Podcasts about shared savings

Navigating Value-Based Pediatric Care: A Deep Dive with Dr. Sian JonesIn this episode, sponsored by Hippo Education and Freed AI Medical Scribes, join the hosts as they sit down with repeat guest Dr. Sian Jones, the president of Complete Child's Health, to discuss the nuances and implications of value-based contracts in pediatric care. They explore the definition of 'value' in healthcare, the challenges of short-term versus long-term savings, and the ethical considerations of preventive care for children. The conversation delves into the healthcare business model, the importance of quality metrics, and innovative approaches to healthcare funding and reimbursement. This comprehensive discussion aims to illuminate how value-based care can significantly impact child health and the pediatric community.00:00 Introduction and Sponsor Message00:40 Welcoming Dr. Sean: Pediatrician's View on Value-Based Contracts01:55 Defining Value in Pediatric Care03:44 Challenges in Measuring Value and Impact06:15 Insurance Companies and Value-Based Payments09:01 Ethical and Economic Questions in Pediatric Care10:55 Shared Savings and Preventive Care19:40 Direct-to-Employer Model and Ethical Considerations37:48 Ethical Dilemmas in Value-Based Care38:37 Challenges in Pediatric Care Quality39:14 Direct-to-Employer Healthcare Models40:06 Membership Models and Consumer Choice41:27 Variations in Pediatric Care42:05 Catastrophic Care and Reinsurance45:03 Medicaid for Children: Pros and Cons48:56 Investing in Preventive Care51:51 Healthcare Spending and Economic Impact54:24 Innovative Programs and Social Determinants of Health01:06:06 Aligning Financial Incentives with Quality Care01:08:58 Conclusion and Final ThoughtsSupport the show

For the two million Americans diagnosed with cancer each year, the emotional toll of absorbing the news is often exacerbated by uncertainty about the variety of treatments, and confusion trying to navigate a fragmented healthcare system. Accompanying patients on that journey and smoothing the way for them is where Thyme Care enters the picture, a company that supports and supplements the care provided by oncology practices at no cost to patients. “We do the types of things that everybody in the oncology space knows should be done, but it's often hard to operationalize them at scale,” says Dr. Brad Diephuis, the company's chief business officer and a cancer survivor himself. Those things include tracking patient reported outcomes and providing proactive symptom monitoring throughout cancer treatment in order to catch problems early and prevent unnecessary interventions and hospitalizations. Data presented at the American Society of Clinical Oncology conference in 2022 indicates Thyme Care is delivering on its value proposition for insurance plans and other payers: reducing costs and increasing patient satisfaction. Join host Michael Carrese in learning why Diephuis thinks its shared savings model is succeeding, how its “care pod” model works, and what the company's plans are for growth.Mentioned in this episode: https://www.thymecare.com/

As the healthcare industry moves towards achieving CMS's goal of having every Medicare beneficiary in an ACO or ACO-like model by 2030, we must focus on patients in institutional settings. For long-term care patients, better care and better health means ensuring patients receive advanced care planning and regular wellness visits. And it also requires providers and facilities to work together in preventing avoidable hospitalizations and unnecessary SNF and hospice utilization. Unfortunately, the needs of geriatric patients in an institutional setting are often overlooked as compared to other populations in the vast environment that falls within the influence of value-based care. LTC ACO -- the first ACO in the country focused specifically on the special needs of Medicare beneficiaries residing in long-term care facilities -- is changing that narrative. The mission of LTC ACO is to dramatically improve the quality and cost of healthcare delivered to these Medicare beneficiaries, rewarding participating providers for achieving these outcomes. Using this approach, it is their vision to revolutionize the way healthcare is provided to Medicare beneficiaries residing in long-term care facilities. Joining us this week in the Race to Value is Jason Feuerman, the President and Chief Executive Officer of LTC ACO. In addition to leading one of the only ACOs that is dedicated exclusively to management of long-term care facility residents, Jason supports managed care and strategic value-based initiatives for Genesis HealthCare, the biggest post-acute care operator in the country. In this episode, you will learn about LTC ACO implemented a program in the traditional Medicare population that mirrors Institutional Special Needs Plans (I-SNPs). He discusses how the ACO engages and incentivizes providers and facilities and has operationalized a data infrastructure to drive care interventions. They have woken up an entire ecosystem with their approach to value-based care and have generated well over $40M in Shared Savings throughout their lifespan. By focusing on improving care outcomes and engaging providers, they have become the industry-leading exemplar for improving patient outcomes in long-term care!   Episode Bookmarks: 01:30 Introduction to Jason Feuerman and LTC ACO, the first ACO focused specifically on the special needs of Medicare Beneficiaries residing in long-term care facilities. 03:00 LTC ACO was launched by Genesis Healthcare, the biggest post-acute care operator in the country, with significant experience in MA risk and bundled payment models. 06:00 Lessons Learned from MA: How Institutional Special Needs Plans (I-SNPs)provided an operational thesis for LTC ACO in the Medicare Shared Savings Program. 07:00 By improving quality and driving down unnecessary costs, LTC ACO returns the Shared Savings earned to LTC facilities and the physicians who support them. 08:00 “Waking up the ecosystem” by providing outcomes data to long-term care providers. 10:00 Achieving capital efficiency in a model where there is no downside risk. 12:00 How capital requirements for delegated Medicare Advantage differ from the MSSP model. 13:00 Less than 15% of residents in long-term care facilities are in a MA plan. (Limited business opportunities in Medicare Advantage) 15:30 Applying the same tenets of I-SNPs to a Medicare ACO (e.g. aligning providers and providing rewards with surpluses) 16:00 “Waking up an Ecosystem”:  Most LTC providers do not know what happens to their patients once they leave the long-term care institutional setting. 17:00 How data can be used to inform long-term care providers how their patients are doing across the continuum. 18:30 The use of AI for population-based predictive analytics to identify potential health risk (see recent Press Release regarding ClosedLoop AI partnership) 19:00 “Long-term care providers gravitate towards population health data and how they can contribute to bending the cost curve....

The accountable care organizations (ACO) model is one of the greatest tools in the value-based care toolbox, with ACOs in the Medicare Shared Savings Program producing savings five years in a row. Sam Starbuck, VP and GM at Privia Quality Network, shares how physician engagement, patient access, and data transparency are all key to savings and quality improvements.

The Institute for Advancing Health Value has recently released two new Intelligence Briefs highlighting two major impactful events in the movement to value-based care. 2021 MSSP Performance Results Analysis:  The Institute analyzes 2021 performance data, sharing high-level program performance and examining savings across participation tracks, by the provider type, size and location of ACOs, and their experience in the program, and reflects on the future of the MSSP in light of the recently proposed changes to the program and the beginning of CMS's new capitated total cost of care model, ACO REACH. The ACO REACH Final Cohort:  The Institute analyzes the incoming final cohort of provisionally-accepted REACH ACOs within the context of the model's history, analyzing the roster relative to GPDC's current participants, and sharing expectations for the future.  (This Intelligence Brief was sponsored by Bamboo Health.) Check out this special bonus episode where Eric and Dan interview Kate de Lisle on her research analysis on these recent CMS announcements.  You may also download these Intelligence Briefs at  https://www.advancinghealthvalue.org/analysis-of-mssp-2021-and-aco-reach-2023/ Episode Bookmarks: 01:30 Download the new Institute intelligence briefs on the 2021 MSSP Performance Results and the ACO REACH Final Cohort 02:30 Background on Kate de Lisle, Senior Manager of Payment & Delivery Transformation at Leavitt Partners 04:00 Recently announced MSSP Results as an important bellwether for the success of the value movement 05:30 Total program savings of nearly $5.4 billion over the model's lifetime 06:30 5th consecutive year of net savings – has the MSSP demonstrated proof of concept? 07:00 Was 2021 a good year for the MSSP since the net savings wasn't quite as large as the year prior? 07:30 The average per beneficiary PMPM savings amount was $164 (double what it was in 2019) 08:00 81% of ACOs generated savings and 58% earned a Shared Savings bonus.  Quality scores were also high. 08:45 89% of ACOs taking downside risk generated savings (compared to 76% that saved in an upside-only track) 09:15 Risk-bearing ACOs generated $5.3M per ACO (compared to $2.9M for non-risk bearing) 09:45 ACOs led by physician groups realized the most savings. 10:00 Hospital-led ACOs realized a decline in savings. 10:30 Years of experience in the MSSP is no longer a straightforward predictive indicator of performance success. 14:00 Last month, CMS released the names of the 110 provisionally-accepted organizations selected to join the ACO REACH model starting in 2023 15:30 Only 47% of REACH applicants were provisionally accepted. 17:30 New cohort had similar profiles of selected groups accepting Global and Professional Risk. 18:00 New entrants are serving vulnerable and high-risk populations. 19:00 Groups moving from Next Gen ACO to ACO REACH 20:30 Far fewer payer-led ACOs in the new REACH cohort 21:30 What considerations did CMS take into account when selecting for participation in the new REACH program? 22:00 Sustained interest in ACO REACH from VBP enablement companies (e.g.Aledade, agilon health) 23:30 Provider-owned enablement companies participating REACH (e.g. Castell Health) 24:30 Upstart primary care companies accepted into ACO REACH (e.g. Oak Street Health, Iora Primary Care, ChenMed, Cano Health, Cityblock, ConcertoCare) 25:00 ChenMed  (a leading full-risk MA primary care practice in the country) is included in the new ACO REACH cohort. 25:30 OneMedical has also been accepted into the program. 26:30 The Institute for Advancing Health Value has a complimentary membership for provider organizations! 27:00 Will CMMI be sunsetting various APMs, including specialty care models like BPCI and CJR programs? 28:30 Kate speaks about the “weak signals” being broadcasted by CMMI around the future of the APM portfolio. 30:00 What impact will ACO REACH have on the CMS 2030 Goal?

MHACO Chief Medical Officer Rob Chamberlin, MD, announces the innovation projects that the ACO is funding this year through a special allocation of shared savings. Also, we meet Heather Ward, MD, BACON's new co-host!

My guest is Dr. Roger Fowler, Vice President, and Chief Medical Director of Quality, Performance and Innovation with CHRISTUS Health in Irving, Texas.As an expert in population health, quality, and healthcare reform, Dr. Fowler offers a rich perspective on the historical events that underpin our current state of U.S. healthcare. His belief is that we must move away from payment systems that reward the quantity of procedures performed, and move toward those programs that reward excellent outcomes for patients and the community.Dr. Fowler describes how quality measures themselves have their origins in the way insurance companies ranked desirable vs. undesirable physicians based on each physician's claims data. It was all about costs. The use of the term Medical Loss Ratio (MLR) is an important reminder of the insurance industry's perspective about medicine vs. the perspective we as physicians have. MLR means that the resources spent on providing medical care for patients is the Loss referred to in this acronym. A family medicine physician for 40 years, Dr. Fowler says when he first heard medical care referred to as a loss it was like fingernails on a blackboard for him.Dr. Fowler has compelling stories of how the healthcare system goes haywire. He talks about the unintended consequences of early “hospitalization insurance” and EMTALA regulations and he laments the various ways unscrupulous characters cash in on patients' vulnerabilities. His expertise and patience almost meet their match with my ignorance about Medicare programs. He labors to help me understand some of the key points of Medicare Advantage, Traditional Medicare, ACOs, Shared Savings programs, and more. After we finished our conversation, I requested a CME certificate.As a patient advocate and expert on population health and quality, he is passionate about getting to a reasonable level of spending on primary care (currently only 5-6% of U.S. healthcare spending is on primary care). He believes doubling the dollars spent on primary care would make significant inroads to address U.S. cost and quality woes.See the newsletter episode #34 for a glossary of some of the terms discussed: https://bit.ly/LTLmoreinfoMeet Roger Fowler, MDDr. Fowler is the Vice President and Chief Medical Director of Quality, Performance and Innovation with CHRISTUS Health, an international not-for-profit health system with hospitals, clinics, physicians and staff in five states and in Latin America.Dr. Fowler envisioned, launched and provided leadership for the department of Population Health for the Trinity Clinic in Tyler, Texas, before that organization merged with CHRISTUS Health. Ultimately, he became the Chief Medical Director of Population Health and Health Plans, and CMO for the CHRISTUS Health Quality Care Alliance (ACO) and CHRISTUS Quality Network (CIN). Most recently Dr. Fowler assumed leadership for the Pharmacy and Quality Improvement departments for the health plan and the Medical Management Department.Dr. Fowler has a broad history of administrative and governance roles, including chairman of the Trinity Clinic board for five years. He began his career as a family medicine physician in a solo practice in 1981 in Kilgore, Texas, providing full spectrum family medicine care. He is a husband, father, grandfather and has been a runner for 43 years.https://www.linkedin.com/in/roger-n-fowler-md-faafp-14513236/RogerNFowler@gmail.comhttps://bit.ly/JAMAarticleEP34https://bit.ly/AAFP_articleEP34SIGN UP FOR OUR NEWSLETTER: https://bit.ly/LicensedToLeadSignup

Stephen Nuckolls grew up listening to his physician father talk about how healthcare could save money for Medicare if it was accountable for outcomes. It was with this intent that he built Coastal Carolina Health Care (CCHC) in 1998, a multi-specialty practice managing 36,000 patients with 60 providers across 16 sites of care in Eastern North Carolina. CCHC serves in both urban and rural communities, with a mission is to promote the health of its patients by providing high quality, compassionate, comprehensive, and personalized health care. It's no surprise that Stephen and his team formed one of the first 27 MSSP ACOs, Coastal Carolina Quality Care. Currently in the 8th year of the Medicare Shared Savings Program (ENHANCED Track), the ACO performs at the highest quality levels nationally and has saved consecutive years. The ACO exemplifies the vision of Stephen's leadership, captured in the ACO's slogan, “Tomorrow's Health Care Delivered Today.” Episode Bookmarks: 05:00 Stephen reflects on the influence of his physician father who championed value-based care early on 05:40 Setting up Coastal Carolina Health Care, PA (CCHC), a multi-specialty group practice, in 1998 to be accountable for cost and quality 06:00 Leveraging ancillary services and electronic health records to prepare for the future state of value-based care 06:45 The passage of the Affordable Care Act in 2010 as an opportunity for Stephen's practice to demonstrate value 07:00 Stephen and his physicians head to Washington, D.C. to collaborate with CMS on the early design of the Medicare Shared Savings Program 07:20 The struggles of balancing FFS and VBC in the early years of Coastal Carolina Quality Care (CCQC) ACO 08:45 “It's not the actual doctor services that are expensive.  The real big costs are in hospitalizations.” 09:00 ACO Care Management dropped Hospital Admissions per 1000 by 22% 11:00 Engaging physicians in the early years of the ACO before Shared Savings performance 12:30 Mandatory transition to downside risk in the “Pathways to Success” MSSP final rule and how ACOs should evaluate potential for future success 13:30 Getting comfortable and fully understanding the ACO benchmarking methodology 13:50 “Ultimately we need to have risk in the game, but we need to recognize that different ACOs are in different periods in their transformation.” 14:00 How CCQC ACO is consistently ranked among the top performers nationally in quality measure performance, clinical outcomes, and Shared Savings returns 16:00 How having one practice in the ACO with one electronic health record supported quality outcomes 17:00 Selecting “true north” standardized quality measures that are managed consistently across the entire payer contract portfolio for all patients 17:20 Implementing a successful point-of-care quality measure reporting dashboard 18:00 Developing an equitable physician compensation/incentive structure as a key to success for driving quality 19:00 ACO concerns related to diminishing returns over time due to sustained performance in comparison to the benchmark 21:00 Advantages in specialist integration within the ACO due to multispecialty practice model 23:00 Capital investments required to build an ACO population health management infrastructure 26:00 Efficiencies gained by being a one-TIN/one practice ACO and how Advanced Payment ACO Model funds were used to build a Chronic Care Management program 27:00 Investments in automated dashboards for quality reporting to identify and manage gaps in care 28:00 Annual Wellness Visits (AWVs) as a source of funds for practice transformation in primary care 29:00 Reinvesting funds back into the ACO versus distribution to physicians 29:30 A recent investment in an “extended care” clinic  (a higher acuity center with ER physicians, hospitalists, and nurses) 31:00 How the extended care clinic resulted in an ER visit per 1000 rate of 25 for self-i...

North Carolina seems like an unlikely laboratory for value-based care. It refused to expand Medicaid coverage under the Affordable Care Act and ranks in the bottom third among states in measures of overall health. North Carolinians are experiencing stagnant or worsening population mortality rates and substantial health disparities, with 15% percent of residents living below the poverty line, and over one million (10% - 9th highest in the US) North Carolinians uninsured. Health care costs are rising, crowding out other state budgetary priorities and limiting wage increases. But the state has embarked on one of the country's most ambitious efforts to transform how health care is defined and paid for. Accountable Care Learning Collaborative co-founder Dr. Mark McClellan, CMS Administrator during the George W. Bush administration, has publicly stated the “No state is moving as far and as fast as North Carolina.” UNC Health is leading that charge. Mark Gwynne, DO, is the President and Executive Medical Director of UNC Health Alliance (statewide CIN) and UNC Senior Alliance (NextGen ACO): his leadership, results, and vision for the future provide Race to Value listeners a rich viewpoint for value. The physician-led CIN unites independent and employed providers in a program that drives collaboration and communication across the health care continuum to improve quality of care, control health care costs, and work in partnership to provide coordinated care  Their recent performance has reduced the cost of care for 140,000 Blue Cross NC members, earned $17.5 million in quality and shared savings payments, and achieved a 100% quality score. The NextGen ACO is one of only a few academic organizations participating in the highest-risk alternative payment model and ranks #1 nationally for quality. Bookmarks: 3:55 The state of Value-Based Care transformation in North Carolina in juxtaposition with the state's health outcome challenges 4:49 “North Carolina: The New Frontier For Health Care Transformation” (Dr. Mark McClellan: “No state is moving as far as fast as North Carolina.”) 7:03 “We've created a pretty good substrate for our payer partners across market segments where we are really starting to see the scale that we need to catalyze this kind of work.” 7:28 The tipping point for value-based care transformation of 35-40% needed to capitalize on investments and leverage the altruism of providers 8:00 The key to value-based success in NC is based on Partnership (e.g. partnering with forward-thinking payers) 8:35 UNC Health Alliance and its recent outstanding performance of $17.5M in shared savings and 100% quality score in the Blue Premier program 11:13 Dr. Gwynne discusses how Blue Cross NC is approaching its collaboration with his CIN and what the national payer community can learn about partnership with providers to transform care delivery 12:01 Transparency in calculating benchmarks and MLR and making quality targets achievable 13:54 Investing in a robust infrastructure around clinical quality improvement and establishing improvement collaboratives among primary care practices 14:23 Pivoting an internal infrastructure to focus on outcomes with appropriate patient outreach, provider education, facilitating improvement efforts in practices, and making EMR adjustments to support the work 16:25 The economic effects of COVID-19 on the PCP community and the Blue Cross NC “Accelerate to Value” stabilization program 21:17 Dr. Gwynne discusses how primary care practices should be looking at capitation in the years to come 23:15 Dr. Gwynne shares his perspective in balancing shared savings distribution to providers with capital re-investment (UNC Health Alliance distributes 80% of Shared Savings to its providers across all contracts) 23:47  Making key investments in data analytics, systems to support health equity, intensive case management services, point-of-care interventions,

Today's episode follows Austin Regional Clinic (ARC), a large multi-specialty medical group that serves over 500,000 patients in Austin, Texas. Founded in 1980 as an HMO, ARC is coming full-circle on their journey in value-based care as they now serve more than half of their population in value-based contracts. Tyler Willson, VP of Population Health and Clinical Quality talks with us about the tipping point for value, ARC's strategy during and post-COVID, as well as partnerships with payers. We also explore Austin's unique market where corporate giants like Apple, Tesla, Amazon, and IBM are turning the area into a hub for innovation, which offers a unique opportunity for ARC. Find out what will happen with Medicare Advantage plans in the market, how analytics and automation are enhancing care, and how an important partner is making it all possible for ARC to be a leader in the race to value.   Bookmarks: 4:01 Reaching the financial tipping point in health value 5:24 Austin Regional Clinic's value-based care journey 8:28 Tyler describes ARC's current population health infrastructure 9:08 The shift of payment environment towards full- and delegated-risk models 10:25 Sourcing capital and investments to build infrastructure 10:45 JV with Agilon Health (a PE-backed company that supports ARC in taking fully delegated, capitated risk in Medicare Advantage) 11:35 Evaluating the landscape to determine strategic planning horizon, scope, and scale for VBC portfolio 12:00 How the increased level of involuntary risk will necessitate strategic investments in enhanced care models 12:35 Lessons from COVID-19 in determining the “true” risk in ARC's revenue portfolio 13:40 Shared Savings are critical lifelines in the COVID era 14:40 Austin, TX as an emerging national innovation hub 16:04 “so much of an organization's capacity for innovation comes from what it believes” 17:00 Competition for workforce talent in Austin 17:30 How to design and implement patient satisfaction surveys to collect meaningful data 18:53 Austin as an “innovate or die” type market 19:35 An outline of poor public health measures in the state of Texas 21:04 ARC's commitment to patient access as a bedrock principle 24:05 ARC's holding true to its value proposition during the pandemic crisis 25:11 Ensuring patient access to telehealth 26:00 Creating a patient-centered care medical home by focusing on patient access 27:10 An overview of ARC's quality measure performance 29:00 ARC's focus on automation, predictive analytics, and extensive outreach to ensure successful closure of care gaps 33:45 The use of ML and NLP in algorithms to drive automation in burden of illness documentation 36:22 Predictive analytics as the “unicorn of our industry” 38:00 Development of a Medicare Advantage strategy in partnership with Agilon 41:30 Incubating the types of infrastructure to test innovation viability for managing full-risk MA 42:31 The importance of an investment partner in ARC's expansion of its full-risk MA portfolio 43:00 Market growth of Medicare Advantage being driven by consumer price sensitivity 45:00 Capturing accurate documentation in the burden of illness to the highest level of specificity 46:30 Advocating for CMS to include audio-only visits as a means to document and revalidate HCC codes 49:30 An overview of ARC's participation in Medicare ACO program with Ascension Seton 50:58 Evaluation of the Direct Contracting ACO model 53:50 Employer-physician collaboration to deliver quality care

MaineHealth Accountable Care Organization (MHACO) serves a uniquely heterogeneous population that is spread across coastal, rural, and urban communities with multiple different cultural components. And they serve the oldest population of all states in the Union! The organization's ED utilization in its early years was historically around 775 visits per thousand – a significantly high number when compared to other ACOs in the country which were well below 700. At the same time, the ACO was about 10% lower than other ACOs in providing primary care services. Find out how MaineHealth was able to implement a Value Oversight Committee, leverage technology, improve processes, and engage their workforce to achieve nearly $20 million dollars in savings in its first year of contracting with CMS in the Medicare Shared Savings Plan.   In this episode we speak with Jennifer Moore, MBA is the president of MHACO, whose membership includes 10 acute care hospitals and over 1,600 private practice and employed physicians, and manages numerous commercial ACO value-based contracts. These ACO contracts cover approximately 230,000 Medicare and commercial lives. Jen has significant expertise in value-based contracting, ambulatory quality measurement and performance, data analytics, and provider relations activities.  Jen is a board member of the National Association of Accountable Care Organizations (NAACOS) and serves as chair of the NAACOS governance committee. Listen to MHACO's BACON podcast: https://mainehealth.org/mainehealth-accountable-care-organization/provider-resources/bacon-podcast Bookmarks: 4:24 Introducing an extreme ED Utilization scenario and how the ACO initiated an historic turnaround! 5:57 Jen discusses how critical the Value Oversight Committee (VOC) is pivotal to the success of the ACO 6:48 Diagnosing a Patient Access issue in the ACO with key metrics (ED visits/K and PCP visits/K) 7:30 “Houston, we have a problem” (the ACO was higher than the market in 16 of 17 contracts!) 8:00 Performing a root cause analysis of high ED utilizers 8:41 Loneliness is a major driver of ED use 9:05 Getting stakeholder buy-in for the ED Problem: showing physicians there was actually a failure in the care model by using data 9:44 Finding actionable data and knowing what steps to take to solve a problem 11:28 The importance of flexibility in ACO operations: solving challenges at the local level in each of MHACO's regions 12:12 Leveraging population health management data, SMEs, and Value Oversight Committee to develop a focused operational tactics 12:30 Selecting tactics for the ED Playbook:  1) Patient Education campaign and 2) Actionable Care Planning 12:50 Implementing the “Where to Go for Care” Patient Education Campaign 14:44 Implementing ED Actionable Care Planning 16:45 Risk Stratification and Predictive Modeling (Johns Hopkins ACG) 19:30 ED Propensity Scoring (Urgent Risk, Impactability, Frequent ED Utilizers, Recent ED Utilizers) 20:00 Capturing Social Determinants of Health Data 21:15 Transitioning from a Centralized to an Embedded Care Management Model 23:50 The “a-ha moment” during the pandemic:  the need for more primary care capitation 24:10 Telehealth deployment during COVID-19 26:50 The importance of Clinical Documentation as a driver of ACO contract performance 28:45 Engaging specialists in clinical documentation 30:35 MHACO's “heat map” report for Top 10 ACO quality measures 33:30 MHACO's practice incentive report for other ACO quality measures 34:00 Payer collaboration 36:00 Joint venture between MaineHealth and Anthem Blue Cross and Blue Shield 36:35 Forming a Provider Advisory Council to make recommendations to payers 39:35 The leadership domains that are most relevant and impactful for ACOs 42:00 Designing a compensation formula for distribution of P4P and Shared Savings to physicians

Anna Rose Welch talks about a new whitepaper that explains why now is the best time for a U.S. biosimilars shared savings model.

Justin Chamblee and Alex Kirkland join Mark Reiboldt to discuss COVID-19 interim rules and waivers that change shared savings and other value-based strategies. Justin and Alex discuss how these changes will affect accountable care organizations (ACOs) and clinically integrated networks (CINs) taking on risk, the opportunity for shared savings, and how capitated models are faring throughout the pandemic.   Contact Information Subscribe to our feed in Apple Podcasts, Google Podcasts, Spotify, or your preferred podcast provider. Like what you hear? Leave a review! Not there? Let us know! We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on topics for future episodes.  Email us: feedback@cokergroup.com Connect with us on LinkedIn: Coker Group Company Page Follow us on Twitter: @cokergroup Follow us on Instagram: @cokergroup Like us on Facebook: @cokerconsulting   Episode Synopsis Many healthcare providers are struggling as expenses skyrocket and elective procedures are deferred or canceled altogether, eliminating major revenue sources. Value-based initiatives are on-hold because most value-based arrangements require a significant financial commitment to start and healthcare providers are less likely to put more money at risk. Providers have shifted their focus to sustaining losses from the outbreak. Justin and Alex explain what is happening in the industry to mitigate total shared losses and reduce the burden on providers. They also discuss their opinions on how COVID-19 will impact value-based strategies.   Extras Blog: Understanding Value-Based Compensation Models Article: Five Questions to Consider when Evaluating Readiness for Value-Based Care Blog: ValuePath™: Supporting Organizations Making the Transition to Value-Based Reimbursement

HSAs are Key to Consumer-Driven Patient-Centric Insurance, Covering the Sickest, Flexible Choices, Shared Savings, Solving the Free-Rider Problem, Cost of Voluntary Uninsureds, Expected Outcomes, Ownership, Portability

On PopHealth Week, Wednesday, April 17th, 2019  entrepreneur, author and innovator Dave Chase weighs in on community health plans and shared savings. "Dave Chase is the creator of the Health Rosetta and cofounder of the Health Rosetta Institute and Health Rosetta Group. He was also CEO/Co-founder of Avado, a digital health company acquired by & integrated into WebMD & Medscape. The Health Rosetta is the blueprint for purchasing healthcare wisely, sourced from real life experience implementing practical, non-partisan solutions. His work applies the Health Rosetta in two areas. The Health Rosetta Institute creates LEED-like certifications for better purchasing healthcare benefits. It's primary current focus is the U.S. employer healthcare market, but the Health Rosetta isn't inherently employer or U.S. specific. The Health Rosetta Group is a holding company and investment group that drives healthcare's transformation. It uses innovative approaches to build and fund the next generation of healthcare tech and services companies." Join us!  

While shared savings could be several years in the future for fledgling accountable care organizations, there are shortcuts for physician practices in ACOs to generate population health revenue immediately, explains Tim Gronniger, senior vice president of development and strategy for Caravan Health. In this HealthSounds episode, Gronniger outlines the rationale for using three Medicare billing codes--the annual wellness visit (AWV), chronic care management and advanced care planning--to create revenue that offsets ACO infrastructure costs.

Health care is on a path to value, regardless of health care reform uncertainties. Thus, critical access hospitals need to understand accountable care, especially if considering joining an ACO. This webinar will present a new Excel-based tool developed by the Rural Health Value team and Premier, Inc. The Critical Access Hospital Pro Forma for Shared Savings assesses the financial implications of joining a Medicare Shared Savings Plan Accountable Care Organization (ACO). The publicly available, free tool highlights five-year revenue and expense forecasts financial projections that compare current state to Medicare ACO participation and an easy to understand table and chart summary outputs, including hospital and physician financial projections. Download podcast slide decks from the SRHT website. Speakers: Clint MacKinney, MD, MS, Clinical Associate Professor in the Department of Health Management and Policy at the College of Public Health, University of Iowa and Deputy Director of the Rural Policy Research Institute (RUPRI) Center for Rural Health Policy and Analysis Jane Jerzak, CPA, RN, Partner, Wipfli LLP This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $957,510 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

Should You Have a Shared Savings Account With Your Spouse? By Douglas Goldstein, CFP® What's the best way to invest with your spouse? Should you have a shared savings account or separate accounts? Whenever I help a couple set up U.S.-based brokerage and investment accounts, I ask whether they want a “joint” account, or whether they want to keep their money separate. Shouldn't couples always invest together? In an ideal world, spouses would combine both their personal and their financial affairs. But given the complexities of today's family structure, one account type doesn't meet everyone's needs. Some couples enter matrimony on equal financial footing, while others have children from previous marriages, and debts from the past. Before deciding on the structure of the account, therefore, consider each party's assets, obligations, and needs. Money should not become a power tool in a marriage. Benefits of a joint account A joint account often makes sense as either owner can give trade orders in a joint brokerage account and write checks to withdraw money. On the other hand, bank-to-bank wire transfers require both signatories on the account to sign. In the event that one party dies, there is paperwork that the surviving spouse must sign before accessing the money. Depending on how quickly the forms are filed, and how fast a proper “release” comes, it could take quite some time before the money becomes available. A good trick, therefore, is to make sure that each spouse has access to enough funds to pay the bills for several months in the event that the joint account gets frozen. Should second marriages set up a joint account? Consider important factors like prenuptial agreements and the need for financial independence (which doesn't mean financial secrets) when deciding whether to combine funds in a second marriage. Many times, spouses agree to each keep a separate account for personal investing but also a shared account for household expenses. If you're in this situation, listen to a financial podcast on the topic of shared savings accounts: www.GoldsteinOnGelt.com/2-Marriage. Douglas Goldstein, CFP®, is the director of Profile Investment Services, Ltd. www.profile-financial.com. He is a licensed financial professional both in the U.S. and Israel. Call (02) 624-2788 for a consultation about handling your U.S. investments from Israel. Securities offered through Portfolio Resources Group, Inc., Member FINRA, SIPC, MSRB, FSI. The opinions expressed are those of the author and not those of Portfolio Resources Group, Inc. or its affiliates.

Physician-hospital organizations have been around before, but it's the emphasis on quality that sets today's PHO apart from the 80's version. In PHO 2.0, where healthcare value is favored over volume, clinical integration of participating physicians is a prerequisite, agree Greg Mertz, director of Healthcare Strategy Group, and Travis Ansel, its manager of strategic services. In this interview, they talk about the essential first steps of PHO creation and the perennial challenges of physician engagement and clinical leadership in this emerging collaborative model. Greg Mertz and Travis Ansel explored the key contractual elements to consider when creating a PHO during a January 23, 2013 webinar, "Physician Hospital Organizations: Developing a Collaborative Structure for Shared Savings Agreements," a 45-minute program sponsored by The Healthcare Intelligence Network.

George Van Antwerp General Manager, Pharmacy Solutions Silverlink Communicationse: gvanantwerp@silverlink.comm: 314-517-8915Blog: www.georgevanantwerp.com Interview with Industry Expert & Avid Blogger George Van Antwerp - Silverlink •A more outspoken push for pharmacist involvement in ACOs.“I really think that CMS was remiss in not explicitly including the drug benefit in the Shared Savings model. Because the industry recognizes that it's important, what we are seeing is that the people who are planning on participating in the ACOs are already reaching out to the PBMs to lean on them to develop programs. So by default, we will end up being participants in it indirectly versus directly…. It's the most frequently used benefit. It's hard to imagine that you'll be able to have a successful ACO model without considering the effects of somebody involved in health outcomes.”  Brit Pim, VP and general manager of the Medicare/Medicaid division of Express Scripts, Inc. (from Drug Benefit News) •MTM moving from a required program in Medicare to an optional program for commercial populations. The Academy of Managed Care Pharmacy (AMCP) recently conducted a survey of its members to get an update on current MTM programs being offered by payers. Out of 57 respondents — which included 43 health plans, six PBMs, five integrated delivery systems and three other organizations — only six reported using MTM programs for their commercial populations alone. Another 17 said they use MTM programs for both Medicare and commercial populations. (from Drug Benefit News) •Continued focus on pharmacists and distribution of vaccines. Immunizations are crucial to protecting patients from developing and dying from vaccine-preventable diseases, and in order to be successful, a team effort is required for all health care professionals to increase immunizations.29 Pharmacists are in a pivotal position to increase awareness about the importance of vaccinations and identify those patients who may benefit from specific vaccinations. By continually increasing awareness about the availability and importance of vaccinations, patients can make informed decisions to protect themselves and their family members. (Pharmacy Times article) •The correlation between adherence and medical cost savings and ongoing focus on adherence as a critical issue. (see also post on 15 Things You Should Know About Medication Non-Adherence)Up to 50 percent of chronically ill people stop taking their medication within the first year. Pharmacists understand many of the contributing factors, which range from cost and side effects to the inherent challenges of taking multiple medications and can help address them. In fact, CVS Caremark research shows a pharmacist in a face-to-face setting is the most effective healthcare professional at encouraging patients to take medications as prescribed. (CVS Caremark press release) •The increasingly public (or legislative) debates about the value of pharmacy and how and where to capture value.•See NCPA•See PCMA•See Express Scripts / Walgreens current dispute http://georgevanantwerp.com/2011/07/18/5-indicators-of-pharmacies-crossing-the-chasm/ See omnystudio.com/listener for privacy information.

George Van AntwerpGeneral Manager, Pharmacy SolutionsSilverlink Communicationse: gvanantwerp@silverlink.comm: 314-517-8915Blog: www.georgevanantwerp.com Interview with Industry Expert & Avid Blogger George Van Antwerp - Silverlink •A more outspoken push for pharmacist involvement in ACOs.“I really think that CMS was remiss in not explicitly including the drug benefit in the Shared Savings model. Because the industry recognizes that it’s important, what we are seeing is that the people who are planning on participating in the ACOs are already reaching out to the PBMs to lean on them to develop programs. So by default, we will end up being participants in it indirectly versus directly…. It’s the most frequently used benefit. It’s hard to imagine that you’ll be able to have a successful ACO model without considering the effects of somebody i

The patient-centered medical home is at the heart of Mesa County, Colorado's shared savings model, explains David West, M.D., a hospitalist, family physician and healthcare consultant from Grand Junction, Colorado. Dr. West describes how the shared savings model can be adapted across markets, including the conditions and factors that must be present for this approach to be feasible. He also shares a unique provider incentive that is keeping hospital stays of Medicare patients at less than one-third the national average, one of the factors that has the nation touting this area as a model for efficient healthcare delivery. Dr. West examined how to structure a shared savings agreement during "Shared Savings in the Medical Home," a 45-minute webinar on March 31, 2010.