Podcasts about bundled payments

This week, please join author Karen Joynt Maddox and Associate Editor Sandeep Das as they discuss the article "Changes in Cardiovascular Spending, Care Utilization, and Clinical Outcomes Associated With Participation in Bundled Payments for Care Improvement−Advanced." For the episode transcript, visit: https://www.ahajournals.org/do10.1161/podcast.20231002.799650

The Medicare Team catches up with special guests Ashley Fitch, Director of Community Partnerships and Innovation from Mount Sinai and Kathy Vesley, President and CEO of Bay Aging to learn more about how they are addressing social determinants of health through building networks of community-based organizations. Meg and Melissa also discuss Medicare Open Enrollment, the Bundled Payments for Care Improvement Advanced (BPCI-A) extension, and all things flu season.Here are some tips from AARP to avoid Medicare fraud during open enrollment season: https://www.aarp.org/money/scams-fraud/info-2019/medicare.html

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.

Patients with more advanced disease are returning to hospitals in pre-pandemic volumes and the cost of treating them is now higher. On MedAxiom HeartTalk, host Melanie Lawson speaks with Stuart Jacobson, Founder & CEO of Biome Analytics, Amber Pawlikowski, MSN, RN, CPHQ, Director of Client Services & Quality Improvement Analytics at Biome Analytics, and Bradley Hubbard, MD, Cardiologist at Trinity Health Michigan Heart to discuss the struggles of quality performance improvement during a time of massive resource shortages and some of the major barriers that clinicians face. We're also joined by Joel Sauer, MBA, Executive Vice President, Consulting and Denise Busman, MSN, Vice President, Care Transformation at MedAxiom who share insights on how organizations can use analytics to better achieve the “Quadruple Aim” of healthcare. Guest Bios Bradley Hubbard, MD, Cardiologist, Trinity Health Michigan Heart - Dr. Hubbard has more than 20 years of experience practicing in the area. His clinical interests include cardiac MRI, critical care, and monitoring quality outcomes. Dr. Hubbard also has additional training in adult comprehensive echocardiography and nuclear cardiology. He is the director of the coronary care unit and section head of cardiology at St. Joseph Mercy Ann Arbor, as well as a clinical instructor in internal medicine at the University of Michigan Medical School. Amber Pawlikowski, MSN, RN, CPHQ, Director of Client Services & Quality Improvement Analytics, Biome Analytics - Amber is a passionate and driven healthcare leader with over a decade of experience in healthcare delivery and services. She is considered a young, rising figure and prominent voice in the areas of data analytics and quality improvement methodologies. As a healthcare leader, Amber has created, directed, implemented, and continuously monitored quality strategic plans and outcomes for the nation's largest CVSLs with specific focus on cardiothoracic surgery, vascular surgery, cardiology (medical, interventional and electrophysiology) and interventional radiology. Amber currently serves as Director of Client Services and Quality Improvement Analytics at Biome, a leading provider of performance solutions for enterprise cardiovascular centers  Stuart Jacobson, Founder & CEO, Biome Analytics – An entrepreneur, Stuart Jacobson co-founded Biome Analytics in 2013.  Denise Busman, MSN, VP, Care Transformation at MedAxiom - Denise brings more than 30 years of experience as a cardiovascular clinician and leader to MedAxiom. Her clinical expertise is complemented by a passion for engaging multi-disciplinary teams to transform care delivery and enhance clinical quality. Known for her work in program development and change management, Denise is skilled in the implementation of new programs and clinical initiatives. Denise joins MedAxiom from Spectrum Health, a multi-hospital system in Michigan, where she held a variety of positions including critical care educator and cardiology clinical nurse specialist. Most recently, her focus was directed toward clinical improvement and quality for the cardiovascular service line, where she implemented innovative approaches to care and served as a trusted advisor to cardiovascular physicians and team members. Denise holds a bachelor's degree in nursing from Michigan State University and master's degree in nursing from Grand Valley State University. She has been active with the American College of Cardiology for many years as a Michigan Chapter board member and cardiovascular team liaison, ACC Scientific Program Committee member, and reviewer of scientific abstracts. Joel Sauer, MBA, EVP - Consulting, MedAxiom - Since 2010 Joel Sauer has been providing consultative services around the country to accelerate the value transition in health care, particularly within the cardiovascular realm. A significant area of concentration has been creating contemporary and effective physician/hospital partnership structures, utilizing employment and other contractual arrangements (such as professional services agreements) and joint ventures. His work includes full-service line advancement, including governance and leadership development, and the creation of targeted co-management programs. Joel is an expert in vision and strategy setting, cultural and operational integration, and physician compensation plan design that promotes the vision and objectives of the organization. Prior to consulting, Joel spent 14 years as Chief Executive Officer of a large Midwestern multi-specialty physician group that included 23 cardiologists. In 2008 Joel led his group through acquisition by a major health system and then took over as CEO of its entire physician enterprise, which eventually included nearly 500 providers. A recognized national resource in cardiovascular physician compensation, Joel is author of the annual MedAxiom Provider Compensation & Production Survey and has expertise in provider workforce planning and development.  Along with the entire MedAxiom Consulting team, he is a resource in new federal payment models such as the Quality Payment Program and the Bundled Payments for Care Improvement Advanced (BPCI Advanced), and other episode payment-based arrangements. Joel is often published in health care magazines, blogs and trade journals and is a regular speaker at national health care meetings.  Bonus Links:https://biome.io/

August 30, 2021: Dr. Eric Quiñones from World Wide Technology joins Bill for the news for some post HIMSS talk. Plus how can your IT team prepare for a COVID surge? Crisis teams have been sent to hard-hit COVID hospitals in Oregon. Tom Burton from Providence St. Joseph reveals how they are generating patient engagement ROI. NYU Langone experienced significant growth in digital engagement. The May cyberattack cost Scripps nearly $113M in lost revenue. And The National Emergency Tele-Critical Care Network (NETCCN) is here with their clinical care teams to help you.Key Points:How do you get ready for a COVID surge as an IT organization? [00:14:32] National Emergency TeleCritical Care Network [00:09:50] I don't think people necessarily ask the questions that they should ask. Dig deeper. Really look at where the facts are coming from. Investigate yourself. [00:21:25]Design thinking - human centered process problem solving [00:25:30] World Wide TechnologyStories:Crisis teams' sent to hard-hit COVID hospitals in Oregon - AP NewsCOVID-19 accelerated ongoing digital transformation efforts at NYU Langone - Healthcare Finance NewsA technological approach to patient engagement shows ROI for Providence St. Joseph Health - Healthcare Finance NewsMay cyberattack cost Scripps nearly $113M in lost revenue, more costs -  FierceHealthcareARE YOU A HEALTHCARE ORGANIZATION OR A HOSPITAL IN NEED OR PREPARING FOR COVID SURGE SUPPORT?

Featuring articles on vaccine effectiveness against the delta Covid-19 variant, injectable cabotegravir for prevention of HIV infection, antibody to factor XI after total knee replacement, year 1 of the Bundled Payments for Care Improvement–Advanced payment model, and on a new dimension in the RNA world; a review article on signature cytokines and immune-mediated inflammatory diseases; a case report of a woman with fever, sore throat, and confusion; and Perspective articles on confronting long-haul Covid, on the criminalization of gender-affirming care, and on when low tech wins.

In this week's episode of Tuning In to the C-Suite podcast, MHE had the pleasure of speaking with Sach Jain, CEO of Carrum Health. In the discussion Sach touched on how adopting value-based care is treating conditions and lowering cost burdens, but there remains to be concern in medical spend when it comes to planned surgeries. Sach also talked about how adopting bundled payments can be just as good of a solution as the newer price transparency rule when assisting in patient's high medical costs. 

Where are value-based reimbursement models headed? Two new studies gave us a few clues. We talked about it on today's episode of the 4sight Friday Roundup podcast. Here the week's biggest news around market-based change. David Johnson is CEO of 4sight Health. Julie Vaughan Murchinson is Partner of Transformation Capital and former CEO of Health Evolution. David Burda is News Editor and Columnist of 4sight Health. Subscribe on iTunes, Spotify, other services. Click play to listen to the 6/25/2021 Episode.

The all-too-common visualization of balancing between the two canoes of fee-for-service (FFS) and value-based care (VBC) is an appropriate illustration of the pressure that providers feel, but maintaining balance is clearly focused on staying upright, on survival. The challenge is that the FFS canoe has a motor, and the paddle for the VBC canoe is not enough to change direction – clearly the tools used to optimize reimbursement in the two worlds are oftentimes diametrically opposed. The mission behind VBC (lower cost, better outcomes, better care) has not been sufficient for many to overcome the momentum of the status quo, the requirement for margin that is the focus of FFS. This week's episode features two leaders in the race to value who have vital insights focused on achieving margin in risk, giving provider leaders more clarity to make the best decisions for their organizations in positioning for the future. François de Brantes serves as Senior Vice President of Commercial Business Development at Signify Health. He leads customer development of the Medicare Advantage, Self-Insured Employer, and Commercial Payer markets. He has spent close to two decades working to transform the U.S. healthcare system by improving incentives for providers and consumers in order to encourage value-based decisions.  He is the foremost expert on designing and implementing episodes of care programs for employers, providers and health plans. Joe Fifer is president and CEO of the Healthcare Financial Management Association. HFMA's mission is to lead the financial management of health care. With more than 50,000 members, HFMA is the nation's leading membership organization of healthcare finance executives and leaders. Prior to assuming this position in 2012, Joe spent 11 years as vice president of hospital finance at Spectrum Health in Grand Rapids, Mich. He also spent time with McLaren Health Care Corporation, Ingham Regional Medical Center and Ernst & Young.   Episode Bookmarks: 02:00 Introduction to our Mission-Oriented Expert on Value-Based Care, François de Brantes (SVP, Signify Health) 02:20 Introduction to our Margin-Focused Healthcare Finance Executive, Joe Fifer (President & CEO, HFMA) 03:40 Healthcare organizations must position themselves for value-based payment without going bankrupt in the process! 05:00 The recently released report entitled, "The Future of Value-Based Payment: A Road Map to 2030” 07:00 François provides his perspective on the current state of value-based care and the current track record of CMS and CMMI payment models 11:30 Joe explains how excessive healthcare spending has forced the U.S. under-invested in infrastructure 13:00 Moving from payment model experimentation to a more focused set a models with the right incentives to move the industry forward 14:30 Performance Results of the Bundled Payments for Care Improvement (BPCI) initiative 16:00 How François and Joe initially met 10+ years ago while working on a bundled payment program 17:45 François explains how making better decisions in post-acute care when managing an episode of care can generate margin at the patient-level 21:00 Joe on why CFOs are leery of value-based payment because of the variation and uncertainty of the financial model, and how to create an attitudinal change 23:30 CMMI needs to develop a core set of APMs that show evidence in helping the delivery system make the right decisions around resource allocation to optimize their organizational structures. 25:00 Is there an organizational tipping point for value-based care based on the percentage of their revenue portfolio at risk? 26:00 François explains the “CFO's Dilemma” (i.e. shifting a portion of FFS revenue to risk with increased associated margin per patient that can offset the decrease in the overall margin from the loss of incremental hospitalization revenue in FFS) 27:40 The “CFO's Dilemma” is all about reaching a tipping point...

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.

When healthcare quality management expert Donna Kurek made the switch to a more rural hospital system, she realized that there exists a whole different set of social determinants to consider in Appalachia, especially in the context of bundled payments.

When healthcare quality management expert Donna Kurek made the switch to a more rural hospital system, she realized that there exists a whole different set of social determinants to consider in Appalachia, especially in the context of bundled payments.

When healthcare quality management expert Donna Kurek made the switch to a more rural hospital system, she realized that there exists a whole different set of social determinants to consider in Appalachia, especially in the context of bundled payments.

Bundled payment programs are designed to promote value-based care and remain largely voluntary. With the deadline to renew or modify contracts rapidly approaching and Medicare’s acceleration towards mandatory models, a four-person panel with varying perspectives discusses whether linking payments to clinical episodes can reduce Medicare expenditures while maintaining or improving quality of care. Learn more about various alternative payment models created to achieve value-based care using AAOS' Value-Based Care Continuum guide. Hosted by: Kristen Coultas, AAOS Advocacy Communications Director 

This episode features a session from Becker's Spine, Orthopedic and Pain Management-Driven ASC + the Future of Spine Virtual Event: The Future of Practice, Bundled Payments, Out-of-Network, Venture Capital, Hospital Partnerships and More The conversation includes insight from the following speakers: Nader Samii, Chief Executive Officer, National Medical Billing Services Sigurd Berven, MD, Orthopedic Surgeon, The University of California San Francisco Thomas Schuler, MD, FACS, Chief Executive Officer, Founder and Spinal Surgeon, Virginia Spine Institute Scott L. Blumenthal, MD, Founder, Medical Director, Center for Disc Replacement, Texas Back Institute

Bill Nordmark joined Aver from PaySpan, Inc., where he was Chief Growth Officer. Nordmark brings decades of experience to Aver in the innovation and development of healthcare reimbursement systems, as well as in the growth and success of early-stage companies. Nordmark held many management positions during his 11-year tenure at PaySpan, including leading its Payer […] The post Bill Nordmark with Aver appeared first on Business RadioX ®.

We sat down with Paul Bartosic, Director of Sales at Harvard Pilgrim, to discuss how they've been responding to the COVID-19 pandemic, what their clients are doing with their wellness funds, how they are utilizing bundled payments and what their service team is doing to help improve the member experience.

written post at https://healthy-skeptic.com/2020/01/13/bundled-payment-research/

Although fee-for-service payments may encourage volume without rewarding quality, bundled payments may incentivize providers to avoid patients more prone to complications...

Although fee-for-service payments may encourage volume without rewarding quality, bundled payments may incentivize providers to avoid patients more prone to complications...

Although fee-for-service payments may encourage volume without rewarding quality, bundled payments may incentivize providers to avoid patients more prone to complications...

Simplifying the payment process for healthcare can be like turning a large ship, but bundled payments have been a large step forward. Dr. James Ballard, an orthopedic surgeon in Portland, walks through the benefits of bundled payments for patients, payers, and providers. When doctors look at the world, they can bemoan all the difficulties of the healthcare system, or they can look at them and find opportunity in the challenge. Find all of our show podcasts on your favorite podcast platforms. https://www.healthcarenowradio.com/listen/

Simplifying the payment process for healthcare can be like turning a large ship, but bundled payments have been a large step forward. Dr. James Ballard, an orthopedic surgeon in Portland, walks through the benefits of bundled payments for patients, payers, and providers. When doctors look at the world, they can bemoan all the difficulties of the healthcare system, or they can look at them and find opportunity in the challenge.This conversation is brought to you by P3 Inbound. See acast.com/privacy for privacy and opt-out information.

Skilled nursing providers can get chills at the thought of alternative payment models, which include Medicare arrangements such as bundled payments — one reimbursement shared by a range of providers for a single episode of care. After all, many bundled payment programs achieve their savings by cutting down on post-acute spending, adding pressure to already-squeezed skilled nursing facilities. But Brian Fuller, the CEO of Integrated Care Solutions, thinks SNFs shouldn't despair. ICS is a care coordination company and bundled payments convener under the Bundled Payments for Care Improvement — Advanced program, and Fuller sees both sides of the acute and post-acute world. He joined Rethink to talk about how SNFs need to change their mindset and get creative to thrive in a value-based world. Listen to this episode to learn: - The disconnects between acute and post-acute care, and what they need to learn to come together - Why post-acute is a savings target in alternative payment models, and how SNFs can take control of their own destiny within their market - The tenets SNFs need to adopt as their "true north" for success in the evolving world of value-focused health care

In this week’s episode, we focus on Intermountain Healthcare’s announcement that it has formed a “comprehensive health platform company focused on elevating value-based care capabilities.” The new organization, named Castell, will be led by Rajesh Shrestha as president and CEO. Shrestha will continue to serve as vice president and chief operating officer of Community Based Care for Intermountain. Other briefs include: Gilead Sciences’ research and development collaboration with Belgian biopharmaceutical company Galapagos NV, valued at more than $5 billion. Genentech’s recent spate of research agreements. John Muir Health is forming “a comprehensive relationship” with Optum. The closing of Michigan’s Together Health Network. Physician participation in CMS’ Advanced Alternative Payment Models doubles in 2018. Care New England withdraws from merger discussions with Lifespan and Brown University. Memorial Hermann names Dr. David Callender as its new president and CEO, effective September 1. About Darwin Research Group Darwin 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 this episode, we’re joined by leaders from two organizations to discuss the benefits and challenges of bundled payments. Jennifer Waterbury is senior bundled payment engineer for AdventHealth, a health care system with facilities in nine states. Mark Hiller is vice president of bundled payment services at Premier, a health care improvement company that unites approximately 4,000 U.S. hospitals and health systems, and 165,000 other providers and organizations.

Value-based care has been a big prerogative of CMS for the last decade, and it's not going away, Brian Kern, a lawyer with Frier Levitt, told Amy Ellis, director of quality and value-based care at Northwest Medical Specialties. The government programs, such as the Bundled Payments for Care Improvement, Medicare Shared Savings Program, and Oncology Care Model, are important because practices learn from them and hopefully take these similar models to private payers, which transform healthcare. Through these value-based care programs, data analytics is crucial to help physicians understand cost, improve outcomes, and increase patient satisfaction.

In this week’s episode, John talks EHRs and physician burnout, prescription drug prices in TV ads, and more. Highlights include: Gundersen Health System and Marshfield Clinic talk merger. Bon Secours Mercy Health signs letter of intent to acquire Dublin, Ireland-based Bon Secours Health System. UnitedHealthcare’s new bundled payment program for maternity care. U.S. District Court judge struck down the 340B rate cut. Washington becomes the second state to announce a subscription-based payment model for HCV drugs. About Darwin Research Group Darwin 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.

Rich Daly interviews Michael Wolford, a senior manager at DHG Healthcare, about the early results of Bundled Payments for Care Improvement Advanced. Also, five reasons why health systems will need advanced cost accounting in a segment sponsored by Strata Decision Technology.

Steve Wiggins has seen a thing or two in his more than three decades as a healthcare entrepreneur. His Oxford Health Plans introduced “pods,” a precursor of the Accountable Care Organization and he led HealthMarket, an early player in the consumer directed health plan space. He’s carried the same themes into his current  role as Read More The post Remedy Partners founder Steve Wiggins explains why he’s high on bundled payments (podcast) appeared first on Health Business Group.

Participants: Mary O'Connor, M.D., & Bill Finerfrock Summary: An orthopedic surgeon's perspective on health disparities. Dr Mary O'Connor believes that new outcomes-based payment models such as bundled payments are exacerbating health disparities by ignoring the huge variance in circumstances for patients, and forcing providers to exclude more complex patients. In the real world, patients are getting very different care because of their race, gender, location and economic means, and some patients are squeezed out of the system completely through a process of "cherry picking and lemon dropping". Health inequities are widening as a result. Is risk-adjustment - incorporating social determinants - part of the solution?

Join us today as we speak with Greg Sawchyn from Ohio Health about the secrets of bundled payments and social determinants of health using personalization.

Prepared for bundled payments? Are cost avoidance strategies, like same-day discharge and care pathway optimization, the keys to success? Dr. Amit Amin says 60-70% of costs are attributable to index hospitalization. So how do we mitigate inpatient costs for cardiovascular healthcare? Dr. Amit Amin is Assistant Professor of Medicine at Washington University School of Medicine and Cardiologist at Barnes-Jewish Hospital in Saint Louis, Missouri. Ginger Biesbrock, PA-C, MPH, MPAS, AACC, is Vice President of MedAxiom Consulting.

Fixing healthcare to transition away from fee for service toward a more value-based model

Hospitals can cut medical bills and raise the quality of care by bundling up multiple services in one bill notes new research by Penn medicine's Amol Navathe. See acast.com/privacy for privacy and opt-out information.

Amol Navathe, Leonard Davis Institute Senior Fellow and Perelman School of medicine Assistant Professor of Health Policy and Medicine at the Perelman School of Medicine, joins host Dan Loney to discuss his new research looking at hospital savings in the first year of hip and knee surgery mandatory bundled payments, explaining how these findings affect health care organizations, clinicians and policy makers on Knowledge@Wharton. See acast.com/privacy for privacy and opt-out information.

Listen NowThe Medicare Shared Savings Program's Accountable Care Organization (ACOs), created by Section 3022 of the 2010 Affordable Care Act constitutes the flagship Medicare pay for performance (P4P) program.  Though there are other P4P (also termed pay for value) models, for example two bundled payment models (Bundled Payments for Care Improvement and Comprehensive Care for Joint Replacement), they are short-lived CMS demonstrations.   If the federal government is to bend the Medicare spending curve or make the program more financially sustainable it will likely be due moreover to the success of ACOs.  Though provider participation in ACOs is substantial, this year there are 561 ACOs providing care to 10.5 million Medicare beneficiaries, the program has to date achieved marginal success.  Over four performance years (2013-2016), ACOs have saved substantially less than one percent of annual Medicare spending (now over $700 billion) - which is why the DHHS Secretary Alex Azar recently admitted candidly ACO performance has been "underwhelming" and "lackluster."  Even before the Medicare ACO program formally began there have been questions and criticism about the model's design.  Perhaps no one has written more about the model's flaws than Kip Sullivan.    During this 32 minute conversation Mr. Sullivan discusses the genesis of ACOs including results from its predecessor, the Physician Group Practice demonstration, assumptions made in the the design of the model, e.g., the relationship between cost and quality and the effectiveness of financially incenting physicians, and moreover the problem of addressing care quantity instead of pricing.  In sum, Mr. Sullivan argues the Medicare ACO model is fatally flawed and will not achieve meaningful success. Mr. Kip Sullivan is currently a member of the board of the Minnesota chapter of Physicians for a National Health Program.  Mr. Sullivan began his career as a staff attorney for the New York Legal Aid Society and as a researcher for Citizens Action League in California.  Form 1980 through 2000 he researched universal health insurance and a single payer system for Minnesota COACT (Citizens Organized Acting Together).   He also served as a consumer representative on the Minnesota Governor's Health Plan Regulatory Reform Commission in the 1980s.  From 2000 to 2007 Mr. Sullivan was a health system analyst for the Minnesota Universal Health Care Coalition.  Mr. Sullivan has written over 150 health policy articles for the American Journal of Public Health, the Journal of Health Politics, Policy and Law, the LA Times, The Nation, The New England Journal of Medicine, The New York Times, and others.  He published 2006 "The Health Care Mess: How We Got Into It and How We'll Get Out of It."  Mr. Sullivan earned his undergraduate degree from Pomona College and his law degree the Harvard School of Law.   Mr. Sullivan's latest essay, "Curb Your Enthusiasm," is at: http://thehealthcareblog.com/blog/2018/04/16/curb-your-enthusiasm/.The Lawton Burns and Mark Pauly essay titled, "Transformation of the Health Care Industry: Curb Your Enthusiasm," in the the recent Milbank Quarterly, that is noted during this discussion is at: https://onlinelibrary.wiley.com/doi/full/10.1111/1468-0009.12312. 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

As patients move out of an acute care setting (e.g., an ICU) into a post-acute setting (skilled nursing facility, rehabilitation facility, or even home), there is a challenging handoff that must occur to ensure their safe transition and ongoing recovery. Caregivers must be able to take all of the patient's information and complex medical situation and build a care plan that will allow them to regain their health and hopefully avoid future problems. This handoff is one of the areas of healthcare that can represent a chokepoint. Clay Richards is CEO of NaviHealth, a Cardinal Health company that helps healthcare organizations create and manage those care transitions. They help “manage patients, improve clinical and financial outcomes, and share risk with payors and providers.” Richards joined us on The Future of Health to explain the problem of care transitions and NaviHealth's solution.

Listen NowCMS has been experimenting with Medicare bundled payment arrangements, where the provider is reimbursed a total fee (either prospectively or reconciled retrospectively), for three decades.  Under ACA authority CMS' Center for Medicare and Medicaid Innovation (CMMI) has launched several five-year bundled payment demonstrations, most notably BPCI that began in 2013.  The BPCI demo allows providers to voluntary accept a bundled payment for any one of 48 Diagnosis Related Groups (DRGs), for example a heart attack, under three care models.  Model Two is the most popular.  It begins with an anchor acute hospital stay followed by 30 to 90 days of post acute care.  The most common Model Two bundle is for hip or knee replacement surgery.  Recently, the Lewin Group completed its third evaluation of the BPCI.  Regardless of the demonstration's performance to date, has it moreover reduced spending and/or improved care quality and outcomes, it is anticipated CMS will renew the BPCI demo in the very near future since the current demo times out this September. During this 25-minute discussion Mr. Clay Richards discusses naviHealth's BPCI's efforts, the company's BPCI financial and quality results to date, Lewin Group's most recent BPCI evaluation and how the demonstration can be improved under a reauthorized BPCI demonstration.  Mr. Clay Richards is CEO of naviHealth, a post-actue care transition company and one of the nation's largest BPCI convenors.  The company, founded in 2012, partners with approximately 50 hospitals in 25 states, collectively they account for over 40,000 BPCI care episodes  annually.  Prior to joining naviHealth, Mr. Richards served as Senior Vice President of Healthways, Inc.  Mr. Richards' community service includes serving on the Martha O'Bryan Center Board, the Oak Hill School Board and on the Vanderbilt Owen Graduate School of Management Board of Visitors.  Mr. Richards was graduated from Washington and Lee University and from the University of Mississippi School of Law.Information on naviHealth is at: https://www.navihealth.com/.Information on the BPCI demo and the Lewin Group's evaluation can be found at: https://innovation.cms.gov/initiatives/bundled-payments/.   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

In this episode, Christine Gordon and Kate Gillespie of Virtua Health System discuss their recent involvement in Medicare’s BPCI program and what future developments may hold. 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, I am joined Read More

 Mike Dendy is Vice Chairman & CEO of Advanced Medical Pricing Solutions (AMPS), an Atlanta, GA-based health care cost management company, serving the self-funded (ERISA) payer community. Since joining the Company in 2005, Mike has overseen all aspects of AMPS management, ranging from sales and marketing, to finance and client relations. AMPS has seen organic growth of over 300% over the last 5 years and has continued to increase its offerings in the health care cost containment space. AMPS clients range in size from those in the Fortune 500 to mid-sized regional employers. Prior to joining AMPS, Mike served as Chairman & CEO of HPS Paradigm Administrators Inc. from 1997 until its subsequent sale in 2004. HPS Paradigm is a health insurance Third-Party Administrator (TPA) serving corporate and government employer groups throughout the United States. During his tenure as CEO, HPS Paradigm experienced strong corporate growth, increasing on average 50% in fee income per year, while achieving industry leading EBITDA margins of over 22%. In 2000, Mike oversaw HPS' business process outsourcing (BPO) relationship with Memorial Hospital of Savannah, Georgia, which at the time was one of Georgia's largest hospital systems. Mike served as Executive Director of Memorial's TPA, HMO, PPO, UR/UM and Case Management services provided for the benefit of Chatham County area employers. From 1992-1997, Mike founded and managed Health Partners Services, Inc. (HPS), a brokerage and consulting firm, which specialized in stop-loss insurance, benefit plan design, provider negotiations, pharmacy benefit management, disease management, predictive analysis, and cost containment. HPS developed community health system plans in a number of southeastern US markets and grew consulting revenues to $600,000 annually. Mike holds 2 master's degrees, from Georgia State University in Business Administration (MBA), and Healthcare Administration (MHA) and bachelor's degrees from the University of Georgia in both Journalism and Psychology. In addition to his graduate and undergraduate achievements, Mike attended executive management programs at Harvard's Business, Public Health, and Law Schools. Mike serves on the Advisory Board for the Robinson College of Business and the School of Healthcare Administration at Georgia State University and is the former Board Chairman for the National Safe Care Campaign. Mike was awarded the School of Health Administration's Healthcare Executive of the Year in 2015. 00:00 Easing into the “inflection point” for employee healthcare. 02:30 The motivations of an HR Manager vs. a CFO. 03:35 Investigating why costs are as high as they are. 03:45 The overall cost of Healthcare equation, and how to reduce those costs. 05:00 “How can an employer make an intelligent decision when they have no idea what they're paying for services?” 06:40 “The only way you can really drive down the cost of healthcare is to find a way to purchase services less expensively.” 08:00 Defined Contributions Healthcare Plans. 11:30 How do you decide what to pay for? 16:00 Bundled Payments vs. Defined Contributions. 19:40 “There is a point when it's fair for both the payer and provider.” 21:30 “Typically, the providers that cost less are better because they've figured out how to provide services more affordably.” 23:20 “Get a grip on where you are now.” 29:30 You can learn more at www.advancedpricing.com

Dr. Hunt graduated from the University of Osteopathic Medicine and Health Sciences, Des Moines, Iowa and completed his residency in Pediatrics. During his military service, Dr. Hunt's held key leadership positions. As Chief Medical Information Officer, he has implemented ‘Epic' and ‘Cerner' EMRs. He is Board Certified in pediatrics and received a Master of Science in Medical Informatics. In April 2013, Dr. Hunt was appointed CPHO (Chief Population Health Officer [CMO/CMIO]) for St. Vincent's Health Partners, Inc., a Physician Hospital Organization with more than 400 providers, and St. Vincent's Medical Center. Dr. Hunt provides physician leadership and direction for the planning, design and implementation of clinical information systems at St. Vincent's Health Partners, Inc. and oversees quality and utilization for its provider network. Under the leadership of Dr. Hunt, St. Vincent's Health Partners, Inc. was the first organization in the country to become accredited and re-accredited by URAC as a Clinically Integrated Network and is leading the charge in changing the face of healthcare in CT. Currently, working with organizational leaders, Dr. Hunt is engaged to develop information system infrastructure to support a super clinically integrated network. As Chief Executive Officer (2016), he is now focused to develop additional opportunities for medical management with employers and payers, enhance network contracting, and continue to support organizational transformation to value reimbursement. Dr. Hunt joined St. Vincent's Health System (SVHS) as CMIO in August 2014. He is working closely with clinical and information technology associates to transition to ongoing operations after the Cerner EMR implementation. Additionally, Dr. Hunt participates with the Valued Care Alliance [VCA] (a newly formed six hospital consortium in Connecticut in which St. Vincent's Medical Center is a founding member) to establish system-wide population management infrastructure. The VCA has been recognized as a leading advanced network by Connecticut and participates with the Community and Clinical Integration Program, and awarded the Accountable Health Communities (AHC) model grant by CMS. 00:00 Revenue from Risk-Sharing vs. FFS. 04:00 Evaluating Reimbursement Models and how Patient Satisfaction plays into this. 06:15 Growing Networks and explaining to Consumers how Payment Models affect them. 06:45 Helping Providers effectively participate in the Bundled Payment Program. 11:35 BPCI: Bundled Payment Care Improvement. 12:00 Disease Categories St. Vincent is working with in Bundled Payments. 12:30 Assuming Pharmacy Risk vs. Medical Risk. 13:00 How St. Vincent selects Health Partners. 16:30 Managing Continuity of Care. 18:00 Identifying Transitions of Care. 21:00 Reducing unnecessary use of the ED. 22:30 Using Urgent Care as an extension of PCPs. 28:30 “Don't view that shared savings as a negative.” 31:40 Making Shared Savings Net-Positive.

Bringing over ten years of experience as an entrepreneur and consultant to CipherHealth, Zach Silverzweig works with hospitals to achieve patient-centered care through the elegant application of innovative and forward-thinking solutions. He leads CipherHealth's product and development teams, managing the solution lifecycle from concept to napkin to prototype to launch to profitability. Zach also plays a key role in managing the company's financial operations and helping to shape CipherHealth's corporate architecture. Prior to CipherHealth, Zach served as founder and CEO of an online fitness planning website. Zach has worked as a consultant at Pace Harmon and Archstone Consulting, where he helped healthcare payors, providers and the Fortune 500, improve operations, increase performance, and reduce costs. 00:00 You can listen to Zach's first episode on the podcast, Episode 41. 01:30 The upcoming products CipherHealth is getting ready to launch. 02:50 “First it's a question of how mature your core product is.” 03:30 “How do we help hospitals engage with patients, and how do we use that engagement to drive outcomes?” 06:00 The ‘Internet of Things.' 06:30 Managing High-Risk Patients. 06:45 Creating Integrated Pathways. 08:30 “How do you put them on a path that's going to get them in a fundamentally different place?” 09:00 Closing Gaps of Care. 12:30 Cyber Security and HIPAA. 15:15 Broadening Cipher's focus from Readmission to Patient Engagement. 19:30 Best practices for Patient Discharges. 21:20 Predictive Analytics. 24:50 The Core Outcomes in the Hospital Space. 26:20 The concept behind Bundled Payments.

Richard Duszak Jr., MD, FACR, professor and vice chair of health policy and practice in the department of radiology and imaging sciences at Emory University School of Medicine, and Danny Hughes, PhD senior director of health policy research at the Neiman Health Policy Institute discuss the bundled payment model, how it fits in the transition from volume-to-value-based care, and how this model could affect how you get paid. 

Sherri Douville brings over a decade in healthcare consulting, sales, marketing, and entrepreneurial experience to her leadership at Medigram.  She now serves as a frequent moderator and panel coach at Health IT conferences.  Prior to this, she founded a healthcare technology consulting practice.  Medigram is a mobile, intelligent enterprise solution for healthcare that enables clinicians to communicate securely and efficiently, with intelligent context and images wherever they are, via the Medigram iOS app, Android app, or web client.  As CEO for Medigram, Sherri has successfully planned and executed on the development, design, and build of the enterprise grade version platform, Medigram 2.0, which is based on an independent, secure and scalable database.  This allows for the Medigram 2.0 platform to flexibly adapt to evolving healthcare business requirements. Sherri has experience in over a dozen disease states from over 9 years in clinical sales at Johnson & Johnson where she participated in the management development program, won a number of awards, and was recognized as an industry leader by Standard & Poor's Vista Research division while it was part of McGraw-Hill. Sherri now serves on the Board for HIMSS Northern California where she is Co-Chair for the Innovation conference, Co-Chair for program panels, and contributes to the newsletter. She is an advisory board member for the National Bundled Payment Collaborative, serves as a member of Santa Clara University's Board of Fellows, and as Co-Chair of the mentoring team at TiE's (The Indus Entrepreneur) youth entrepreneurship program.  She earned her BS degree in Combined Sciences from Santa Clara University and two big data analytics certificates through MIT.  Sherri recharges while exercising, reading, writing, and by spending time with her husband and friends cooking, hiking, and learning together. President & CEO, Medigram, Inc. Email: sherri@medigram.com www.medigram.com www.linked.com/in/sdouville https://medium.com/@SherriDouville https://www.peerlyst.com/users/sherri-douville   @SherriDouville @Medigram 00:00 How we should be thinking about ‘sure' things. 03:00 Managing and Focusing on underlying improvements that will stay the same, no matter what the end goal becomes. 03:45 Where Bundled Payments falls in the certain vs. uncertain future. 06:20 “If you don't have information that's stuck in silos, then there's no possible way you can coordinate care.” 07:50 Possible name changes and delays, but why Bundled Payments will go on in some way, shape, or form. 09:30 Coordinating Care across settings and having Interoperability. 10:00 How Medigram makes all of these worries easier. 10:45 A Medigram use case. 11:45 How Medigram facilitates communication between Care Settings. 15:40 “Just because it works on a computer doesn't mean it's going to work on a mobile app.” 19:30 “It's all about driving context.” 20:00 “The Digital Doctor,” by Robert M. Wachter. 22:50 Where a text in Medigram goes, and where it winds up. 27:00 Sherri gives some advice to potential Health Tech creators. 28:45 “To succeed in the current environment it's important to be really specific.” 29:40 You can find out more information by searching Sherri Douville on LinkedIn and Medium.

Dr. Myron Smith discusses bundled payments and their effects on healthcare delivery and coordination

In this episode, Christine Gordon, Manager of Reimbursement, and Kate Gillespie, AVP of the Orthopedic and Spine service line, of Virtua Health System discuss their experience participating in Medicare’s BPCI program and the factors that were instrumental in their success with bundled payments to date. Learn how to listen to The Hospital Finance Podcast on your mobile device. Michael Read More

Listen NowToday, CMS launched the agency's second bundled payment demonstration, a mandatory five-year initiative in approximately 800 hospitals nation-wide.  It's titled, the Comprehensive Care for Joint Replacement (CJR).  The CJR essentially reimburses hospitals a predetermined amount for a 90-day hip or knee surgical and rehab episode of care.  CMS is emphasizing hip and knee replacement surgeries because they account for the single largest Medicare dollar amount and highest percent of annual 30 day episode spending.  This demonstration follows CMS's voluntary Bundled Payment for Care Improvement (BPCI) demonstration that provides bundled payments for 48 care episodes (including hip and knee replacements) via four care model designs.  How successfully hospitals, orthopedic surgeons and various post acute providers manage these care episodes will be important if CMS is to better control Medicare spending growth.   (Listeners will recall I discussed moreover the theory of bundled payment arrangements with Harold Miller this past September 23rd.)  During this 29 minute conversation Mr. Gera provides and overview of Signature Medical Group and their orthopedic bundled payment work under both CMS's BPCI and CJR demos.  More specifically, he discusses how hip and knee replacement surgical patients are identified, how the bundled payment care team is assembled, how the care episode is manged, how quality is measured, profit sharing conducted and moreover principles his organization has developed to succeed under these capitated payment arrangements.  Mr. Jim Gera is the Senior Vice President of Business Development for Signature Medical Group, Inc., a multi-specialty group of physicians located in St. Louis and rural Missouri.   Among other related activities Mr. Gera co-authored an Advanced Payment Medical Accountable Care Organization application and a successful CMS Strong Start for Mothers and Newborns grant award.   Recently he has also served as a Chair for several CMS innovation grant reviews.  Mr. Gera's previous experience includes working with other physician group practices, in outpatient facilities and in managed care both in Medicare Advantage and Special Needs Plans.  Mr. Gera received his MBA from Southern Illinois University at Edwardsville.For more on CMS's CJR demonstration see:  https://innovation.cms.gov/initiatives/cjrFor more on Signature Medical Group see: http://www.signatremedicalgroup.com/  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

In this episode, Maria Miranda, Director of Reimbursement Services at BESLER Consulting discusses her impressions and findings from a recent meeting focused on bundled payments. She examines clinical vs. financial approaches to the issue and predictions for mandatory Medicare bundled payment programs going forward. Learn how to listen to The Hospital Finance Podcast on your mobile Read More

A serial entrepreneur, Steve Wiggins made his bones in health care two decades ago running Oxford Health Plans, a company he describes as being a mix between Castlight and Oscar. Today, Wiggins is chairman of Remedy Partners, a company that’s offering itself to providers as go-between in managing bundled payments from CMS. “We’re the cheapest way into the pro-gram,” Wiggins tells Breaking Health Host Steve Krupa in this week’s podcast. “It would cost a provider anywhere between 4-5% on these bundles to manage them themselves.” Remedy Partners, which manages $5 billion in payments, is able to do the same job for less. Hear Wiggins’ unique take on how companies like Remedy can help fix health care. Guest Bio: Steve Wiggins has over 30 years of experience launching and managing health care companies and has founded seven health care companies including Oxford Health Plans, which grew into a Fortune 300 company under his leadership. Steve is a Managing Director of Essex Woodlands, one of the oldest and largest health care venture capital and growth equity firms. He was also the Founder, Chairman and CEO of HealthMarket, Inc., an insurance company that gave birth to innovative Consumer Driven Health Plans. He co-founded Health Partners, Inc, a physician practice management company. He was also a co-Founder of Intelliclaim, Inc., which provided claim auditing and productivity software and services to over twenty health insurance companies before it was sold to McKesson, and he was the founding investor in Ben-efitPort, LLC, a consolidation of health insurance general agencies. Steve graduated from Macalester College and has an MBA from Harvard Business School.

Dr. Win Whitcomb shares his entrepreneurial journey running the nation's first 24/7 hospitalist program, starting the Society of Hospital Medicine, and his exciting work in bundled payments at Remedy Partners. The ModernMD: Dr. Win Whitcomb Win Whitcomb, MD, MHM, is Chief Medical Officer of Remedy Partners, where he oversees all aspects of the clinical enterprise, and the intersection between clinical, technology, and business areas. A practicing hospitalist for the past twenty years, Win has led the development of the hospitalist specialty since 1994, when he assumed leadership of the nation's first 24/7 on-site hospitalist program. Dr. Whitcomb is cofounder and past president of the Society of Hospital Medicine. Dr. Whitcomb was one of the first three to receive hospital medicine's most prestigious achievement award, the Master in Hospital Medicine, in April 2010. Success Quote: “Eighty percent of success is showing up.” - Woody Allen White Coat to Business Suit: Dr. Whitcomb trained in internal medicine and lead the nation's first 24/7 hospitalist program at Mercy Hospital in Springfield MA. Dr. Whitcomb shares his journey starting the Society of Hospital Medicine (SHM), pioneering the field of hospitalist medicine, and his transition to full time entrepreneur. Idea to Venture: The Idea: Can bundled payments improve quality care and reduce cost? Bundled payments are an innovative new payment model that includes financial and performance accountability in episodes of care. Listen as Dr. Whitcomb shares his work at Remedy Partners and their big vision to improve the efficiency of healthcare delivery, quality of care, and increase patient satisfaction. Biggest Lesson Learned: Physician leadership is critical for any healthcare organization to successfully to transition into value based payments. Listen as Wins shares his insights for physicians looking to lead the charge! Business Rounds: Best Advice: Fail, Fail fast if you are going to fail, and don't be afraid to fail. Take chances, and get a little crazy! Daily Success Habit: Go off the beaten path and read bodies of knowledge related to medicine. The exciting insights and innovations come from connecting these dots at the major intersections.    Healthcare Trends: Empathy: At the core of the medical profession, physicians must be able to deeply connect, understand, and empathize with their patients.  By enhancing our empathy, we can improve the patient experience. Transitional Care: Patient transitions between care setting and venues with limited access to immediate primary care. New payment models and delivery systems are creating a new business case for a transitional care company to create and specialize in outpatient clinics that leverage technology and new care codes to improve transitions of care. Links: http://www.remedypartners.com/ http://zatohealth.com/ http://www.hospitalmedicine.org/

The system of healthcare delivery in the United States is in the midst of a meaningful transition. Traditional fee for service paradigms are moving towards what has been termed value-based approaches. Doctors Joshua HIrsch, Geraldine Mcginty and Greg Nicola examine recent developments and discuss how specialist can participate and help lead that transition.Listeners to the podcast might enjoy reading the following JNIS articles that are associated with the discussion:The Bundled Payments for Care Improvement Initiative http://goo.gl/ddQU5rThe Burwell roadmap http://goo.gl/33qM3HThe Bundled Payments for Care Improvement Initiative http://goo.gl/5aBQX7