Infographic: 2016 Physician Revenue Survey

April 29th, 2016 by Melanie Matthews

The average salary for all physicians is $1,560,688, up from $1,448,136 when the survey was last conducted in 2013, but down from a high of $1,855,773 in 2004, according to a new survey by Merritt Hawkins.

Merritt Hawkins released an infographic that details the study results, including average salaries for primary care physicians, specialists and all physicians.

With more than a quarter-century of experience with value-based reimbursement models, Humana is ideally positioned to help physician practices navigate the transition from fee for service to fee for value. The payor's multi-level Accountable Care Continuum rewards physician practices for care coordination of Medicare beneficiaries along the population health spectrum.

During Physician Value-Based Reimbursement: Quality Rewards for Population Health describes the four tiers of Humana's Physician Quality Rewards program as well as the support, training, technologies and outcomes associated with these pay-for-value relationships.

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Infographic: Risk-Ready Providers Jump Into Government Programs

April 27th, 2016 by Melanie Matthews

Providers are playing an increasingly important role in government programs. These range from active participation in the government marketplace by launching Medicare Advantage and Managed Medicaid products to indirect effects through quality programs that are (to a large extent) controlled by providers, according to a new infographic by Oliver Wyman Group.

The infographic looks at trends in provider-sponsored Medicare Advantage plans and Medicaid risk contracts and drills down into the Oregon and North Carolina markets.

With the nation's leading accountable care organizations already testing the waters with CMS' newest value-based reimbursement opportunity, the Next Generation Accountable Care Organization Model, healthcare organizations are evaluating how this new opportunity aligns with their value-based contracting strategy. With a looming application deadline for a 2017 start for the next round of Next Generation ACOs, the clock is ticking. And, with one approved Next Generation ACO, River Health ACO, already departing the program effective February 1st, the "Go-No Go" decision has become even more critical.

During Next Generation ACO: An Organizational Readiness Assessment, a 60-minute webinar on April 5, 2016, now available for replay, Healthcare Strategy Group's Travis Ansel, senior manager of strategic services, and Walter Hankwitz, senior accountable care advisor, will provide a value-based, risk contract roadmap to determine organizational readiness for participation in the Next Generation ACO Model in particular and in risk-based contracts in general.

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Infographic: Digital Patient-Provider Connections Critical to Value-Based Care

April 25th, 2016 by Melanie Matthews

You're collecting information about your patient's health, but what are you doing with it? Does it sit—disconnected—in your digital systems? Or does it travel seamlessly between them?

A new infographic by UbiCare shows how hospitals and patients efficiently form a meaningful relationship and why digital connections and education are essential to value-based care.

2016 Healthcare Benchmarks: Digital HealthDigital health, also referred to as 'connected health,' leverages technology to help identify, track and manage health problems and challenges faced by patients. Person-centric health management is slowly acknowledging the device-driven lives of patients and health plan members and incorporating these tools into care delivery and management efforts.

2016 Healthcare Benchmarks: Digital Health examines program goals, platforms, components, development strategies, target populations and health conditions, patient engagement metrics, results and challenges reported by healthcare organizations responding to the February 2016 Digital Health survey by the Healthcare Intelligence Network.

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Infographic: Medicare ACO Road Map

April 22nd, 2016 by Melanie Matthews

Provider participation in accountable care organizations (ACOs) is becoming the new normal. As of January 1, 2016, there were 434 ACOs in the Medicare Shared Savings Program. More than 160,000 providers now participate in an MSSP ACO. These organizations now serve 7.7 million Medicare beneficiaries residing in 49 of the 50 states, according to a new infographic by PYA.

The infographic provides a road map to the MSSP destination of shared savings.

With the nation's leading accountable care organizations already testing the waters with CMS' newest value-based reimbursement opportunity, the Next Generation Accountable Care Organization Model, healthcare organizations are evaluating how this new opportunity aligns with their value-based contracting strategy. With a looming application deadline for a 2017 start for the next round of Next Generation ACOs, the clock is ticking. And, with one approved Next Generation ACO, River Health ACO, already departing the program effective February 1st, the "Go-No Go" decision has become even more critical.

During Next Generation ACO: An Organizational Readiness Assessment, a 60-minute webinar on April 5, 2016, now available for replay, Healthcare Strategy Group's Travis Ansel, senior manager of strategic services, and Walter Hankwitz, senior accountable care advisor, will provide a value-based, risk contract roadmap to determine organizational readiness for participation in the Next Generation ACO Model in particular and in risk-based contracts in general.

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Horizon Episodes of Care Program Prototype for Value-Based Specialty Care and Reimbursement

April 21st, 2016 by Patricia Donovan

Horizon BCBS-NJ's Episodes of Care program engages specialists across a suite of nine episodes.

Imagine a value-based healthcare payment model in which the sole financial hazard to specialist providers is the risk of amassing additional revenue.

Further, envision a scenario in which these specialists are invited to design their payment program, from the model's intent to key quality metrics.

Those are some highlights of Horizon Blue Cross Blue Shield of New Jersey's Episodes of Care (EOC) program, a value-based model designed to focus specialists on the provision of quality- and value-based care across nine separate episodes, from joint replacement to hysterectomy to oncology.

Hailed as a national leader in advancing the episodes model as a prototype for value-based specialty care, Horizon is careful to distinguish its EOC program from a bundled payment initiative, for two key reasons.

"First, our EOC program is a quality-based program; it's not only about the payment or payment structure," explained Lili Brillstein, director of the Horizon Episodes of Care program during a recent webinar, Episodes of Care: Improving Clinical Outcomes and Reducing Total Cost of Care Through a Collaborative Payor-Provider Relationship.

Secondly, bundled payments typically refer to a prospective model in which a bundled amount of money is paid to a provider or group of providers in advance of services being delivered, while Horizon's retrospective model pays providers after services have been provided.

The upside-only nature of Horizon's retrospective model contributes to the program's collaborative nature, Ms. Brillstein added. "If the metrics are met, savings are shared. If the metrics are not met, we’re not punishing our partners."

There is other evidence of collaboration and of Horizon's desire to see the providers succeed in the EOC program. One example is the payor's use of case mix-adjusted budgets at the practice level rather than the prevalent member-specific risk-adjusted budgets. "This budgeting allows Horizon to create an opportunity for providers to move the needle [on a metric], and benefit from that. The opportunity for cost savings and shared savings also is dramatically improved."

Another case in point is Horizon's invitation to prospective providers to talk through the episode's construct, intent and design prior to its launch.

Horizon's engagement of providers in the EOC program has "changed the spirit of the relationships between the payor and the provider," Ms. Brillstein noted. "It’s like nothing I’ve ever seen before. Our provider partners have become our ambassadors for the program."

Select EOC results presented during the webinar indicated that outcomes are better for EOC partners—in the area of reduced readmissions, for example—than they are for physicians not in the EOC program.

Horizon expects to launch at least three more episodes in 2016, including a Crohn’s Disease episode that will take into account behavioral health services for those members. While the payor fully expects to move to a prospective model, it believes its current EOC model is preparing them for that eventuality, softening the transition from fee for service to prospective payments.

"[That transition] doesn’t just happen. You don’t sign the paper, and suddenly know what to do. It is an evolutionary transformative process," concluded Ms. Brillstein.

Click here to listen to an interview with Lili Brillstein: Horizon BCBSNJ Episodes of Care: No-Risk Retrospective Model Paves Way for Value-Based Migration

Infographic: Prescription Drug Spending Trends

April 20th, 2016 by Melanie Matthews

Prescription drug spending rose sharply in 2014, driven by growth in expenditures on specialty drugs, including medications to treat cancer and hepatitis C. Medicare's spending on prescription pharmaceuticals also has risen, largely due to the addition of the Medicare prescription drug benefit in 2006: between 2004 and 2014, the program's share of U.S. drug expenditures increased from 2 percent of $193 billion to 29 percent of $298 billion.

A new infographic by Visualizing Health Policy from the Kaiser Family Foundation spotlights these and other national spending trends on prescription drugs and the public's views on pharmaceutical prices.

What's the cost of medication non-adherence? As high as $290 billion annually, according to one frequently cited estimate. An equally bitter pill to swallow is the dismal C+ grade in medication adherence earned in 2013 by Americans with chronic medical conditions, according to the first National Report Card on Adherence from the National Community Pharmacists Association (NCPA).

Fortunately, the healthcare industry is striving to improve performance in this area. 42 Metrics for Improving Medication Adherence: Interventions, Impacts and Technologies provides convincing evidence of the impact of nine key interventions on medication non-adherence—from the presence of pharmacists in patient-centered medical homes to medication reconciliation conducted during home visits.

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Infographic: Countdown to the Merit-Based Incentive Payment System

April 18th, 2016 by Melanie Matthews

The Merit-Based Incentive Payment System (MIPS) was created by the Medicare Access and CHIP Reauthorization Act of 2015 to streamline several of CMS's value-based programs including Meaningful Use, Physician Quality Reporting and Value-Based Modifier.

An infographic by SA Ignite highlights the basics on MIPS including eligibility, scoring, financial impact, qualifications, and exemptions.

One year after the Centers for Medicare and Medicaid Services began reimbursing physician practices for chronic care management services, Bon Secours Medical Group is now comfortable with the CCM reimbursement requirements and is reporting that it's unique approach to this revenue opportunity is ramping up nicely. And, the organization's approach to chronic care management reimbursement is helping to position itself for advance care planning as a new billable CMS event in the upcoming year.

During Physician Reimbursement in 2016: Workflow Optimization for Chronic Care Management and Advance Care Planning, a January 26th webinar, now available for replay, Robert Fortini, PNP, chief clinical officer for Bon Secours Medical Group, will provide an inside look at his organization's experience with CMS' chronic care management reimbursement this year and how they are leveraging this experience for CMS' newest billable event in 2016—advance care planning.

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Infographic: Alternatives for Potentially Preventable ER Visits

April 15th, 2016 by Melanie Matthews

Ten common conditions represented more than 2 million annual emergency room visits in New York at an estimated cost of about $1.3 billion, and nine out of 10 of them could have been avoided or treated elsewhere, according to research issued by Excellus BlueCross BlueShield.

A new infographic by Excellus BlueCross BlueShield highlights key findings from the study, including the impact of preventable visits and the geographic regions with higher rates of preventable visits.

Asked by its C-suite to quantify contributions of its multidisciplinary care team for its highest-risk patients, AltaMed Health Services Corporation readily identified seven key performance metrics associated with the team. Having demonstrated the team's bottom line impact on specialty costs, emergency room visits, and HEDIS® measures, among other areas, the largest independent federally qualified community health center (FQHC) was granted additional staff to expand care management for its safety net population.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations chronicles AltaMed's four-phase rollout of care coordination for dual eligibles—a population with higher hospitalization and utilization and care costs twice those of any other population served by AltaMed.

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Can Digital Health Drive Down Diabetes Costs?

April 14th, 2016 by Patricia Donovan

The majority of organizations engage in digital health to enhance patient satisfaction with their healthcare experience, according to March 2016 HIN market metrics.

New metrics from the Healthcare Intelligence Network (HIN) have determined that 58 percent of digital health initiatives target patients with diabetes, the global cost of which is now $825 billion per year, according to a new report from the Harvard T.H. Chan School of Public Health.

Harvard, the World Health Organization and nearly 500 researchers around the globe recently conducted the largest-ever worldwide study of diabetes levels.

Respondents to the February 2016 Digital Health Survey by the Healthcare Intelligence Network report that, along with the diabetes population, individuals with congestive heart failure and hypertension are also closely monitored by digital health programs.

Weight and vital signs, key indicators that can signal complications with diabetes and other chronic conditions, are the health activities most frequently monitored by digital health, said 63 percent of survey respondents, a trend Melanie Matthews, HIN executive vice president and chief operating officer, would like to see expanded.

"In our device-driven era, many individuals already use at least one electronic tool for health-related reasons. Coaching people to use digital health to monitor vital signs like weight and blood pressure will foster self-management." And with chronic conditions held in check, the industry should see a drop in hospital utilization and associated cost, Ms. Matthews predicted.

Digital health, also called ‘connected health,’ leverages technology to identify, track and manage patients' health problems.

The survey also identified these digital health trends:

  • Individuals at moderate risk for hospitalization are the most engaged in digital health, said one-quarter of respondents.
  • Seventy percent said the principal goal of digital health is to elevate patient satisfaction with the healthcare experience.
  • Individuals at risk of a health crisis or hospital admission are the most heavily invested in digital health, according to one-quarter of respondents.
  • Mobile and tablet apps are the front-running digital health platforms, say 78 percent of these respondents, with online health education the principal digital health activity for 58 percent.
  • Overall, patient engagement proves the biggest digital health hurdle to overcome, say 23 percent of respondents.

For more 2016 digital health metrics, download the Digital Health Survey executive summary.

Hinfographic: Care Plans Put Healthcare Team on Same Page

April 13th, 2016 by Melanie Matthews

Though supporting technologies may vary, most healthcare organizations develop detailed, evidence-based, sharable care plans that follow high-risk patients through clinical episodes and transitions of care, with the goal of enhancing care quality and engagement and reducing spend, according to the 2015 Care Plans survey by the Healthcare Intelligence Network.

A new infographic by HIN examines how care plans are distributed and stored, how long patients' care plans are tracked and the frequency of care plan tracking.

2016 Healthcare Benchmarks: Care PlansDetailed evidence-based care plans that follow high-risk patients through clinical episodes and transitions of care help these patients and their providers assess the level of care needed, evaluate services available and empower patients with goals of care, a strategy that impacts quality, outcomes and patient experience and engagement.

2016 Healthcare Benchmarks: Care Plans examines care plan utilization strategies and successes from more than 75 healthcare organizations responding to the November 2015 Care Plan survey by the Healthcare Intelligence Network. Click here for more information.

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