Value Based Health Care

How to Impact 54.7 million Medicare Beneficiaries

The Leading Age Conference recently held in Chicago was focused on Post Acute Care Management interventions. The blend with Better Care, Better Health and Reducing Cost are essential legs to the PAC stool.

Better Care- by improving and maintaining quality and patient outcomes as well as eliminating or avoiding re-admissions is paramount to eliminating potentially preventable conditions. How we can address better health-we need to focus on primary care driven management as well as focus on prevention and wellness.

Reducing cost by eliminating duplication and improving coordination are key drivers by CMS in addressing reimbursement payment models in the ‘ reform environment”. Providers will be reimbursed for value and increasing quality as well as providing cost efficient care. We will be eliminating the silos of care by integrating payment models-

We are moving the payment continuum from FFS-Performance based, FFS-Shared savings-Risk sharing and ultimately the end point of full capitation.

Aligned with the transience of payment models is the Bundled Payment Approach- ( Medicare BPCI Models) As of 1.1.2017 a total of 1361 participants in Model 2 CMS initiatives is encompassing 340 acute care hospitals, 620 SNF’s, 256 physician groups 9 Inpatient Rehab Facilities and 81 home health agencies.

Accountable Care Organizations seem to be poised to ne the “integrators” and are getting better in time, as to achieving savings. In 2014 they saved $ 411 million and in 2015 they achieved savings of more than $ 466 million. Twenty-One  NextGen ACO’s  are being cultivated to graduate from FFS to capitation via multiple payment mechanisms.

The core principle is to create a financial model with long term sustainability. Your community delivery system needs to embrace the new approaches or they will not be sustainable.