Value Based Contracting in Action The UMC Physician Journey

Family Practice Internal Medicine Pediatrics Gastroenterology Neurosurgery Pediatric Gastroenterology Radiation Oncology Allergy & Immunology Pain Medicine Thoracic Surgery Cardiology Developmental Behavioral Pediatrics Pediatric Critical Care

Value Based Care Alternative to fee-for-service Reimbursement based on quality rather than quantity Payments are tied to outcomes which improves quality Better health for individuals which reduces cost

Value Based Care Lower Cost Better Health for Populations Better Care for Individuals Lower Cost

Quality Strategies PQRS Meaningful Use Value Based Modifier MACRA

The Quality Journey Begins Quality Measurement & Selection Validation and Submission Education Development of workflows According to CMS, when reported by eligible professionals nationwide, quality measures work together to provider better care coordination and better health care at lower costs.

Quality Journey continues Meaningful Use defined the use of electronic health records but went beyond the implementation of a certified EHR 3 Stages to Meaningful Use Stage1 Data capture and Sharing Stage 2 Advance Clinical Processes Stage 3 Improved Outcomes

Three Part Aim Better Health Populations Lower Better Care Cost Medicare Access and CHIP Reauthorization Act of 2015 Better Health Populations Lower Cost Better Care Three Part Aim

Hurdles to Value Based Care Making the Shift to value-based contracting Hurdles to Value Based Care Shortage of Time Volume vs Value Payer Negotiation Patient Care Coordination I am in favor of progress; It’s change I don’t like Mark Twain

Where do we go from here Value Based Payment Models Pay for performance Shared Savings Patient Centered Medical Home Accountable Care Organization Value Based Payment Models

Pay for Performance Cost saving metrics defined by the payer Shared Savings Transition from episodic health care Value based and patient centered Patient Centered Medical Home Disease Management Preventative Services Care Coordination Accountable Care Organizations Improved Care Coordination between primary care providers, hospitals and specialists

Current State Patient Centered Medical Home 01 02 Managed Care Organization Shared Savings Plan Pay for Performance Agreements 03 UMC Accountable Care Organization 04