Future Healthcare Payment Models An Overview
|
|
- Hannah Norris
- 5 years ago
- Views:
Transcription
1 Future Healthcare Payment Models An Overview Carter Dredge
2 THERE IS A CRITICAL NEED TO TRANSFORM HEALTHCARE DELIVERY & PAYMENT 2
3 Significant Variation in Population Utilization Spine Surgeries per 1,000 Medicare Enrollees Source: Dartmouth Atlas of Healthcare
4 Significant Variation in Intra-Episode Utilization 4
5 Paying for Medicare Income taxes would have to increase by more than 160% to finance growth at the historical rate of 2.5 percentage points faster than GDP growth, increasing the income tax rate in the top bracket, for example, to 92% from 35%. The Economics of Financing Medicare, New England Journal, July 2011
6 Getting to Affordability Intermountain Healthcare Patient Services Net Revenue in Millions $6,000 Lower Revenue Rate Increases Manage Utilization $5,500 Historical Revenue Growth Trend $5,000 $4,500 $4,000 $3,500 $3,
7 We Have A Number of Options for Payment Reform Reference: APII Public Meeting
8 If I took the liberty to update this today * * ** *** Where we will focus on our discussion Episodic and Global Payment the Clear Winners *Robert Mechanic & Stuart Altman (Health Affairs -2009)
9 Total Cost Per Person Cost = Per X Process Processes Per Episode X Episodes Per Person Examples Cost per Day in a Hospital # of Days in a Hospital A Hospital Stay Incentive Efficiency Intra-Episode Utilization Population Utilization FFS Bundled Global
10 Bundled Payment Cost Example Total Knee Replacement Payment Hospital Inpatient (i.e. DRG pmt) $ 10,500 Hospital Outpatient $ 500 Inpatient Rehab (IRF) - 25% $ 5,000 Skilled Nursing Facility (SNF) 15% $ 1,500 Home Health 25% $ 750 Home 50% $ 500 Part B Professional (i.e. Professional Fee) $ 3,000 All other Part B (i.e. Pharmacy, DME, etc.) $ 300 Total Episode Cost $ 22,050 10
11 Risks and Rewards Risk = Uncertainty of the level of spending and clinical outcomes Risks and rewards go together More risk is not inherently bad, and typically speaking, the larger the risk, the larger the potential reward; managing risk is about influence, control, and scale Two main classifications of risk for healthcare payment: Actuarial Risk: (e.g. someone getting sick) Performance Risk: (e.g. errors, inefficiencies, patient behavior) Payment reform is about shifting performance risk to providers, with the logic that those providers have more control over these risks RISK CASH TRANSFER 11
12 Clinical Evolution Population Needs- Based Care Management, Evidence Based Prevention and Wellness CDS, Continuum of Care Analytics, Transition Management, Predictive Modeling Value improvement benefits flow exclusively to payers Payment model rewards providers for higher value care Registries, Basic Care Management, Population Analytics, EBM Protocols Limited Capability Payment model rewards focus on acute, episodic care Unmanageable risk for providers Independent Physicians and Hospitals- FFS Insurance Company Bears Financial Risk for a Population Care Coordination Fees- PCMH Bundled Case Rates Payment Evolution Population- Based Risk Contracts Health System Bears Financial Risk for a Population
13
14 Barriers to Adopting New Forms of Payment Individual payer initiatives can create first-mover disadvantages Need to reach the tipping point Different episode definitions and a lack of a payment distribution mechanism/network In short Free-riding Not Enough Critical Mass Complexity These Can Be Solved Through Strategic Leadership!
15 In Summary Organizations that want to seriously move to Population Health Management need to do the following key things: Manage the full spectrum of a member s health Accept financial risk to a much broader degree Significantly increase the level of evidence-based high value care provided Engage with patients, clinicians, any many other new partners in new ways Intermountain Healthcare, 2014
16 Retrospective Reconciliation Overview Reference: AHCPII Public Town Hall Hall Meeting
17 Retrospective Reconciliation Thresholds Reference: AHCPII Public Town Hall Meeting
18 Retrospective Reconciliation Gains and Losses Reference: AHCPII Public Town Hall Meeting Reference: AHCPII Public Town Hall Meeting
19 "Because of the way we measure things, it doesn't make sense to do what makes sense. Clayton Christensen
20 Miles Per Gallon 32 Ton-Miles Per Gallon 17 How Do We Measure Success? Source: Greg Poulsen, 2016 Trustee Conference Presentation
21 Population Health Value DME $1 spent on mobility HME potential savings of $17 in fall related costs $1 spent on supplemental O2 therapy potential savings of $10 in avoided COPD complications $1 spent on CPAP therapy potential savings of $7 in obstructive sleep apnea (OSA) complications Source: VGM Spring Meeting (
22 Team-Based Care (i.e. PPC & MHI) Results 13.73% p< Emergency Visits Hospital Admissions 4.15% p< Specialty Visits Laboratory Tests Radiology Tests 2.20% p< PCP Visits Urgent Care Visits % p= % p=0.002 Prescriptions % p= % p< % p< % Change in Utilization Routinized TBC vs. No TBC
23 Team-Based Care (i.e. PPC & MHI) Results All Patients None 1 condition 2 conditions 3 conditions 4 conditions >5 conditions $-115 p=0.008 $-72 p=0.184 $-191 p=0.010 $-285 p=0.025 $-981 p< $-745 p=0.029 PMPY Impact (Delivery System Payments) by # of Chronic Conditions Routinized TBC vs. No TBC $-1349 p=0.060
24 TeleHealth PPC & MHI Continuous Improvement and Analytics Patient Education Health Promo & Wellness New SelectHealth Products Capital Budgeting Pricing / Transparency Building The Bridge Integrated Care Management Regional Alignment Structure Payer Contracts Shared Dec Benefit Design Fee for Service World Evidence Based Medicine Used Evidence Based Medicine Defined Physician Pmt Model Homecare Services Population Health Management World
25 WHY SHOULD WE TRANSFORM HEALTHCARE PAYMENT?
26
27
28
29
30 Thank You! Questions? Carter Dredge
Payment Reform in Support of Population Health Management
Payment Reform in Support of Population Health Management Aligning Forces for Quality Employers - Providers Summit October 25, 2011 Charles Chodroff, MD, MBA, FACP Senior Vice President, Chief Clinical
More informationThe Emergence of Value-Based Care: Present and Future Tense
The Emergence of Value-Based Care: Present and Future Tense Erik Johnson, Vice President for Value-Based Care May 2016 What Is Value-Based Care? While the concept of value-based care has existed for years,
More informationThe Case For Value ACA to MACRA to MIPS
The Case For Value ACA to MACRA to MIPS 2016-2019 Robert E Nesse M.D. Professor of Family Medicine Mayo Medical School Senior Director of Health Care Policy and Payment Reform nesse.robert@mayo.edu What
More informationUsing Analytics To Transform Your ACO
Using Analytics To Transform Your ACO How to Develop Effective Cost Reduction Strategies Presented July 2016 Agenda and Presenter External Forces and Market Response Critical Success Factors Analytics
More informationAAOS MACRA Proposed Rule Summary (Short)
AAOS MACRA Proposed Rule Summary (Short) Merit-Based Incentive Payment System (MIPS), Advanced Alternative Payment Model (APM) Incentive, and Criteria for Physician-Focused Payment Models Ref: CMS-5517-P
More informationEmbracing the Future of Care Delivery: What have we learned?
Embracing the Future of Care Delivery: What have we learned? Robert Nesse, M.D. Senior Advisor for Healthcare Policy and Payment Reform CEO, Mayo Clinic Health System 2010-2015 2014 MFMER slide-1 Fundamental
More informationClinically Integrated Networks and Population Health The next chapter in healthcare
Clinically Integrated Networks and Population Health The next chapter in healthcare M A T T H E W M A T U S I A K, D H S C, F R I P H ( UK) M T ( A S C P ) Health System Challenges While the Uninsured
More informationMedicare payment policy and its impact on program spending
Medicare payment policy and its impact on program spending James E. Mathews, Ph.D. Deputy Director, Medicare Payment Advisory Commission February 8, 2013 Outline of today s presentation Brief background
More informationGENERAL BENEFIT INFORMATION
Authorization Policy The following policy applies to Tufts Health Plan contracted providers rendering outpatient and inpatient services. This policy applies to Commercial 1 products (including Tufts Health
More informationHealthcare Reform and Its Impact on the Care Delivery System
Healthcare Reform and Its Impact on the Care Delivery System Agenda 1) The Era of Healthcare Reform 2) Healthcare Reform and Post-Acute Care 3) Succeeding in the Reform Era: Managing the Continuum of Health
More informationComprehensive Primary Care Payment Calculator User s Guide
1 Comprehensive Primary Care Payment Calculator User s Guide Prepared by Health Data Decisions August 2017 Disclaimer: Information provided in connection with this calculator by FMAHealth and its contributors
More informationGulf Coast and LA HFMA Payer Summit Value-based contracts same healthcare business?
Gulf Coast and LA HFMA Payer Summit Value-based contracts same healthcare business? Richard R. Vath, MD FMOLHS SVP/Chief Clinical Transformation Officer President Health Leaders Network and Medicare ACO
More informationDHCFP. Provider Payment: Trends and Methods in the Massachusetts Health Care System
DHCFP Provider Payment: Trends and Methods in the Massachusetts Health Care System Prepared by Allison Barrett and Timothy Lake, Mathematica Policy Research, Inc. February 2010 Deval L. Patrick, Governor
More informationFUNDS FLOW METHODOLOGY FOR RISK-BASED CONTRACTS
CENTER FOR INDUSTRY TRANSFORMATION MAY 2015 FUNDS FLOW METHODOLOGY FOR RISK-BASED CONTRACTS Authors Amy Bibby Partner, DHG Healthcare amy.bibby@dhgllp.com Matthew Fadel Manager, DHG Healthcare matt.fadel@dhgllp.com
More informationHEALTH POLICY & EDUCATION SERIES
HEALTH POLICY & PAYMENT EDUCATION SERIES Medicare s Bundled Payment Initiatives The information in this document is based off of policy information available as of August 2016. Updated information may
More informationPopulation-Based Healthcare: Structural Models and Options
Population-Based Healthcare: Structural Models and Options George Choriatis, Esq. Rivkin Radler LLP Presented at: Annual Fall Meeting New York State Bar Association Health Law Section Albany, New York
More informationQuarterly Report As of December 31, 2018 and for the three and six months ended December 31, 2018
Quarterly Report As of December 31, 2018 and for the three and six months ended December 31, 2018 Table of Contents Part I: Overview... 1 Part II: Leadership Changes... 1 Part III: Strategic Acquisitions...
More information10/17/2014 Risk-Based Payment Methodologies A National Perspective Art Jones, MD. AccountableCareInstitute.com
10/17/2014 Risk-Based Payment Methodologies A National Perspective Art Jones, MD FQHCs Bridge the Gap in Care Bridge Built and Maintained by FFS Dollars 2 CMMI View of FFS Medicine 3 Accountability High
More informationDELIVERING HIGHER-VALUE MATERNITY CARE
DELIVERING HIGHER-VALUE MATERNITY CARE Designing Alternative Payment Models for Better Care, Lower Spending, and Financially Viable Maternity Care Providers Harold D. Miller President and CEO Center for
More informationReinsurance / Stop-Loss and How You Can t Live Without It In Risk
Reinsurance / Stop-Loss and How You Can t Live Without It In Risk Facilitated by: John P. Schmitt, Ph.D, FASHRM Managing Director Reliance Consulting Group October 13, 2016 = General Session = Introductions
More informationControlling Healthcare Costs through Innovative Methods - Analytics
Controlling Healthcare Costs through Innovative Methods - Analytics 2 What are we seeing? Trend is improving, but still significantly above general inflation 10% 8% 6% 9.0% 9.0% 8.5% 7.5% 6.5% 6.8% 6.2%
More informationLehigh Valley Health Network
Lehigh Valley Health Network Journey to Accountable Care November 19, 2014 Powered by Populytics Lehigh Valley Health Network Fast Facts In Allentown/Bethlehem area, north of Philadelphia Recognized by
More informationThe Health Insurance Market in Virginia. Maureen Dempsey, MD, MSc, ACC, FAAP Anthem Blue Cross and Blue Shield June 8, 2017
The Health Insurance Market in Virginia Maureen Dempsey, MD, MSc, ACC, FAAP Anthem Blue Cross and Blue Shield June 8, 2017 Anthem Inc. at a Glance Broad geographic footprint and customer base ` BCBS plans
More informationCoverage Expansion [Sections 310, 323, 324, 341, 342, 343, 344, and 1701]
Summary of the U.S. House of Representatives Health Reform Bill October 2009 The following summarizes the major hospital and health system provisions included in the U.S. House of Representatives health
More informationClinical Episode Contracting for Commercial Payers January 2019
Clinical Episode Contracting for Commercial Payers January 2019 1 About This Resource Background Bundled payments for care delivery have received significant attention within the Medicare payment program
More informationThe Payment Reform GLOSSARY. Definitions and Explanations of the Terminology Used to Describe Methods of Paying for Healthcare Services.
The Payment Reform GLOSSARY Definitions and Explanations of the Terminology Used to Describe Methods of Paying for Healthcare Services First Edition INTRODUCTION There is growing national recognition that
More informationBuilding a New Payment System: Stakeholder Perspectives on Principles and Elements
Building a New Payment System: Stakeholder Perspectives on Principles and Elements Robert L. Broadway, FHFMA VP of Corporate Strategy, Bethesda Healthcare System, Boynton Beach, FL Chairman, HFMA Presentation
More informationProspective vs. Retrospective. Will Bundled Payment Really Be.. Fee For Service
Fee For Service Episode Based Payment: Are You Ready For Medicare s Next Wave of Provider Payment Reform? Payer Robert Mechanic, MBA The Estes Park Institute January 30, 2012 Hospital Surgeon Specialist
More informationPRINCIPAL ACCOUNTABLE PROVIDER MANUAL
Health Care Payment Improvement Building a healthier future for all Arkansans Arkansas Payment Improvement Initiative Episodes of Care PRINCIPAL ACCOUNTABLE PROVIDER MANUAL Program Overview MPI 6037 1/17
More informationPRINCIPAL ACCOUNTABLE PROVIDER MANUAL
Health Care Payment Improvement Building a healthier future for all Arkansans Arkansas Payment Improvement Initiative Episodes of Care PRINCIPAL ACCOUNTABLE PROVIDER MANUAL Program Overview MPI 6037 1/17
More informationStuart H. Altman. The Changing Health Care System: Economic Forces Pushing States To Become More Involved
The Changing Health Care System: Economic Forces Pushing States To Become More Involved Stuart H. Altman Sol Chaikin Professor of Health Policy The Heller School for Social Policy and Management Brandeis
More informationInvestor Presentation. August 2007
Investor Presentation August 2007 Forward-Looking Statement This presentation should be considered forward-looking and is subject to various risk factors and uncertainties. For more information on those
More informationPROVIDER MANUAL. In the Colorado Access Provider Manual, you will find information about:
In the Colorado Access Provider Manual, you will find information about: Section 1. Colorado Access General Information Section 2. Colorado Access Policies Section 3. Quality Management Section 4. Provider
More informationWASHINGTON RURAL HEALTH ACCESS PRESERVATION. Enabling Rural Hospitals in Washington State To Survive and Thrive
WASHINGTON RURAL HEALTH ACCESS PRESERVATION Enabling Rural s in State To Survive and Thrive Origin and Goals of WRHAP Project WSHA/DOH New Blue H Project Identified issues threatening sustainability of
More informationValue-Based Contracting. Optum Life Sciences March 22, 2018
Value-Based Contracting Optum Life Sciences March 22, 2018 Our vision Better cost controls CREATE networks & products tailored to each market s unique needs and competitive cost structure Maximizing new
More informationAetna s value based payment models aim to pay for value delivered, not services rendered
Aetna s value based payment models aim to pay for value delivered, not services rendered Aetna currently has 22% of spend running through contracts with a value based component. Value Based Contracting
More informationFigure 1: Original APM Framework
Contents Overview... 2 This Year s APM Measurement Effort... 3 Scope... 3 Data Source... 4 The LAN Survey... 4 The Blue Cross Blue Shield Association Survey... 8 The America s Health Insurance Plans Survey...
More informationA Practical Discussion of Value and Quality Based Payments What Do I Do Now?
Emerging Challenges in Primary Care: 2016 A Practical Discussion of Value and Quality Based Payments What Do I Do Now? Modified from AHLA Physicians and Hospitals Law Institute 2016 Faculty Ellie Bane
More informationS E C T I O N. National health care and Medicare spending
S E C T I O N National health care and Medicare spending Chart 6-1. Medicare made up about one-fifth of spending on personal health care in 2002 Total = $1.34 trillion Other private 4% a Medicare 19%
More informationRisk Adjusted Episodes as Benchmarks for ACOs: A Society of Actuaries Sponsored Study
Risk Adjusted Episodes as Benchmarks for ACOs: A Society of Actuaries Sponsored Study Presented by Bill O Brien, FSA, MAAA Consulting Actuary Milliman Houston, TX (832) 878-4078 Preconference I Agenda
More informationP r e p a r i n g f o r G l o b a l P a y m e n t : W h a t Yo u S h o u l d B e D o i n g N o w
P r e p a r i n g f o r G l o b a l P a y m e n t : W h a t Yo u S h o u l d B e D o i n g N o w Peter R. Epp, CPA Managing Director May 9, 2013 O V E R V I E W Commonwealth s Payment Reform Overview and
More informationMarket Driven Health Care Reform in Maine: the Health Care System and
Market Driven Health Care Reform in Maine: How Market Principles can Improve the Health Care System and Why Maine is Leading the Country Elizabeth Mitchell CEO Maine Health Management Coalition www.mhmc.info
More informationHow Health Reform Saves Consumers and Taxpayers Money
How Health Reform Saves Consumers and Taxpayers Money The Affordable Care Act Lowers Costs and Improves Quality June Health reform s three major goals insurance reform, affordable coverage, and slower
More informationAdvanced Analytics. The key to unlocking the Triple Aim and Value-Based Purchasing. Ines Vigil MD, MPH, MBA
Advanced Analytics The key to unlocking the Triple Aim and Value-Based Purchasing Ines Vigil MD, MPH, MBA Advanced Analytics: The key to unlocking the Triple Aim and Value-Based Purchasing Current State
More informationConfiguration of Network and Financial Management Systems to Support Multiple Value Based Reimbursement Models
Configuration of Network and Financial Management Systems to Support Multiple Value Based Reimbursement Models Kristina Rollings Product Director, Emerging Solutions March 24, 2014 Agenda 1. State of the
More information04/12/2016 C H A L L E N G E S F A C I N G U N I T E D S T A T E S H E A L T H C A R E S Y S T E M
M I C H A E L J. S E E L, M. D. I M P L E M E N T I N G C H A L L E N G E S F A C I N G U N I T E D S T A T E S H E A L T H C A R E S Y S T E M Emphasis on Health care, not Health Fragmented Delivery and
More informationToday s Payers and Providers
Today s Payers and Providers Strategies for Success Emad Rizk, MD President and Chief Executive Officer Accretive Health Session Objectives Description of value based models in the market Data elements
More informationRisky Business: Crystal Run Health Plans. Michelle A. Koury, MD Jonathan Nasser, MD Crystal Run Healthcare
Risky Business: Crystal Run Health Plans Michelle A. Koury, MD Jonathan Nasser, MD Crystal Run Healthcare About Crystal Run Healthcare Physician owned MSG in NY State, founded 1996 >350 providers, >30
More informationGenesis HealthCare. A Leading National Provider of Post-Acute Services. August 2015
Genesis HealthCare A Leading National Provider of Post-Acute Services August 2015 Safe Harbor Statement Certain statements in this presentation regarding the expected benefits of the Skilled Healthcare
More informationINFORMATION ABOUT YOUR OXFORD COVERAGE
OXFORD HEALTH PLANS (CT), INC. INFORMATION ABOUT YOUR OXFORD COVERAGE PART I. REIMBURSEMENT Overview of Provider Reimbursement Methodologies Generally, Oxford pays Network Providers on a fee-for-service
More informationPATH TOWARD PAYMENTS THAT REWARD VALUE
PATH TOWARD PAYMENTS THAT REWARD VALUE David Muhlestein, PhD JD Chief Research Officer Leavitt Partners @DavidMuhlestein December 18, 2017 1 PRESENTATION OVERVIEW 1. Current Trends 2. Are ACOs Delivering
More informationTHE $10,000 QUESTION: TACKLING THE COMPLEXITIES OF VALUE-BASED PHYSICIAN COMPENSATION
THE $10,000 QUESTION: TACKLING THE COMPLEXITIES OF VALUE-BASED PHYSICIAN COMPENSATION HFMA First Illinois Chapter August 12, 2014 Stu Schaff Manager, DGA Partners Agenda > Background & Context > Measures
More information2015 Benefits Overview
2015 Benefits Overview ASPIRE HEALTH ADVANTAGE VALUE (HMO) BENEFIT Monthly Plan Premium Out-of-Pocket Limit (In-Network Medicare-covered benefits) Annual Part C Deductible (all services except for Prescription
More informationRetirees with Medicare (RETIREMENT DATE ON or AFTER March 1, 2015) Benefits Comparison Benefits effective January 1, December 31, 2017
Pelican HRA1000 Magnolia Local Plus Network Blue Cross and Blue Shield of Louisiana Preferred Care Providers & Blue Cross National Providers Blue Cross and Blue Shield of Louisiana Preferred Care Providers
More informationOpportunities for Orthopedic Specialists in BPCI Advanced
Opportunities for Orthopedic Specialists in BPCI Advanced January 13 th, 2018 Introduction CMS announced the voluntary Bundled Payment for Care Improvement (BPCI) Advanced program on Tuesday, Jan 9 th
More informationAuthorizations & Notifications
6 Medical Authorizations & Notifications OVERVIEW Health Choice Generations is confident that our Primary Care Physicians are capable of providing the majority of medically necessary services to the patients
More informationValue-Based Reimbursement Contracting: Strategies for Payer-Provider Success
Value-Based Reimbursement Contracting: Strategies for Payer-Provider Success Presented by: Jim Wright Vice President, xg Health Solutions Agenda Key Considerations for Value Based Contracting Keys for
More informationCREATING A PHYSICIAN-LED HEALTHCARE FUTURE Better Care for Patients, Lower Healthcare Spending, & Financially Viable Physician Practices
CREATING A PHYSICIAN-LED HEALTHCARE FUTURE Better Care for Patients, Lower Healthcare Spending, & Financially Viable Physician Practices Harold D. Miller President and CEO Center for Healthcare Quality
More informationRewarding High Quality: Practical Models for Value- Based Physician Payment
Rewarding High Quality: Practical Models for Value- Based Physician Payment Introduction In its 2013 report, Moving Beyond Fee-for-Service, the Alliance of Community Health Plans (ACHP) addressed the increasing
More informationACO Benchmarks and Financial Success SOA Sponsored Research
ACO Benchmarks and Financial Success SOA Sponsored Research Presented by: Rong Yi, PhD Milliman, New York City 6 th National Predictive Modeling Summit December 6, 2012 DISCLAIMER The research project
More information31 Flavors of Risk: Effectively Making the Transition to Value- Based Care. November 2013
31 Flavors of Risk: Effectively Making the Transition to Value- Based Care November 2013 1 Objectives Understand the Bigger Picture Define the Flavors of Risk Understand Key Capabilities, Benefits, & Challenges
More informationLeveraging New Business Models to Improve Value
Leveraging New Business Models to Improve Value Kenneth Kaufman, Kaufman Hall June 24, 2014 Today s Agenda 1. The Macro Economic Issues Driving Real Change in Healthcare 2. The Statistical Picture 3. The
More informationMaryland Health Services Cost Review Commission (HSCRC) Global Budget Revenue (GBR) under the Maryland All-Payer Model
Maryland Health Services Cost Review Commission (HSCRC) Global Budget Revenue (GBR) under the Maryland All-Payer Model January 19, 2018 1 Goals of Today s Discussion Overview of Maryland s unique healthcare
More informationHealthcare Finance Trends and Perspectives
Healthcare Finance Trends and Perspectives AONE Annual Conference, Fort Worth, TX April 2 nd, 2016 Chuck Alsdurf, MAcc, CPA Director, Healthcare Finance Policy, Operational Initiatives Healthcare Financial
More informationIntroduction to the Centers for Medicare & Medicaid Services (CMS) Payment Process
Introduction to the Centers for Medicare & Medicaid Services (CMS) Payment Process Thomas Barker, Foley Hoag LLP tbarker@foleyhoag.com (202) 261-7310 October 1, 2009 Overview Medicare Basics Paths to Medicare
More informationCardiac Bundle (AMI, CABG, and SHFFT), CR and ACO Track 1+ January 11, 2017
To Dial-in: 877.668.4490 or 408.792.6300 Event Number: 669 367 723 Cardiac Bundle (AMI, CABG, and SHFFT), CR and ACO Track 1+ January 11, 2017 CMS Final Rule and Materials Advancing Care Coordination through
More informationSummary of Benefits. SelectHealth Advantage Essential Clark County
Summary of Benefits SelectHealth Advantage Essential Clark County 1 Our Plan. Your Advantage. SelectHealth Advantage offers: >> $0 monthly premium >> $0 medical deductible >> for all Medicare-covered preventive
More informationMANAGED CARE READINESS TOOLKIT
MANAGED CARE READINESS TOOLKIT Please note: The following managed care definitions reflect a general understanding of the terms. It will be important to read managed care contracts very carefully as they
More informationWhen the Dust Settles-What s Next?
When the Dust Settles-What s Next? AMA IPPS Conference Robert Nesse M.D. Senior Director of Payment Reform Mayo Clinic nesse.robert@mayo.edu What is Driving the Change in Healthcare? Common Belief: The
More informationthan value. infrastructure for value-based payment, it is apparent that greater assumption of
EXECUTIVE BRIEFING Value-Based Contracting: How to Think Like a Payer It is widely recognized that the rate of healthcare spending in the U.S. is unsustainable. In recent years, experts of all types, from
More informationSome of the services this plan doesn t cover are listed on page 5. See your policy Yes plan doesn t cover?
Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual Plan Type: Network This is only a summary. If you want more detail about your coverage and costs, you can
More informationConnecting Risk, Severity, and Quality in Healthcare Measurement and Management. American College of Medical Quality October 29, 2009
Connecting Risk, Severity, and Quality in Healthcare Measurement and Management American College of Medical Quality October 29, 2009 1 Your presenters Greger Vigen, FSA MBA. Consulting Actuary, Los Angeles
More informationA Guide to Medicare s s Financial Challenges and Options for Improvement
A Guide to Medicare s s Financial Challenges and Options for Improvement December 12, 2011 December 2011 Notes for speakers: Presentation of the full slide deck will take approximately 25 to 30 minutes,
More informationPROVIDER MANUAL. In the Colorado Access Provider Manual, you will find information about:
In the Colorado Access Provider Manual, you will find information about: Section 1. Colorado Access General Information Section 2. Colorado Access Policies Section 3. Quality Management Section 4. Provider
More informationJ.P. Morgan 35 th Annual Healthcare Conference. DRAFT 01/04/17 1p
J.P. Morgan 35 th Annual Healthcare Conference DRAFT 01/04/17 1p Forward-Looking Statements This presentation includes forward-looking statements within the meaning of Section 27A of the Securities Act
More information2016 Benefits Overview
2016 Benefits Overview ASPIRE HEALTH ADVANTAGE VALUE (HMO) BENEFIT Monthly Plan Premium Out-of-Pocket Limit (In-Network Medicare-covered benefits) Annual Part C Deductible (all services except for Prescription
More informationVolume to Value The Great Transformation of American Medicine
Volume to Value The Great Transformation of American Medicine 2010-2020 Richard I. Fogel, MD FHRS Chief Clinical Officer St. Vincent Health October 2015 Fee for Service You get paid for what you do The
More informationIndividual Insurance
Health Insurance Health Insurance against loss by illness or bodily injury. Health Insurance provides coverage for medicine, visits to the doctor or emergency room, hospital stays and other medical expenses.
More informationUNDER AGE 65 HEALTH PLANS FOR PARTICIPANTS. Kern County 2019 Retiree
Kern County 2019 Retiree HEALTH PLANS FOR PARTICIPANTS UNDER AGE 65 For current participating physician information, please contact each plan directly. This summary is for information purposes only. Members
More informationRetirees with Medicare (RETIREMENT DATE BEFORE March 1, 2015) Benefits Comparison Benefits effective January 1, December 31, 2017
Network Eligible OGB Members Pelican HRA1000 Blue Cross and Blue Shield of Louisiana Preferred Care Providers & Blue Cross National Providers (retirement date BEFORE 3/1/2015) Magnolia Local Plus Blue
More informationAffordable Care Act Update: Implementing Medicare Costs Savings
Affordable Care Act Update: Implementing Medicare Costs Savings This new law recognizes that Medicare isn t just something that you re entitled to when you reach 65; it s something that you ve earned.
More information(C) MERCER MERCER
OVERVIEW OF MLTSS CAPITATION RATE DEVELOPMENT METHODOLOGY (C) MERCER 2015 0 MERCER 2015 0 C A P I T A T I O N R A T E S E T T I N G O B J E C T I V E S Develop a payment structure that will best match
More informationThis is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.networkhealth.com/benefits/sbc/individualpolicy.pdf or
More informationAligning health plans and providers: Working together to control costs
Aligning health plans and providers: Working together to control costs US health care costs continue to rise more rapidly than is sustainable. Health care spending was $3.2 trillion in 2015, a 5.3% increase
More informationBasics of Medicare Coverage and Payment. Tom Ault Health Policy Alternatives April 20, 2007
Basics of Medicare Coverage and Payment Tom Ault Health Policy Alternatives April 20, 2007 Two Pathways for Medicare Coverage Decisions National coverage decisions (NCDs( NCDs) Developed by CMS Only 10%
More informationANALYSIS OF THE IMPLEMENTATION OF THE VIRGINIA MEDICAL FEE SCHEDULES EFFECTIVE JANUARY 1, 2018
NCCI estimates that the implementation of Virginia s Medical Fee Schedules (MFS) in accordance with House Bill (HB) 378, effective January 1, 2018, will result in an overall impact of 1.9% on workers compensation
More informationClinic Comparison Reporting. June 30, 2016
Clinic Comparison Reporting June 30, 2016 Agenda Introduction and Background Meredith Roberts Tomasi, Q Corp Program Director Measures, Methodology and Reports Doug Rupp, Q Corp Senior Analyst Application
More informationA Guide to Medicare s s Financial Challenges and Options for Improvement. May 22, 2012 *updated*
A Guide to Medicare s s Financial Challenges and Options for Improvement May 22, 2012 *updated* May 2012 American Academy of Actuaries American Academy of Actuaries 17,000-member professional association
More informationFrequently Asked & Answered Questions NY Health and Medicare
Frequently Asked & Answered Questions NY Health and Medicare Pending state legislation known as NY Health would ensure that ALL New Yorkers have comprehensive insurance coverage through a single payer
More informationBending the HealthCare Cost Curve: Challenges and Opportunities
Bending the HealthCare Cost Curve: Challenges and Opportunities Cathy Schoen Senior Scholar, NYAM Also see Background Chart Pack - Online Presentation to National Conference of State Legislatures Chicago
More information1199SEIU National Benefit Fund Summary of Benefits and Coverage: What This Plan Covers and What It Costs
1199SEIU National Benefit Fund Summary of Benefits and Coverage: What This Plan Covers and What It Costs Coverage Period: Beginning 04/01/2014 Coverage for: Wage Classes I & II and Early Retirees with
More informationEvidence-Based Program Reimbursement Strategies. Timothy P. McNeill, RN, MPH
Evidence-Based Program Reimbursement Strategies Timothy P. McNeill, RN, MPH 1 Medicare & Value Based Purchasing 2 Medicare Advantage Changes 3 DSMT Requirements 4 CDSME Tip Sheet Opportunities for EB Programs
More informationPRACTICE TRANSFORMATION. Moving Towards A Future of Team Based Care. Michael A. Kolber, PhD, MD
PRACTICE TRANSFORMATION Moving Towards A Future of Team Based Care Michael A. Kolber, PhD, MD 1 2 Financial Disclosures: None Thomas Cole, The Voyage of Life: Childhood 4 Medicare Passed into Law 1965
More informationSummary of Benefits. Custom PPO Combined Deductible /60. City of Reedley Effective January 1, 2018 PPO Benefit Plan
Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits Custom PPO Combined Deductible 35-500 80/60 City of Reedley Effective January 1, 2018 PPO Benefit Plan
More informationThe Value of Health Plan Networks January 28 th, 2016
The Texas Association of Health Plans The Value of Health Plan Networks January 28 th, 2016 JAMIE DUDENSING, CEO The Texas Association of Health Plans The Texas Association of Health Plans (TAHP) is the
More informationTotal Health Care USA, Inc.: Total Saver Complete Summary of Benefits and Coverage: What this Plan Covers & What it Costs
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.thcmi.com or by calling 1-800-826-2862 Important Questions
More informationMerit-Based Incentive Payment System (MIPS): Knee Arthroplasty Measure. Measure Information Form 2019 Performance Period
Merit-Based Incentive Payment System (MIPS): Knee Arthroplasty Measure Measure Information Form 2019 Performance Period 1 Table of Contents 1.0 Introduction... 3 1.1 Measure Name... 3 1.2 Measure Description...
More informationControlling Health Care Spending Growth. Michael Chernew Oct 11, 2012
Controlling Health Care Spending Growth Are new payment strategies the solution Michael Chernew Oct 11, 2012 Definitional issues matter Definition of spending Cost per service [i.e. Price] Spending per
More informationMCHO Informational Series
MCHO Informational Series Glossary of Health Insurance & Medical Terminology How to use this glossary This glossary has many commonly used terms, but isn t a full list. These glossary terms and definitions
More informationMerit-Based Incentive Payment System (MIPS): ST-Elevation Myocardial Infarction (STEMI) with Percutaneous Coronary Intervention (PCI) Measure
Merit-Based Incentive Payment System (MIPS): ST-Elevation Myocardial Infarction (STEMI) with Percutaneous Coronary Intervention (PCI) Measure Measure Information Form 2019 Performance Period 1 Table of
More information