1. CHBE Feb 21, 2012 QHP Contracting and Delivery System Improvement Don Crane President and CEO

2. Contracting and Delivery System Reform “Insanity is doing the same thing, over and over again, but expecting different results.” Albert Einstein Albert EinsteinAlbert EinsteinAlbert Einstein

3. Suggestion # 1 Match CMS Innovation..... …..by including Pioneer and MSSP ACOs as Qualified Health Plans.

4. Suggestion #2 (cont.) “Invite” only Qualified Health Plans that: a.)contract with providers that are Accountable for Cost and Quality, and b.) possess specific attributes and competencies

5. Suggestion #2 (cont.)  Accountable for Cost?  Population Based payment, bundled payment, or shared savings  Accountable for Quality?  Performance Measurement, reporting, and bonus at the group level

6. Suggestion #2 (cont.) “Invite” only QHPs that will contract with providers possessing specific attributes and competencies Required attributes and competencies….a short list for illustration:  Disease registries for all major chronic diseases  Hospitalists to help prevent avoidable admissions and assist with appropriate length of stay

7. Suggestion #2 (cont.) Required attributes and competencies….a short list: (cont.) Required attributes and competencies….a short list: (cont.)  Post discharge continuity of care program, including case managers, discharge planners, social workers  Review program for all unplanned inpatient readmissions  Organized palliative care and hospice program  Complex care management program  EMR deployment