Focus On Data in Era of Value-Based Models of Reimbursement

“Despite the continued prevalence of the traditional fee for service reimbursement models as the primary method of payment, over time healthcare’s reimbursement will give way to value-based models of reimbursement.”

That prediction made by longtime friend and consultant Russell Foster surrounding the need for accurate data as value-based models of reimbursement continue to emerge has come true.

You know that valued-based reimbursement today is a significant focus. Payer reimbursement strategies are tipping in favor of providers who can deliver the clinical and financial goods. In the mix are bundled payments, shared savings, pay for performance and bonuses.

Payment Bundling, PHO Shared Savings, and Pay for Performance are all in the mix of emerging models of episode-based payments, physician-hospital organizations and physician bonus structures.

One major health payer’s 6,300 enrolled primary care physicians can earn bonus payments across six measure sets — a broad spectrum of measures from clinical and quality measures to prescribing Continue reading

Advertisements

More than 4000 Physicians Now Designated Patient Centered Medical Homes by Blue Cross Blue Shield of Michigan

Some 4,022 primary care doctors, have been designated as patient-centered medical homes for the 2014 program year by Blue Cross Blue Shield of Michigan.

The doctors are members of 1,422 physician practices that combined care for more than 1.2 million BCBSM members in 78 of Michigan’s 83 counties.

The program, in its sixth year, continues to lead the nation in size and cost savings, BCBSM said.

The health plan said it recorded certified savings of $155 million in prevented ER and hospital claims from the first three years of the PCMH designation program.  Savings estimates for year four are expected later this year.

“Data from 2013-2014 shows adult patients in Blue-designated PCMH practices had a 27.5 percent lower rate of hospital stays for certain conditions than non-designated practices,” BCBM said. Continue reading

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

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

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.

 

 

Model of Highly Coordinated Care Begun By Aetna, Baptist Memorial Health Care

Employers and their workers will get access to what is described as highly coordinated care from physicians and facilities in the Baptist Select Health Alliance, under terms of a collaborative care agreement between Aetna and Baptist Memorial Health Care,  Memphis.

Aim of the collaboration is to bring a “new health care model” to Aetna members and introduce Aetna Whole HealthSM, a commercial health care product, officials said.

The Baptist Select Health Alliance is a clinically Continue reading

Are MCOs adequately addressing member satisfaction needs?

Related to the member communication initiatives of MCOs is meeting member\patient satisfaction.

So are health plans addressing patient satisfaction as a top priority?

This is question, from our Managed Care Leadership Survey, stirs strong opinions from providers, payers and others.

For instance: “No. Major carriers are doing just enough to maintain their satisfaction levels. They are also building their own satisfaction surveys to give the impression that they are top notch. A better way would to use a consistent measure like CAHPS to monitor.”

“Yes. New rules and bonus payments”

“No. Too little in the way of real tools, peer to peer assistance”

“No. Growing limits on provider access and increased carveouts are creating growing member dissatisfaction.”

“Yes. Adequately, yes. Meeting expectations, probably not. All depends on the benchmarks one is willing to use to measure member satisfaction.”

Source: Managed Care Information Center