Mission Health Receives 100 Percent of At-Risk Dollars in Payer Incentive Program

Since 2004, the US healthcare system has annually ranked last relative to 10 other developed nations in quality, access, efficiency, equity, and health outcomes. In an effort to improve the quality of care and patient outcomes in the U.S., the Center for Medicare and Medicaid (CMS) launched a series of quality incentive programs designed to generate a shift from volume to value-based reimbursement.  The health insurance industry soon followed their lead, and started writing contracts with hospitals in which a percentage of payment was based on performance on selected quality metrics.

Faced with the challenge of reporting on numerous incentive programs with differing expectations, Mission Health leveraged their enterprise data warehouse to aggregate the data needed to track the quality measures. With millions of dollars on the line with one particular payer, Mission developed an analytics application to monitor performance on the metrics in that contract.  The application was used to analyze whether performance feedback and workflow changes would lead to improved performance on the metrics, thus ensuring that they would maximize reimbursement, while improving care for patients.

Results:

  • Achieved 100 percent of all at risk dollars.
  • 100 percent of the ambulatory metric targets were exceeded, some by as much as 19 percent.
  • All five hospitals exceeded targets for 80 percent or more of their inpatient metrics.
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40,000 Covered Lives: Improving Performance on ACO MSSP Metrics

The U.S. healthcare system is the most expensive in the world, but data consistently shows the U.S. underperforming relative to other countries on most dimensions of performance. The Centers for Medicare & Medicaid Services’ (CMS’s) accountable care organization (ACO) model is aimed at addressing that issue by offering financial incentives for providers to improve the health of populations and reduce costs through greater efficiencies and a focus on preventive care.

Mission Health formed a Medicare Shared Savings Program (MSSP) ACO called Mission Health Partners (MHP), which is responsible for 40,000 patient lives. MHP knew that its manual approach to data collection and reporting would not be sufficient for the required ACO quality metrics. By leveraging a previously implemented enterprise data warehouse platform and implementing an ACO MSSP analytics application, MHP was able to automate the processes of data-gathering and analysis and align the data with ACO quality reporting measures. The visibility and transparency of near real-time, online performance data coupled with focused process improvement has resulted in subsequent improvement in all 33 of the ACO performance metrics. Specifically, improvements have included:

  • 9.6 percent increase in compliance over all reported ACO metrics, with 23,000 more patients receiving recommended treatment or screenings.
  • 98.9 percent of eligible patients received screenings for clinical depression and follow up.
  • 40 percent increase in number of patients receiving any cancer screening; 46 percent improvement in the number of patients receiving colorectal cancer screening.
  • 456 percent increase in the number of patients getting fall risk screening.
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Allina Health: A Successful Approach to Improving VTE Care and Prevention across a Large Health System

An estimated 1 million cases of venous thromboembolism (VTE) occur each year in the United States—with approximately 300,000 of these cases resulting in death. These sobering statistics led Allina Health to embark on a journey to address prevention and improved care for its VTE patients—one of the most common causes of hospital-related death in the United States—and one of the most preventable. Supported with analytics, Allina implemented a physician-led, multidisciplinary workgroup to standardize order sets and engage clinicians in improvement efforts. To date, their system-wide efforts have generated measurable improvements including an 11 percent increase in VTE bundle compliance rate, a 96.9 percent compliance with VTE prophylaxis, and a 41 percent increase in compliance with VTE warfarin therapy discharge instructions.

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Standardizing Labor and Delivery Best Practices to Improve Outcomes

Advancing women’s health is a key part of the nation’s healthcare quality improvement and population health management agenda. Mission Health has embarked on a journey to standardize its best practices and develop a more systematic method for collecting and analyzing data related to perinatal care. With an EDW serving as its analytics platform, and a newly implemented clinical improvement model, Mission is able to monitor performance on several evidence-based practices designed to improve maternal and newborn care. Learn how they have sustained a zero elective delivery rate, and how they have reduced the time they spend manually collecting data and calculating rates.

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How to Avoid PQRS Penalties and Earn Potential Incentives with Accurate Submission of Quality Measures

CMS has recently transitioned its Physician Quality Reporting System (PQRS) program from a pay-for-reporting program to a program that will now apply a negative payment adjustment to providers who do not satisfactorily report data on quality measures. Memorial Hospital faced a significant problem when its PQRS reporting process was hampered by its transition to a new EHR system. They needed a solution. Learn how Memorial successfully used their enterprise data warehouse to submit the necessary data to a certified registry, avoiding a four percent Medicare reimbursement adjustment, and providing them with the potential to earn an incentive payment. They also now have several patient registries that can be used for quality improvement initiatives in clinical care, patient safety, and care coordination.

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Measuring and Reporting The Joint Commission’s Perinatal Core Measures using Clinical Analytics

Addressing The Joint Commission (TJC) core measures is a challenge for healthcare organizations. Hospital EMR data issues are well known by quality and patient safety, and clinical quality improvement clinicians. Read how this healthcare organization is using their healthcare enterprise data warehouse and clinical analytics to establish accurate baseline measures and ongoing near real time performance tracking for their TJC perinatal core measures.

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Other Content in MACRA / Regulatory Measures

Posts

Preparing for Changes to Medicare Reimbursement—The Latest CMS Proposed Measures

Health systems that aren’t prepared for changes to Medicare reimbursement under a value-based system risk quality penalties and reduced reimbursement. They can protect themselves by following the Centers for Medicare and Medicaid Service’s (CMS) annual Measures Under Consideration List—and not waiting till it’s too late to address gaps in their system. The measures accepted from the list of proposals will help determine the areas of care delivery that Medicare will hold organizations accountable for.

It’s never too early for health systems to prepare. CMS selects measures that are already nationally recognized as priority areas for improvement, giving organizations proactive direction in their improvement strategy.

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Is Value-Based Healthcare Here to Stay? Looking for Answers in New Policies

Healthcare leaders are eager for a modicum of clarity when it comes to the industry’s shift to value-based healthcare given the uncertainties of Congress and the new Administration.

Fortunately, an analysis of three key pieces of information tells us value-based healthcare is likely here to stay:

  1. The 21st Century Cures Act (Cures).
  2. The Executive Order on reducing the “burden” of the Affordable Care Act (ACA).
  3. Tom Price’s comments at his confirmation hearings.

It is a relatively safe bet that value-based healthcare delivery and payment programs will continue to be supported by federal law and regulation for several reasons:

  • Bipartisan support: The success of Cures indicates that bipartisan cooperation will continue on key healthcare issues.
  • Market-based innovation: The emerging evidence is that Congress and the Administration will support innovation in payment and delivery models.
  • Support for Existing ACA Innovation programs: Although highly uncertain, there are some indications that not all of the ACA will be scrapped.
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Introducing Health Catalyst MACRA Measures & Insights—Addresses Top Physician Concern: Capturing Compliance Measures

A recent Health Catalyst®/Peer60 survey revealed that compiling quality metrics is the top concern for physicians—a regulatory burden expected to worsen in 2017 as physicians struggle to report quality metrics for the Medicare Access & CHIP Reauthorization Act (MACRA)—the federal law that changes the way Medicare pays doctors.

MACRA Measures & Insights™—Health Catalyst’s new MACRA solution—does so much more than alleviate this reporting burden:

  • Helps health systems track and monitor all MACRA measures across multiple departments.
  • Helps systems maximize Medicare reimbursement and monitor performance against measures year over year.
  • Enables healthcare organizations to tactically and strategically identify the optimal measures to include within multi-year, value-based care contracts with commercial payers.

Powered by the Health Catalyst Analytics Platform™, which can integrate virtually all of the granular data in a healthcare system, including claims and other external data, MACRA Measures & Insights gives health systems deep insight into performance measures at the degree of detail required for measurement and performance improvement.

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Are Health Systems Ready for MACRA? Survey Reveals the Number One MACRA Concern and Varying Degrees of Readiness

The Medicare Access and Chip Reauthorization Act (MACRA) replaces a number of value-based reimbursement programs and will use 2017 as its first reporting year. But, despite being right around the corner, a survey of healthcare professionals around the country reveals only one-third are ready.

But while only 35 percent of respondents have a strategy and believe they’re prepared for MACRA, most will participate in the new program. A majority of surveyed hospitals believe MACRA will benefit their physicians (or that they’ll at least break even).

MACRA is new, complicated, and rife with uncertainties given the new administration. According to the survey, the top concern for health systems is compiling MACRA quality measures. But despite the industry’s slow movement towards MACRA, the bottom line is that it’s right around the corner, so hospitals must start preparing for MACRA today.

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Hospital Readmissions Reduction Program: Keys to Success

Avoidable readmissions are a major financial major problem for the healthcare industry, especially for government payers. To tackle this problem, CMS launched the Hospital Readmissions Reduction Program (HRRP). While some hospitals may be able to absorb the financial penalties under HRRP, they still need to track increasingly complex reporting metrics. Most tracking solutions are inadequate for today’s complicated reporting needs. A healthcare enterprise data warehouse and analytics applications, however, are designed to solve the numerous reporting burdens. When used together, they also deliver a robust solution that enables hospitals to track and drive real cost and quality improvement initiatives, all without the need for users to be technical experts.

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Webinars

Introducing Leading Wisely™: The Next-Generation of Executive Decision Support

Healthcare leaders are tasked with managing the most complex and changeable industry on Earth, one in which access to the right information at the right time is mission critical. Yet many are almost literally drowning in information as they struggle to collect and interpret data from dozens of IT systems and hundreds of reports in competing formats.

To help, Health Catalyst has announced a breakthrough technology marking the long-awaited next step in the evolution of executive decision support. The web-based solution automatically transforms data, key measures and goals from multiple business units into the fundamental insights critical to leadership. This product combines and analyzes near real-time data from every available IT system and software program, and then enables users to customize information, share it with others, and set their own alerts and notifications. As a result, leaders are empowered to take control of the data deluge to more effectively plan, prioritize improvement projects, create alignment among groups, strategize best solutions, and communicate decisions effectively.

Dorian DiNardo, Senior Vice President of Product Development, discusses this new product with the following primary benefits:

  • Visibility across all of your key measures and goals to strategize, balance, and optimize your performance
  • Provides a single source of cross-organizational truth via the Health Catalyst data warehouse
  • Gives real-time ability to slice-and-dice different vertical or horizontal views with additional drill-down capabilities
  • Prioritize and communicate with proactive notifications, alerts, and social interactions
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MACRA and the New Quality Payment Program: Most Frequently Asked Questions

The Medicare Access and CHIP Reauthorization Act (MACRA) overhauls the payment system for Medicare providers. It’s a complex program that requires careful study so physicians can make the best choice for how they want to report. This choice ultimately impacts reimbursement and the potential bonuses or penalties associated with each reporting option.

This FAQ covers both tracks of the new rule, the Merit-based Incentive Payment System (MIPS), and the Advanced Alternative Payment Model (APM), with a background review and a comprehensive list of questions and answers.

It’s a practical guide complete with next steps for strategic and tactical planning.

Making Sense of the New MACRA Announcement

The healthcare transformation from fee for service to fee for outcomes just got an adrenaline shot in the arm April 27th when the Department of Health and Human Services surprised many in the market by announcing a Quality Payment Program, a proposed set of new rules to take effect in 2019 based on key provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

You may have many questions, such as:

  • What does this mean for you?
  • How will it impact your payments?
  • What should you be doing today to prepare?
  • With quality as a key component to payment, how will it be measured?

While the dust is yet to settle from the momentous thud of the 962-page proposal that was dropped seven days ago, Bobbi Brown, Health Catalyst Vice President of Financial Engagement, has a head start in understanding the ramifications of this proposal with more than 30 years working across the largest and most complex healthcare organizations.

Join Bobbi as she delivers a primer on these important changes.

We look forward to you joining us.

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Healthcare Reform: Implications For Your Health System (Webinar)

Penalties are coming. Are you prepared? Widely recognized as one of healthcare’s most knowledgeable speakers on healthcare policy, Brian Ahier will provide an in-depth look at current healthcare reform and more specifically the implications of the HITECH Act from 2009 as well as the Patient Protection and Affordable Care Act.

In this webinar, Brian covers:

  1. The most important details defining the Affordable Care Act regulation,
  2. Future implications of this body of reform legislation,
  3. Paths healthcare executives can take to prepare,
  4. The importance of analytics to navigate healthcare reform,
  5. The fundamental issues pertaining to Meaningful Use.
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