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Infographic: Digital Patient-Provider Connections Critical to Value-Based Care

You’re collecting information about your patient’s health, but what are you doing with it? Does it sit—disconnected—in your digital systems? Or does it travel seamlessly between them?

A new infographic by UbiCare shows how hospitals and patients efficiently form a meaningful relationship and why digital connections and education are essential to value-based care.

2016 Healthcare Benchmarks: Digital HealthDigital health, also referred to as ‘connected health,’ leverages technology to help identify, track and manage health problems and challenges faced by patients. Person-centric health management is slowly acknowledging the device-driven lives of patients and health plan members and incorporating these tools into care delivery and management efforts.

2016 Healthcare Benchmarks: Digital Health examines program goals, platforms, components, development strategies, target populations and health conditions, patient engagement metrics, results and challenges reported by healthcare organizations responding to the February 2016 Digital Health survey by the Healthcare Intelligence Network.

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Infographic: Medicare ACO Road Map

Provider participation in accountable care organizations (ACOs) is becoming the new normal. As of January 1, 2016, there were 434 ACOs in the Medicare Shared Savings Program. More than 160,000 providers now participate in an MSSP ACO. These organizations now serve 7.7 million Medicare beneficiaries residing in 49 of the 50 states, according to a new infographic by PYA.

The infographic provides a road map to the MSSP destination of shared savings.

With the nation’s leading accountable care organizations already testing the waters with CMS’ newest value-based reimbursement opportunity, the Next Generation Accountable Care Organization Model, healthcare organizations are evaluating how this new opportunity aligns with their value-based contracting strategy. With a looming application deadline for a 2017 start for the next round of Next Generation ACOs, the clock is ticking. And, with one approved Next Generation ACO, River Health ACO, already departing the program effective February 1st, the “Go-No Go” decision has become even more critical.

During Next Generation ACO: An Organizational Readiness Assessment, a 60-minute webinar on April 5, 2016, now available for replay, Healthcare Strategy Group’s Travis Ansel, senior manager of strategic services, and Walter Hankwitz, senior accountable care advisor, will provide a value-based, risk contract roadmap to determine organizational readiness for participation in the Next Generation ACO Model in particular and in risk-based contracts in general.

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Horizon Episodes of Care Program Prototype for Value-Based Specialty Care and Reimbursement

Horizon BCBS-NJ's Episodes of Care program engages specialists across a suite of nine episodes.

Imagine a value-based healthcare payment model in which the sole financial hazard to specialist providers is the risk of amassing additional revenue.

Further, envision a scenario in which these specialists are invited to design their payment program, from the model’s intent to key quality metrics.

Those are some highlights of Horizon Blue Cross Blue Shield of New Jersey’s Episodes of Care (EOC) program, a value-based model designed to focus specialists on the provision of quality- and value-based care across nine separate episodes, from joint replacement to hysterectomy to oncology.

Hailed as a national leader in advancing the episodes model as a prototype for value-based specialty care, Horizon is careful to distinguish its EOC program from a bundled payment initiative, for two key reasons.

“First, our EOC program is a quality-based program; it’s not only about the payment or payment structure,” explained Lili Brillstein, director of the Horizon Episodes of Care program during a recent webinar, Episodes of Care: Improving Clinical Outcomes and Reducing Total Cost of Care Through a Collaborative Payor-Provider Relationship.

Secondly, bundled payments typically refer to a prospective model in which a bundled amount of money is paid to a provider or group of providers in advance of services being delivered, while Horizon’s retrospective model pays providers after services have been provided.

The upside-only nature of Horizon’s retrospective model contributes to the program’s collaborative nature, Ms. Brillstein added. “If the metrics are met, savings are shared. If the metrics are not met, we’re not punishing our partners.”

There is other evidence of collaboration and of Horizon’s desire to see the providers succeed in the EOC program. One example is the payor’s use of case mix-adjusted budgets at the practice level rather than the prevalent member-specific risk-adjusted budgets. “This budgeting allows Horizon to create an opportunity for providers to move the needle [on a metric], and benefit from that. The opportunity for cost savings and shared savings also is dramatically improved.”

Another case in point is Horizon’s invitation to prospective providers to talk through the episode’s construct, intent and design prior to its launch.

Horizon’s engagement of providers in the EOC program has “changed the spirit of the relationships between the payor and the provider,” Ms. Brillstein noted. “It’s like nothing I’ve ever seen before. Our provider partners have become our ambassadors for the program.”

Select EOC results presented during the webinar indicated that outcomes are better for EOC partners—in the area of reduced readmissions, for example—than they are for physicians not in the EOC program.

Horizon expects to launch at least three more episodes in 2016, including a Crohn’s Disease episode that will take into account behavioral health services for those members. While the payor fully expects to move to a prospective model, it believes its current EOC model is preparing them for that eventuality, softening the transition from fee for service to prospective payments.

“[That transition] doesn’t just happen. You don’t sign the paper, and suddenly know what to do. It is an evolutionary transformative process,” concluded Ms. Brillstein.

Click here to listen to an interview with Lili Brillstein: Horizon BCBSNJ Episodes of Care: No-Risk Retrospective Model Paves Way for Value-Based Migration

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Infographic: Prescription Drug Spending Trends

Infographic: Prescription Drug Spending Trends

Wednesday, April 20th, 2016
This post was written by Melanie Matthews

Prescription drug spending rose sharply in 2014, driven by growth in expenditures on specialty drugs, including medications to treat cancer and hepatitis C. Medicare’s spending on prescription pharmaceuticals also has risen, largely due to the addition of the Medicare prescription drug benefit in 2006: between 2004 and 2014, the program’s share of U.S. drug expenditures increased from 2 percent of $193 billion to 29 percent of $298 billion.

A new infographic by Visualizing Health Policy from the Kaiser Family Foundation spotlights these and other national spending trends on prescription drugs and the public’s views on pharmaceutical prices.

What’s the cost of medication non-adherence? As high as $290 billion annually, according to one frequently cited estimate. An equally bitter pill to swallow is the dismal C+ grade in medication adherence earned in 2013 by Americans with chronic medical conditions, according to the first National Report Card on Adherence from the National Community Pharmacists Association (NCPA).

Fortunately, the healthcare industry is striving to improve performance in this area. 42 Metrics for Improving Medication Adherence: Interventions, Impacts and Technologies provides convincing evidence of the impact of nine key interventions on medication non-adherence—from the presence of pharmacists in patient-centered medical homes to medication reconciliation conducted during home visits.

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Tags: cost of prescriptions, Prescription Drugs, prescription spending

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Infographic: Countdown to the Merit-Based Incentive Payment System

Infographic: Countdown to the Merit-Based Incentive Payment System

Monday, April 18th, 2016
This post was written by Melanie Matthews

The Merit-Based Incentive Payment System (MIPS) was created by the Medicare Access and CHIP Reauthorization Act of 2015 to streamline several of CMS’s value-based programs including Meaningful Use, Physician Quality Reporting and Value-Based Modifier.

An infographic by SA Ignite highlights the basics on MIPS including eligibility, scoring, financial impact, qualifications, and exemptions.

One year after the Centers for Medicare and Medicaid Services began reimbursing physician practices for chronic care management services, Bon Secours Medical Group is now comfortable with the CCM reimbursement requirements and is reporting that it’s unique approach to this revenue opportunity is ramping up nicely. And, the organization’s approach to chronic care management reimbursement is helping to position itself for advance care planning as a new billable CMS event in the upcoming year.

During Physician Reimbursement in 2016: Workflow Optimization for Chronic Care Management and Advance Care Planning, a January 26th webinar, now available for replay, Robert Fortini, PNP, chief clinical officer for Bon Secours Medical Group, will provide an inside look at his organization’s experience with CMS’ chronic care management reimbursement this year and how they are leveraging this experience for CMS’ newest billable event in 2016—advance care planning.

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Tags: Meaningful Use, Merit-Based Incentive Payment System, MIPS, Physician Quality Reporting System, Value-Based Modifier

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