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GE Healthcare Camden Group Insights Blog

The Great Risk Shift: A Strategic Road Map for Providers

Posted by Matthew Smith on Apr 13, 2016 2:47:41 PM

By William Ringwood, Manager, GE Healthcare Camden Group

When assuming financial risk for healthcare delivery, a provider has many options to choose from and a broad range of internal and market-based factors to consider to be able to choose the right option for its specific circumstances.

An unprecedented shift of financial risk from payers to providers is occurring within the healthcare delivery system as a result of reform efforts. Healthcare providers have many important strategic decisions to make in preparation for this shift that will have a profound impact on their future success. Foremost among these decisions is choosing from the broad range of risk options available to providers, including quality incentive and penalty programs, Medicare accountable care organization (ACO) models with various degrees of risk and requirements, commercial shared savings, bundled payments, cobranding, and partial/full capitation or percentage of-premium models. It is clear that government and private payers, as well as employers and the general public, are pushing to improve overall healthcare value by increasing providers’ degree of risk.

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Risk, Providers

Topics: ACO, Medicare, Risk-Based Contracting, Healthcare Delivery, Risk, William Ringwood

Moving from Utilization Management / Referral Authorizations to True Population Health Management

Posted by Matthew Smith on Feb 9, 2016 4:28:16 PM

Historically, many organizations managing care in a risk-bearing structure such as independent practice associations, medical groups, or related enabling entities such as management services organizations have primarily concentrated on utilization management, referral authorization, and claims processing, with attention to cost containment and ensuring all compliance standards are met. These functions have served as an "operational core," focused on getting the job done and meeting necessary requirements.

As they evolve, these organizations realize that simply "getting it done" will not suffice; they need to increase the focus on the clinical delivery process in order to affect the health outcomes of their populations.

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 Population Health

Topics: Population Health, Risk-Based Contracting, Healthcare Analytics

Report: Hospital ACO Participation Projected to Double in 2014

Posted by Matthew Smith on Jan 7, 2014 11:11:00 AM

ACO, Accountable Care OrganizationsHospital participation in accountable care organizations (ACOs) is projected to double in 2014, as providers are developing core ACO capabilities, according to a new survey of 115 senior executive respondents by the Charlotte, N.C.-based Premier Healthcare Alliance.

During a press conference call on Wednesday, Dec. 18, Joe Damore, vice president, population health management, Premier, said the survey’s results are consistent with what he and his team are seeing from various healthcare organizations. “There is a growing trend of managing high-risk populations by using a lot of healthcare resources,” Damore said.  “We are seeing an improvement in reducing cost, and increasing health quality and patient satisfaction by managing high-risk patients in a positive way.”

The survey respondents were primarily CEOs (43.5 percent), chief financial officers and chief operating officers across 35 states. More than 18 percent say their hospitals currently participate in an ACO, up from 4.8 percent in spring 2012. This growth is projected to accelerate, with about 50 percent of respondents suggesting their hospitals will participate in an ACO by the end of 2014. Overall, 76.5 percent of respondents say their hospital does or will participate in an ACO, according to the report, “Fall 2013 Economic Outlook.”

The pace of ACO adoption has been slower than originally anticipated by senior executives surveyed 18 months ago. Though 51.8 percent of executives predicted in the spring of 2012 that their systems would create or join an ACO by the end of 2013, results show that only 23.5 percent will likely meet that projection—and those that do might not achieve immediate cost savings.

Damore attributes this to a difficult process that poses numerous challenges. “Organizations are moving from being acute care hospitals to taking on populations across the continuum for 365 days,” he said. “How do you build the core components of that? It is a multi-year journey, so it would be naïve to think that [savings will be produced] right away. The organizations that are having success have experience in managing populations for long periods of time. They have invested in building an infrastructure for a decade or more with elements such as electronic health records (EHRs), data warehouses, and analytics tools.”

According to survey results, the majority of health systems are developing partnerships and making investments in the infrastructure necessary to better manage population health. Among investments:

  • Lifestyle and wellness coaching was most often cited overall by 71.6 percent of hospital executives.
  • Almost half of rural hospitals use virtual care or telemedicine to connect with patients, compared to 1 in 3 non-rural hospitals.
  • Patient-centered medical homes (PCMHs) are also popular for non-rural hospitals, large hospitals and hospitals in an integrated delivery network (IDN).

Leaders from two healthcare organizations— the Roanoke, Va.-based Carilion Clinic and the Milwaukee, Wis.-based Aurora Health Care—joined the press call and discussed their experiences in building successful ACO models. Michael Jeremiah, M.D., chair, Department of Family and Community Medicine, Carilion Clinic and the Virginia Tech-Carilion School of Medicine, is a part of Doctors Connected, a Medicare Shared Savings Program (MSSP) participant.

Carilion, which cares for nearly one million residents across 18 counties in western Virginia, recently expanded its PCMH network to 45 homes, and the combination of Carilion’s physician-led governance, comprehensive EHR implementation, extensive primary care network, and mix of rural and urban patients make the Carilion PCMH model unique, said Jeremiah.

Key Carilion medical home strategies include: a central repository for all records of patient care, which provides for standardization of care across all PCMH providers; measurement of outcomes of patient care, and an integration of medical homes with other Carilion patient care sites, which allows for efficient management of the patient across the care continuum, Jeremiah explained.

“We recognized early on in our population health management efforts that having a robust IT infrastructure would be critical to our success,” added Stephen Morgan, M.D., senior vice president and CMIO at Carilion Clinic. “An EHR by itself would not provide all the data and analytics that we would need. We started to mix claims data and clinician data to provide us a picture on what the patient is doing inside and outside our system.”

To this end, according to the survey, access to integrated data with sophisticated population health status measurement is important to ACO formation. According to respondents:

  • 72.5 percent are integrating clinical and claims data to better manage population health.
  • 50 percent are using predictive analytics to forecast patient/population needs.
  • 46.3 percent are using an integrated data solution to reduce silos.

“Within our organization, clinical teams will always serve as the 'backbone' to the challenging work around population health,” Jeremiah said. “But IT and health analytics provide the 'nervous system' that allow us to fully function and achieve optimal patient experiences and outcomes while controlling cost.”

There are several value drivers at the fully-integrated Aurora Healthcare, a 15-hospital system serving more than 1.2 million annually throughout eastern Wisconsin and northern Illinois, said Richard Klein, executive vice president, enterprise business group at Aurora. These include: screening for prevention, nurse navigation for chronic disease management, onsite education, and connection between the care coordination and the plan design, among others, Klein said.

“As a self-insured employer, we've been diligently working on this with our own employees for 15 years. Now, we've built an organization that is integrated, highly efficient and is able to produce a better result for the patient,” Klein said.

In summary, an ACO connected to a high quality/efficiency system drives real value, said Klein, adding, “High-quality disease management and clinical engagement does yield significant savings in the defined population. ACOs can be a superior model for taking risk.”

Topics: ACO, Population Health, Risk-Based Contracting, Accountable Care Organizations

New Presentation Download: Accountable Care & Risk-Based Contracting

Posted by Matthew Smith on Jun 19, 2013 12:58:00 PM

Download, PDF download, Health DirectionsDirect from HFMA's ANI2013, this presentation was delivered by Health Directions President/CEO Daniel J. Marino and Asad Zaman, MD, on Thursday, June 19.

Missed out on ANI this year? No problem. Simply click the button, below, and you can download the presentation PDF.

Their presentation, titled A Practical Approach Toward Accountable Care and Risk-Based Contracting: From Design to Implementationshares advanced strategies and lessons from a large health system's experience in creating an accountable care enterprise. Participants learn how to develop critical financial systems and integrate them with clinical programs and technology initiatives to position for value-based reimbursement.

The presentation covers financial performance indicators, clinical quality measures, clinical integration strategies and key technology resources. Attendees learn to combine clinical outcomes measures with claims data to track the cost of care and position.

After this session, attendees will be able to:

  • Plan clinically integrated programs that reduce costs and improve outcomes
  • Establish clinical and financial measures for organizational accountability
  • Combine clinical outcomes measures with claims data to track the cost of care
  • Promote value-based coordinated care and negotiate accountable care contracts using risk-based, value purchasing, or performance-based models

Tools and Takeaways

Sample metric reports for managing accountable care initiatives and examples of clinical integration goals with performance measures for multiple stakeholders, supporting technology and processes, outcomes, and contractual incentives.

Topics: Accountable Care, ACO, Accountable Care Organization, Risk-Based Contracting, Accountable Care Organizations

HD to Present on ACO Risk-Based Contracting at HFMA ANI2013

Posted by Matthew Smith on Jun 18, 2013 11:37:00 AM

HFMA, ANI2013, Health Directions, Dan Marino

Health Directions President/CEO, Daniel J. Marino, takes to the podium Wednesday morning alongside Asad Zaman, MD, to discuss risk-based contracting at HFMA's ANI2013 in Orlando, FL. 

Their presentation, titled A Practical Approach Toward Accountable Care and Risk-Based Contracting: From Design to Implementationshares advanced strategies and lessons from a large health system's experience in creating an accountable care enterprise. Participants learn how to develop critical financial systems and integrate them with clinical programs and technology initiatives to position for value-based reimbursement. The presentation covers financial performance indicators, clinical quality measures, clinical integration strategies and key technology resources. Attendees learn to combine clinical outcomes measures with claims data to track the cost of care and position.

A Practical Approach Toward Accountable Care and Risk-Based Contracting: From Design to Implementation (F04) 1.5 CPEs

Wednesday, June 19, 2013 10:00 -11:15 a.m.

Topic Area:
CFO/Executive Leadership

After this session, you will be able to:

  • Plan clinically integrated programs that reduce costs and improve outcomes
  • Establish clinical and financial measures for organizational accountability
  • Combine clinical outcomes measures with claims data to track the cost of care
  • Promote value-based coordinated care and negotiate accountable care contracts using risk-based, value purchasing, or performance-based models

Level
Advanced

Prerequisites/Prework
Familiarity with reimbursement models, health IT systems, evidence-based medicine, and population health; general knowledge of accountable care, clinical integration, and risk-based managed care contracting

Tools and Takeaways
Sample metric reports for managing accountable care initiatives and examples of clinical integration goals with performance measures for multiple stakeholders, supporting technology and processes, outcomes, and contractual incentives

Speakers
Asad Zaman, MD
Chairman, Internal Medicine Department
Advocate South Suburban Hospital

Daniel Marino, MBA, MHA
President and CEO
Health Directions LLC

Topics: Accountable Care, ACO, Reimbursement, Risk-Based Contracting

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