What is Being Thrown into Your Healthcare Reimbursement Stew: All with a Goal of Care Improvement

Bundled payments, new models of reimbursement, care transitions, value-based reimbursement, readmission penalties, are all part of the jargon in payer and provider circles today.

And there is no lack of opinions on what new or a combination of all is the answer to quality care, cost savings and outcomes results. All approaches come with some risks to providers and financially to payers.

On the eve of the new year, the Centers for Medicare & Medicaid Services (CMS) released the health care organizations selected to participate in  the Bundled Payments for Care Improvement initiative, an innovative new payment model.

“Under the Bundled Payments for Care Improvement initiative,” organizations will enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality, more coordinated care at a lower cost to Medicare,” CMS said. Continue reading

Advertisements

What is Being Thrown into Your Healthcare Reimbursement Stew: All with a Goal of Care Improvement

Bundled payments, new models of reimbursement, care transitions, value-based reimbursement, readmission penalties, are all part of the jargon in payer and provider circles today.

And there is no lack of opinions on what new or a combination of all is the answer to quality care, cost savings and outcomes results. All approaches come with some risks to providers and financially to payers.

On the eve of the new year, the Centers for Medicare & Medicaid Services (CMS) released the health care organizations selected to participate in  the Bundled Payments for Care Improvement initiative, an innovative new payment model.

“Under the Bundled Payments for Care Improvement initiative,” organizations will enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality, more coordinated care at a lower cost to Medicare,” CMS said. Continue reading

Cigna’s Collaborative Care Now Includes Small Physician and Specialist Groups, Hospitals

Cigna said it has expanded its Cigna Collaborative Care to include health care professionals wherever they are in the health care delivery system.

The health insurer said it has developed a new suite of value-based initiatives called Cigna Collaborative Care that builds on the company’s Cigna Collaborative Care (CAC) initiatives.

The CAC is Cigna’s approach to achieving the same population health goals as accountable care organizations (ACOs): better health, affordabilityandexperience. The CACarrangements began first with large physician groups and integrated delivery systems. Now, the CAC expands value-based initiatives to include small physician groups, specialist groups, and hospitals, in addition to large physician groups, officials said.

Besides the large physician practices, the incentive-based Cigna Collaborative Care includes:

————————————————————————————————–

The Guide to Value-Based Reimbursement: Profiting from Payment Bundling, PHO Shared Savings, and Pay for Performance explores emerging models of episode-based payments, physician-hospital organizations and physician bonus structures.

—————————————————————————————————

  • Small physician groups including small private practices and unorganized physician groups. These arrangements represent an opportunity to help the 40 percent of Cigna customers with high-cost conditions and complex needs that are treated by small physician groups.7 Cigna has established arrangements on a pilot basis with small physician groups in select markets.
  • Hospital arrangements designed to promote quality, efficiency and safety for customers seeking hospital care. Research indicates that 25 percent of customers with high-cost conditions or complex needs are treated at a hospital each year.8 To date, Cigna has established arrangements with more than 150 hospitals, and continued development is planned for 2014.
  • Specialist groups focusing on the five specialties that account for 57 percent of medical spending – orthopedics, obstetrics-gynecology, cardiology, gastroenterology and oncology.9 Cigna launched orthopedic and maternity-focused arrangements in 2013, with continued development in 2014.

“The best way to achieve sustainable change in the health care system is to reach all stakeholders through personalized connections,” said Chief Medical Officer Alan M. Muney, M.D.

The CAC “enables us to engage health care professionals and customers in ways that are meaningful to them, which will help drive better health, affordability, and experience, he added”

Cigna said its CAC initiative is aimed at accomplishing the same population

Driving Value-Based Reimbursement with Integrated Care Models

The burgeoning fee-for-value environment is rewarding networks of providers who collaborate and coordinate care, bridging the gap between health systems and physicians and sparking dialog and care compacts between primary care and specialists.

Even top-performing Pioneer ACOs are rethinking the role of specialists in care coordination.

Driving Value-Based Reimbursement with Integrated Care Models, a new report from the Healthcare Intelligence Network, examines WellPoint’s practice transformation effort and the reimbursement models that support it, while providing a framework in which to evaluate the patient-centered medical neighborhood (PCM-N) model.

Julie Schilz, director of care delivery transformation for WellPoint, and Terry McGeeney, MD, MBA, director of BDC Advisors, share their visions for this emerging care experience, from structuring incentives and reimbursement to rewarding high-quality and efficient care to identifying and engaging specialists in a medical home neighborhood.

Learn more about driving value-based reimbursement with integrated care models.

NEWS FACTS: This 45-page resource provides details on the following:

  • Three key practice transformation roles developed by WellPoint that address the critical elements of transformation;
  • How the physician practice transformation program complements WellPoint’s overall reimbursement strategy with fee-for-service and a shared savings component;
  • The Quality Gate for clinical and utilization metrics for WellPoint’s shared savings arrangement;
  • How to identify and engage specialists to participate in a medical neighborhood;
  • How to help physicians understand the link between meaningful use, the patient-centered medical home and medical neighborhoods;
  • Lessons learned in building medical neighborhoods;

and much more.

Learn more about driving value-based reimbursement with integrated care models.

Target Audience: Presidents/CEOs, CFOs, chief operating officers, vice presidents, medical directors, analysts, business development executives, consultants, directors, executive directors, financial/business managers, marketing executives, principals and strategic planning executives.