Sample Disease States With Rapid Vesus Eventual Economic Returns Disease Program Asthma Congestive Heart Failure Diabetes Hyperlipidemia Hypertension Low Back Pain Osteoporosis H:present/hmoprmce Return on Investment Pneumonia Depression Weight Reduction Rapid Eventual djsslides
Basic And Advanced Return-On-Investment (ROI) Equations * Costs associated with the specific program (e.g., disease-specific case managers, educational materials, and development costs). Basic ROI Equation Direct Costs of Program * + an Allocated Percentage of Overhead - Disease Episode Costs Preimplementation - Disease Episode Costs Postimplementation Direct Costs of Program + Allocated Overhead - (Disease Episode Costs Preimplementation - Disease Episode Costs Postimplementation) + (Benefit of Avoided Complications in Dollars + Benefits of Improved Clinical Outcomes in Dollars) + Additional Revenue of Increased Use of In-System Resources Attributed to the Disease Management Implementation ROI = Advanced ROI Equation ROI = djsslides
Payments Should Align Reimbursement with the Implementation of Best Practices (Disease Management) Payments Should Align Reimbursement with the Implementation of Best Practices (Disease Management) Financial Success is Tied to the Outcomes of a Defined Population Financial Success is Tied to the Outcomes of a Defined Population Outcomes-Based Contracting djsslides
Shared Objectives for Managed Care Organizations and Provider Systems DISEASE MANAGEMENT Component 1. ACCESS 2. SERVICE 3. QUALITY 4. VALUE Access to All Sites and Providers Where Appropriate High Patient Satisfaction Across the Entire Experience Best Practice Approach Optimal Resource ($s) Use (more or less) Goal djsslides
Current System Versus Outcomes-Based Contracting Current System Outcomes-Based Contracting PATIENTS Complex Registration,Non-Restricted Access Referral Requestsby Protocol PHYSICIANS Documentation RequiredDocumentation for for ReimbursementClinical Care OFFICE STAFF Billing, Paper WorkDisease Mangement for Payers Support ADMINISTRATIVE30%5% COSTS djsslides
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