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ACOs taking on more financial risk


FierceHealthcare reports that new data suggest  that Accountable Care Organizations are adapting to the need to take on more   financial risk. But, the news service adds, “Reducing costs and managing population health remain key challenges, … prompting an investment in add-on technologies like population analytics.”

The National Association of ACOs and Leavitt Partners surveyed 240 organizations and found that ACOs across the board plan to participate in “at-risk arrangements.” Nearly half have chosen  shared savings and losses, with another 38 percent picking capitation-based agreements.

Meanwhile, the number and sophistication of ACO contracts have  expanded, the report says. This includes ACO providers following alternative value-based payment methodologies in parallel.  Fierce reports that ACOs seem to have been particularly attracted to the patient-centered medical home model, “present in 86 percent of the organizations surveyed. The survey also noted satisfaction with bundled payment models in some areas of care.”

To read the Health Affairs blog entry, please hit this link.

To read the FierceHealthcare article, please hit this link.




For better performance management in bundling


The American Hospital Association recommends these steps to support performance management in bundling:

  • “Develop a system to identify patients likely to qualify for bundled episodes early and assess their risk for complications, and track their progress through the bundle episode.
  • “Develop multidisciplinary teams, led by physician champions, in the implementation of standard care processes to reduce variations in care to improve patient outcomes and reduce costs.
  • “Develop a high-functioning discharge planning process.
  • “Enhance data analytics and information sharing capabilities.”

Meanwhile, says a piece in Hospitals & Health Networks, Burlington, Mass.-based Lahey Health has partnered with xG Health Solutions,  in Columbia, Md., to help guide it through its bundled-payment adoption, as well as to provide analysis of CMS data from procedures using bundled payments.

Thus Lahey now knows the analytics of where and when  patients get care within 90-days after discharge,  when patients visit  emergency departments, and whether they’re  readmitted to the hospital other than at Lahey. This information helps to identify patterns the knowledge of which can be used to improve care quality.

The H&HN piece reports:

”{D}ata showed patients participating in the total joint {replacement} bundle were being readmitted with wound infections. After assessing various options, the hospital adopted seven-day dressings, which reduced infections and enhanced patient and staff satisfaction by eliminating multiple dressing changes per day while in-house and associated hospital readmissions post-discharge.”


“One of the keys to success under the bundled-payment model is developing ongoing communication with other providers within the community. Bringing together representatives from the hospital, including physicians, along with home health, acute rehab, and skilled-nursing providers, has helped build trust and understanding of what role each group serves.”

But ”it is critical that physicians have dedicated time to focus on process improvement initiatives under bundled payment.”

To read more, please hit this link.


Bundled payments: Big promise, big pitfalls


See hip replacement at left.

David Blumenthal, M.D., and David Squires have written a very cogent and realistic overview of the promises and pitfalls of bundled payments. Among their remarks:

“Healthcare economists are drawn to bundled payments because a bundle of care constitutes a clinically and intuitively meaningful “product” — in this case, the clinical episode. Defining clear products in healthcare helps create markets in which providers directly compete on quality and price. One barrier to effective healthcare markets has been that prices, when available, tend to relate to inputs into clinical care — such as pills, bandages, bed days, or X-rays — that are not meaningful to consumers of care and that don’t necessarily predict the total costs of care. ”

“Yet bundled payments have drawbacks. First, it can be complicated to define and track the type of care that should be included in the bundled payments for which a given provider is at risk. Knee and hip replacements are well-suited to bundles because they often involve comparatively young patients who are physically active (often the source of their joint damage) and want to remain so. But when patients have multiple chronic conditions that interact with each other, it becomes less clear whether the bundle should include the costs of caring for all those problems….Monitoring the fairness of these interactions could become burdensome and increase administrative costs.”

“{A}s the hip patient example suggests, bundles could inhibit certain types of care coordination, even as it encourages other types. On the plus side, bundles may encourage hospitals to work more closely with rehab centers. On the negative side, bundles may encourage specialists’ already strong tendency to see patients not as whole individuals, but as single disease problems or procedures, and to diminish their sense of responsibility for costs of illnesses not included in their particular bundled payment.”

{B}undled payments could encourage destructive competition for patients with profitable bundles. The otherwise healthy patient needing a knee replacement may prove more profitable than a knee replacement patient with complicating problems such as heart, lung, or kidney disease. While risk adjustment could somewhat compensate for cherry-picking, such adjustments have not proven foolproof in the past, and an entirely new fleet of risk adjusters that are specific to given clinical episodes will likely be required. Monitoring the work of multiple risk adjusters and possible gaming by providers could become yet one more administrative expense.”

“{B}undled payments may make it harder for population-based payment methods like ACOs to be successful. Providers who participate in ACOs assume responsibility for all the care their patients need during a given period of time, including specialty care. This general accountability for their patients’ health encourages efforts to coordinate care, especially for complex patients. Still, to be financially viable, ACOs must generate savings from existing services. If independent specialty providers capture the elective procedures for which savings are easiest to generate through bundled payments, it could be harder for ACOs to find those savings within their own service mix.”

To read this entire essay, please hit this link.





Anthem plans to offer incentives for integrated-care certification


Anthem Blue Cross and Blue Shield plans in Ohio and 13 other states have become the nation’s first health-insurance plans to offer providers incentives for obtaining integrated-care certification (ICC) from the Joint Commission, Healthcare Dive reports.

“The certification will help Anthem meet its care coordination measure under its Quality-In-Sights hospital incentive program, its performance-based reimbursement program for hospitals,” the news service reported.

So far only one Florida hospital, Parrish Medical Center, has attained integrated-care certification from the Joint Commission. “Anthem hopes its recognition of the standard will prompt hospitals to do so,” Healthcare Dive said.

The decision is part of a broader effort by CMS to reimburse based on quality, not quantity of procedures. Among CMS’s initiatives is a proposed bundled- payment model for heart attacks and bypass surgeries, with a demonstration project to be launched at 98 sites next year.

“The Joint Commission launched the ICC a year ago to recognize providers that excel at communication, information sharing and other behaviors aimed at creating a seamless experience for the patient across multiple healthcare settings,” Healthcare Dive reported.

To read the whole article, please hit this link.



CMS offers 2-year extension for bundled-payment program


CMS is  offering participants in the Bundled Payments for Care Improvement initiative the option to extend participation an additional two years, says a blog post from Patrick Conway, M.D., CMS’s acting principal deputy administrator and chief medical officer.

Rather than ending the program this fall, participating providers can extend participation through Sept. 30, 2018.

Becker’s Hospital Review says that the agency hopes that “the extension will help it better determine the effectiveness of the program, which aims to incentivize providers to improve care coordination by paying for services patients receive across an episode of care, such as a heart bypass surgery or hip replacement.”

Dr. Conway wrote: “By extending their participation, CMS will be able to provide a more robust and rigorous evaluation of the initiative and determine whether the efforts of bundling payments are successful in providing better care while spending healthcare dollars more wisely”.

The initiative tests four payment models, which vary based on the services in the episode of care and whether payments are made prospectively or retrospectively. BPCI has 1,522 participants, nearly all of which are in Models 2, 3 and 4.

The extension will be available to providers in Models 2, 3 and 4 that began the BPCI initiative in October 2013 or in 2014.

Healthcare IT in 2016


This article  by John Halamka in tech-focused MedCity News makes predictions for health IT in 2016. They include, here in stripped-down form:

1. “Population health will finally be defined and implemented.”

2. “Security threats will increase.”
3. “The workflow of EHRs will be re-defined. ”

4. “Email will gradually be replaced by groupware.”

5. “Market forces will be more potent than regulation.”

6. “Apps will layer on top of transactional systems empowered by FHIR {Fast Health Interoperability Resources}.”

7. “Infrastructure will be increasingly commoditized.”

8. “Less functionality with greater usability will shape purchasing decisions.”

9. “The role of the CIO will evolve from provisioner/tech expert to service procurer and governance runner.”

10. “The healthcare industry will realize that IT investments must rise for organizations to meet customer expectations, survive bundled payment reimbursement methods, and create decision support/big data wisdom.”


Fee-for-value leader Dr. Beauregard joins CMG


George Beauregard, D.O., has joined Cambridge Management Group (CMG) as a senior adviser. Dr. Beauregard has been a leader in moving hospitals and physicians into the new world of fee-for-value care.

He has 20 years of experience in private practice in internal medicine and vast experience with pay for performance; performance- and risk-based contracts involving commercial and Medicare payers; EMR/HIT implementation, and Accountable Care Organization and Bundled Payment development.

In his recent role as senior vice president and chief clinical officer for the PinnacleHealth System, based in Harrisburg, Pa., he worked closely with the clinical and administrative leadership to help PinnacleHealth achieve enterprise- wide success in successful CMS Accountable Care and Bundled Payment initiatives; quality and performance improvement; clinical integration, and HIT optimization. This helped lead CMS to welcome RiverHealth ACO, of which PinnacleHealth is a founding member, into the 2014 Medicare Shared Savings Program.

Prior to joining PinnacleHealth, in September 2012, Dr. Beauregard was president and chief medical officer of Southcoast Physicians Network, in Massachusetts.  His leadership helped gain Southcoast admission into the 2013 Medicare Shared Savings Program.

Before that, he was co-founder, in 1996, of Primary Care LLC, the largest independent community-based primary-care-physician network in eastern Massachusetts. Dr. Beauregard guided a merger of that entity with Tufts Medical Center in 2005 to form the New England Quality Care Alliance (NEQCA), where he then served as chairman of the board for four years. He also was trustee of Tufts Medical Center Physicians Organization Inc.

George Beauregard is a graduate of the University of New England College of Osteopathic Medicine. He has been awarded Diplomate Certificates by the American Board of Internal Medicine and the National Board of Osteopathic Medical Examiners.


Medicare incentive programs’ big design flaws


Design flaws are hurting Medicare’s incentive programs, reports Modern Healthcare’s Melanie Evans, using the experience of Hebrew Home in New York City as a prime example. She says that such programs must “offer a robust link between efforts, performance and reward, and incentives must be large enough to make a difference, experts say.”
“The CMS, private payers, policymakers and provider systems are placing heavy reliance on using financial incentives to change provider behavior to improve quality of care and reduce costs. …Half of what the traditional Medicare program spends will be tied to rewards for quality and cost control by 2018. That will mean continued growth of accountable care and bundled-payment contracts. Other incentives that penalize or reward hospitals for quality and safety, known as value-based purchasing, will be linked to 90% of Medicare spending by 2018.”
“But researchers say much depends on properly structuring the incentive programs to achieve the desired results. Public policy inside and outside healthcare is strewn with incentive programs that have fallen short of producing the desired results. The consequences of poorly designed incentives can be higher spending and lower quality care. For evidence, look no further than Medicare’s fee-for-service payment model, which has been widely blamed for encouraging greater volume of services, causing higher spending and exposing patients to the risks of unnecessary and disjointed care.”





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