South Jersey Healthcare SWOT Analysis of Value Based Payment Models

Mission Statement  Mission: –To provide high quality health services that improve the lives of all we serve.  Vision: –South Jersey Healthcare is the region’s leading network of health care providers, delivering the full continuum of primary, acute and advanced care services.

Organizational Values  Quality  Partnership  Empowerment  Integrity  Stewardship  Compassion

Micro/Macro Analysis  Accredited by Det Norse Veritias Healthcare, Inc. (DNV)  The DNV accreditation includes: –Centers for Medicare and Medicaid (CMS) conditions of participation –International Organization of Standardization (ISO) guidelines  DNV/ISO 9001 connection –the ability to engage frontline staff in identifying and solving of problems that interfere with the provision of quality care. –Focus on consistent service, customer satisfaction and continual improvement

Micro/Macro Analysis  Continuous quality improvement –Six Sigma –DMAIC –Transparency

Micro/Macro Analysis  Technology: –EMR –MIDAS –PACS –Quadramed QUAN TM –Press Ganey

Value-Based Health Care Funding The goal of value-based health care funding legislation is to ensure the establishment of a health care system capable of “providing safe and effective care to the people who need it at a cost that is reasonable and equitably distributed”. (Russell, 2012, p.123)

Strengths  The financial viability of the traditional Medicare fee-for service program is protected for beneficiaries and taxpayers.  Medicare payments are linked to the value of care.  Providers have joint clinical and financial accountability for health care in their communities.

Strengths  Restructured fee-for-service system provides ensured access to high-quality, cost and safety of care.  Beneficiaries receive information on quality, cost, and safety of care.  Payment systems support well-coordinated care across providers and settings.  Electronic health records help providers deliver high-quality, efficient, and coordinated care.

Weaknesses  Fee-for-service  Bundled payments/capitation  First generation pay-for performance  Quality measures not consumer focused  Fragmentation  Potential for increased disparities  Lose focus or gaming

Weaknesses  validity & reliability of quality measures –no appeal process –unintended consequences financial sanctions reputation cost containment at expense of patient care little opportunity for improvement  Cost of adopting additional health information technology/training/support for data collection

Opportunities  Affordable Care Act  Evaluate the impact of new models for care delivery and payment on health outcome  Consumer engagement  Provider feedback  Reward quality of care versus volume

Opportunities  Consumer focused measures of performance  Dashboard of measures that provide complete picture of care provided  Focus measurement on areas of care where improvement greatest  Ensure measures generate the most valuable information  Collect data efficiently  De-emphasize check-the box measures  Explore –High-Value Care Initiative –Shared savings

Threats  Social – “silver tsunami”  Economic –recession –unemployment/loss of employer sponsored health coverage –fraud/abuse  Ethical – “ends justify the means”  Legal/Political –current tort system

What's Next?  Expansion of pay-for performance programs  Rewards –how much? –how often?  Performance improvement/sustainability  Provider acceptance  Monitoring/evaluation –control/comparison groups –health outcomes –disparities –

References  References  Baker, D. W., Qaseem, A., Preston, P., Schneider, L. A., Eric, C., & American College of Physicians Performance Measurement Committee (2013). Design and use of performance measures to decrease low-value services and achieve cost-conscious care. Annals of Internal Medicine, 158(1),  Curtin, L. L. (2012). Health policy, politics,and professional ethics. In D. J. Mason, J. L. Leavitt, & M. W. Chaffee (Eds.), Policy & politics in nursing and health care (6th ed. (pp ). St Louis, MO: Elsevier.  Jha, A. K., Joynt, K. E., Gray, E. J., & Epstein, A. M. (2012). The long-term effect of PremierPay for Performance on patient outcomes. The New England Journal of Medicine, 366,  Kurtzman, E., & Johnson, J. (2012). Quality and safety in health care: Policy issues. In D. J. Mason, J. K. Leavitt, & M. W. Chaffee (Eds.), Policy & politics in nursing and health care (6th ed. (pp ). St. Louis, MO: Elsevier.

References  Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2012). Policy & politics in nursing and health care (6th ed.). St. Louis, MO: Elsevier.  Nugent, M. E. (2011). Aligning managed care contracts, compensation plans and incentive models. Healthcare Financial Management, 65(11),  Robert Wood Johnson Foundation. (2012). Pay-for-performance [Health policy brief]. Retrieved from Health Affairs website:  Russell, G. E. (2012). The United States health care system. In D. J. Mason, J. K. Leavitt, & M. W. Chaffee (Eds.), Policy & politics in nursing and in health (6th ed. (pp ). St Louis, MO: Elsevier.  Thorpe, K. E., & Ogden, L. L. (2010). The foundation that health reform lays for improved payment, care coordination, and prevention. Health Affairs, 29(6),  Van Leuven, K. A. (2012). Population implications for nurse practitioners. The Journal for Nurse Practitioners, 8(7),