health care homes and payment reform ross owen, m.p.a. bhcag workshop 6/21/12
TRANSCRIPT
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Health Care Homes and Payment Reform
Ross Owen, M.P.A.BHCAG Workshop6/21/12
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Multi-Payer Investment in Primary Care Transformation
SOURCE: Adapted from MDH Health Economics Program, Medicare enrollment data and SEGIP
enrollment data
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Payment Approaches to Support the HCH
Fee-for-Service
Fee-for-Service + Budget-
Neutral HCH Payment Shared
SavingsShared Savings
and Shared Losses
Global Payment
Reimbursement Models
Provider Economic Incentives
Deliver More Care
Reduce Costs, Improve Quality Outcomes and
Experience
“Accountable Care/Total Cost of Care”
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HCH Payment Within Accountable CarePublic purchaser ACO models embed
HCH payment within calculated costs◦Medicare Shared Savings Program◦Pioneer ACO◦MN Medicaid Health Care Delivery
Systems DemonstrationCore HCH elements considered
foundational to ACO definitions◦NCQA ACO accreditation criteria◦Primary care as the locus of patient
attribution
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Primary Care is the Foundation of Accountable Care
Miller, Harold. Center for Healthcare Quality and Payment Reform:http://www.chqpr.org/downloads/HowtoCreateAccountableCareOrganizations.pdf
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Value to PurchasersPublic budgets assume neutrality for direct
HCH payments: “no new money” A ready-made “blue ribbon” designating
advanced primary care models in your backyard◦ Selective Contracting
◦ Tiered Networks
◦ Direct Financial Support for non-Visit Based Care
Evidence that care coordination is most effective the closer it is to the setting of care
More work to do to demonstrate both short- and long-term return on investment (ROI) for commercially-insured
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Changing Role of PurchasersIncreasingly active role in
designing and influencing provider reimbursement models
Comparing value of available coordination/support services
Aligning incentives for patients and providers with the desired outcomes (e.g. deductibles)
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QUESTIONS?