Value Based Care Learning Kit€¦ · Highmark Inc. Mari Vandenburgh is the Director of Value Based Reimbursement for Highmark Inc. She is part of the team leading the implementation

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PRIMER VIDEO View a five minute video on basic value based care concepts

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WEBINAR VIDEO LIBRARY Browse a library of value based care webinar videos, companion slides and overview information for each event

NEWSLETTER LIBRARY Browse a library of entire issues of Value Based Payment News

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HealthcareWebSummit Webinar Video Library Menu page 1 Main Menu

Highmark True Performance Program Value-Based Care at

Highmark October 3, 2018 | 61 Minutes

Overview | PowerPoint | Watch Video

Understanding MSSP Pathways to Success: Milliman

Analysis/Implications September 21, 2018 | 53 Minutes


Value-Based Specialty Care:

Anthem's Approach September 20, 2018 | 59 Minutes


Key Considerations for Financial Modeling Value-Based

Payment Arrangements May 24, 2018 : 59 Minutes


Episode Payment Models: CJR Results and BPCI

Advanced Opportunities February 28, 2018 | 61 Minutes


Value Based Care Transformation Trends –

Future Care Web Summit 2018 January 25, 2018 | 34 Minutes


Provider Coding Accuracy in Commercial Value Based Contracts

Impact on Risk Adjustment December 13, 2017, 58 Minutes


Quality Payment Programs in 2018: Medicare,

MA Plans and Medicaid December 5, 2017 | 68 Minutes


Employer Partnerships with ACOs - 8th Annual Accountable Care

Web Summit 2017 November 5, 2017 | 36 Minutes


HealthcareWebSummit Webinar Video Library Menu page 2 Main Menu

Alternative Payment Models in Medicaid - Deloitte Research Could MACRA be Catalyst?

October 25, 2017 | 57 Minutes Overview | PowerPoint | Watch Video

Value Based Rx Contracting Tactics and Techniques: Navigating Legal

and Regulatory Complexities September 14, 2017 | 62 Minutes


Understanding Medicare’s Use of Episode-Based Alternative Payment

Models August 30, 2017 | 53 Minutes


Value-based payment models in Oncology: Deloitte Research on Impact of New Payment Models

May 31, 2017 | 49 Minutes Overview | PowerPoint | Watch Video

Impact of ACOs on MIPS Payments - ACO Participation Can Increase MACRA Score

May 17, 2017 | 24 Minutes Overview | PowerPoint | Watch Video

Deloitte Research: Strategies to drive health care value: Bundled payments and post-acute care

April 13, 2017 | 50 Minutes Overview | PowerPoint | Watch Video

MACRA and Medicare Advantage Plans: Synergies and

Potential Opportunities March 29, 2017 | 56 Minutes


Highmark launched its True Performance program in January of 2017, with the goal to improve health care quality outcomes for members, reduce annual increases in total health care costs and help physicians engage in patient care coordination and population health management. Highmark Inc. and affiliates operate health insurance plans in Pennsylvania, Delaware and West Virginia that serve 5 million members, and are among the ten largest health insurers in the United States and comprise the fourth-largest Blue Cross and Blue Shield-affiliated organization.

Highmark's True Performance is a value-based reimbursement program for Primary Care Physicians (PCPs) focused on affordability and quality of health for Highmark members. The program evaluates PCPs' ability to deliver the right care at the right time and in the most appropriate setting, and rewards PCPs for their performance on quality and cost/utilization measures.

Based on Highmark's claims data through the end of 2017, Highmark members who are seeing a PCP in the True Performance program had 11 percent fewer Emergency Room visits in 2017 than members seeing a PCP not in the program, and Highmark estimates that potentially avoided costs were over $38 million in just the first year of the True Performance program. Additionally, members seeing a PCP in the True Performance program had 16 percent fewer inpatient admissions in 2017 compared to members seeing a PCP not in the program – at a potentially avoid cost savings of $224 million.

Please join us on Wednesday, October 3, 2018, at 1 PM Eastern as Highmark’s Mari Vandenburgh shares Highmark's approach to value-based care and the results and components of their True Performance program in the HealthcareWebSummit event: The Highmark True Performance Program: Value Based Care at Highmark.

After attending this webinar, attendees will be able to: 1. Understand Highmark's approach to stakeholder engagement and provider collaboration with Value-Based

Care. 2. Explore the scope and results-to-date of Highmark's True Performance program. 3. Examine the True Performance reimbursement and program components. 4. Ascertain how True Performance functions by combining incentive payments, data and analytics and

personal support 5. Engage in interactive learning through online question submission, attendee feedback and opportunity for

follow up questions, and networking with attendees, faculty and other professionals through dedicated LinkedIn group.

https://www.managedcarestore.com/summit.htm

Mari Vandenburgh Director of Value Based

Reimbursement Highmark Inc.

Mari Vandenburgh is the Director of Value Based Reimbursement for Highmark Inc. She is part of the team leading the implementation and operational execution of Highmark’s evolving value based reimbursement strategies. In her role, she also advances recommendations to modify technical platforms and capabilities. Ms. Vandenburgh has been with Highmark in a variety of roles since 2005. She has a Bachelor of Science from Duquesne and a Master of Health Administration from the University of Pittsburgh.

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Value Based Payment News Library Menu page 1 Main Menu

November 2018 Second Edition • Value Is an Enigma in Healthcare by Todd Tetreault • 'Volume- to Value-Based Care: Physicians are Willing to Manage Cost, but Lack Data and Tools’ • Industry News with briefs regarding: Leavitt Partners, Facing Addiction, Remedy Partners;

Change Healthcare, ACO Partner, BCBS of Arizona, Horizon BCBS; Lumeris

November 2018 First Edition • ACOs and CINs: Go-to-Market Success Requires Robust, Digital Provider Information by Thomas

White • LAN Update Sees ‘Progress’ Toward Goal of 50% of Payment in APMs • Industry News with a brief regarding: Oak Street Health, Humana.

October 2018 Second Edition • Foundation Survey Finds Little Physician Faith in Future of Value-Based Payment • BPCI-Advanced Participants: 832 Acute Care Hospitals, 715 Physician Group Practices • Industry News with briefs regarding: UPMC Health Plan, AtlantiCare, Continuum Health

October 2018 First Edition • How Value-Based Strategies Can Squeeze More Juice from the Medicaid Orange • Journal Scan: AJMC, JAMA, Health Affairs • Industry News with a brief regarding Turn-Key Health.

September 2018 Second Edition • Perspectives: Articles Offer Insight, Advice on 'Myth of Coordinated Care,' Reducing Waste in

Provider Practices • Washington Watch: HHS Concedes Mandatory Models Coming Back • Industry News with briefs regarding: UChicago Medicine, Humana; VillageMD

September 2018 First Edition • Press Ganey Advice: Move Past Targeted Initiatives to Compete on Value With Strategic

Transformation • Washington Watch: Lantana Awarded MIDS Umbrella Contract; Encompass Quality Clients Get

‘Exceptional Performance’ Money • Industry News with briefs regarding: Connance; Leukemia & Lymphoma Society; Florida

Medicaid Program.

August 2018 Second Edition • Navigant: Academic Medical Centers Trail on Cost, Quality Metrics • Washington Watch: CAQH CORE; Accountable Doctors • Industry News with a brief regarding Phynd

August 2018 First Edition • New Study Reveals 'Stalled Progress Toward Value-Based Care' • Washington Watch: RI Wants to Add Value to Medicaid Program • Industry News with briefs regarding: Altruista Health; Commonwealth Care Alliance; Butler

Health System; LexisNexis; Mutual of Omaha; Lumeris.

July 2018 Second Edition • Firm Finds Healthcare Companies Focusing on Issues Around Value • Washington Watch: APG ‘Cautiously Optimistic’ About PFS, QPP Proposals • Industry News with briefs: Highmark, Boehringer Ingelheim, Nassau-Queens, AAOE

July 2018 First Edition • Washington Watch: Emphasizing Value: MedPAC Looks at Quality, CMS to Change Home Care

Payment; CMS Emp hasizes Payment Changes Based on Patient Factors • Industry News with briefs regarding: National Alliance Healthcare; Remedy Partners


June 2018 Second Edition • California Health Care Foundation Examines Small Centers’ Big Impact on Value • Washington Watch: FDA Comments on ‘Drug Competition and Value-Based Care and APMA,

MyMipsScore Collaborate to Help Podiatrists • Industry News with briefs regarding: Centegra Health System; Express Scripts; Florida Cancer

Specialists.

June 2018 First Edition • Why Value-Based Care Success Starts with Aligned Physician Compensation by Debbie

Zimmerman MD, Corporate Chief Medical Officer, Lumeris, St. Louis • Physicians Organizing to Maximize Value-Based Payment • Industry News with briefs regarding Community Oncology Alliance and Regional Cancer Care

Associates

May 2018 Second Edition • 6 Strategies for Building a Great Medicaid Provider Network by Marcel Tetzlaff • UnitedHealthcare Says Value-Based Care Program for Knee, Hip and Spine Procedures

Demonstrates Improved Health Outcomes, Reduced Costs • Industry news with briefs regarding: Partnership to Empower Physician-Led Care; OCHIN;

Netsmart; LifeWorks Northwest and Genuine Health

May 2018 First Edition • Major Players, Major Plays: Highmark, Humana Launch and Expand Value-Based Payment

Programs • Big Changes Get Big Responses: Thought Leaders Speak Out on Value • Industry News with a brief regarding CMS

April 2018 Second Edition • Surveys, Reports Outline Present, Future of Value-Based Payment • Numerof Survey: Population Health Leaders Leave Laggers Even Farther Behind

April 2018 First Edition • Input Variable Considerations for Predictive Model Development in Value-Based Care by

VitreosHealth • Half of Hospitals Saved Under CJR: Bigger, Busier & Not-for-Profit • Industry Briefs with news regarding: Lumeris, BayCare, Philips, Lynn Community Health Center,

BCBS Network of Michigan, AMA, Anthem and TRIARQ

March 2018 Second Edition • Cancer Panel Calls for ‘Urgent Collaborative Action’ on Value-Based Rx Pricing • Duke Report Calls for Better Alignment of Device Price, Value • M2HCC: ‘Nearly Every State’ Engaged in Value-Based Payment • Industry News with briefs regarding UnitedHealth Group; Geisinger and Medacta

March 2018 First Edition • Value-Based Reimbursement: Applying Past Health IT Lessons for Future Success by Brett Furst • United Report Says Value-Based Care ‘Improves Quality, Health’ • Industry News with briefs regarding: Urgent Care Association of America; Healthcare

Transformation Consortium; Kansas Health Information Network and Diameter Health.

February 2018 Second Edition • Doctor Group to HHS: ‘Define Value the Same for Everyone’ • Health Data Manager Validic Offers Tips for Maximizing Technology in Value-Based Care • Industry Briefs with news regarding: Centene, Association of Community Cancer Centers and

apollomed


February 2018 First Edition • Ease the Transition to Value-Based Care by Discovering Hidden Treasure in Your Data by Rose

Higgins • Surveys: Patients, Providers, Payers Disagree on Key Aspects of Value • Industry Briefs with news regarding: Mutual of Omaha, Lumeris and Blue Cross of Idaho

January 2018 Second Edition • Finding the Right Path to Value-Based Care: Lessons from High-Performing Organizations by

Caitlin Sweany MPH • Major Blues Plans Add Value-Based Partnerships • Washington Watch

January 2018 First Edition • Quality, Performance Measurement Standards in Organizations’ Sights • AMGA Survey Sees Groups Slowly Embracing Risk – Despite Obstacles

December 2017 Second Edition • AHA Examines Institutions’ Key Value Drivers • Washington Watch

December 2017 First Edition • Value-Based Payment Models More Firmly Established • Innovation and Value Initiative Launches Open-Source Measurement Tool • Industry News with briefs regarding: Equality Health, LHS Health Network, The Centers for

Medicare and Medicaid Services

November 2017 Second Edition • Humana Reports Success With Value-Based Model • Companies Embrace ACOs, Bundled Pricing to Rein Costs • Industry News with a briefs regarding: Cigna, U.S Women's Health Alliance.

November 2017 First Edition • CMS Finalizes QPP, Fee Schedule Rules for 2018 • Focus Group, Study Examine Evolving Value Emphasis • Industry News with briefs regarding: Health Care Payment Learning & Action Network, Blue

Cross Blue Shield of Massachusetts, The American Society for Radiation Oncology, Orange Care Group, Montefiore Health System Inc., Cleveland Clinic

• Very Few’ ACOs Cover Continuum of Care

October 2017 Second Edition • Prime Research Questions Cost Savings from Value-Based Insurance Designs • NAACOS, Leavitt See ACOs ‘Slowly’ Accepting Risk • Industry News with briefs regarding: Humana, PatientPing, WellCare

October 2017 First Edition • RAND Sees ‘Unintended Consequences’ of Bundled Payments • Survey: ‘Anticipation High’ for New Bundled Payments • AMA Seeks Further Relief From Value-Related Changes to CMS Programs • Industry News with briefs regarding: MI Blues; VillageMD; ReportBuyer; Aetna; Vanderbilt

Health; Highmark; and Medical Group of Pennsylvania

September 2017 Second Edition • Deloitte Asks: ‘Could MACRA Be Catalyst for States’ Value-Based Care Efforts?’ • Integra Connect: Specialty Practices ‘Unprepared for MACRA Requirements’ • Industry News with briefs regarding: Tufts; Amgen; Humana; and Highmark


September 2017 First Edition

• MassHealth ACO Transition Takes Shape • HHS Cites MSSP ACOs’ Potential for Lower Costs, Higher Quality • Magazine Sees Pay Raises Favoring Value-Focused Executives • Industry News with a brief regarding Tandigm Health

August 2017 Second Edition • CMS Aims to Axe Value Programs Despite Lower Costs, Same Quality • Doctor Group Seeks MA Participation, Advanced APM Link • Avelere: ACOs Left Almost $900M on the Table in 2015 • Industry News with briefs regarding: Community Medical Group; Anthem BlueCross BlueShield;

Amerigroup RealSolutions; Renaissance Physicians; USMD Health System • Journal Scan: American Journal of Pharmacy Benefits ; JAMA Forum; and JAMA Viewpoint.

August 2017 First Edition • Coding Takes on New Importance in Value-Based Reimbursement by Rodger Smith • KPMG, AMA See Physician Frustration with Mounting MACRA Pressures • Industry News with briefs regarding: VillageMD; Wellcare Health Plans; St. Elizabeth Healthcare

July 2017 Second Edition • Deloitte Survey Sees Early Success for Value-Based Oncology Payment Models • Besler Report Details Hospital Tactics for EPM Success • Industry News with briefs regarding Healthify; MyMipsScore; Able Health; and Clinicient. • Movers and Shakers: Jacobus Consulting; SPH Analytics; Privis Health; and The Chartis Group.

July 2017 First Edition • Aetna’s Value-Based Deals Focus on Rural Members, Diabetes Patients • Experts Say ‘Ongoing Innovation Will Drive Bundled Payment Models’ • MACRA Proposal Moves Programs Forward • Industry News with briefs regarding Premier; Press Ganey; and Express Scripts • Journal Scan: Social Determinants’ Impact Success With Value-Based Deals; Savings Reported

By CMS Do Not Measure True ACO Savings; and VBP for Community Health Centers?

June 2017 Second Edition • Quest Sees Plans, Physicians Investing in IT Together to Promote Value • Cardinal Health Report Sees Little Oncologist Support for MACRA • Industry News with briefs regarding: Hackensack Meridian Health; Tribridge; Modernizing

Medicine; Geisinger. • World Economic Forum Outlines Pathways to Value

June 2017 First Edition • Outcomes-Based Deals Heating Up • UPMC Health Plan Forms Center to Promote Outcomes-Based Deals • Industry News with briefs regarding: Highmark Health; Carrum Health; Express Scripts • Journal Scan: MACRA, Rx Costs Under Researchers' Microscopes

May 2017 Second Edition • RAND Sees MACRA Saving on Hospital, MD Payments • Stoltenberg Notes Leaders’ MACRA Woes, Offers Ideas • MACRA Views, Pro and Con, Dominate Coverage • Industry News with briefs regarding: DocsInk; SPH Analytics; Humana; SocialCare.

May 2017 First Edition • Jumbo Employers Urge Aggressive Move to Value • Recent Research Examines Links Among MACRA, ACOs & Payment Levels • Industry News with briefs regarding: BridgeHealth; Loran Group Consultancy; Datashop • Milliman Report How-To: ‘Building a Successful Value-Based Payer Contracting Strategy’


April 2017 Second Edition • PTAC Approves Physician-Focused Reforms; CHQPR Cheers • Altarum Research Confirms Bundled Payment Cost Savings • Industry News with briefs regarding: Ropes & Gray; Lexology; JAMA Internal Medicine;

AffiniCorp; genele; Navvis • Physician Survey Sees Lukewarm Response to Move to Value

April 2017 First Edition • Research Examines Details of Value-Based Payment in Action • Washington Watch with stories regarding: CMS Delays Bundled Payment Programs; Avalere:

'Risk Bearing ACOs'; The Future for CMMI • Industry News with briefs regarding: IMAT; MEDfx; CareCloud; Excel Health; Humana; KLAS;

PeerWell; Schon Klinik; PCPI.

March 2017 Second Edition • Bridging the Gap: Why Providers Must Marry Clinical and Environmental Data By Jaspinder

Grewal • Device Makers Propose Value-Based Anti-Kickback Safe Harbors • Industry News with briefs regarding: PharmaSmart; McKesson; Collaborative Health Systems;

Cigna; SPH Analytics • Journal Scan: Editorial Outlines Views on MDs’ Role in Value

March 2017 First Edition • Milliman Report Details Medicare Advantage, MACRA Overlap • Industry News with briefs regarding: Staywell; Doctella; eMDs; Cave Consulting Group. • Innovation Flourishing Under Emphasis on Value • Washington Watch: Value Still in Policymakers’ Sights

February 2017 Second Edition • Numerof Report Details Value Aspects of Move to Population Health • Industry News with briefs regarding: Verscend Technologies, KLAS; Premier; and Modernizing

Medicine. • Journal Scan: Recent Articles Examine Bundled Payments

February 2017 First Edition • Industry Leaders Implore White House to Maintain Focus on Value • IHA Sees Provider Performance Improvement, Calls for More • Industry News with briefs regarding: Archway Health; CAPG; Vanguard Medical Group. • GAO Report Examines Small, Rural Docs’ Value Program Woes, Fixes

January 2017 Second Edition • Don’t Leave Risk Adjustment Money on the Table by Pam Klugman • IHA Details Design Decisions for Successful P4P Programs • Industry News with briefs regarding: Archway Health; Cigna; Scripps Health; Centers for

Medicare & Medicaid Services

January 2017 First Edition • Study Finds Up to 20% Waste in Healthcare Spending • How CareSkore’s Data Analysis Services Helped Health System Meet Value-Based Payment

Mandates by Jaspinder Grewal • Washington-Watchers Now Worried About Value’s Fate • Industry News with briefs regarding: United Healthcare; EMRSystems; Accordion Health;

American Hospital Association; xG Health Solutions; VitreosHealth; CitiusTech; and Advantmed.

Volume 3, Issue 22 November Second Edition 2018

published by Health Policy Publishing, LLC 209.577.4888 www.ValueBasedPaymentNews.com

T

Value Is an Enigma in Healthcare by Todd Tetreault, Vice President, Contract Strategy and Pricing, Johnson & Johnson Medical Devices Companies

oday, “value” is an enigma in healthcare; it means different things to different stakeholders. It’s harder still to measure -- and for all the measures that different stakeholders are choosing to implement, there’s little alignment.

Nevertheless, alignment is one of the top attributes for a health system to be ready to transition to value-based care. Because stakeholders in the healthcare ecosystem are at very different stages of the journey towards value-based care, the pace of adoption and success varies. Some stakeholders have been slow to adapt to value-based care; others are much further along in their journey to delivering value. Additionally, the constant pace of change and reliance on more traditional models creates a great deal of variation. The same dynamic exists on the supplier side as we try to anticipate the changing landscape and needs of the provider.

To help accelerate the transition to value-based care, it is critical to have measurable evidence of the factors impacting value -- such as clinical outcomes, patient satisfaction and cost reduction. An important barrier to this is a lack of a one accepted definition, as well as misalignment among stakeholders as to what constitutes value. In the medical devices area, alignment on metrics for determining value is critical to designing and implementing value-based business arrangements.

The expectation among some health systems is that evidence of positive outcomes is required before negotiations on a value-based contract can begin, which can limit the ability to develop and co-create innovative contracting models. For value-based contracting to move from being a vision to an integral part of continued process improvement, all parties must come together to create an environment for mutual goal-setting, performance measurement and ongoing adjustment based on shared experience and learning.

‘Volume- to Value-Based Care: Physicians are Willing to Manage Cost, but Lack Data and Tools’ “Physicians have long focused on quality, but they now have to pay attention to resource utilization as well, with the goal of reducing overall cost of care. To succeed, they need data on costs, tools to analyze costs related to outcomes and aligned financial incentives.

Lack of information limits physicians’ ability to perform certain tasks: 43% [can’t] find low-cost lab and imaging options and 36% cannot identify high-quality skilled nursing facilities, rehab or home health.

A comprehensive toolkit could include technology and appropriate staff resources, improved processes, education and care management support. Health systems should consider moving from simple bonuses to comprehensive performance management programs.”

(continued on page 2)

== from the Deloitte 2018 Survey of US Physicians; visit deloitte.com

http://www.deloitte.com/

2 Value Based Payment News November Second Edition 2018

to subscribe: visit www.ValueBasedPaymentNews.com or call 209-577-4888 page 2

Value Is an Enigma in Healthcare …continued from page 1 And they need to be in it for the long haul, because there are no quick fixes. JJMDC, UCSF Team Up on OR Perioperative Efficiency At the Johnson & Johnson Medical Devices Companies, my team and I work with hospitals and health systems to design and implement programs that add value, and we hold ourselves accountable to the shared measures we agree upon at the outset of program implementation. For example, JJMDC partnered with UCSF Health to improve perioperative efficiency in the operating room.

• UCSF Health leveraged our Perioperative Efficiency capability, which offers tailored approaches to help reduce operational costs and variation in clinical processes by streamlining the movement of JJMDC devices through the surgical services and sterile processing departments. In this example, alignment around shared goals was a critical success factor.

• While UCSF Health already was performing above benchmark for overall procedure OR set-up time prior to the partnership, it had a clearly defined need to improve instrument set-up time.

• JJMDC took a data-driven, measurable approach. By leveraging the “CareAdvantage from the Johnson & Johnson Family of Companies” approach, UCSF Health improved instrument tray set-up time in the operating room by three minutes for hip procedures and six minutes for knee procedures.

• It also realized a 57% reduction in the total number of JJMDC surgical instrument trays, a 29% decrease in the number of JJMDC instruments used across total hip and knee procedures and a 46% reduction in the average number of open JJMDC trays.

• As an illustrative example, this translated to an estimated cost savings totaling more than $262,000 annually1, but results may vary by health system.

This engagement was unique because both parties had a common goal, were aligned on value, were able to collect meaningful data and together implemented a measurable and actionable program that fell within a defined scope that had buy-in from leadership. In addition, this example illustrates how value can come in the form of efficiencies in the operational costs of the products, versus purely focused on purchase cost. I offer this example because it is not just a case study in procedure innovation, but innovation that can help advance the clarity of value. Ultimately, value is about meta-data and how that data is structured. When stakeholders come together utilizing foundational data, it makes everyone smarter and able to deliver on meaningful results that truly add value for everyone -- hospitals, clinicians and, ultimately, patients.

Contact Tetreault via Iris Shaffer at 312 368 7544 or at [email protected]. 1 UCSF-Specified Assumption: $75/tray; Siegel GW, Patel NN, Milshteyn MA, Buzas D, Lomborado DJ, Morawa LG. “Cost analysis and

surgical site infection rates in total knee arthroplasty comparing traditional vs. single-use instrumentation.” J Arthroplasty 2015; 30(12): 2271-4.

Value-Based Payment News November Second Edition 2018 Volume 3 Issue 22 ISSN Print (2327-7335) ISSN Electronic (2327-7343) Publisher: Clive Riddle, President, MCOL Editor: Russell A. Jackson Value-Based Payment News is published monthly by Health Policy Publishing LLC. Newsletter publication administration is provided by MCOL. Value-Based Payment News 1101 Standiford Avenue, Suite C-3, Modesto CA 95350 | Phone: 209-577-4888 | [email protected] Copyright 2018 by Health Policy Publishing LLC. All rights reserved. No part of this publication may be reproduced or transmitted by any means, electronic or mechanical, including photocopy, fax or electronic delivery, without the prior written permission of the publisher.

Six Top Attributes for a Health System to Be Ready for Value-Based Care

Here they are, based on our experience:

1) Alignment among internal stakeholders – clinicians, administrators and others – and between health systems and suppliers around the willingness to innovate and adopt new business models.

2) Agreement on a common goal, which involves aligning on actions and incentives to ensure joint value creation.

3) Having the data and analytics to be able to define and measure outcomes.

4) Embracing the need to shift care delivery models to focus on what matters most to the patient as the ultimate customer.

5) Applying digital and mobile platforms and tools to enhance patient navigation along the care continuum.

6) And lastly, trust -- critical for any partnership, and built through the previous five attributes.

mailto:[email protected]


November Second Edition 2018 Value Based Payment News 3

© 2018, Health Policy Publishing, LLC. All rights reserved. No reproduction or electronic forwarding without permission. page 3

Healthcare Alliance Launches Alternative Payment Model for Addiction Recovery A “national multi-sector alliance” of healthcare industry leaders-- including Leavitt Partners, Facing Addiction with The National Council on Alcoholism and Drug Dependence and Remedy Partners – reports creating the Addiction Recovery Medical Home model, an Alternative Payment Model “engineered to provide patients with a long-term, comprehensive and integrated pathway to treatment and recovery.” The Alliance for Recovery-Centered Addiction Health Services’ framework “establishes a broad continuum of care, from emergent and stabilizing acute care settings to community-based services to managing patient needs in a chronic disease model,” a statement explains; the model “incorporates aspects of fee-for-service, episodes of care, quality adjustments and shared savings, and “promotes improved integration with financial incentives that benefit all stakeholders.”

• Says Remedy: “We see the most progress in healthcare when the clinical and the economic incentives are aligned. The Addiction Recovery Medical Home model aligns the interests of patients, providers and payers through a new risk-based payment methodology.”

• The company adds: “Combined with the right therapeutic approaches to care, this payment system is the type of innovation that we need to accelerate our progress in dealing with the opioid crisis.”

• The problem, says Leavitt: “Various programs and treatment settings operate in isolation from one another, with limitations in requisite information-sharing with other key parties.”

• The ARMH model, though, “is designed with the flexibility to meet providers and patients where they are, while honoring chronic disease management principles that will improve the coordination and application of care and recovery support.”

The Alliance intends to pilot the ARMH model in at least two markets next year. “A rigorous research methodology will be developed and leveraged to study the effects of the model when compared to non-ARMH models,” the statement says, “and to study correlations between specific model tenets and the corresponding outputs.” Members also include Anthem, AmeriHealth Caritas, the American Hospital Association, Beacon Health Options, CaseSource, FAVOR Greenville, the Healthcare Financial Management Association, Intermountain Healthcare and Third Horizon Strategies. Visit www.leavittpartners.com, www.facingaddiction.org and www.remedypartners.com.

Blues News: 3 Plans Report Value Updates Blue Cross Blue Shield of Arizona reports results for the first complete plan year of its “novel shared savings program” with Change Healthcare and ACO Partner, Blue Cross Blue Shield of Massachusetts and South Shore Health System say they’ve “launched a groundbreaking program to improve care and lower costs” and Horizon Blue Cross Blue Shield of New Jersey notes that “patients of value-based care providers have better outcomes that lower total cost” and that “value-based payments to physicians are up 10%.” Here are details.

In the BCBSAZ/Change program, called ACO Partner:

• Participating providers “reported a 26.3% lower 30-day readmission rate and a 28.1% lower all-cause readmission rate than the non-participant cohort,” a statement points out.

• “They also reported 20% fewer admissions and 15.2% fewer emergency department visits per 1,000 treated members.”

• And they beat the cohort’s Quality Index by 2.7% -- and “drove lower specialty pharmacy spend, decreased imaging utilization and more High-Efficiency Network specialist referrals.”

• ACO Partner is actually a value-based care joint venture of Change and Trinnovate Ventures, a BCBSAZ subsidiary, that “contracts with independent providers to earn shared savings, and provides them with sophisticated patient data analytics, care coordination and provider engagement services.”

• High-performing providers are rewarded for progress, and their “level of performance is reflected across key cost and quality metrics relative to the non-participating cohort.”

• The result: the BCBSAZ Shared Savings Program remitted $1 million to 603 participating providers and “drove a risk-adjusted claims cost trend from 2016 to 2017 that was 3.7% lower than the cohort trend.”

In the BCBSMA/South Shore pilot:

• A hospital’s financial reward system is “tied to its success in working with physician groups in its immediate geographic area -- even those affiliated with other hospitals -- to provide high-quality, cost-effective care,” a statement from the carrier explains.

Industry News

(continued on page 4)

http://www.leavittpartners.com/

http://www.facingaddiction.org/

http://www.remedypartners.com/

4

published by Health Policy Publishing, LLC 209.577.4888 www.ValueBasedPaymentNews.com

www.ValueBasedPaymentNews.com

Blues News: 3 Plans Report Value Updates…continued

• The pilot expands on BCBSMA’s decade-old Alternative Quality Contract, “a first-of-its-kind payment program for physician groups;” under it, the statement adds, Blue Cross pays doctors a set amount to care for patients and rewards them when they meet certain quality standards.”

• It “helped motivate hospitals to collaborate with physician groups,” it says, but it “did not fundamentally change the volume-based payment incentives for hospitals.”

• The refined model “asks hospitals to be stewards of care in their communities, collaborating with physicians to improve quality, outcomes and cost for the patients they share, and rewarding them for their success in doing so.”

• Indeed, the statement says, BCBSMA will “provide the data, support and financial incentives to help hospitals improve care and lower costs for everyone who comes through their doors, regardless of primary care affiliation.”

• The pilot will last for three years, and “will allow Blue Cross to test and refine the model as it considers how to expand the program to other hospitals.”

In the Horizon BCBSNJ report: • The carrier says that “members receiving care from

doctors who participated in one of its patient-centered, value-based care programs were less likely to be admitted to the hospital and more likely to have essential health screenings and had a lower overall cost of care.”

• The company also reports that “more than 70% of its in-network primary care doctors participated in one or more of its value-based care programs, a 20% increase over the last two years.”

• Horizon adds: “The question is no longer whether to pursue value-based partnerships, it is which models deliver the best quality improvements and patient experience and are most effective at lowering an individual’s total cost of care.”

• In 2017, compared to all commercial members, members engaged with value-based providers experienced:

== a 4% lower total cost of care trend == a 4% lower rate of inpatient admissions == a 6% higher rate for colorectal cancer

screenings == a 7% higher rate of breast cancer screenings == a 24% lower rate of readmissions for those

with diabetes == an 11% improvement in managing diabetes == a 6% lower medical cost trend for those with

congestive heart failure

Blues News: 3 Plans Report Value Updates…continued == a 2% reduction in potentially avoidable ER

visits year over year • In 2017, value-based payments totaled $104-

million -- in addition to what those providers were reimbursed on a fee-for-service basis.

Visit changehealthcare.com, acopartner.com and azblue.com. Visit bluecrossma.com and southshorehealth.org. And visit horizonblue.com.

Lumeris Congratulates Essence Health on 8th ‘4.5 Stars or Higher’ Rating Lumeris, which calls itself “the industry leader in value-based care,” reports that its inaugural client, Essence Healthcare, earned its eighth consecutive rating of 4.5 stars or higher in the Centers for Medicare and Medicaid Services’ 2019 Medicare Advantage Health Plan Star Ratings. Those ratings – which, a statement notes, “place Essence in the top 20% of all MA plans,” help benefici-aries make more informed coverage decisions. Essence “offers a unique, collaborative approach to Medicare Advantage insurance,” it adds, “by working with providers in a virtually integrated delivery system, leveraging transformative technology and innovative physician and consumer engagement services from Lumeris to provide clinicians with the actionable clinical and financial data they require to proactively manage and coordinate patient care.” Here’s how plans can elevate their own ratings, according to Essence CEO Richard Jones:

1) Align around stars. “Prioritize CMS requirements so that the entire organization understands their importance. By keeping stars top-of-mind, everyone can focus on satisfaction and quality across departments. Stars also mean MA operations should not be treated like other lines of business.”

2) Engage physicians. “While this seems obvious, it is often the missing link in MA plan success. Tying physician incentives to member benefits aligns all parties, but providers need to be empowered to succeed. They also need actionable tools and information, programs designed for value-based care and collaborative support to engage effectively with patients and deliver improved outcomes.”

3) Keep at it for the long haul. “Strong star ratings come from the long game. Work today is rewarded much later than tomorrow -- clinical work delivered this year impacts star ratings two years from now. Consider not only how to enhance care delivery, but also how to better monitor and track performance for feedback to continuously adapt to rising quality standards.”

Visit lumeris.com.

Industry News

http://www.changehealthcare.com/

http://www.acopartner.com/

http://www.azblue.com/

http://www.bluecrossma.com/

http://www.southshorehealth.org/

http://www.horizonblue.com/

http://www.lumeris.com.to/

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Documents

Value Based Care Learning Kit€¦ · Highmark Inc. Mari Vandenburgh is the Director of Value Based Reimbursement for Highmark Inc. She is part of the team leading the implementation