Recapping Value-Based Payment – Getting from Here to There…

By | HCEG Top 10, HealthEdge, payment, reimbursement, Risk-Sharing, Value-Based Payment, Webinar Series | No Comments

Our sponsor partner HealthEdge hosted HCEG’s Webinar Series event in March: Value-Based Payments – Getting from here to there…

Harry Merkin, VP of Marketing at HealthEdge and Dave Mika VP of Enterprise Core System Operations at Independent Health shared insight and real world experience on how health plans and their provider networks can transition from traditional fee for service (FFS) to value-based payment (VBP).

This blog post recaps highlights of the webinar and provides access to additional information from the webinar. A recording of the webinar can be found here. You can also check out this Twitter Moment summarizing live Tweets from the webinar.

Value-Based Payment Began in the Late 1990’s 

In the late 1990’s, capitation models began paving the way for change from traditional FFS payment models to models focused on helping establish effective, cost-efficient practice models. In the last few years, value-based payments have become the latest and greatest models for reimbursement of care. The importance of value-based payments is supported by HealthCare Executive Group members ranking Value-Based Payment as #3 on the 2018 HCEG Top 10 list.

Moreover, recent statements by current and former HHS officials have supported the need for value-based payment:

“There is no turning back to an unsustainable system that pays for procedures rather than value”, and the transition “needs to accelerate dramatically.” – Alex Azar, Secretary of HHS, 3/5/18 at the Federation of American Hospitals’ conference

“I highly encourage health care leaders to listen intently to his full remarks. The transition to value is moving forward; if you aren’t already preparing for it, it is time to get on-board.“ – Michael Levitt, former governor of Utah and former HHS Secretary

Value-Based Payment Can Lower Costs and Improve Outcomes

Harry Merkin shared the results of a November 2017 Humana study showing that VBP programs achieve meaningful gains in cost and quality vs. traditional FFS methods with total healthcare costs associated with VBC plans 15% lower than care costs of FFS plans. And a more recent survey by the Healthcare Financial Management Association revealed that 70% of healthcare organizations participating in VBP programs have achieved positive results.

Value-based Payment Must Address the Quadruple Aim

Independent Health’s Dave Mika shared real-world insight into the experience his organization has witnessed. A key focus raised by Dave is that health plans looking to implement or extend value-based payment programs must address the four pillars of the Quadruple Aim

  1. Enhancing patient experience
  2. Improving population health
  3. Reducing costs
  4. Improving the work life of health care providers

Questions from Webinar Participants About Value-Based Payment

HCEG webinar series events always include the opportunity for questions from participants and this webinar was no exception. Two of many questions included the following short, paraphrased responses by Dave Mika – and other questions can be obtained from the webinar recording:

What is the key to gaining alignment with PCP’s?

Answer: Actively reaching out to and collaborating with key stakeholders in the local community.

What data has proven to be most useful to the provider network?

Answer: Information on patient gaps in care– ideally provided at the point of care in the physician’s workflow – can be very effective in improving value.

And More on How to Get There from Here…

In addition to the above, the webinar addressed the following considerations for transitioning from traditional FFS programs to VBP programs:

  • Aligning delivery and reimbursement models with high-performing providers
  • Tools for members to self-manage and self-navigate the care delivery system
  • Technology support including web and digital capabilities

The move to value-based reimbursement appears inevitable, and only those health plans and providers that begin to transition and adapt today will be successful in the future. Change doesn’t happen overnight. To learn more about how making the transition from FFS to VBP, check out the webinar recording, consider contacting HealthEdge for more information and keep in touch with the HealthCare Executive Group by connecting with us on Twitter, Facebook, LinkedIn and subscribing to our newsletter.

Value-Based Payments – Getting from here to there…

By | Healthcare Reform, HealthEdge, payment, reimbursement, Value-Based Care, Value-Based Payment | No Comments

 value-based payments (VBP) models. Capitation models traditional fee-for-service (FFS)

Since the late 1990’s, the reimbursement landscape in healthcare has been changing. Capitation models paved the way for a change from traditional fee-for-service (FFS) payment models to a focus on helping physician partners establish effective, cost-efficient practice models. And now value-based payments are the latest and greatest models for reimbursement of care. In fact, value-based payments were ranked by HealthCare Executive Group members as #3 on the 2018 HCEG Top 10 list.

value-based payments (VBP) models. Capitation models traditional fee-for-service (FFS) MACRAWhile uncertainty surrounding healthcare reform in the United States continues and the industry waits for more definitive reimbursement policy from the federal government, one thing is certain—the trend for value-based payments (VBP) continues. Health plans and providers really have no choice but to transition from the traditional fee-for-service model in order to drive down soaring costs and positively impact patient outcomes.

“There is no turning back to an unsustainable system that pays for procedures rather than value” and the transition “needs to accelerate dramatically.”

– Alex Azar, Secretary of Health and Human Services, March 5, 2018 at the Federation of American Hospitals’ conference

Obstacles in the Path to Value-based Payments

There are many obstacles that must be addressed to successfully implement value-based payments models that reward providers for positive performance and encourage poor performers to improve. In order to achieve the expected outcomes and performance required by VBP, health plans must have the flexibility to develop, implement and administer value-based contracts with providers responsible for care delivery, care management, and care coordination across the medical neighborhood.

value-based payments (VBP) models. Capitation models traditional fee-for-service (FFS) MACRA

How to get there from here…Value-based Payments

On Thursday, March 22, 2018 at 2:00PM ET, Harry Merkin of HealthEdge and Dave Mika of Independent Health will share their insight and real world experience on how to get from here to there with value-based payment. Some of the information they will share includes:

  1. Essential elements of a transition from traditional Fee For Service to Value-based Payment
  2. Independent Health’s story of how important technology-driven strategies are to their adoption of value-based payments
  3. How models being driven by CMS are also impacting commercial contracts
  4. How some health plans are responding to the value-based payment movement including findings from a study of value-based care payments by Humana
  5. The importance of primary care physicians as critical to transforming the way health care is delivered
  6. The type of technology support needed by health plans and providers

The move to value-based reimbursement is inevitable, and only those health plans that adapt will be successful in the future. And developing the capabilities to effectively respond to change doesn’t happen overnight.

Reserve your seat today and learn how to get there from here

Thurs, March 22, 2018 | 11:00am PT / 2:00pm ET Healthcare Executive Leadership Forum at Guidewell Innovation Center

Learn About Value-Based Payments from Industry Thought Leaders

Presenter – Harry Merkin

Vice President of Marketing, HealthEdge

Harry Merkin has worked with both payers and providers through many dynamic changes in healthcare for a number of years. He is currently responsible for Marketing at HealthEdge, including product marketing, demand generation and thought leadership. He previously had similar responsibilities at Evariant and NaviNet and has collaborated with many transformative entities across the healthcare landscape. Harry has helped introduce and promote innovative enterprise software solutions that enable payers to improve their competitive effectiveness, as well as perform valuable communications between payers and providers, and allow providers to effectively collaborate with patients and consumers as well as with each other

Co-Presenter – Dave Mika

Vice President, Enterprise Core System Operations, Independent Health

Dave Mika plays an integral role in leading the operations unit at Independent Health, located in Buffalo, NY. He is responsible for the coordination of activities across the organization to more effectively manage workloads and partner closely with individual business unit owners to achieve operational excellence. A former Army Reserve combat medic and Licensed Practical Nurse with more than 30 years of experience in the health insurance industry, Mika has also held management positions in member appeals, provider relations, project management and product development and implementation.

Recap of Webinar: ‘Care Redesign: Lowering Costs While Improving Patient Outcomes’

By | HealthEdge, Sponsor, Value-Based Care, Webinar Series | No Comments

As more Accountable Care Organizations (ACO) are formed and as value-based reimbursement arrangements between payers and providers expand, the need for assessing non-traditional drivers of health outcomes, leveraging payer, provider and community resources and enhancing collaboration between patients, providers and payers are becoming key to improving outcomes and managing costs.

Our Thursday, October 26, 2017, Harry Merkin, VP of Marketing at our sponsor partner HealthEdge teamed up with Barbara Berger, VP of Care Management at First Care Health Plans, to present “Care Redesign: Lowering Costs While Improving Patient Outcomes,” HealthEdge’s entry in this month’s HCEG Webinar Series.  The webinar presented innovative, real-world examples of how First Care Health Plans is improving member outcomes and lowering their cost of care via three primary approaches:

  1. Collaborating with providers and health systems
  2. Partnering with community resources
  3. Making critical information available to key stakeholders

Addressing Discontinuances of Care

Barbara shared that, while the high volume, time-sensitive nature of healthcare delivery often leads to a discontinuance of care delivery and management between the silos in which payers and providers often operate, the increased data sharing associated with the emergence of ACO’s and value-based reimbursement and care models are helping to align care provided by providers and health plan payers. Examples of balancing the proper people, processes and technologies were shared.

Population Assessments and Social Determinants of Health

Barbara emphasized the importance of carefully and thoroughly assessing an individual’s health care, behavioral and social needs as part of a periodic, recurring population assessment and how doing so can have a key, beneficial impact to healthcare outcomes.  And with “Social Determinants of Health” forming the basis (bottom) of Maslow’s Triangle of Needs, First Care is starting to include an assessment of member’s social determinants of health in their population assessment program. Factors such as the following are included in the population assessment:

  1. Access to Healthcare Services
  2. Access to Food
  3. Access to Local Community Resources
  4. Access to Transportation Options
  5. Public Safety
  6. Financial Status

After Barbara shared her insight on this currently popular topic, Harry Merkin stated: “The phrase ‘social determinants of health’ is no longer a buzzword!”

Addressing Social Determinants of Health

Barbara shared an overview about First Care’s “Expecting the Best Maternity Program” that combines case management and utilization management to complement care provided by physicians while guiding and supporting members – and their family – through member pregnancies; particularly high-risk pregnancies.

Besides services such as assistance with locating medical providers, toll-free 24/7 access to a clinician and a package of select products and services aimed at supporting pregnant women, the program also includes an innovative “Nurse-Family Partnership” where a First Care nurse is paired with an expecting family to help the patient and her immediate family members understand and manage the pregnancy. First Care nurses regularly reach out to ask questions on how the pregnancy is progressing and answer any questions the patient and family may have.

The program has resulted in a significant per decrease in NICU maternity admissions.

The Recording, The Content and More Insight from HealthEdge

The webinar presented three considerations for payer-provider population health programs:

  1. Be methodical about population assessment
  2. Integrate People, Process and Technology with Providers
  3. Use value-based contracts to align vision of member/patient care

You can learn more about how collaborating with providers and health systems, partnering with community resources and making critical information available to key stakeholders can improve outcomes and lower costs by checking out this recording of the webinar and these few slides from the presentation. If you would like more information or if you have any questions on the content of this webinar, please feel free to contact HealthEdge too.

More Information

HealthEdge Website

HealthEdge on Twitter

First Care Website

First Care on Twitter

If you’re not a HCEG member and would like more information on becoming a member, please see this page or email Juliana Ruiz.