Value-Based Care

Insights

Britney Rosenau

Evolving CMS Quality Measures Move Towards More Patient-Centered Care, Less Burden for Clinicians

With today’s comprehensive Meaningful Measures initiative, CMS has refocused healthcare quality measures on improving patient needs and experiences, reducing regulatory burden on clinicians, and removing barriers to value-based payment. The evolved quality measures center on patient, clinician, and health system needs and strategic goals to truly impact improving care and lowering costs.
Meaningful Measures, according to CMS, must meet seven criteria:

Are patient-centered and meaningful to patients, clinicians, and providers.
Address high-impact measure areas that safeguard public health.
Are outcome-based where possible.
Minimize the level of burden for providers.
Create significant opportunity for improvement.
Address measure needs for population-based payment through alternative payment models.
Align across programs.

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Adam Bell
Kristen McRae

Continuity of Care Documents: Today’s Top Solution for Healthcare Interoperability Demands

While healthcare waits for the expanded data interoperability that FHIR promises, the industry needs an immediate solution for accessing and using disparate data from across the continuum of care. With FHIR potentially several years away, continuity of care documents (CCDs) are the best option for acquiring the ambulatory clinical care data health systems need to close quality gaps today. Because organizations that rely only on claims data to drive quality improvement risk missing out on more that 80 percent of patient information, CCDs are the current must-have answer to interoperability for successful quality improvement.

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Health Catalyst Editors

Healthcare’s Next Revolution: Finding Success in the Medicare Shared Savings Program

A series of revolutions has driven the development of the U.S. healthcare system, enabling dramatic improvements in all aspects of healthcare quality and outcomes over the past century. Although healthcare organizations have focused on moving towards value-based care for decades, the data shows that the shift is indeed taking place and fee-for-service models are declining.
New changes to the Medicare Shared Savings Program (MSSP) will help drive this change as revisions to MSSP require ACOs to take on more financial risk earlier. This article covers the following topics:

Important moments in history that led to today’s current challenges.
Why financial imperatives drive cultural change in our economic model.
Ways MSSP can help healthcare organizations achieve financial success.
How to utilize data to develop better healthcare delivery systems.

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Health Catalyst Editors

ACOs and CINs: Past, Present, and Future

Accountable Care Organizations (ACOs) and clinically integrated networks (CINs) are two types of organizations working to address the problem of rising costs. As ACOs and CINs continue to evolve, organizations moving into value-based care (VBC) face an ever-changing landscape. This article looks at the evolution of the ACO and CIN models, what new tools ACOs employ today to promote success, and lessons learned from organizations that have succeeded in alternative payment models. It also explores what healthcare experts believe the future of alternative payment models will look like and competencies to develop to meet those changing demands.

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Health Catalyst Editors

Five Action Items to Improve HCC Coding Accuracy and Risk Adjustment With Analytics

A hot topic in healthcare right now, especially in the medical coding world is the Hierarchical Condition Category (HCC) risk adjustment model and how accurate coding affects healthcare organizations’ reimbursement.
With almost one third of Medicare beneficiaries enrolled in Medicare Advantage plans, it’s more important than ever for healthcare organizations to pay attention to this model and make sure physicians are coding diagnoses appropriately to ensure fair compensation. This article walks through basics of the risk adjustment model, why coding accuracy is so important, and five action items for interdisciplinary work groups to take. They include:

Having an accurate problem list.
Ensuring patients are seen in each calendar year.
Improving decision support and EMR optimization.
Widespread education and communication.
Tracking performance and identifying opportunities.

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Adam Bell
Carol Owen
Dan Soule
Eric Crawford

Pairing HIE Data with an Analytics Platform: Four Key Improvement Categories

Population health and value-based payment demand data from multiple sources and multiple organizations. Health systems must access information from across the continuum of care to accurately understand their patients’ healthcare needs beyond the acute-care setting (e.g., reports and results from primary care and specialists). While health system EHRs have a wealth of big-picture data about healthcare delivery (e.g., patient satisfaction, cost, and outcomes), HIEs add the clinical data (e.g., records and transactions) to round out the bigger picture of patient care, as well as the data sharing capabilities needed to disseminate the information.
By pairing HIE capability with an advanced analytics platform, a health system can leverage data to improve processes in four important outcomes improvement areas:

Workflow
Machine learning
Professional services
Data governance

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Health Catalyst Editors

ACOs: Four Ways Technology Contributes to Success

With an increasing emphasis on value-based care, Accountable Care Organizations (ACOs) are here to stay. In an ACO, healthcare providers and hospitals come together with the shared goals of reducing costs and increasing patient satisfaction by providing high-quality coordinated healthcare to Medicare patients.
However, many ACOs lack direction and experience difficulty understanding how to use data to improve care. Implementing a robust data analytics system to automate the process of data gathering and analysis as well as aligning data with ACO quality reporting measures.
The article walks through four keys to effectively implementing technology for ACO success:

Build a data repository with an analytics platform.
Bring data to the point of care.
Analyze claims data, identify outliers, including successes and failures.
Combine clinical claims, and quality data to identify opportunities for improvement.

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Health Catalyst Editors

Social Determinants of Health: Tools to Leverage Today’s Data Imperative

Social determinants of health (SDOH) data captures impacts on patient health beyond the healthcare delivery system. Traditional health data (e.g., from healthcare encounters) only tells a portion of the patient and population health story. To understand the full spectrum of health impacts (e.g., from environment to relationship and employment status), organizations need data from their patient’s daily lives. The urgency for SDOH data is particularly strong today, as value-based payment increasingly presses health systems to raise quality and lower cost. Without fuller insight into patient health (what happens beyond healthcare encounters) organizations can’t align with community services to help patients meet needs of daily living—prerequisites for maintaining good health.
Standardizing SDOH data into healthcare workflows, however, requires an informed strategy. Health systems will benefit by following a standardization protocol that includes relevant and comprehensive domains, engages patients, enables broader understanding of patient health, integrates with organizational EHRs, and is easy for clinicians to follow.

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Jonas Varnum

Value-Based Care: Four Key Competencies for Success

How prepared are healthcare organizations to enter into value-based care? Many may not be ready. While early value-based care adopters have focused on improving and measuring quality, they’ve often overlooked steps to bear the associated financial risk. Now that health systems can enter into alternative payment models and risk-based contracts, they need to ensure that cost is as much a priority as quality.
Health systems can achieve sustainable value-based care success by optimizing the five core competencies of population health management:

Governance that educates, engages, and energizes.
Data transformation that addresses clinical, financial, and operational questions.
Analytic transformation that aligns information and identifies populations.
Payment transformation that drives long-term sustainability.
Care transformation as a key intervention in value-based contracts.

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Bobbi Brown, MBA

DSRIP in 2018: Continuing Efforts for Medicaid Reform

As a performance-based incentive program, DSRIP (the Delivery System Reform Incentive Payment) is designed to help participating states reform Medicaid. To date, 13 states have implemented DSRIP and received a Section 1115 waiver from CMS to transform their Medicaid programs and align them with value-based reimbursement. These states have agreed to budget neutrality, transparency, statewide quality metrics, and frequent reporting of outcomes.
While each state’s program structure and objectives are unique, under DSRIP, participating states share three key goals:

Reducing the total medical spend.
Improving patient outcomes.
Establishing a direct link between provider performance and payment.

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Bobbi Brown, MBA

Linking Clinical and Financial Data: The Key to Real Quality and Cost Outcomes

Since accountable care took the healthcare industry by a storm in 2010, health systems have had to move from their predictable revenue streams based on volume to a model that includes quality measures. While the switch will ultimately improve both quality and cost outcomes, health systems now need the capability of tracking and analyzing the data from both clinical and financial systems. A late-binding enterprise data warehouse provides the flexible architecture that makes it possible to liberate both kinds of data to link it together to provide a full picture of trends and opportunities.

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Bobbi Brown, MBA

Value-Based Purchasing: Four Need-to-Know Domains for 2018

Health systems that meet the 2018 Hospital Value-Based Purchasing Program measures stand to benefit from CMS’s $1.9 billion incentive pool. Under the 2018 regulations, CMS continues to emphasize quality. To reduce the risk of penalty and vie for bonuses, it’s increasingly critical that organizations leverage data to build skills and processes that meet more demanding reimbursement measures.
To thrive under value-based payment, healthcare systems must understand CMS’s four quality domains, and their associated measures, for 2018:

Clinical Care
Patient- and Caregiver-Centered Experience of Care/Care Coordination
Efficiency and Cost Reduction
Safety

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Russ Staheli, MPH

Advanced Analytics Holds the Key to Achieve the Triple Aim and Survive Value-based Purchasing

Every hospital and health system has to juggle significant IT needs with a limited budget. In the middle of these demands and possibilities, hospital executives have to prioritize and decide which technology solutions are the most critical to the health of their organization. I call these most critical IT solutions “survival software.” Advanced clinical analytics solutions are the survival software of the near future, as they really hold the key to achieving the triple aim and survive value-based purchasing.

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Bobbi Brown, MBA
Jared Crapo

The Key to Transitioning from Fee-for-Service to Value-Based Reimbursement

The shift from fee-for-service to value-based reimbursements has good and bad consequences for healthcare. While the shift will ultimately help health systems provide higher quality lower cost care, the transition may be financially disastrous for some. In addition, the shifting revenue mix from commercial payers to Medicare and Medicaid is creating its own set of challenges. There are, however, three keys to surviving the transition: 1) Effectively manage shared savings programs to maximize reimbursement. 2) Improve operating costs. 3) Increase patient volumes. With an analytics foundation, health systems will be able to meet and survive today’s healthcare challenges.

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Bobbi Brown, MBA

The Top Three Healthcare Financial Trends in 2017: Payment Transitions, Disruption, and New Skills

Influential healthcare financial trends in 2017 emerged in three areas:

Transitions in payment.
Disruption from familiar players and newcomers.
Emerging data skillsets.

Uncertainty has been a common theme for 2017. Organizations continue waiting for clarity on the future of the Affordable Care Act (ACA), while working to implement value-based care. Changes from established healthcare organizations as well as the arrival of prominent newcomers (e.g., Amazon) add to the unsettled outlook, as do emerging data skillsets.
Amid the uncertainty, however, healthcare is clearly continuing on the path to patient-centered care. Organizations best positioned for 2018 will understand their performance in 2017’s top three healthcare financial trends as they evaluate their preparedness for the coming year.

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Leslie Falk

Population Health Documentary Highlights Three Success Stories Transforming Healthcare

The documentary, “A Coalition of the Willing: Data-Driven Population Health and Complex Care Innovation in Low-Income Communities” shows how precision medicine and care management can be effective tools for successful population health. The film highlights three programs that use data to hotspot populations of high-risk, high-need patients, and then deploy unique, targeted care management inventions. The documentary, which initially aired during the 2017 Healthcare Analytics Summit, presents hopeful solutions, scalable across diverse patient populations, that are leading to exceptional results and the future of healthcare transformation.

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Health Catalyst

Chilmark Report Studies the 2017 Healthcare Analytics Market Trends and Vendors

Chilmark’s 2017 Healthcare Analytics Market Trends Report is a trove of insights to the analytics solutions driving the management of population health and the transition to new reimbursement models.
The report reviews the analytics market forces at work, such as:

The need to optimize revenue under diverse payment models.
The increasing importance of analytics in general, and a platform in specific, that can aggregate all data.
Continuing confusion about how to react to MIPS and APMs.
The growing importance of providing a comprehensive set of open and standard APIs.
The need for better tools to create analytics-ready data stores.

The report is also a succinct guide to the 17 leading analytics vendors (which represent EHR, HIE, payer, and independent categories) with the most promising products, technology, and services offerings in the market.

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Dan Unger

From Surviving to Arriving: A Road Map for Transitioning to Value-Based Reimbursement

When it comes to transitioning to value-based reimbursement, health systems consistently ask two questions:

Why should I invest in reducing utilization when 90+ percent of my business is still fee-for-service (FFS)?
Where do I start?

This value-based reimbursement road map can help systems transition from barely surviving to successfully arriving (while respecting both shared-risk and FFS worlds):
Stop #1: Surviving— If you don’t get paid for the risk you take on, then you can’t survive long term.
Stop #2: Sustaining—Numerous clinical interventions occur in hospitals that systems can focus on to help improve the bottom line.
Stop #3: Succeeding—Build out competencies on a smaller population with aligned incentives so you can negotiate deeper alignment with key payers.
Stop #4: Arriving— The ultimate destination, where the lines between traditional healthcare delivery and public health are blurred.
Although healthcare is far from arriving at the value-based reimbursement destination, it can use this road map’s pragmatic strategies for heading down the right road.

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Amanda Rich
Brian Eliason, MIS

Against the Odds: How this Small Community Hospital Used Six Strategies to Succeed in Value-Based Care

The constant thread weaving through every healthcare organizational strategy should be adherence to the Triple Aim. But with uncertainty generated by the changes at the federal level, healthcare organizations may be tempted to put their value-based care plans on hold. This article explains why that’s not necessary and lists six strategies for thriving under a fee-for-value model:
1.) Use Leadership and Team Structure to Support Improvement
2.) Drive Down Costs
3.) Reduce Unnecessary Waste
4.) Encourage the Learning Organization
5.) Prioritize Patient Education
6.) Track Data and Outcomes
This blog cites one small medical center with odds stacked against it, and how it is managing to not only weather the changes, but also distinguish itself by staying true to the values of the Triple Aim.

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Eric Just

Understanding Risk Stratification, Comorbidities, and the Future of Healthcare

Risk stratification is essential to effective population health management. To know which patients require what level of care, a platform for separating patients into high-risk, low-risk, and rising-risk is necessary. Several methods for stratifying a population by risk include: Hierarchical Condition Categories (HCCs), Adjusted Clinical Groups (ACG), Elder Risk Assessment (ERA), Chronic Comorbidity Count (CCC), Minnesota Tiering, and Charlson Comorbidity Measure. At Health Catalyst, we use an analytics application called the Risk Model Analyzer to stratify patients into risk categories. This becomes a powerful tool for filtering populations to find higher-risk patients.

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Brant Avondet

The Formula for Optimizing the Value-Based Healthcare Equation

Two variables are required in the value-based healthcare equation if it is to add up to a profitable contract. One variable, optimizing the care for the patient population, is commonly included and is a focus for most healthcare systems involved in managing population health. However, a second variable, getting the right dollars in order to care for that population, is often overlooked. And yet this variable is easier to attain. It’s a matter of appropriately assessing the risk of the population by addressing inaccurate diagnoses coding. Here, we offer four methods for solving this variable: identifying high-risk gaps over time, persistent diagnosis tracking, identifying code adequacy, and identifying likely diagnoses.

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Aaron Neiderhiser
Ben Castleton
Bobbi Brown, MBA

Why Pioneer ACOs Are Disappearing and 3 Trends to Expect from the Exodus

Over half the Pioneer ACOs have dropped from the program in the last four years, despite achieving $304 million in savings, and fifty percent of the participating ACOs receiving shared savings reimbursements. Why the exodus? Overutilization and inconsistent performance benchmarking and attribution hindered the ability of many participants to achieve success. The overall impact of the program, however, has been a positive one for value-based care. In the next 3-5 years, providers and health systems will bear more of the financial risk of the populations they serve. The proliferation of data, and the tools to analyze and exchange it, will be critical to the long-term success of value-based care.

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Jared Crapo

Why Adding External Data to Your EDW Is Critical to Driving Outcomes Improvement

Many healthcare organizations are entering, or are planning to enter, into some type of at-risk contract, be it a bundled payment program, a Medicare Advantage plan, or an ACO. In order to manage these contracts most effectively, integrating external and internal claims data in to the EDW is critical. Aggregating data in to an EDW from internal, disparate, clinical, administrative, and financial systems is the first critical step to identify opportunities for quality improvement. However, external data from organizations such as CMS and commercial payers, along with benchmarking and consumer and demographic data, also has the potential to improve the quality of care, increase patient satisfaction, and lower costs. In the new world of at-risk contracts, integrating external and internal data enables leaders to successfully oversee, manage, and strategically plan for future at-risk arrangements.

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Dan Soule

Advanced Care Management: Healing the Whole Patient

In the new world of value-based care, success is defined as consistently delivering excellent, value-based care, and improving patient outcomes, long-term. Making the vision of value-based care a reality will require a cross-functional team, focused on healing the entire patient according to the principles of advanced care management. Recognizing the needs of the whole patient, instead of only focusing on the specific condition, especially in a shared-risk arrangement, can have a profound effect on everyone, most importantly the patient. To achieve success the entire team, including physicians, nurses, social workers, psychiatrists, and social workers,   must work together and coordinate their efforts. Building a genuine and trusting relationship between the patient and care team is the cornerstone of ACM programs. Helping a patient feel better can inspire them to be an active part of their treatment plan. A successful ACM strategy can inspire the care team to drive long-term, tangible change, leading to improving outcomes for the organization and the patient.

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Paul Horstmeier

Michael Porter and Others Show How to Deliver Better Care in Value-based Healthcare Documentary

Healthcare organizations from Hamburg to Gothenburg to Boston are realizing the future of care delivery through a value-based approach, as portrayed in this video documentary featuring professor Michael Porter of the Harvard Business School. Measured Outcomes: A Future View of Value-Based Healthcare explains how value-based care is a methodology that involves standardizing outcome measurements, tracking them over the long term, and putting clinical teams in place with the longevity needed to build a sustainable program. More importantly, it is healthcare that matters most to patients because they report and track their own quality measurements, giving them a say in their own healthcare experience. Providers are winning, patients are winning, and the results for the organizations showcased in this video are remarkable, such as an 88 percent prostatectomy success rate for the Martini-Klinik in Hamburg, Germany, compared to a 32.8 percent rate for the rest of the country. And with just 10 surgeons on staff, they are doing more volume than any other facility in the world, by far, all attributable to their value-based approach.

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