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Tracey Moorhead President and CEO May 15, 2015 No Disclosures ©AAHCM.

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Presentation on theme: "Tracey Moorhead President and CEO May 15, 2015 No Disclosures ©AAHCM."— Presentation transcript:

1 Tracey Moorhead President and CEO May 15, 2015 No Disclosures ©AAHCM

2 has been defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group."


4 4 Pt/Cg Interactions: face-to-face, telephonic, and electronic Predictive Analytics & Risk Stratification Patient Engagement & Motivational Interviewing Patient- Centered Goals and Care Plan Assessment and Care Coordination by RN Health Coaching and Support Collaboration with Primary Care and Other Providers Financial and Clinical Outcomes & Reporting

5 5 A Dual Imperative for Home Health Providers

6 Performance RiskUtilization Risk Bundled Pricing Bundled Payments for Care Improvement program Commercial bundled contracts Pay-for-Performance Value-Based Purchasing Readmissions penalties Quality-based commercial contracts Shared Savings Medicare Shared Savings Program Pioneer ACO Program Commercial ACO contracts Cost of CareQuality of CareVolume of Care Categorization of Risk-Based Payment

7 7

8  Providing Value ◦ Role of home-based care in new models ◦ Variation from traditional services & populations ◦ Ability to impact quality & efficiency metrics  Reimbursement: ◦ Potential for commoditization ◦ Downward pressure on rates ◦ Assumption of risk?  Participation in Narrow Networks

9 Patient Centered Medical Homes coordinate patient treatment through primary care physicians to ensure patients receive the necessary care when and where they need it, in a manner they can understand Health Homes facilitate access to and coordination of the full array of primary and acute physical health services, behavioral health care and long-term community- based services and supports Primary Care Case Management uses primary care providers to monitor and approve the care of enrolled Medicaid beneficiaries Accountable Care Organizations brings together doctors, hospitals, and other health care providers to coordinate care for patients while achieving quality and cost targets Managed Care providers patient care within a restricted network of providers and in which utilization is monitored by a managing company

10 Fee-for- Service Payment per service delivered Pay-for- Performance A portion of payment is based on performance on established metrics (e.g., quality, safety, efficiency) Care Coordination PMPM A per member per month payment for care coordination services (in addition to payment for medical services) Shared Savings A spending target is established and savings generated against the target are shared between the payer and provider. Can also apply to losses Bundled Payments A single payment for a group of services defined around a clinical condition & period of time, often delivered by different providers (can be done retro- spectively) Capitation A per member per month fee for some (partial) or all services provided to a patient

11  Data will be one of the primary lynchpins to success. You must be able to answer questions like: ◦ How much does each of my services cost? How is that cost distributed across the organization? How am I performing against cost and efficiency metrics right now? How are we performing against others in the market? Where is there unnecessary cost? ◦ How am I performing on established quality metrics right now? Where am I underperforming? Is there variation occurring within the organization? If so, where and why? ◦ Where are my patients coming from (geographically and other sites of care) and where are they going to? What is the patient’s condition when we get them and when they leave us? Which patients do I need to be paying close attention to?  Increasingly, your own organization’s data will not be enough ◦ Claims data from all payers ◦ Clinical records from other providers

12 Clinical, functional, and social profile Level of patient activation Care plan & performance against care plan using evidence based guidelines Patient utilization across healthcare settings Risk stratification to identify high risk and rising risk patient cohorts Performance on population health metrics Performance for specific populations, e.g., dual eligibles Cost per service / bundle of services Cost and clinical quality performance against performance-based contract targets now and projected Variation in performance by site of service/practitioner Patient “leakage”

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