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GE Healthcare Camden Group Insights Blog

The Move from Volume to Value: Now is the Time for Change

Posted by Matthew Smith on Jun 2, 2016 12:19:54 PM

By Daniel J. Marino, MBA, MHA, Executive Vice President, GE Healthcare Camden Group

Healthcare delivery (and physician reimbursement specifically) is undergoing unprecedented transformation. While most physician practices still operate largely in a fee-for-service ("FFS") world, government and commercial payers alike have signified their intent to reimburse physicians and other providers based on value.

Thriving in an Uncertain World

Many physicians recognize that the FFS system is imperfect at best, but the evolving value-based reimbursement system is ill-defined, leaving physicians facing a great deal of uncertainty. During this time of uncertainty, medical practices have opportunities to improve performance and position themselves for success in the rapidly changing healthcare market. It is natural to begin focusing on clinical measures and outcomes as a means for proving value, but it is just as important to remain financially viable during the transition. By understanding the structures of evolving reimbursement methodologies, changing health plan dynamics, and developing market trends, we can thrive in this uncertain world.

The Department of Health and Human Services’ (HHS) is actively involved in the fundamental shift in reimbursement, moving from volume to value in Medicare payments, reinforcing the shift to value-based care. Organizations that begin to incorporate strategies around the “value proposition” will be in the best position to meet industry demands for value-based reimbursement. This will require a dedicated strategic “call to action” across organizations and their provider community.

Controlling the Momentum of Change

There remains a fundamental question regarding how quick an organization should move to value-based care and controlling the momentum of change. Although some of the drivers are market dependent, others are based on embracing key concepts around the “triple-aim principles” and preparing the organization for the future. High-performing organizations are building their clinically integrated networks, forming ACOs, and incorporating reimbursement programs around bundled payments and minimal risk-based contracts, while still reaping some opportunities from the current fee-for-service contracts. 

The transition into value-based care is a paradigm shift of culture, care model redesign, reimbursement, and quality outcomes that takes time. Organizations that begin to plot the “value-based care” path now, while fee-for-service is still their predominant reimbursement, will be in the best position to refine their care delivery models and protect their revenue streams. It will come down to embracing the concepts of patient-centered care while focusing on improving access and reducing the cost curve. Health systems must begin to squeeze operating costs out of the system and incorporate patient-centered care models focusing on an “ambulatory-focused” model of care that carefully manages transitions across the continuum.

Balancing Risk

Many commercial payers in some markets have already begun the transition, with many more to follow.  A strong value proposition along with creating the patient-centered strategy is key to finding the right “change momentum” for your organization. Focusing on providing the value proposition, engaging physicians to lead the care redesign, and incorporating programs such as bundled payments and shared savings help to make sure organizations appropriately embrace the pace of change within their market. It also ensures the organization can maintain a steady forward pace by balancing appropriate risk with solid potential for clinical and financial gains.

Volume to Value


Marino_Dan.jpgMr. Marino is an executive vice president with GE Healthcare Camden Group with more than 25 years of experience in the healthcare field. Mr. Marino specializes in shaping strategic initiatives for healthcare organizations and senior healthcare leaders in key areas such as population health management, clinical integration, physician alignment, and health information technology. With a comprehensive background in all aspects of practice management and hospital/physician alignment, Mr. Marino is a nationally acknowledged innovator in the development of Accountable Care Organizations and clinical integration programs. He may be reached at daniel.marino@ge.com.
 

Topics: HHS, Bundled Payments, Department of Health and Human Services, Value-Based Reimbursement, Value-Based Care, Daniel J. Marino

Moving from Volume to Value: The Time for Change is at Hand

Posted by Matthew Smith on Jan 28, 2015 4:24:00 PM

By Daniel J. Marino, MBA, MHA
Senior Vice President, The Camden Group

volume valueThe Department of Health and Human Services’ (HHS) press release on Monday announcing its fundamental shift in reimbursement, moving from volume to value in Medicare payments, reinforced the shift to value-based care. As discussed in our “Top Ten Healthcare Trends to Watch in 2015,” organizations that begin to incorporate strategies around the “value proposition” will be in the best position to meet industry demands for value-based reimbursement. This will require a dedicated strategic “call to action” across organizations and their provider community.

Even with the HHS announcement, there remains a fundamental question regarding how quick an organization should move to value-based care and controlling the momentum of change. Although some of the drivers are market dependent, others are based on embracing key concepts around the “triple-aim principles” and preparing the organization for the future. High-performing organizations are building their clinically integrated networks, forming ACOs, and incorporating reimbursement programs around bundled payments and minimal risk-based contracts, while still reaping some opportunities from the current fee-for-service contracts. 

The transition into value-based care is a paradigm shift of culture, care model redesign, reimbursement, and quality outcomes that takes time. Organizations that begin to plot the “value-based care” path now, while fee-for-service is still their predominant reimbursement, will be in the best position to refine their care delivery models and protect their revenue streams. It will come down to embracing the concepts of patient-centered care while focusing on improving access and reducing the cost curve. Health systems must begin to squeeze operating costs out of the system and incorporate patient-centered care models focusing on an “ambulatory-focused” model of care that carefully manages transitions across the continuum.

HHS will begin to set clear goals and a timeline that guide their movement from fee-for-service to fee-for-value for Medicare reimbursement. Many commercial payers in some markets have already begun the transition, with many more to follow.  A strong value proposition along with creating the patient-centered strategy is key to finding the right “change momentum” for your organization. Focusing on providing the value proposition, engaging physicians to lead the care redesign, and incorporating programs such as bundled payments and shared savings help to make sure organizations appropriately embrace the pace of change within their market. It also ensures the organization can maintain a steady forward pace by balancing appropriate risk with solid potential for clinical and financial gains.

Daniel J. Marino, The Camden GroupMr. Marino is a senior vice president with The Camden Group with more than 25 years of experience in the healthcare field. Mr. Marino specializes in shaping strategic initiatives for healthcare organizations and senior healthcare leaders in key areas such as population health management, clinical integration, physician alignment, and health information technology. He may be reached at dmarino@thecamdengroup.com or 312-775-1701.

Topics: HHS, Bundled Payments, Department of Health and Human Services, Value-Based Reimbursement, Value-Based Care, Daniel J. Marino

CMS Proposes Major CEHRT Revision for 2014 Meaningful Use

Posted by Matthew Smith on May 20, 2014 4:55:00 PM

HHS, Health and Human ServicesEligible professionals and hospitals will have greater flexibility in demonstrating meaningful use in the 2014 reporting year based on a rule proposed by the Department of Health & Human Services (HHS).

In a joint statement, the two federal agencies overseeing the EHR Incentive Programs — the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) — have indicated that providers would be allowed to use either 2011 Edition certified EHR technology (CEHRT) or a combination of 2011 and 2014 Editions CEHRT for their EHR reporting period in 2014 for both EHR Incentive Programs. However, in 2015 all eligible providers will be required to use technology certified under the 2014 Edition criteria.

The proposed rule should offer relief to eligible providers struggling to implement 2014 Edition CEHRT. CMS went as far as providing a meaningful use hardship exception for physicians and hospitals finding themselves in that predicament.

“Increasing the adoption of EHRs is key to improving the nation’s health care system and the steps we are taking today will give new options to those who, through no fault of their own, have been unable to get the new 2014 Edition technology, including those at high risk, such as smaller providers and rural hospitals,” National Coordinator Karen DeSalvo, MD, MPH, MSc, said in a public statement.

CEHRT, Meaningful Use, CMS

The proposed rule also includes a provision to extend Stage 2 through 2016 and begin Stage 3 in 2017.

“We have seen tremendous participation in the EHR Incentive Programs since they began,” CMS Administrator Marilyn Tavenner said in a public statement. “By extending Stage 2, we are being receptive to stakeholder feedback to ensure providers can continue to meet meaningful use and keep momentum moving forward.”

Read the proposed rule here.

Topics: EHR, Meaningful Use, HHS, Medicare, CMS, EHR Incentive Program, CEHRT, Department of Health & Human Services

Security Risk Assessment Tool Helps Providers Ensure HIPAA Compliance

Posted by Matthew Smith on Mar 31, 2014 2:59:00 PM

HHS, Department of Health and Human Services, Meaningful UseU.S. Department of Health & Human Services (HHS) has released a new Security Risk Assessment (SRA) tool to help health care providers in small-to-medium sized offices conduct risk assessments of their organizations. 

The SRA Tool is the result of a collaborative effort by the HHS Office of the National Coordinator for Health Information Technology (ONC) and Office for Civil Rights (OCR). The tool is designed to help practices conduct and document a risk assessment to evaluate potential security risks in their organizations under the Health Insurance Portability and Accountability Act (HIPAA) Security Rule.

The application, available for downloading at www.HealthIT.gov/security-risk-assessment, also produces a report that can be provided to auditors.  The webpage contains a User Guide and Tutorial video to help providers begin using the tool.

Security Risk Assessment for Meaningful Use

Conducting and reviewing a security risk assessment is not only a key requirement of the HIPAA Security Rule, but is also a core objective for providers participating in the Medicare and Medicaid EHR Incentive Programs.

The CMS Security Risk Analysis Tipsheet helps providers understand:

  • Steps for conducting a security risk analysis
  • How to create an action plan
  • Security areas to be considered and their corresponding security measures
  • Myths and facts about conducting or reviewing a security risk analysis

Be sure to review the steps and conduct or review the analysis.  It is required in both stages of meaningful use to receive an incentive payment.

SRA Tool Feedback

ONC is requesting that users provide feedback on the new SRA Tool.  Public comments on the SRA Tool will be accepted until June 2, 2014.

For more information about the requirements for meaningful use, visit the EHR Incentive Programs website.

Topics: EHR, EMR, Meaningful Use, HHS, Security Risk Assessment

CMS Publishes Final Rule for Stage 2 of Meaningful Use

Posted by Matthew Smith on Aug 23, 2012 3:39:00 PM

CMS Meaningful USeToday, Health and Human Services (HHS) Secretary Kathleen Sebelius announced the next steps in the Obama administration’s work to help doctors and hospitals use electronic health records.

“The changes we’re announcing today will lead to more coordination of patient care, reduced medical errors, elimination of duplicate screenings and tests and greater patient engagement in their own care
,” Secretary Sebelius said.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, doctors, health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt and meaningfully use certified electronic health record (EHR) technology.

More than 120,000 eligible health care professionals and more than 3,300 hospitals have qualified to participate in the program and receive an incentive payment since it began in January 2011. That exceeds a 100,000 goal set earlier this year.

That includes more than half of all eligible hospitals and critical access hospitals and 1 out of every 5 eligible health care professionals.  The program is divided into three stages:

  • Stage 1 sets the basic functionalities electronic health records must include such as capturing data electronically and providing patients with electronic copies of health information.
  • Stage 2 (which will begin as early as 2014) increases health information exchange between providers and promotes patient engagement by giving patients secure online access to their health information.
  • Stage 3 will continue to expand meaningful use objectives to improve health care outcomes.

Today, HHS’ Centers for Medicare & Medicaid Services and HHS’ Office of the National Coordinator for Health IT released final requirements for stage 2 that hospitals and health care providers must meet in order to qualify for incentives during the second stage of the program, and criteria that electronic health records must meet to achieve certification.


The requirements announced today:

  • Make clear that stage two of the program will begin as early as 2014. No providers will be required to follow the Stage 2 requirements outlined today before 2014.
  • Outline the certification criteria for the certification of EHR technology, so eligible professionals and hospitals may be assured that the systems they use will work, help them meaningfully use health information technology, and qualify for incentive payments.
  • Modify the certification program to cut red tape and make the certification process more efficient.
  • Allow current “2011 Edition Certified EHR Technology” to be used until 2014.

The CMS final rule also provides a flexible reporting period for 2014 to give providers sufficient time to adopt or upgrade to the latest EHR technology certified for 2014.

A fact sheet on CMS’s final rule is available at http://www.cms.gov/apps/media/fact_sheets.asp.

A detailed fact sheet on ONC’s standards and certification criteria final rule is available athttp://healthit.hhs.gov/standardsandcertification.

The final rules announced today may be viewed at http://www.ofr.gov/inspection.aspx?AspxAutoDetectCookieSupport=1. More information on the Stage 2 rule can be found at the CMS EHR Incentive Programs website atwww.cms.gov/EHRIncentivePrograms.

Meaningful Use, Meaningful Use Incentives

Topics: EHR, EMR, Meaningful Use, HHS, CMS, Stage 2

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