Caroline R. Piselli RN, DNP(c), MBA, FACHE PricewaterhouseCoopers Health Industries Advisory Director Building Your Plan to Get from Here to There: Steps.

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Presentation transcript:

Caroline R. Piselli RN, DNP(c), MBA, FACHE PricewaterhouseCoopers Health Industries Advisory Director Building Your Plan to Get from Here to There: Steps Required to Achieve a Blended Services Model

Source: PwC Health Research Institute National Trends / Role of Government Payment Methodologies Shifting Demographics New Customers Empowered Consumer Care Anywhere, Anytime Agenda

Source: PwC Health Research Institute New Health Economy Transformation TRANSFORMATION from a fee for service environment to population health aligned with risk is a current to future state process. Key critical success factors expand well beyond payment methodology design, actuarial computation and include some of the following: 1- INNOVATIVE Design 2- Population Health- OUTCOMES focused 3- Current to future state VISION driven 4- RISK linked to OUTCOMES, not process 5- Flexible & Adaptable to CONTINUAL IMPROVEMENT 6- CONTINUAL COLLABORATION 6- Sense of URGENCY and ACCELERATION

Source: PwC Health Research Institute Is Your Organization Prepared for the New Health Economy ?

Source: PwC Health Research Institute

ACA Implementation

Source: PwC Health Research Institute

13 Some Published Examples to Follow

Source: PwC Health Research Institute

MD Statewide Experience: PPC Cost Savings Source: Health Affairs December 2012 Source: Health Affairs, December :12; doi: /hlthaff

Source: PwC Health Research Institute Potentially Preventable Events

Source: PwC Health Research Institute

20 PDF picture

Source: PwC Health Research Institute

Balancing insurer risks in the reformed insurance market: Incentivize health plans to participate

Source: PwC Health Research Institute

Population Management Readiness Develop a network across a geography that delivers evidence-based care to improve the quality, efficiency and coordination of health care services Leveraging: Data Transparency Critical Mass Long Term Commitment Consumer Value

Source: PwC Health Research Institute

Questions? Caroline R. Piselli, RN, MBA, FACHE Health Industries Advisory Director PricewaterhouseCoopers

Source: PwC Health Research Institute