brooks' Complete Care program supporting the organization's bundled payment clinical outcomes and financial results.

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Infographic: Hospitals and Value-Based Care

June 22nd, 2016 by Melanie Matthews

While healthcare organizations broadly support the goals of value-based reimbursement, there are mixed results in achieving those goals, according to a new survey by HealthCatalyst. Many hospitals have embraced value-based initiatives such as accountable care organizations and bundled payments that reward higher quality care while penalizing low quality but few of those surveyed are faring well against Medicare's goal of tying half its $597 billion in annual payments to value-based care.

A new infographic by HealthCatalyst examines the likelihood of healthcare organizations meeting CMS' value-based reimbursement goal, the percent of healthcare organizations that are currently engaged in risk-based contracts and the importance of analytics in value-based success.

The New Physician Quality Reporting: Positioning Your Practice for MACRA's Merit-Based Incentive Payment System,A new CMS proposed rule would combine several of its existing physician value-based reimbursement programs, including the meaningful use EHR Incentive Program, the Physician Quality Reporting System (PQRS) and the Value-Based Payment Modifier (VBM). This proposal is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which replaced the Sustainable Growth Rate (SGR) formula for physician reimbursement. Under this current proposal, physicians will be reimbursed by Medicare under either the Merit-based Incentive Payment System (MIPS) or Alternative Payment Models (APMs) starting in January 2017. As this reimbursement shift by CMS moves forward, physician practices are re-examining how they report on physician quality. Most practices will opt for the MIPS program based on their current risk-contracting strategies.

During The New Physician Quality Reporting: Positioning Your Practice for MACRA's Merit-Based Incentive Payment System, a 45-minute webinar on July 14th, Eric Levin, director of strategic services, McKesson, will provide a brief MACRA overview and outline where practices need to focus for the remainder of 2016 to avoid reimbursement penalties in 2017 based on the proposed rule.

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Infographic: The Payor/Provider Perspective on the Switch to Value-Based Care

March 28th, 2016 by Melanie Matthews

Healthcare decision-makers are not ready for the switch to value-based healthcare, according to a new infographic by Xerox.

The infographic highlights results from a recent Xerox study on the payor and provider perspective on value-based healthcare.

Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) has awarded $3 million to 51 specialty medical practices as part of a shared savings arrangement through the company's Episodes of Care (EOC) program. The doctors, in five different specialty areas, earned the payments by achieving quality, cost efficiency and patient satisfaction goals in 2014 while treating more than 8,000 Horizon BCBSNJ members. As the largest commercial payor of Episodes of Care in the United States, Horizon BCBSNJ recently reported far lower hospital readmission rates and improved clinical outcomes for members in its EOC practices versus non-EOC practices in 2014.

During Episodes of Care: Improving Clinical Outcomes and Reducing Total Cost of Care Through a Collaborative Payor-Provider Relationship, a March 31, 2016 webinar at 1:30 p.m. Eastern, Lili Brillstein, director of the Horizon EOC program, will share the details behind the health plan's EOC program, from the episodes they have bundled to the goals and results from the program.

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Infographic: Three Essentials for Success Under Value-Based Reimbursement

February 17th, 2016 by Melanie Matthews

Only 24 percent of providers feel their current population health management efforts are mature, but by 2020 75 percent of leading commercial contracts will be value-based, according to a new infographic by Medicity.

The infographic examines three essentials for provider financial and clinical success in value-based reimbursement, as well as details on how organizations measure population health success and the area where organizations struggle most.

Care Coordination in an ACO: Population Health Management from Wellness to End-of-LifeWhen acknowledging its position as a top-ranking Medicare Shared Savings Program (MSSP), Memorial Hermann is quick to credit its own physicians—who in 2007 lobbied for a clinically integrated network that formed the foundation of the current Memorial Hermann accountable care organization (ACO). Now, eight years later, collaboration and integration continue to be the engines driving the ACO's cost savings, reduced utilization and healthy patient engagement rates associated with Memorial Hermann ACO's highest-risk population.

Care Coordination in an ACO: Population Health Management from Wellness to End-of-Life details Memorial Hermann's carefully executed journey to quality and the culmination of the ACO's community-based care management program.

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Infographic: Chronic Care Management Revenue Opportunities

December 9th, 2015 by Melanie Matthews

The value of gaining experience and proficiency with population management and value-based reimbursement is becoming essential as Medicare shifts a greater portion of its payments to these methodologies. Medicare's chronic care management reimbursement codes allow practices to get paid while learning about this new shift and gaining confidence and competence with value-based reimbursement, according to a new infographic by McKesson.

The infographic examines the incidence of chronic conditions among Medicare beneficiaries and the revenue opportunity for practices that bill Medicare under the Chronic Care Management codes.

Starting this past January, Medicare is reimbursing physician practices for select Chronic Care Management (CCM) services not previously eligible for reimbursement, underscoring the vital role of care management in primary care.

Physician Reimbursement for Chronic Care Management: Identifying New Practice Revenue Opportunities offers practical guidance to prepare physician practices to maximize CCM reimbursement in the year ahead.

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