Hitting the Trails: Take a guide on your value-based care journey

Posted by Continuum on Jan 10, 2017 11:00:00 AM

The healthcare payment landscape seems to change every week. Developing a strategy for success is nearly as tough as assessing what alternative payment model (APM) programs you should pursue. Is there a benefit to staying focused on
fee-for-service? Are pay-for-performance models the right path for your organization? How much risk is too much risk for you? New Call-to-action

The good news is there’s no one path to value-based care success. The various programs offer different benefits to healthcare organizations of all types. Understanding the full ecosystem of programs available to you is critical to make sure you start your journey to future success on the right path.

As with any journey, keeping a guide handy is a smart plan. Continuum’s value-based payment experts have developed a new reference to help you make sure you’re on the right track. This infographic, “The Trail Guide to Value-Based Care Success,” offers key insights and reminders about the benefits for various payment programs, common challenges, and tips for making the most of your participation.

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Topics: value-based reimbursement, payment reform

Quality Where it Counts -- Focusing on Care & Patient Satisfaction

Posted by Michael Renzi, DO, FACP on Dec 20, 2016 1:59:00 PM

The amount of change hitting the healthcare industry is enough to make any provider dizzy. For primary care providers especially, implementing and optimizing new workflows and
technology to capture every healthcare dollar you’ve earned can easily make you lose focus on the single most important aspect of your practice: patient satisfaction.

New alternative payment models (APMs) are supposed to refocus patient care by incentivizing for the quality and cost of care delivered. To succeed in the new healthcare world, providers need to ask themselves: how can they help their local healthcare network deliver high quality care to their patients, when and where the patients need it, at the right price? We’ve put together a list of three key factors to help providers—and patients—make the most of APMs.

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Topics: quality of care, patient experience

The Trump Healthcare Market

Posted by Don McDaniel on Dec 13, 2016 11:10:00 AM

What a more capitalist approach to payment reform could uncover in the new administration

The healthcare industry is facing a new kind of unknown with the incoming Trump administration. As President-elect Trump lays out his plans and makes his appointments for key roles, we’re beginning to get more clarity into what we should be able to expect in the coming months and years in terms of how healthcare policy, regulations, and payments may change. 

At this point, the healthcare future is unpredictable. In general, however, I think there are some things that are going to be increasingly important to the state of the healthcare economy.

Here are the four things I'm most interested in watching over the coming months:

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Topics: payment reform, Affordable Care Act, ACA, healthcare policy

Five Essential Population Health Management Tips

Posted by Tim Weldon on Dec 6, 2016 10:30:00 AM

Success in VBC initiatives depends on smart pop health strategies

Population Health Management (PHM) is the buzzword of the moment when it comes to success in value-based care initiatives. There’s a good reason for that – done right, PHM has a strong chance of helping providers realize the goals of the triple aim and generate real revenue to reinvest in their organizations.

Don’t let all of the buzz distract you from reality. As we’ve learned from watching Big Data’s hype cycle, it’s important to focus on how you can make PHM work most effectively for you. It’s becoming clear that simply purchasing a PHM solution isn’t the silver bullet that’s going to deliver success.

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Topics: Practice Transformation, Value-Based Healthcare, population health management, PHM

Straight to the top:  The right kind of “top of credentials”

Posted by Michael Renzi, DO, FACP on Nov 29, 2016 11:02:00 AM

One of the key requirements of VBC success—and one of the components of Industrial Strength medical practices—is the notion of all organizational staff working at the “top of credentials.” The most basic, agreed-upon definition of this idea has its roots in the medical home world, and essentially boils down to this: it’s an effort to offset workflow inefficiencies by getting the existing staff working mostly within their skillset. That seems like common sense, but practices tend to limit what a team member can do based on their certification, rather than what they could do based on their capabilities.

There’s a prerequisite before a practice even starts this top of credentials journey: to get these new tasks done by the right people, the right people need to be in the office in the first place. As practices struggle to maintain financial stability and fight margin erosion, adding more capable (and expensive) staff simply isn’t an economic option. Instead, we’ve got to look to how to increase capacity within the capability confines of the existing team.

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Topics: Patient-Centered Medical Home, PCMH, top of credentials

MACRA Final Rule: 4 Key Changes

Posted by Continuum on Nov 15, 2016 11:15:00 AM

The Centers for Medicare & Medicaid Services (CMS) recently released its final rule for sweeping reimbursement regulations that start on Jan. 1, 2017.
Known as MACRA (the Medicare Access and CHIP Reauthorization Act of 2015), this legislation will have a profound impact on physicians and their practices.

On the plus side, the final rule softens some of the proposed regulations. This easing should help providers comply and thereby support CMS’s goals: to enhance care quality, reduce overall costs of care, and improve patient satisfaction. The best-performing providers will receive the greatest payment increases.

At the same time, eligible Medicare providers who have not yet prepared for MACRA should move quickly. Those who ignore the new reporting requirements completely -- by not submitting data to CMS -- will receive the full 4% payment penalty for 2017, and greater reductions thereafter.

MACRA establishes the Quality Payment Program (QPP), which offers providers a choice between two reporting tracks: the Merit-Based Incentive Payment System (MIPS) or Advanced Alternative Payment Model (Advanced APM).

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Topics: MACRA

What's the better innovation investment—process or technology?

Posted by Don McDaniel on Nov 8, 2016 11:00:00 AM

In our recent white paper, “Industrial Strength,” I mention one of the most interesting and powerful players in the global healthcare landscape, Devi Shetty. In that white paper, we examine the causes of the pre-industrial state of the U.S. healthcare industry, and discuss how we can most effectively repair it. 

One of the biggest factors hindering us is a seeming misunderstanding over the role of innovation, particularly in terms of technology. I’ve talked to so many people who believe that there must be some sort of magic bullet—be it a new platform, new software, or new way of understanding data—that technology will develop to solve all of our problems. I argue that this is the wrong way to think about innovation, and the wrong place to focus our efforts. 

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The medical home model: What physicians need to know

Posted by Continuum on Nov 1, 2016 1:08:19 PM

The concept of a “medical home” has evolved over the years, starting in the 1960s as the center of medical records for a child with special healthcare needs. Today, that definition is greatly expanded: A medical home is a partnership between the patient, family and primary care provider, in cooperation with specialists and community supports, according to the U.S. Department of Health and Human Services. It can encompass children and adults, regardless of their healthcare needs.

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Topics: Value-Based Healthcare, MIPS, APMs

Effective financial incentives drive value-based care (VBC) adoption

Posted by Michael Renzi, DO, FACP on Oct 18, 2016 11:22:00 AM

For years, providers and payers have been at odds with each other. Arguments about reimbursement rates, network inclusion, and claims management created relationships that were, at best, adversarial. The move away from fee for service (FFS) to value-based care (VBC), however, is triggering a shift all its own—new lines of communication are opening between payers and providers. This change is helping control costs and improve how care is delivered.

No matter how you slice it, there’s one clear path to increasing payer satisfaction and provider satisfaction at the same time: increasing the percentage of physician revenue linked to value-based contracts. While there’s critical and wonderful benefits that come along with value based care, such as better quality and outcomes, lower costs, and higher patient satisfaction, the only thing that will make providers adopt new practices is if there’s a strong financial benefit to do so.

Payers should be providing every willing physician with per member per month (PMPM) payments and shared savings, and those PMPM dollars should fund positive innovation in people, technology, and operations. Yet, shared savings programs have two inherent flaws that limit their ability to keep providers focused on the goals of the program: uncertain revenue streams and limited financial potential in terms of FFS revenue. Even a highly successful shared savings program will only yield a few percentage points in top line revenue—meaning that more than 95 percent of revenue is still FFS.

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Topics: Value-Based Healthcare, Alternative Payment Models, payer contracts

Can a hospital build a sustainable, high-performing physician organization?

Posted by Don McDaniel on Oct 11, 2016 11:17:43 AM

Last week, I was at yet another healthcare industry forum focused on value-based care. 

The sessions were decent, but I zeroed in on one session. Pairing a health plan executive and a physician leader – a “how to” on collaboration between health plans and physicians, only the millionth one of these. This one, however, felt different. The plan represented was a big one, (one with that "Indicia"), and the physician leader has been a dynamic champion of changing our broken system. So what was different? The bold transparent representation about the importance of independent physician networks and the now well-documented data that patients seen by non-employed primary care physicians generate lower aggregate growth in medical spending than patients seen by employed physicians in hospital-controlled ecosystems.

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