POPULARITY
4 episodes with alternative payment models
2 episodes with alternative payment models
2 episodes with alternative payment models
2 episodes with alternative payment models
2 episodes with alternative payment models
2 episodes with alternative payment models
2 episodes with alternative payment models
2 episodes with alternative payment models
2 episodes with alternative payment models
Drs. Zeev Kain and Jonathan Gal discuss the article “Scoping Review: Anesthesiologist Involvement in Alternative Payment Models, Value Measurement, and Nonclinical Capabilities for Success in the United States of America” published in the January 2025 issue of Anesthesia & Analgesia.
David W. Johnson and Julie Murchinson talked about the future of Alternative Payment Models under a Trump administration based on their breakdown of the latest stats on alternative payment model adoption on, “What Direction Will Alternative Payment Models Head Over the Next Four Years?” the new episode of the 4sight Health Roundup podcast, moderated by David Burda.
In today's episode Erin Gallardo, PT, DPT, NCS and Claire McLean, PT, DPT, NCS had the pleasure of interviewing APTA President Roger Herr and asking all of the burning questions about what it's like to run a neuro practice with Medicare as it is and where we're going. Roger shared his journey into physical therapy and his extensive experience in key roles that gave him a wide angle perspective of the profession he advocates for now. Alternative Payment Models for PT Practices - Herr emphasized the importance of finding local, regional payment models that best fit each practice's needs, whether that's working with employers, payers, or patient groups. - He discussed strategies like opting out of Medicare, negotiating contracts, and exploring cash-based services to create sustainable business models. Challenges for Micro Practices - Smaller PT practices often struggle with billing, communicating with payers, and navigating the complexities of Medicare coverage. - Could clearer guidelines around medical necessity and skilled care be a helpful short-term goal? Advocacy Efforts for the PT Profession - Herr highlighted the need to shift from volume-based to value-based care, and to advocate for recognizing the downstream costs and impact on patients. - He discussed opportunities in Medicaid, annual wellness visits, and partnering with patient advocacy groups to drive change. Modernizing Medicare Access - Herr explained efforts to update Medicare legislation and allow beneficiaries to directly contract with physical therapists. - This could provide more flexibility and options for patients, though the details around rules and limitations are still being worked out. Leveraging Technology and AI - Herr shared insights on how technology and AI can support population health management, documentation, and reducing administrative burdens for PT practices. APTA Infographic of Prior Authorization ChoosePT How Medicare Determines Payment HH and SNF Download the APTA Advocacy App ChoosePT Directory - Sign up by logging into APTA account, then go to Online Profile, then Find a PT Instagram rogeraherr X @RAHPT Facebook Roger Herr
What is your just cause? Karen Dale is DC Market President for Amerihealth Caritas. She is a bold and fearless leader whose “Why” is to be a catalyst for change to promote equity and deeply support people encountering difficulties. In this episode she shares the leadership practices that support this work from sharing power, to community co-design and embracing disagreement on teams. We discuss:A powerful partnership with the Children's Law CenterThe path to value-based payment for community organizationsThe future of public health education: providing the system, structure and culture that encourages every student to be a catalyst for positive changeHow DC is starting to address decades of under-investment in Wards 7 and 8 through its equity budget reviewKaren discusses the just cause for a school of public health in today's world: “It would be to create … a system, structure and culture that infuses what every student needs to be a catalyst for positive change for human beings … [A] school that creates that culture, gives people the tools, gives them the encouragement, gives them the freedom to try and fail, but learn and apply – that would be amazing. Because … we need a whole generation of people who are in the fight.”Relevant LinksKaren's commencement address to George Mason gradsNPR piece on partnership with Children's Law CenterNew payment approaches for EPSDTGuidance for Health Care Entities Partnering with Community-Based Organizations: Addressing Health-Related Social Needs in Alternative Payment Models. [hcp-lan.org]About Our GuestKaren M. Dale is Market President for AmeriHealth Caritas District of Columbia, a mission-based Medicaid Managed Care Organization in Washington, D.C., and the Chief Diversity, Equity, and Inclusion Officer for the AmeriHealth Caritas Family of Companies. Her focus includes applying a health equity lens to impact all levels of policies, processes, decisions, laws, and outcomes for the communities AmeriHealth Caritas serves.She also leads a decidedly metric-driven business approach to mobilize leaders and accelerate strategies to advance diversity, equity, and inclusion inside and outside the walls of AmeriHealth Caritas. As a result, opportunities for people to experience health, wholeness, and belonging are enhanced by addressing the social, economic, and environmental conditions that are drivers of poor health.Her hobbies include gardening, creating healthy Caribbean recipes, traveling, and watching her son's soccer games.Connect With UsFor more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email claudia@theother80.com and follow us on twitter...
In this episode, we explore the world of Alternative Payment Models (APMs) in healthcare. APMs offer a revolutionary approach to incentivizing high-quality, cost-efficient care delivery. CCI's own, Jessica Ortiz, is joined by Amit Pabla of Valley Community Healthcare in Los Angeles, in this engaging conversation around the changing landscape of healthcare payments. From his unique operational perspective, Amit offers practical insights for healthcare organizations considering a transition to this model, and discusses the diverse applications of APMs as it pertains to social drivers of health. He also unveils essential elements of this cultural shift in healthcare and the journey towards a value-driven and quality-centric approach. Learn more about the people, places, and ideas in this episode: Amit Pabla, Chief Operating Officer at Valley Community HealthcareCal AIM explained (California Health Care Foundation)Alternative Payment Models (Centers for Medicare & Medicaid Services)Technology Hub, a CCI program that helps organizations vet, pilot, evaluate, and spread innovative digital health solutions targeting Medicaid markets and historically underinvested communities
The Centers for Medicare & Medicaid Services is trying to cut physician Medicare payment yet again. Jennifer Hananoki, JD, assistant director on the AMA Federal Affairs team, joins to address the proposed 2024 Medicare physician pay schedule. She breaks down the 3.36% cut to physician reimbursement, plus what the MIPS scores for 2022 and Oct. 9 deadline to file an appeal mean for physicians. American Medical Association CXO Todd Unger hosts.
In this episode of the MGMA Week in Review podcast, we feature content on medical groups struggling to find clinically relevant alternative payment models. We also discuss the uptick in M&A activity in the healthcare space. Sources: Medicare and APM Models: https://www.mgma.com/mgma-stat/medical-groups-struggle-to-find-clinically-relevant-alternative-payment-models M&A transactions: https://www.healthcaredive.com/news/hospital-health-system-M-A-returns-pre-pandemic-levels-Kaufman-Hall/687558/?utm_source=email&utm_medium=marketo&utm_campaign=con-gen-may-2023-newsletter1108-07-18&mkt_tok=MTQ0LUFNSi02MzkAAAGNCExYJBkCLHwku0QUOrLiVV07qkVoW_bl3LGZf3X8e_35RlenM-QyzCj7z-WV4cCcbV9lgqEuaSxGo6kNbPtOfGHWMAILq_TL5_us1q3qlg Resources: MGMA Stat: mgma.com/stat Ask an Advisor: www.mgma.com/ask-an-advisor MGMA Membership: www.mgma.com/membership MGMA Advocacy: www.mgma.com/advocacy MGMA Consulting: www.mgma.com/consulting/overview If you would like additional tools and resources related to medical practice leadership or you have stories to share with us, email us at podcasts@mgma.com. Thank you again for taking the time to listen to the MGMA podcast network.
Picture this: A fearless group of experts, clad in lab coats adorned with glitter and neon colors, gathered around a conference table, ready to shake up the status quo. They've got their thinking caps on, equipped with LED lights that flash with every ingenious idea!But don't let their quirky attire fool you—these trailblazers are serious about transforming community health through alternative payment models. From lightning-fast brainstorming sessions to futuristic visions of a world where healthcare teams provide amazing care to patient populations, the Chispas leave no stone unturned!Does your organization already have APM contracts? Are they thinking about it? Have you heard of APMs? No matter where you are, this conversation will help you think about how to get ready for APMs!Get ready to ignite your curiosity with the Chispas, a team that's setting the world of healthcare ablaze! Join us in this sizzling episode as we delve into the realm of Alternative Payment Models. Follow us on LinkedIn, send us an email, follow us on Facebook, or check out our website.Host:Adrienne MannGuests:Brizzia Burgos Gabriel Del MuroMelissa StratmanSharae Huff
From WEDI's 2023 Spring Conference. The Health Care Payment and Learning and Action Network (HCPLAN) established the Health Equity Advisory Team (HEAT) to help identify and prioritize opportunities to advance health equity through alternative payment models (APMs). The HEAT's goal is person-centered and focuses on leveraging APMs to help make needed care more accessible, drive better patient outcomes, and reduce disparities. We welcomed HEAT's co-chairs, Dr Marshall Chin from the University of Chicago and Karen Dales from Amerihealth Caritas to discuss the group's work and their mission to address and eliminate health disparities while identifying payment models that aid communities. The session was moderated by Michael Pattwell from Edifecs who also serves as WEDI's Payment Model Workgroup Co-Chair.
In this episode, we're diving headfirst into the world of Alternative Payment Models (APMs). You don't need to be a CFO to care about this episode. If you care about quality care for patients and the future of healthcare, this episode is for you!So strap on your thinking caps and prepare to be surprised at your interest in healthcare finance in this interview with Curt Degenfelder!Follow us on LinkedIn, send us an email, follow us on Facebook, or check out our website.Host:Adrienne MannGuests:Curt Degenfelder
Dr. John Neil is the Executive Vice President and Chief Physician Executive and Network Strategy Officer for HonorHealth in Scottsdale, Arizona. Dr. Neil drives physician engagement throughout HonorHealth, working to ensure that physicians have input and involvement in the decision-making processes of the healthcare system. His work with clinical teams focuses on strategic initiatives, operations, clinical services and the continuum of patient care.An interventional radiologist by clinical training, he joined HonorHealth as the organization's senior physician leader in 2015 and has since held leadership roles with the organization's medical staff, Scottsdale Health Partners, and the HonorHealth Board of Directors. His professional experience includes serving as the chairman of Southwest Medical Imaging, a large radiology practice that has been active in ambulatory development, practice mergers and joint ventures.Dr. Neil holds a bachelor's degree in biochemistry from the University of Kansas and graduated with honors from Washington University School of Medicine. John Marchica, CEO, Darwin Research GroupJohn Marchica is a veteran health care strategist and CEO of Darwin Research Group. He is leading ongoing, in-depth research initiatives on integrated health systems, accountable care organizations, and value-based care models. He is a faculty associate in the W.P. Carey School of Business and the graduate College of Health Solutions at Arizona State University.John did his undergraduate work in economics at Knox College, has an MBA and M.A. in public policy from the University of Chicago, and completed his Ph.D. coursework at The Dartmouth Institute. He is an active member of the American College of Healthcare Executives and is pursuing certification as a Fellow.About Darwin Research GroupDarwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin's client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 2010 as Darwin Advisory Partners, LLC and is headquartered in Scottsdale, Ariz. with a satellite office in Princeton, N.J.
Rob Allen, FACHE, President and Chief Executive Officer, Intermountain HealthcareRob Allen, FACHE, was named as the new president and chief executive officer of Intermountain Healthcare and began serving in that role on December 1, 2022. Previously, Rob served as the organization's senior vice president and chief operating officer. In addition to Rob's 25-plus years of executive leadership at Intermountain, he has also held CEO roles at hospitals and health systems in Wyoming, New Jersey, and Massachusetts.A fellow of the American College of Healthcare Executives, Rob has served on many foundation, chamber, and service boards. Rob earned a Master of Business Administration degree from Utah State University and a Bachelor of Science degree in operations management from Brigham Young University. His passion for healthcare began during his childhood as he was raised on a farm in Star Valley, Wyoming, where his mother served as a nurse and later as administrator at Star Valley Hospital. He and his wife, Becky, have three children and four grandchildren.Intermountain Healthcare is headquartered in Utah with locations in eight states and additional operations across the western U.S. Intermountain is a nonprofit system of 33 hospitals, 385 clinics, 60,000 employees, medical groups with some 3,900 employed physicians and advanced care providers, a health plans division called SelectHealth with more than one million members, and other health services. With its mission of “Helping people live the healthiest lives possible,” Intermountain is committed to improving community health and is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes at sustainable costs.John Marchica, CEO, Darwin Research GroupJohn Marchica is a veteran health care strategist and CEO of Darwin Research Group. He is leading ongoing, in-depth research initiatives on integrated health systems, accountable care organizations, and value-based care models. He is a faculty associate in the W.P. Carey School of Business and the graduate College of Health Solutions at Arizona State University.John did his undergraduate work in economics at Knox College, has an MBA and M.A. in public policy from the University of Chicago, and completed his Ph.D. coursework at The Dartmouth Institute. He is an active member of the American College of Healthcare Executives and is pursuing certification as a Fellow.About Darwin Research GroupDarwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin's client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 2010 as Darwin Advisory Partners, LLC and is headquartered in Scottsdale, Ariz. with a satellite office in Princeton, N.J.
Dr. Robert Jarve is the Associate Chief Medical Officer for Population Health at Corewell Health West. In this role, he leads the strategy and development of population health analytics capabilities for the system, as well as the implementation of a value-based care model for underserved, high-risk patients. He is also leading a pilot to help house at-risk patients who are experiencing homelessness.In addition to his administrative responsibilities, Dr. Jarve practices as an internal medicine and pediatrics physician, providing primary care to high-risk patients one day a week. He has diverse experience in population health management, including implementing and leading care management teams, developing care pathways and analytics solutions, and leading the change management of health care teams to more integrated team care models. Dr. Jarve holds BS and MSc degrees from Michigan State University, an MD degree from Wayne State University, and an MBA from Grand Valley State University.Dr. Jarve has lived in Michigan his whole life and enjoys spending time with his wife, two teenage boys, and pets. Outside work, his favorite activities are hiking, reading, traveling, and snowboarding. John Marchica, CEO, Darwin Research GroupJohn Marchica is a veteran health care strategist and CEO of Darwin Research Group. He is leading ongoing, in-depth research initiatives on integrated health systems, accountable care organizations, and value-based care models. He is a faculty associate in the W.P. Carey School of Business and the graduate College of Health Solutions at Arizona State University.John did his undergraduate work in economics at Knox College, has an MBA and M.A. in public policy from the University of Chicago, and completed his Ph.D. coursework at The Dartmouth Institute. He is an active member of the American College of Healthcare Executives and is pursuing certification as a Fellow. About Darwin Research GroupDarwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin's client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 2010 as Darwin Advisory Partners, LLC and is headquartered in Scottsdale, Ariz. with a satellite office in Princeton, N.J.
In his role as Strive Health's Vice President of Strategy & Development, Jackson Brasher draws on more than 15 years of experience to lead Strive Health's system team in their company mission to transform kidney care.Before joining the leadership team at Strive, Jackson held corporate strategy and business development roles at The Advisory Board Company, Trilliant Health, and Cardinal Health – working with hospitals, health systems, and provider practices across the country on various innovation and growth initiatives. Jackson holds a B.A. from the University of Virginia and an M.B.A. from Duke. A Nashville native, Jackson enjoys spending time with his wife, daughter and the family's playful black lab. Outside of the office, he can be found on the lake, at a concert, or planning his next big trip. John Marchica, CEO, Darwin Research GroupJohn Marchica is a veteran health care strategist and CEO of Darwin Research Group. He is leading ongoing, in-depth research initiatives on integrated health systems, accountable care organizations, and value-based care models. He is a faculty associate in the W.P. Carey School of Business and the graduate College of Health Solutions at Arizona State University.John did his undergraduate work in economics at Knox College, has an MBA and M.A. in public policy from the University of Chicago, and completed his Ph.D. coursework at The Dartmouth Institute. He is an active member of the American College of Healthcare Executives and is pursuing certification as a Fellow. About Darwin Research GroupDarwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin's client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 2010 as Darwin Advisory Partners, LLC and is headquartered in Scottsdale, Ariz. with a satellite office in Princeton, N.J.
Briana Contreras, editor of Managed Healthcare Executive spoke with Luis Mosquera, CEO of Health Network One, a provider of specialty benefit management services for health insurers, in this week's episode. In this discussion, Luis and Briana talked about how value-driven decisions in a more value-based market can not only better manage costs for health plans, but create a plan of care to best meet patient's needs. In order to do this, Luis strongly encouraged healthcare executives to experience alternative payment models and shared what payers should check off their list with a new model.
In this episode, we are joined by Nicole Sunder, Director Health Plan Solution Design, PointClickCare and Paul Stout, Program Manager HIE Quality Improvement, Health Services at L.A. Care Health Plan to discuss the meaning of quality, what information is necessary to share to drive outcomes, what Alternative Payment Models mean for the healthcare ecosystem and much more.This episode is sponsored by PointClickCare.
In this episode, we are joined by Nicole Sunder, Director Health Plan Solution Design, PointClickCare and Paul Stout, Program Manager HIE Quality Improvement, Health Services at L.A. Care Health Plan to discuss the meaning of quality, what information is necessary to share to drive outcomes, what Alternative Payment Models mean for the healthcare ecosystem and much more.This episode is sponsored by PointClickCare.
Hi there RevDivers, join us as we interview Doral Jacobsen, founding partner at Prosper Beyond and co-author of MGMA's “Transitioning to Alternative Payment Models” guidebook. Doral chats with us about the importance of payer contracting and provides some great tips and tricks for when you reach out to negotiate those agreements!Find out more in this timely episode and subscribe for future #RevCycle updates with RevDive.Sponsored by: it's Healthcare & Medical Revenue Cycle Specialists LLCFor more information on critical RCM updates, be sure to follow RevDive on our social channels:- Website - Facebook - LinkedIn - Twitter - YouTube
Drs. Jonathan Gal and Gordon Morewood join Dr. Striker for a deep dive into Alternative Payment Models. Listen in as they discuss the role of anesthesiologists in APMs, the development of a MIPS Value Pathway for CMS consideration, ASA's new APM assessment framework and calculator for price modeling of prospective bundled payment, and more. Recorded September 2021.
Skilled nursing care is an important Medicare benefit but it also accounts for significant spending.In Medicare, cost sharing applies to patients' care in skilled nursing facilities after the twentieth day of residence. This prompts a spike in discharges from facilities at that time. But does cutting short these skilled nursing facility stays at day 20 negatively impact patient health?J. Michael McWilliams, a researcher from Harvard Medical School and Brigham and Women's Hospital, and coauthors aimed to answer this question in a paper they published in the May 2021 issue of Health Affairs. They studied the extent to which skilled nursing facility discharges accelerated by Medicare cost sharing are safe.McWilliams and coauthors found no clear evidence that those who are discharged face increased risk of death, hospitalization for fall-related injuries, or all-cause hospitalizations.On this episode of A Health Podyssey, J. Michael McWilliams joins Health Affairs Editor-in-Chief Alan Weil to discuss this research and his perspective on the future of health care financing.Pre-order the July 2021 Health Affairs issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts
Listen to Alan Weil interview Christopher Whaley, a policy researcher at the RAND Corporation, on bundled payments, the promise of direct payments in the commercial market, and whether alternative payments can go from a boutique idea to mainstream model.
In this week's episode, Gabe Scott and Steve Pine discuss recent data showing how health systems participating in Alternative Payment Models compare to other health systems in responding to the COVID-19 crisis, and discuss the future of APMs. Presenters: Steve Pine, Gabe Scott
Host Jeff Lin is joined by Dave Terry, CEO and Founder of Archway Health, they discuss alternative payment models and bundled payment programs in healthcare and how they can impact both providers and patients. Want to stream our station live? Visit www.HealthcareNOWRadio.com. Find all of our show podcasts on your favorite podcast channel and of course on Apple Podcasts in your iTunes store or here: https://podcasts.apple.com/us/podcast/healthcarenow-radio/id1301407966?mt=2
Value-based care seeks to improve care quality while reducing cost, and does so, in large part, through the use of innovative alternative payment models. But for payers, transitioning from volume-based payment (i.e., fee-for-service) to value-based alternatives is easier said than done. On today's show, Mark Berg of McKinsey & Company's Healthcare Innovation group join's Change Healthcare's Rob Capobianco to talk about the steps payers need to take to succeed with value-based care and APMs, and the seven characteristics of successful alternative payment models—the topic of a recent McKinsey report. Here's what they covered: What does McKinsey & Company do and who are their clients (03:47) The importance of having organizational systems in place to scale value-based models (07:57) Value-based payment as a core strategy for medical cost control, and the role of primary care practices (11:16) Value-based care pain points and the importance of stakeholder engagement (18:03) How episodes-of-care can help payers develop their value-based strategies (22:24) The seven characteristics that make a value-based model successful (27:37) How risk shapes success, and how fast or slow to go (32:34) When should payers commit to value as a core strategy (34:40) Episode Resources Contact Cappy Mark Berg's bio The Seven Characteristics of Successful Alternative Payment Models Research: Value-Based Care State-by-State Seminar: How Anthem is Scaling Value-Based Payment Value-Based Payment Resource Hub Show Resources SUBSCRIBE to the podcast using any podcatcher or RSS reader Download the audio and listen offline Get the iOS app Get the Android app Suggest or become a guest Contact Change Healthcare
To date, most alternative payment models (APMs) that have emerged in the shift toward value-based care have been initiated by payers and focused on primary care providers. However, there has recently been a new wave of payment reform in which providers, mostly specialists, are designing and implementing their own APMs in their practices. A study published in the September issue of The American Journal of Managed Care analyzed some of these new payment models to gain insight into what providers are prioritizing in their APMs. To get more insight into the study and its findings, we spoke with study author Suhas Gondi, BA, of Harvard Medical School.
Listen to the very first QuadCast! EGFR, Alternative Payment Models, RBG, and some fun.
Aparna Higgins' career has been focused on value-based payment. More than ten years ago, while she was at Booz-Allen, she co-led the design of the Medicare Hospital Value-Based Purchasing report to Congress. It was one of the first programs recommended to the CMS that defined how hospitals could be assessed and rewarded for care quality. The report’s recommendations were implemented when the CMS was authorized under the Affordable Care Act to implement the program. More recently, as an executive at AHIP (America’s Health Insurance Plans), Aparna led organizational efforts on payment and delivery system reform, included examining and identifying industry-wide best practices in the design and implementation of Alternative Payment Models (APMs), and the core quality measures collaborative. She’s spent most of her career thinking about incentives, incentive design, and how to assess and reward performance. These days Aparna is the founder and CEO of Ananya Health Innovations. She’s also a guiding committee member of the Health Care Payment Learning & Action Network, also known as “the LAN,” which was established to accelerate the healthcare system’s transition to alternative payment models. The LAN’s major contribution to the industry is the APM Framework, which provides healthcare stakeholders with a roadmap to understand, design, and assess the adoption of alternative payment models. We asked Aparna to join us on the podcast to talk about how the APM Framework can help payers and providers achieve their value-based payment goals. On today’s show, we’ll take you through: The LAN’s mission and how it created APMs (02:16) The roadmap, benchmark, and other tools the LAN created to help payers achieve their VBC goals (06:06) A dive into the APM roadmap’s three pillars: APM design, payer/provider collaboration, and patient-centered care (10:20) Why having access to better data is better for providers (15:51) How payers can support providers, especially smaller providers, in analyzing data and identifying areas to focus on (19:12) How payers and providers are changing patient engagement in the real world (21:29) Evolving an APM from retrospective to prospective (28:19) The importance of outcome-focused measurements (33:09) Key tips for payers on advancing their APM programs (35:15) What providers need to be successful in APM models (37:00) How leadership and organizational culture for both payers and providers is key to success (39:00) Aparna’s closing thoughts (40:54) Episode Resources Contact Patrick McGuigan Aparna Higgins bio The Healthcare Payment Learning & Action Network The HCP-LAN APM framework Research: Value-Based Care State-by-State Seminar: How Anthem is Scaling Value-Based Payment Value-Based Payment Resource Hub Show Resources SUBSCRIBE to the podcast using any podcatcher or RSS reader Download the audio and listen offline Get the iOS app Get the Android app Suggest or become a guest
Our guest this week is Dr. Mark Friedberg. Mark is a senior physician policy researcher at the RAND corporation and a practicing primary care physician at Brigham and Women’s Hospital, where he trained in primary care after attending medical school at Harvard. RAND is a non-profit, non-partisan research organization that develops solutions to public policy challenges to make communities healthier and more prosperous. Mark’s research covers a range of topics but focuses in particular on quality measurement and pay for performance. He joins us today to talk about his work, and in particular an exhaustive report he recently published with colleagues from RAND and also the AMA, looking at the effects of alternative payment models on the practice of medicine in the US, a follow up study from work initially done in 2014. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. Follow Mark and Audrey on twitter, and tweet your feedback and suggestions to us at Review of Systems. Or, you can email me at contactATrospod.org. Thanks for listening!
Listen NowMedicare's Fee for Service Alternative Payment Models (APMs), a creation of 2015 MACRA legislation, currently 12 in number with participation largely voluntary, requires Medicare providers to assume financial risk, based on historical spending and quality measurement performance, beyond a "nominal amount." The flagship APM is the ACA's Medicare Shared Savings Program, more commonly termed Accountable Care Organizations (ACOs). Though in its 8th year, the ACO program, that currently provides care to over 10 million assigned Medicare beneficiaries, has not produced meaningful savings (estimates are 1 to 2% annually). Nor have other APMs, largely bundled payment arrangements, produced substantial savings. The Medicare Advantage program (with one-third of Medicare beneficiaries), defined as administrative pricing, does not formally score savings. Over the past few years per capita Medicare spending has been limited, however, program growth or beneficiary enrollment (via the aging baby boomer population) is causing Medicare spending, in sum, to increase substantially. In addition, the soon-to-be-published annual Medicare Trustee's report will show the program will become insolvent within the next few years. During this 26 minute discussion, Mr. Miller provides an overall assessment of APM performance to date. He moreover discusses the shortcomings in APM design or the barriers APM providers face in improving care, e.g., as ostensibly Fee for Service APMs are not reimburse for valuable non-medical services such as social service supports and ways to improve these models. We conclude the discussion with his views on the ACA-created PTAC (the Physician-Focused Payment Model Technical Advisory Committee), that has reviewed to date over 30 submitted APM proposals, none of which have been chosen by Secretary Azar for testing as a Medicare demonstration. Mr. Harold D. Miller is the President and CEO of the Center for Healthcare Quality and Payment Reform. In this role he has worked in more than 40 states and metropolitan regions to help physicians, hospitals, employers, health plans, and government agencies design and implement payment and delivery system reforms. He is also currently one of eleven members of the PTAC. He also serves as Adjunct Professor of Public Policy and Management at Carnegie Mellon University. Mr. Miller has written a number of widely-used papers and reports on health care payment and delivery reform. He has assisted numerous professional organizations in developing alternative payment models designed to support better care for patients at lower cost. From 2008 to 2013, Mr Miller served as the President and CEO of the Network for Regional Healthcare Improvement (NRHI), the national association of Regional Health Improvement collaboratives. He served as a member of the Board of Directors of the National Quality Forum from 2009 to 2015. From 2006 to 2010, Mr. Miller served as the Strategic Initiatives Consultant to the Pittsburgh Regional Health Initiative (PRHI). In 2007, he served as the Facilitator for the Minnesota Health Care Transformation Task Force. In previous positions, Mr. Miller served as the Director of the Pennsylvania Governors Office of Policy Development, Associate Dean of the Heinz School of Public Policy and Management at Carnegie Mellon University, Executive Director of the Pennsylvania Economy League - Western Division, Director of the Southwestern Pennsylvania Growth Alliance and President of the Allegheny Conference on Community Development.For information on the Center for Healthcare Quality and Payment Reform, go to: http://www.chqpr.org/ For information on the PTAC, go to: https://aspe.hhs.gov/ptac-physician-focused-payment-model-technical-advisory-committeePer my mention of Dr. Robert Berenson's recent (February) essay concerning improving the Medicare Fee for Service schedule, go to: https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05411 This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com
Healthcare is moving away from the fee-for-service model, which is impacting the revenue providers are receiving. Learn about 4 of the alternative payment models that providers are weighing as they transition to value based care. --- Support this podcast: https://anchor.fm/healthcare-minute/support
MedAxiom HeartTalk: Transforming Cardiovascular Care Together
Alternative Payment Models will impact your organization's future revenue, whether participating in voluntary models or waiting for mandatory payment policies to take effect. So what role will BPCI Advanced play in this new era, what is "BPCI Advanced Plus", and what are the current drivers and challenges among providers, payers and self-insured employers? David Terry is CEO and Founder of Archway Health. Joel Sauer is Executive Vice President of MedAxiom Consulting.Contact: HeartTalk@medaxiom.com Learn more: https://www.medaxiom.comContact: HeartTalk@medaxiom.com Learn more: https://www.medaxiom.com
On this episode of ACEP's "Frontline", host Dr. Ryan Stanton talks to Dr. Jennifer Wiler about Alternative Payment Models. Do you know what “Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)” is? It’s potentially the most important piece of legislation passed in this decade which is going to change the way physicians and clinicians are paid. Listen in to find out how this impacts Emergency Physicians and how can you help shape these models.
NCHICA's 24th Annual Conference will be held October 8-9, 2018 in Charlotte, NC. We are launching a new podcast series featuring speakers from our upcoming Annual Conference. Our first podcast features Carrie Nixon of Nixon Law Group, who will speaking on Monday, October 8 on The 21st Century Cures Act and the Future of Healthcare. Carrie Nixon is Managing Member of Nixon Law Group and CEO of Nixon HealthNexus, a healthcare reform and innovation consultancy. She is an expert in law and policy issues relating to value-based delivery and reimbursement, including Accountable Care Organizations, Alternative Payment Models, MACRA and MIPS reporting, and telemedicine. She earned her law degree from University of Virginia School of Law. Our podcast host is Janet Kennedy of Get Social Health.
As healthcare costs continue to increase, the industry is looking for innovative ways to reduce spending. One recent structural change is to modify the way doctors are paid. Over the past few years, payers have begun switching from a fee-for-service model, in which doctors are paid by the volume of services provided, to alternative payment models (APMs), where the emphasis is put on the quality of services provided instead of the quantity. There are many different forms of APMs, and Milliman’s Pamela Pelizzari is sitting down with Critical Point to provide a little APM 101.
Second part with Dr Karen Joynt Maddox discussing alternative payment models. In part one, we discussed the history of how quality measures began to be collected to being used in current reimbursement. In part two, we discuss some of the limitations of these models and the unanticipated consequences on some populations. Link to transcript on … Continue reading Alternative Payment Models Part 2 with Dr Karen Joynt Maddox →
The way we pay for medical care is changing. In this first episode of a two-part series, Dr Karen Joynt Maddox explains the history of the transition towards a quality based system. See her article in the New England Journal of Medicine here. Link to transcript on MedPage Today
Nicole Bixler, DO, MBA, FACOFP discusses the various Alternative Payment Models, Medicare Advantage, Capitated Plans and Comprehensive Primary Care Plus in this podcast. She will cover key characteristics of each model to help decide which might be right for your family medicine practice.
Dr. Karen Joynt Maddox is an assistant professor of medicine at Washington University School of Medicine. Stephen Morrissey, the interviewer, is the Managing Editor of the Journal. K.E. Joynt Maddox. Financial Incentives and Vulnerable Populations - Will Alternative Payment Models Help or Hurt? N Engl J Med 2018;378:977-9.
In this episode, Dr. Mark McClellan discusses a recent report from the Health Care Payment Learning and Action Network that looks at the adoption rate of alternative payment models. Learn how to listen to The Hospital Finance Podcast on your mobile device. Mike Passanante: Hi, this is Mike Passanante. And welcome back to the Hospital Finance Podcast. Today, Read More
Host Dr. Ryan Stanton talks to Dr. Jennifer Wiler on alternative payment models.
As critical access hospitals (CAHs) and small rural hospitals evaluate whether to participate in an alternative payment model (APM) as an option under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) for their medical providers, it is important for hospital leadership to evaluate the APM model from a business plan perspective. The APM model requires hospital and clinician integration which will impact reimbursement and how care is coordinated and managed in the both the hospital and practice setting. Pat Schou, Executive Director for the Illinois Rural Community Care Organization (IRCCO), a statewide rural accountable care organization (ACO), discusses the financial strategies IRCCO has undertaken to prepare hospitals and their medical providers for clinical integration. She shares how they measure the return on investment for the ACO as well as for the hospital and medical provider. Ms. Schou explains the advantages and disadvantages of an organization considering becoming a part of an APM. View the slides: https://www.ruralcenter.org/events/alternative-payment-models-business-perspective Speaker: Pat Schou, Executive Director, Illinois Critical Access Hospital Network and Illinois Rural Community Care Organization
The introduction of MACRA marked a major change in physician reimbursement methodology. Prior to this legislation service, volume drove physician revenue. Value has replaced volume as the key driver of revenue. Dr. Davis explores the impact value-based reimbursement, MIPS and Alternative Payment Models (APMs) have on physicians. The participation choices and the effect of employment in a fee-for-service (FFS) environment, rural health clinic (RHCs) and federally qualified rural health clinics (FQHCs) are discussed. View the slides: https://www.ruralcenter.org/events/alternative-payment-models-business-and-physician-perspectives-part-2 Speaker: Gregg Davis, MD, MBA, Chief Medical Officer, Illinois Rural Community Care Organization, LLC
This is the second segment in a three-part series about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This segment explains the criteria for receiving incentive payments through Advanced Alternative Payment Models (APMs). It also identifies the shared savings models that will qualify as Advanced APMs. Speaker: Ryan Severson Download Program Materials
In this episode, Maria Miranda, Director of Emerging Payment Models and Meliza Weiner, Clinical Review Nurse at BESLER Consulting, discuss the impact of patient satisfaction on alternative payment models. Learn how to listen to The Hospital Finance Podcast on your mobile device. Michael Passanante: Hi, this is Mike Passanante. Welcome back to the Hospital Finance Podcast. Today, I’m Read More
In this webinar, Lisa Gall, Clinical Program Manager at Stratis Health, details Alternative Payment Models and explains how Medical Home models can improve care coordination, quality and decrease costs. You will learn how small and rural hospitals can engage and educate clinicians, health care organizations and the community in order to achieve common cost and quality goals. Discover ways to return joy to providers, as they become active participants in the process. Resources relevant to small and rural hospitals will be provided to begin the transformation to value-based care. · Speaker: Lisa Gall, DNP, FNP, LHIT-HP, Clinical Program Manager, Stratis Health
Eric Levin is a Strategic Services Director for McKesson's Business Performance Services division, which provides value-based care solutions to both hospitals and physician groups. In this role, Eric focuses on comprehensive and strategic healthcare sales and business development. Eric has over 15 years of healthcare experience specializing in value-based reimbursement, technology and primary care strategy. With McKesson, Eric led the advanced primary care team in creating payer and provider collaborations that resulted in successful pay-for-performance plans. He also served an integral role in commercializing data warehouse and population health management platforms. Prior to McKesson, Eric held strategic sales roles at NueMD and FSC Pediatrics. 00:00 Delving into reimbursement. 02:00 Fitting into Alternative Payment Models and Value-Based Care. 03:00 How proactive providers, practices, and hospitals are now reaping the rewards of Value-Based Care. 04:00 MACRA, MIPS, and CPC+. 07:00 MACRA: MIPS and Alternative Payment Models 07:50 MIPS vs. Alternative Payment Models: What program you should be using. 08:20 What CPC+ is, and how it fits into the landscape of MACRA, MIPS, and Alternative Payment Models. 11:20 Revenue sources according to Payment Model. 13:00 Eric's advice for making the most of transitioning Payment Models and understanding which program you should adopt. 14:00 Starting with Chronic Care Management or Managing Care Transitions. 15:30 The best strategy in approaching reimbursement. 17:00 Transitional Care Management. 18:00 Outsourcing care. 18:50 James Grant of CareSync - providing CCM Services, as does McKesson as well. 19:15 Eric's insights into Providers' and Payers' geographic emphasis, and how this affects reimbursement. 21:00 How Health System mergers have affected reimbursement. 22:00 Payers becoming Providers and Providers becoming Payers. 24:15 Cost pressures for Payers. 25:30 Creating Bundled Payments. 26:00 Eric's biggest piece of advice for Providers just starting to explore reimbursement options. 27:20 Eric's main expertise as a consultant for McKesson.
Host: Matt Birnholz, MD Guest: Lawrence Kosinski, MD The advancement of the Medicare Access and CHIP Reauthorization Act (MACRA) has catapulted Alternative Payment Models into the spotlight for identifying new value-based approaches to care. But questions persist as to the roles that specialists can and should play in the design and implementation of APMs, how these models will cut healthcare costs, and which administrative partnerships are needed to make them successful. Dr. Lawrence Kosinski, a practicing gastroenterologist with The Illinois Gastroenterology Group, is pioneering one such APM that applies an innovative method for tracking patients between clinic visits. The model, called SonarMD, for which Dr. Kosinski is founder and Chief Medical Officer, provides a web-based platform that pings patients beyond practice settings to help get ahead of issues before they become emergencies.
Host: Matt Birnholz, MD Guest: Lawrence Kosinski, MD The advancement of the Medicare Access and CHIP Reauthorization Act (MACRA) has catapulted Alternative Payment Models into the spotlight for identifying new value-based approaches to care. But questions persist as to the roles that specialists can and should play in the design and implementation of APMs, how these models will cut healthcare costs, and which administrative partnerships are needed to make them successful. Dr. Lawrence Kosinski, a practicing gastroenterologist with The Illinois Gastroenterology Group, is pioneering one such APM that applies an innovative method for tracking patients between clinic visits. The model, called SonarMD, for which Dr. Kosinski is founder and Chief Medical Officer, provides a web-based platform that pings patients beyond practice settings to help get ahead of issues before they become emergencies.
Host: Matt Birnholz, MD Guest: Lawrence Kosinski, MD The advancement of the Medicare Access and CHIP Reauthorization Act (MACRA) has catapulted Alternative Payment Models into the spotlight for identifying new value-based approaches to care. But questions persist as to the roles that specialists can and should play in the design and implementation of APMs, how these models will cut healthcare costs, and which administrative partnerships are needed to make them successful. Dr. Lawrence Kosinski, a practicing gastroenterologist with The Illinois Gastroenterology Group, is pioneering one such APM that applies an innovative method for tracking patients between clinic visits. The model, called SonarMD, for which Dr. Kosinski is founder and Chief Medical Officer, provides a web-based platform that pings patients beyond practice settings to help get ahead of issues before they become emergencies.
Host: Matt Birnholz, MD Guest: Lawrence Kosinski, MD The advancement of the Medicare Access and CHIP Reauthorization Act (MACRA) has catapulted Alternative Payment Models into the spotlight for identifying new value-based approaches to care. But questions persist as to the roles that specialists can and should play in the design and implementation of APMs, how these models will cut healthcare costs, and which administrative partnerships are needed to make them successful. Dr. Lawrence Kosinski, a practicing gastroenterologist with The Illinois Gastroenterology Group, is pioneering one such APM that applies an innovative method for tracking patients between clinic visits. The model, called SonarMD, for which Dr. Kosinski is founder and Chief Medical Officer, provides a web-based platform that pings patients beyond practice settings to help get ahead of issues before they become emergencies.
Dr. Paul Ginsburg is a professor of the practice of health policy and management at the University of Southern California Sol Price School of Public Policy. Stephen Morrissey, the interviewer, is the Managing Editor of the Journal. P.B. Ginsburg and A.M. Rivlin. Challenges for Medicare at 50. N Engl J Med 2015;373:1993-5.
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