Highlights from Day 1 of 2017 AHIP National Health Policy Conference

By | AHIP, Healthcare Reform, Healthcare Revolution, payer, Risk-Sharing, Value-Based Care | No Comments

The 2017 AHIP National Health Policy Conference kicked off today in Washington, DC.

Political, business, and health care leaders from across the nation gathered to dive deeply into our nation’s top policy priorities in an effort to move forward in today’s uncertain healthcare environment.

What a period for healthcare reform in the United States!

In addition to some general comments about healthcare policy and politics, today’s sessions addressed topics such as the following:

  • Risk-sharing and Cost Control
  • Value-based Care
  • Pharmacy Costs
  • Medicaid Exchanges
  • Importance of Social Determinants of Health

Social shares from conference attendees

As is happening more and more at many of today’s top healthcare conferences, conference proceedings, insights and other information were shared on Twitter – among other social channels. Here’s a sample of some interesting shares from Day 1 of the 2017 AHIP National Health Policy Conference.

Thanks to all those noted below who took the time to share with those who were unable to attend the conference.

General Stuff

Handle Tweet
@ajmc_journal There’s still a basic misunderstanding of how health insurance works, says @AHIPCoverage’s Tavenner
@rpalme01 @MD_Insurance @al_redmer ACA “status quo is not an option, status quo is not a solution”  #ACA
@nancyrwise Newt Gingrich sure that SOME bill will be passed this session…  but no direction on what it will include.  #AHCA
@nancyrwise T. Nickel, thank you: “Association Health Plans are awesome… until they are not”  @NAIC_News

Cost of Healthcare & Risk-Sharing

Handle Tweet
@ajmc_journal The only cost containment strategy that works is cost sharing but it can be such a burden that it takes care away–@chipkahn
@avercloud Healthcare payers: Make the move from pilot to full-scale bundled payment adoption. Let’s discuss at #AHIPPolicy
@leah_a_brown The discussion a few years ago was about coverage, now healthcare 2.0 is about cost.
@mahphealth Good point by MD Comm. Al Redmer Jr on NAIC panel Can’t do anything on premiums unless moderate cost of delivering #healthcare
@nancyrwise Great quote: “Pay for value = transferring risk to providers.” M. Chernew
@nancyrwise If health orgs are bigger & more integrated, they are better positioned to own market power: unlikely to lower costs. M. Chernew
@suemontgomery2 Cost of premiums is all about the cost of delivering care. – Ted Nickel at #AHIPPolicy

Value-based Care & Reimbursement

Handle Tweet
@ahipcoverage Consumers want affordable coverage & high-quality care – that’s what value-based care delivers.
@avercloud Debate the policy, but value-based healthcare is here to stay. Let’s discuss bundled payment success at upcoming #AHIPPolicy

Pharmacy

Handle Tweet
@springstex Prescription drug costs pass physician services as biggest slice of health insurance premium
@rpalme01 Keep talking to your local pharmacist and sharing what he tells you.

Medicaid Exchanges, Access & Importance of Social Determinants of Health

Handle Tweet
@ajmc_journal Healthcare reform is a question of access vs true availability. The devil is truly in the details, said @AndyGurmanMD
@nancyrwise Interested in continuing conversations about potential intersection of #Medicaid and Exchange markets in #healthcare #simplicity
@ahipcoverage From transportation, housing & environmental health, plans are addressing social determinants of health

Keep on Top of More Insight on Healthcare Reform

Be sure to follow the Healthcare Executive Group on Twitter, Facebook and LinkedIn where we share insight into the challenges, opportunities and issues facing healthcare executives and others in today’s fast-changing healthcare environment.

How Predictions About Healthcare in 2017 Compare to HCEG Top 10 List

By | analytics, payer, Top 10 | No Comments

2017 Healthcare Predictions HCEG

It’s that time of year when everyone is sharing their thoughts on healthcare predictions and trends for 2017. And the Healthcare Executive Group wants to take this opportunity to share what it considered the Top 10 Priorities, Issues and Challenges facing healthcare supply-side constituents: health plans, payers, providers and health systems.

History of HCEG Top 10 List

The HCEG Top 10 list of Healthcare Priorities, Issues and Challenges has been a pillar of the Healthcare Executive Group for the last 12 years. The list is developed each year during HCEG’s annual forum and reflects what HCEG healthcare executive members think will be their primary focus for the following year.

The HCEG Top 10 list for 2017 includes the following items:

  1. Value-based Payments: targeting specific medical conditions to manage cost and quality of care
  2. Total Consumer Health: improving member’s overall well-being – medical, social, financial, and environmental
  3. Clinical and Data Analytics: leveraging big data with clinical evidence to segment populations, manage health and drive decisions
  4. Cybersecurity: protecting the privacy and security of consumer information
  5. Cost Transparency: growing legislation and consumer demand
  6. Harnessing Mobile Health Technology: improving disease management, member engagement, and data collection/distribution
  7. Addressing Pharmacy Costs: implementing strategies to address growth of pharma costs versus benefits to quality of care and total medical costs
  8. Care Redesign: leveraging team-based care models, focusing on behavioral health and social needs
  9. Accessible Points of Care: telehealth, retail clinics and micro-hospitals vs. large, integrated systems
  10. Next Generation ACOs: additional programs in bundled payment, episodes of care-shared savings, and growing participant base

To be sure, the items on the HCEG Top 10 list may not be considered predictions as much as they are ‘important areas for those on healthcare’s supply side to be aware of in 2017.’

“It’s tough to make predictions, especially about the future” – Yogi Berra

And it’s not just HCEG members who compile lists of predictions and trends for the healthcare industry. In the waning weeks of the year, industry professionals, health plan and hospital system CEO’s, leading consulting firms like PWC and Accenture, research firms like Gartner, media reporters, and a host of others all share their take on what they consider to be important trends and predictions for the upcoming year. Here’s a list of some of those sharing their 2017 Healthcare Predictions.

Given the ubiquity of “predictions for healthcare in 2017” and the fact that healthcare was a primary issue in the U.S. presidential election, it seemed that comparing HCEG ‘s Top 10 list to the summarized results of 2017 healthcare predictions made by others would confirm HCEG’s list and/or call out differences. The fact that the HCEG Top 10 list was compiled BEFORE the presidential election and all of the comparison lists were created AFTER the election is envisioned to, at least somewhat, account for any impact the election may have had on people’s interpretation of priority and value.

Collection of Predictions about Healthcare & Healthcare Technology in 2017

To establish a baseline list of predictions and trends for healthcare in 2017, the lists contained in this blog post were reviewed with categorized based on their primary and secondary categories with the results compared to the items on the HCEG Top 10 list. A few facts and observations about this baseline list:

  1. 36 lists containing a total of 179 “predictions” were curated
    HCEG 2017 Predictions - Major Categories

    HCEG 2017 Predictions – Major Categories

  2. Only predictions that were clearly understood and of sufficient granularity were included
  3. Each prediction was coded with one of the following 19 primary categories
  4. Where possible, a secondary category was assigned

Analysis of 2017 Predictions

Most Frequently Referenced Categories

In terms of most frequently referenced predictions (regardless as too rank) found among the 30 lists reviewed, Emerging Technologies, Reform/Regulations, Analytics & Big Data, Value-based Reimbursement, Access, and Consumerism were among the most frequently cited areas of focus in 2017.

Category Count Corresponding HCEG Top 10 Item(s)
Emerging Technologies 29 6-Harnessing Mobile Technology
Reform/Regulations 24 8-Care Redesign (loose correlation)
Analytics & Big Data 19 3-Clinical and Data Analytics
Value-Based Reimbursement 16 1-Value-based Payments

5-Cost Transparency

Access 13 9-Accessible Points of Care
Consumerism 11 2-Total Consumer Health
Interoperability 9
Finance/Reimbursement 9 1-Value-based Payments

5-Cost Transparency

7-Addressing Pharmacy Costs

Cybersecurity 8 4-Cybersecurity
Mobile Health 6 6-Harnessing Mobile Technology
Processing Efficiency 6
Digital Transformation 5 6-Harnessing Mobile Technology
Collaboration 5 10-Next Generation ACOs
Mergers & Acquisitions 4
Health Literacy 4 2-Total Consumer Health

5-Cost Transparency

Pharmacy 3 7-Addressing Pharmacy Costs
Resources 3
Precision Medicine 2 8-Care Redesign
Wearables 2 6-Harnessing Mobile Technology
Patient Experience 1 2-Total Consumer Health

9-Accessible Points of Care

Categories by Top 3 Rankings

In an attempt to present the data in a more generalized fashion, the following table reflects the ranking of the categories based on the sum of the top three rankings for each item.

Category Count Top 3 Count Top 3 % of Count Corresponding HCEG Top 10 Item(s)
Reform/Regulations 24 15 63% 8-Care Redesign (loose correlation)
Emerging Technologies 29 14 48% 6-Harnessing Mobile Technology
Analytics/Big Data 19 12 63% 3-Clinical and Data Analytics
Consumerism 11 8 73% 2-Total Consumer Health

5-Cost Transparency

Access 13 7 54% 9-Accessible Points of Care
Value-based Care 16 7 44% 1-Value-based Payments

5-Cost Transparency

Cybersecurity 8 6 75% 4-Cybersecurity
Finance/Reimbursement 9 6 67% 1-Value-based Payments

5-Cost Transparency

7-Addressing Pharmacy Costs

Mobile Health 6 6 100% 6-Harnessing Mobile Technology
Collaboration 5 5 100% 10-Next Generation ACOs
Digital Transformation 5 5 100% 6-Harnessing Mobile Technology
Interoperability 9 5 56%
Processing Efficiency 6 5 83%
Health Literacy 4 3 75% 2-Total Consumer Health
Mergers & Acquisitions 4 3 75%
Pharmacy 3 3 100% 7-Addressing Pharmacy Costs
Resources 3 3 100%

Insights on How HCEG List Compares to General 2017 Predictions

While certainly subject to some interpretation and discussion, the following four areas listed by many of those sharing their 2017 Predictions were NOT directly matched to any of the items on HCEG’s Top 10 list.

Category Prediction from Article
Interoperability
  • Acceleration of Interoperability
  • EHR access
  • Financially stable, regional IDNs are spending big dollars toward extended connectivity while rest of the pack looks on
  • Integrated systems
  • Integration of medical & social determinants of health
  • Interoperability: Continuing progress
  • More progress and collaboration around interoperability
  • Organizations choosing platforms vs. application silos will only accelerate
Processing Efficiency
  • $1 of innovation will need $7 of core execution
  • Adoption of auto-adjudication will accelerate
  • Auto-adjudication will drive providers to interact with EHRs, revenue cycle management and practice management vendors.
  • Complex claims outsourcing market grows
  • Cost reduction pressures require balance with compliance demands
  • Focus on front end and middle office business office functions & RCM outsourcing intensifies.
M&A
  • Consolidation of activities to Top 7 Digital Giants
  • Continued growth of merger and acquisitions as the reimbursement mechanisms favor organized groups of providers.
  • Many more insurers will drop out of the marketplaces.
  • Maturation of digital health startups and increasing merger and acquisition activity
Resources
  • Human resources shortage
  • Skilled hospital tech staff recruitment is even more challenging.
  • The rise of non-CIO executives in technology decisions: Not quite yet

Note: Items in above table were culled from various articles listing 2017 Predictions. 

Overall Rankings of 2017 Predictions

The following major categories of 2017 Healthcare Predictions are based on the rank assignments as noted by the author of each of the individual articles/posts.

#1 Ranking 36 % of Ttl #4 Ranking 22 % of Ttl
Reform/Regulations 7 19% Value-Based Care 5 23%
Emerging Technologies 4 11% Analytics/Big Data 4 18%
Value-Based Care 4 11% Reform/Regulations 3 14%
Cybersecurity 4 11% Interoperability 2 9%
Finance/Reimbursement 3 8% Access 2 9%
Analytics/Big Data 3 8%
Consumerism 3 8% #5 Ranking 17 % of Ttl
Emerging Technologies 4 24%
#2 Ranking 34 % of Ttl Value-Based Care 2 12%
Analytics/Big Data 6 18% Processing Efficiency 2 12%
Emerging Technologies 5 15%
Reform/Regulations 5 15% #6 Ranking 12 % of Ttl
Digital Transformation 3 9% Access 2 17%
Consumerism 2 6% Emerging Technologies 2 17%
Finance/Reimbursement 2 6% Reform/Regulations 2 17%
Processing Efficiency 2 6%
Mobile Health 2 6% #7 Ranking 11 % of Ttl
Emerging Technologies 3 27%
#3 Ranking 31 % of Ttl Reform/Regulations 2 18%
Emerging Technologies 5 16% Analytics/Big Data 1 9%
Access 5 16%
Mobile Health 3 10% #8 Ranking 6 % of Ttl
Analytics/Big Data 3 10% Emerging Technologies 3 50%
Consumerism 3 10% Resources 1 17%
Reform/Regulations 3 10% Consumerism 1 17%

Note: Some lists didn’t explicitly rank their predictions as #1, #2, #3, etc. In those cases, rank was assigned based on the precedence of the prediction in the article. I.e. if a specific prediction was listed before another prediction , it was assumed that prediction ranked higher.

Other Insights

The Most Frequently Referenced Categories, Categories by Top 3 Rankings and Overall Rankings of 2017 Predictions Results listed above provide a few instances of correlation with and diversion from the 2017 HCEG’s Top 10 list.

Note: The contents of the tables below were were culled from the various articles listing 2017 Predictions. 

Emerging Technologies

On area of divergence between the HCEG Top 10 list and 2017 Healthcare Predictions Baseline is that Emerging Technologies were not clearly identified by HCEG as of primary focus in 2017. In general, “emerging technologies” are identified as things like 3D printing, AI/machine learning, augmented reality, Blockchain, cloud, drones, Internet of Things, medical devices and robotics. One may argue that, given HCEG’s membership is skewed toward health plans/payers, that  these emerging technologies are not part and parcel of a healthplan/payer-based focus. Given their dominance and potential value, perhaps they should be?

Some Predictions on Emerging Technologies

Adoption of technologies within realm of AI, including RPA and machine learning, will move very fast and take over in many different ways.
Blockchain will move from theory to practice, as pilots and production-ready applications become a reality.
Hype around the Cloud quiets down as it becomes the primary way to build enterprise architecture.
60% of healthcare applications will collect real-time location data and clinical IoT device data and embed cognitive capabilities to discover patterns
Gadgets will continue to be commoditized and competition will grow
IoT will save $1 Trillion a year in maintenance, services & consumables
50% increase in the use of robots to deliver medications, supplies, and food throughout the hospital

Health Reform/Regulations

Given the largely unexpected results of the presidential election, it’s not a surprise that the uncertainty of healthcare reform and regulations jumped to the top position for impacts to healthcare in 2017. Elections have consequences. No doubt as one prognosticator stated “The Trump Presidency Will Rock the Healthcare Boat.”

Some Predictions on Health Reform/Regulations

Massive confusion on status of the ACA
President-elect Donald Trump will likely not fulfill his promise to completely repeal the ACA
The Trump Presidency Will Rock the Healthcare Boat
Regulation drives demand for advanced data and analytics capabilities
Movement by employers away from defined benefit plans to defined contribution plans and increased participation in private exchanges. –
Expand the use of health savings accounts for consumers.
Medicaid expansion costs will be incorporated in the Medicaid block grants
Republicans will attempt to “modernize” Medicare through vouchers or tax credits
There will be continued movement to narrow network products in an attempt to hold down costs.
Federal insurance license changes allowing for competition and selling over state lines
Healthcare startups: Make nice with regulators in 2017

Analytics & Big Data

Predictions about the importance of healthcare analytics made by HCEG members was one area that matched the general baseline as ranking #3.

Some Predictions on Analytics & Big Data

AI (artificial intelligence) or machine learning to translate big data into actionable insights
Convo on healthcare becoming one of most interesting “Big Data” petri dishes society has to offer begins.
Evidence-based decision making (expanded use of data and analytics) to eliminate unnecessary utilization and increase patient safety
Contextualization algorithms will advance exponentially
Advancing data governance
Combining structured and unstructured data
Consortiums of data: genomic, social, EMR, complaint and prescription data, emerge that will create insights never before possible
Mastery of unstructured data will deliver customer insight
Moving to metadata
Taking advantage of real-time data
Startups in analytics space begin to challenge  large, incumbent players and healthcare organizations will begin to actively engage with these new players.

Value-based Reimbursement

Value-based care and reimbursement were highly ranked on both the HCEG Top 10 list and the 2017 Healthcare Predictions Baseline. Given the importance of value-based reimbursement and general bi-partisan support for value-based initiatives like MACRA, VBR should largely survive drastic alteration under the new administration.

Some Predictions on Value-based Reimbursement 

Value-based care will drive adoption of tools for chronic disease management
Easing the training wheels off value-based payment
2017 will be a year for learning about the alternative reimbursement methodologies and planning for the compliance program requirements of the future.
Preparing medical students for work in a value-based world
More performance-based measures beyond cost to quality and satisfaction
Renewed and upgraded Enterprise Resource Planning Systems (ERP) swings back into importance, now for Value Based Care Costing.

Access

HCEG members ranked ‘access’ topics lower than the general baseline.

Some Predictions on Access

The rise of decentralized healthcare and the decline of hospitals.
Significant rise in voluntary services/ healthcare for the wealthy
Self-select virtual care – for convenience
Telehealth will no longer be on the outskirts, pushed into the mainstream with expanded reimbursement policies, usage and outreach programs

Additional Insight Can Be Obtained Here

HCEG Top 10 Info

Collection of 2017 Healthcare Predictions

Raw Data – here is the raw data collected from the various articles on 2017 Healthcare Predictions

Following is a List of Articles used for this analysis – See more info here.

# Title
1 “3 Mega Trends for Healthcare Marketers to Leverage in 2017”
2 “5 healthcare technology trends taking center stage in 2017”
3 “7 Bold Predictions for Healthcare in 2017”
4 “Healthcare CFOs weigh in on 2017 challenges, trends in latest surveys”
5 “Healthcare Industry Trends to Watch”
6 “Healthcare Predictions for 2017”
7 “Healthcare Technology Trends for 2017”
8 “How Consolidation Will Impact Hospitals and Health Systems in 2017”
9 “List Top 10 predictions for IT in 2017 and beyond”
10 “5 healthcare technology predictions for 2017 from Connexica” 
11 “Retail Trumps Healthcare in 2017: Health/Care Forecast for the New Year”  
13 “These Trends Could Reshape Healthcare Tech in the Very Near Future”
14 “Top health industry issues of 2017: A year of uncertainty and opportunity”
16 “Upcoming Trends and Innovations in Healthcare IT 2017”
17 “What to Watch: Health Care Trends for 2017”
18 “10 Predictions for How the Healthcare Industry Will Change in 2017”  
19 “2017 Predictions: Big Data, Digital, and Virtual Care Key to Engage Healthcare’s Empowered Consumer”
21 “4 Business Trends to Watch in the Insurance Industry for 2017”
22 “5 Digital Health Predictions for 2017”
23 “5 Healthcare IT Trends to Watch In 2017” 
24 “7 (plus 1) predictions for healthcare IT in 2017” 
25 “8 Health Tech Challenges and Opportunities in 2017” 
26 “9 Healthcare Tech Trends in “The New Year of Uncertainty” 
27 “Coming Soon to Your Hospital: IoT, Cognitive Computing, Robots and More Ransomware”  
28 “Healthcare Predictions 2017: Accelerated Adoption of Alternative Payment Models”   
30 “How market changes will influence data priorities in healthcare”
31 “Post-Election Predictions for the Healthcare Industry”  
32 “7 digital health predictions for 2017” 
33 “Tom Main and Welltok’s Jeff Margolis Make Their 2017 Predictions” 
35 “2017 Healthcare Trends Forecast: Spok Leaders Weigh In” 
36 “2017 Predictions from Healthcare Leaders Across the Country” 
37 “Trends in health IT for 2017: Ransomware, RPA, blockchain predictions”  
38 “8 technologies that will transform healthcare in 2017 and beyond”  
39 “Five Health IT Trends I’m Looking Forward to in 2017” 
40 “The election is over: 3 health care predictions”  
41 “2017 Predictions: Medicare, Drug Costs, Cybersecurity and More” 

 

HCEG Virtual Panel Summary

By | payer, payment, reimbursement, Uncategorized

2015.08.12 - Reimbursementy

On Thursday, August 6th, HCEG presented and HTMS?sponsored a Virtual Panel??From Concept to Reality: Practical Considerations of Implementing Alternative Reimbursement Models.?? Below is a summary of the call.

To those of us who have been in the healthcare industry for more than a few years it seems we?re always talking about alternatives to fee-for-service reimbursement.? Lots and lots of talk, and only bits of action?as an industry we?re a bit stuck in the gap between theory and practice.

To help us develop practical reimbursement innovation we were fortunate to have panelists today who are not only expert thinkers, they?re expert doers.? The panelists generously shared their practical experience in value-based reimbursement from both payer and provider perspectives.

  1. Craig Samitt, MD, MBA, Partner and Global Provider Practice Leader dug into the details of physician incentive alignment, using his experience at Dean Clinic where 75% of provider revenue was capitated. He offered 9 lessons learned:
  2. Following Dr. DiLoreto, Dan Tuteur, Chief Strategy Officer at Colorado HealthOP shared the pros and cons of being in a startup health plan trying to bring reimbursement and benefit innovation to a well-established marketplace. Benefiting from a blank slate and no historical friction with providers, but handicapped by the inability to promise any patient volume, Colorado HealthOP was successful in finding providers who were already on the path from volume-to-value and capitalize on their interest and experience.? Interestingly, Colorado HealthOP is able to use their benefit agreements to drive change among their members and support from providers.? Members, who complete a health survey, have a basic lab panel done, and select primary care providers are rewarded with richer outpatient mental health and primary care benefits.? Happily, this dynamic has been popular with providers.? Dan predicts Colorado HealthOP will consider capitation for primary care and some limited bundled payments for orthopedics and physical therapy, but significant innovation won?t be implemented until 2017 and thereafter.
  3. David DiLoreto, MD, CEO at Presence Health Partners, opened the discussion by walking us through how his ACO, which represents the continuum of providers, has leveraged its significant experience with government programs into the commercial arena.
    1. Moving from volume to value is a team effort; including physicians from the get-go is crucial.
    2. Don?t look to compensation redesign to fix everything. Peer pressure alone works very well in driving certain desirable changes regardless of reimbursement structures.
    3. Design a balanced mix of incentives. For example, individual physician production is still important, so don?t build compensation formulae that hurt production unnecessarily.
    4. Build a multi-tiered structure including global, departmental, and physician level components. Patient satisfaction and productivity should be evaluated for individual physicians, while quality and access are more meaningfully measured at the departmental level.
    5. Measure at the outset for two reasons?to understand baseline performance, and to benefit from the phenomenon that measurement alone tends to drive behavior changes.
    6. Offer alternatives. Physicians need multiple ?points of entry? depending on the nature of their specialty and their patients.
    7. Size matters?incentives, thresholds, have to be big enough to get the attention of providers and make them change in the desirable direction.
    8. Remember to keep hurdles low enough that providers have confidence they can get over them.
    9. Prepare to change based on evidence and experience.

The panelists also addressed several questions:

Q: When thinking about both impact and level of interest, what are the thresholds in terms of percent of revenue, percent of patients, or other levels do you think apply when trying to move to value-based reimbursement?? How much of a provider?s business must apply for them to be willing to make the investment in changes in practice to participate in an alternative reimbursement scheme?

A: Dr. DiLoreto shared that in his experience, 10% of a provider?s patients falling under value-based reimbursement is sufficient to get the provider?s attention; for a health system, 20-30% of total revenue is the threshold.

A: Dr. Samitt added that once a practice or patient population yields 30-40% of total revenue from value-based payments, the ROI for the provider is enough to drive the entire practice to a population health approach.? Dr. Samitt volunteered that in talking to physicians, he found using percentages was much less compelling than absolute dollars.? 5% seems small; $5,000 seems ?worth the hassle? of making the necessary changes.

A: Dan Tuteur explained that as a start up, they have no opportunity to drive these kinds of numbers, so instead of focusing on the volume of patients or revenue impact, they gravitated to physician who were already on the road to accepting alternative reimbursement.

Q: Can you comment on whether and how you used both benefits and provider contracts to change provider practices?

A: Dan Tuteur opened the discussion by explaining how they began by encouraging shopping for best prices and developing ways to make price transparency an advantage for members.? Colorado HealthOP hired an outside firm to manage this with members, but they found that providers? contract restrictions (with competing plans) made it difficult, in particular the way some contracts defined tiers.? They were helped by the benefit approach of offering better outpatient mental health and primary care coverage if patients participated in the wellness programs summarized above.

A: Dr. DiLoreto talked about the prevalent under-use of wellness benefits by members.? To offset member reluctance, they incorporated encouraging use of wellness benefits in provider contracts, which in turn gets more patients to their primary care physicians.? This has a secondary advantage for the provider and health plans by generating more primary care claims, which is crucial to member attribution to an ACO.

Q: Do you see a future where fee-for-service is the exception?

A: Dan Tuteur explained that as a start up their challenge in moving beyond vanilla fee-for-service is lack of historical data about their rapidly growing membership, where patterns of utilization were very different in year one than in year two.? With an accumulation of data, he believes it will be possible to estimate how quickly such a change could come.

A: Dr. Samitt wrapped up the conversation by stating that it depends on what we mean by fee-for-service?plain old payments without quality measures will become the exception within the next few years, but fee-for-service with quality incentives can and should persist.

Next Stage of Reimbursements

By | payer, payment, reimbursement

2015.07.28 - ReimbursementyTo those of us who have been in the healthcare industry for more than a few years, the perennial discussion about moving away from fee-for-service is getting a bit tiresome when do we stop talking and start doing on a broad scale.

When we look back at the 1960’s (Medicare and Medicaid were passed in 1965), the story was about getting more dollars into the system to pay for the care of elderly and disadvantaged populations. Today, we’re in a serious hunt to find ways to wring dollars out of the system. And the journey we’ve taken with Medicare tells us a lot about what has happened and will happen in the commercial sector.

When Medicare was implemented we paid providers based on submitted charges what seems like a quaint and na’ve approach, but alternatives didn’t show up until 1972 (the HMO Act), with the first reimbursement reform appearing in 1989 when the first step toward non-charge based reimbursement was legislated for Medicare a requirement that professional providers be paid according to a relative value scale. Medicare HMOs didn’t appear until 1997. Every few years another tweak in benefits or payments was legislated, with 2003 bringing the first prescription drug coverage. 2008 started Medicare, tracked in large part by commercial health plans, down the road to mandated reporting on quality measures, federally-incented investments in EHRs, and penalties + payments to drive better, more cost-effective care.

Finally we capped off the decade with the passage of the Affordable Care Act which included not only reforms to the insurance business but various permanent programs to reduce overall costs and improve outcomes. As we look to 2016, when HHS plans to make 30% of its fee for service payments through alternative models and 85% of payments tied to quality or value, growing in 2018 to 50% and 90% respectively, it’s clear we’re moving into a serious doing phase.

For some expert thinking on what this doing phase looks like already and where it’s headed, please join us for our panel discussion From Concept to Reality: Practical Considerations of Implementing Alternative Reimbursement Models. To understand the doing phase, we need to listen to expert doers, and we will be privileged to hear from three of them.

Dr. DiLoreto will talk about how delivery systems are responding to new reimbursement models and provide his perspective on ways payers can work more effectively with their networks.

2015.07.28 - Reimbursementy PromoDan Tuteur will share his lessons from developing innovative reimbursement methods in a startup health plan forging brand new provider relationships.

Craig Samitt will talk about actualizing the vision of changing physician behavior by aligning incentives based on his personal experience.

After their respective brief presentations the panel will take your questions and engage in a lively discussion. Please do not miss this opportunity to listen to and talk about the real world of alternative reimbursement.