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Value Based Contracting in Action
The UMC Physician Journey
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Family Practice Internal Medicine
Pediatrics Gastroenterology Neurosurgery Pediatric Gastroenterology Radiation Oncology Allergy & Immunology Pain Medicine Thoracic Surgery Cardiology Developmental Behavioral Pediatrics Pediatric Critical Care
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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
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Value Based Care Lower Cost Better Health for Populations
Better Care for Individuals Lower Cost
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Quality Strategies PQRS Meaningful Use Value Based Modifier MACRA
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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.
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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
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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
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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
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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
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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
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Current State Patient Centered Medical Home
01 02 Managed Care Organization Shared Savings Plan Pay for Performance Agreements 03 UMC Accountable Care Organization 04
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