The State Innovation Model Grant A Measurement Approach to Achieve the Triple Aim 1.

Slides:

Advertisements

Similar presentations

DDRS Health Homes Initiative: Meeting the Triple Aim through Care Coordination. Shane Spotts Director, Indiana Division of Rehabilitation Services May.

Advertisements

Making Payment Reforms Work for Patients and Families Lee Partridge Senior Health Policy Advisor National Partnership for Women and Families January 28,

Measuring Primary Care Spending in Maine January 20, 2015 Lacey Hartman Sr. Research Fellow.

MANAGED CARE STRATEGIES FOR FINANCING & DELIVERING HIV SERVICES JULIA HIDALGO POSITIVE OUTCOMES, INC. & GEORGE WASHINGTON UNIVERSITY.

1 Proprietary and Confidential 1 Identification of Potentially Avoidable Emergency Department Visits Using Claims Data APHA Session : Advances in.

SUPPORTING THE INTEGRATION OF COMMUNITY HEALTH WORKERS IN MINNESOTA JUNE 5, 2014 The Minnesota Accountable Health Model (SIM Minnesota)

1 Turning data into meaningful knowledge ADVantis™

Will Groneman Executive Vice President System Development TriHealth

Paying for Primary Care: Robert Graham Center Primary Care Forum Washington, DC Two CMS/CMMI payment experiments Jay Crosson March 25, 2014.

Transforming Clinical Practices Grant Opportunity Sponsored by CMS.

Leading the Way Upstream: The Military Health System for 2012 and Beyond June 21, 2011 RADM C.S. Hunter, MC, USN Deputy Director TRICARE Management Activity.

A Case for Quality The Value of Medicaid Managed Care May 10, 2011 Working to Improve Health Every Day May 10, 2011.

Transition to Adult Care Symposium Boston, MA April 27, 2012 Richard C. Antonelli, MD, MS Assistant Professor of Pediatrics Medical Director of Integrated.

House Calls Medicine for High-Risk Pioneer Beneficiaries

Key Points to Understanding the Governor’s Access Plan ( updated 5/14/15) GAP is a new Medicaid plan that will provide limited medical and behavioral healthcare.

Tracey Moorhead President and CEO May 15, 2015 No Disclosures ©AAHCM.

1 Managed Health Care Pricing for Provider Arrangements Presented by Vanessa Olson Seminar on Health and Managed Care October 18, 1999.

Role of Clinical Nurse Specialists in WRHA Palliative Care Program Lori Embleton, Program Director WRHA Palliative Care Program November 21, 2008.

Deploying Care Coordination and Care Transitions - Illinois

CHILD HEALTH NURSING. Specialists of this field are known as pediatric nurse. In comparison to other fields of nursing practice pediatric nursing is very.

Foundations for a Successful Patient-Centered ACO: Federal Law Background Jim Dearing, D.O., FACOFP, FAAFP Chief Medical Officer, Physician Network John.

Interviews Conducted Prior to MissionPoint Launch Network Physicians Significant behavior change will only occur with “payer” control of 30 – 50%

Primary Care and Behavioral Health 2/4/2011 CIBHA.

Primary Care Practice Reports Commercially insured adult and pediatric population Claims incurred January December 2012, with 3 months run-out January.

NEW MEXICO STATE COVERAGE INITIATIVE New Mexico Human Services Department June, 2004 Carolyn Ingram, Director Medical Assistance Division.

An Overview of NCQA’s Relative Resource Use Measures.

CHARTPACK. TOTAL HEALTH CARE EXPENDITURES THCE Growth In Context 3 Total Health Care Expenditures per capita grew by 4.8%, above the health care cost.

Slide #1 What is your clinical/academic training or background? Please select ONE answer that best describes your current primary position 1. Medical doctor.

1 Proprietary and Confidential 1 Geographic Variation in the Rates of Chiropractic Manipulation Treatment in Northern New England APHA Session :

Virginia Health Care Conference Engaging Consumers to Purchase Value June 6, 2013.

IOWA COLLABORATIVE SAFETY NET PROVIDER NETWORK Safety Net Network Advisory Group Meeting – 11/08/2013.

A Roadmap to Integrated Care Primary Care and Behavioral Health The Business Case for Integrated Medical-Behavioral Healthcare An Actuary’s Perspective.

1 State Research Roundtable C Outcome Evaluations of Utah’s Primary Care Network (PCN) Wu, Xu, PhD, Norman Thurston, PhD Mike Martin, MBA, and Keely Cofrin,

CTC CLAIMS DATA COLLECTION AND ANALYSES UPDATE CTC Steering Committee February 13,

ACO’s Al Kurose, M.D. President & CEO Coastal Medical.

LOCKTON DUNNING BENEFITS UNIVERSITY OF ALASKA 2ND QTR FY13 UTILIZATION REVIEW 7/1/2012 TO 12/31/2012.

MaineGeneral Health Aging Advocacy Summit November 14 th, 2012.

Bellin Medical Group Improving Health / Stabilizing Cost George Kerwin

EXPERTISEPARTNERSHIP VALUE January 26, ND QUARTER UTILIZATION REVIEW – 7/1/2010 TO 12/31/10 TRENDSANALYSISSTATISTICSPLANNINGTOOLS.

Accountable Care Organizations: Health Care Delivery Redesign Thomas J. Biuso MD, MBA UnitedHealthcare Medical Director Clinical Assistant Professor of.

EXPERTISEPARTNERSHIP VALUE November 16, 2011 UNIVERSITY OF ALASKA 1 ST QUARTER FY12 UTILIZATION REVIEW – 7/1/2011 TO 9/30/2011 TRENDSANALYSISSTATISTICSPLANNINGTOOLS.

FAMILY MEDICINE AT ITS PEAK Amy Russell, MD Medical Director MAHEC/MMA Primary Care Asheville, NC FAMILY MEDICINE AT ITS PEAK Amy Russell. MD Medical Director.

Federal and State Student Loan Repayment Programs Rachel Ruddock Recruitment and Retention Services Manager Michigan Center for Rural Health (517)

Cost of Care Overview Payment Reform Subcommittee March 11, 2014.

Transforming Care in Patient Centered Medical Home and Accountable Care Organization Hae Mi Choe, PharmD Director, Pharmacy Innovations & Partnerships.

Practice Transformation Initiative AlignmentCCPNHHNPTN Practice Transformation Network is a 4-year CMS sponsored program that prepares NC and SC providers.

MaineCare Accountable Communities Initiative October 2,

DataBrief: Did you know… DataBrief Series ● September 2011 ● No.18 Differences in Service Utilization by Disability and Residence In 2006, seniors with.

Geographic Variation in Healthcare and Promotion of High-Value Care Margaret E. O’Kane November 10, 2010.

Buy Healthcare Vaccines Online

Healthx Analytics: Turning Data Into Actionable Insights

CTC Total COST of CARE UPDATE

Use of BCBSRI Primary Care Provider Profile to Improve Performance

Care Transformation Collaborative of Rhode Island Supporting the Implementation of Comprehensive Primary Care Plus (CPC+) Advancing Primary Care in.

“The Integrator” Optimal Care for All our Members and Patients

Understanding and Using the CMMI and Actuarial Cost & Utilization Reports Hi everyone. I am Katie Matthews and this is Ally Weaver, and we are actuaries.

Paying for Serious Illness Care Under a Global Budget: Opportunities and Challenges Anna Gosline, Senior Director of Health Policy and Strategic Initiatives,

Health Home Program Services

Chart 5.10: RN Employment by Type of Provider, 2015

Robert Hall Director, Government Relations 6/12/2018

Comparing automated mental health screening to manual processes in a health care system Josh biber.

Synopsis of CCNC Initiatives

2019 Health Plan ASU is a self-insured health plan. Employees and ASU pay premiums into the plan, and those premiums are used to pay claims, administrative.

SIM Collaborative Learning Session Using Data to Drive Change

Care Transformation Collaborative of Rhode Island Supporting the Implementation of Comprehensive Primary Care Plus (CPC+) Advancing Primary Care in.

Cover area with cropped image.

Payment Reform to Transform Advanced Illness Care

PASSE Care Coordination

Attribution Claim Algorithm - Hierarchy

Presentation transcript:

The State Innovation Model Grant A Measurement Approach to Achieve the Triple Aim 1

Analytical framework was designed to support affordability initiatives Systematically pinpoints savings opportunities at the population, provider, condition, procedure and patient-level. Standardized price value (acts in the same fashion as a dollar) 2 The Total Cost of Care Calculation (TCOC)

Excludes commercial claims for adults over 65 Excludes claims for babies under age 1 Claims are truncated at $100,000 per member Excludes claims for behavioral health and substance abuse treatment Excludes members that have less than 9 months of medical enrollment for the measure period In the model used by Health Partners - included provider groups with at least 600 members – smaller practices not included 3 It may be the gold standard but It has Limitations

Includes only physicians, physician assistants and nurse practitioners Assigns a specialty to each claim based on the practicing specialty of the serving physician. Includes only the following specialties: family medicine, internal medicine, pediatrics, geriatrics, obstetrics and gynecology Excludes claims not assigned to a specialty Counts each visit once all claims meet the criteria 4 It may be the gold standard but It has Limitations Continued

Total Care Relative Resource Value (TCRRV) algorithm Quantify resource use for all procedures and selected services in a health care system Facilitates easy comparisons across procedure, peer groups and health care settings (inpatient, outpatient, professional and pharmacy) Identifies overuse/inefficiency and price variation within and among provider groups, employer groups, geographic regions and places of service. Optimizes value for ACOs by easy reporting for large organizations seeking to lower costs by improving resource use and lowering price. 5 Resource Use

The final Total Cost of Care and Resource Use measures are expressed as a risk adjusted total cost or resource use per member per month: Risk Adjusted Total Allowed Amount PMPM = (Total Allowed Amount / population membership) / (relative risk score) Risk Adjusted Total Resource Use PMPM = (Total TCRRVsTM / population membership) / (relative risk score) 6 The Metrics

For More Maine SIM Info…… VISIT: 7