Value based contracts are becoming the norm in the healthcare industry. Whether you agree or not with the structure of these payment models and the impetus behind the advent of the new paradigm, the fact is that they are here to stay. Initial results show successes as well as failures begin at the “first mile” stretch. Studies and research indicate that physician led ACOs are gaining popularity.
By Kirit Pandit, MS, MBA
It is now fairly common knowledge that Care Management (CM) programs have had mixed success in reducing the Per Member Per Month (PMPM) cost for a population. There are many publications that site case studies and compile savings and ROI numbers for care management programs across the country in the last 5 years. The results are all over the place. These research publications conclude that most CM programs that are successful are those that are highly integrated, high touch programs.
In 2009, MCNT piloted projects with Blue Cross Blue Shield and CIGNA to serve as a Patient-Centered Medical Home (PCMH), when the two insurers shifted their focus from episodic care to coordinated care and long-term healing relationships.
By Karen Wagner
By using a predictive modeling tool to identify members at risk of becoming high-cost healthcare users, an oklahoma health plan is reducing per member per month costs while increasing member satisfaction.
Steve Dobbs, former CEO of Hillcrest Medical Center and Vitreos Advisor, shares his insights from their participation in the CMS ACE Demonstration project (acute care episode) for bundled payments.
By Dr. Michael Deegan, Karen Kennedy & Jay Reddy
The Four Phases of Population Health Management Maturity
There’s no question that the American healthcare system is undergoing change at an unprecedented pace. Although past transformations were driven by discoveries in medicine, treatments, and procedures, the current transformation is driven by the need to keep the population healthy. New care models are directed at preventive care, proactive chronic disease care, and utilization management,and are being implemented in conjunction with payment models that incorporate financial risk-taking and incentive management.
By Jay Reddy, BS, MBA
That’s how it feels when you are working very hard and investing millions on population care management programs and the results don’t meet your expectations! Some population care management programs are successful while some are not delivering the expected results. The case study results we are going to share will show you why there are “winners” and “losers” in effective population management programs. We hope that the results we share are not only going to be an “eye-opener” but a “game-changer” as the healthcare providers take on risk for population health.
The Affordable Care Act of 2010 (ACA) opens the door to a wealth of opportunities for hospitals and physician groups. They are beginning to adapt to the new pay-for-performance and bundled payment systems and develop population-based care management programs. While the goal of ACA is to hold hospitals and physicians jointly responsible for quality and cost of care, the new payment models span the entire care continuum, including primary care physicians (PCPs), specialists, hospitals, post-acute care, and re-admissions. The biggest winners will be those who can improve quality of care while driving down the costs. Those that focus first on preventive care for top chronic illnesses will be the first to cross the finish line.