Tag Archives: CMS

Alternative Payment Models: Yeah or Nay?

So where do we go with our healthcare system under the new administration? Will we move to Alternative Payment bundled-paymentsModels or will FFS continue? A recent study showed that bundled payments for orthopedic joint replacement appeared to be working at lowering costs while maintaining quality.

At the same time, it seems that Dr. Tom Price, the nominee for Secretary of HHS is not a fan of bundled payment.

Along with Gregg Masters and Doug Goldstein, we’ll be exploring some of these and many other issues about the next phase of healthcare reform during the coming months on PopHealth Week.

Let us know what you think.

 

PopHealthWeek-logo-200

PopHealth Week is a Production of Health Innovation Media and Accountable Health, LLC.

 

AccountableHealth_Logo_ICON-registered-new

Advertisements

Leave a comment

Filed under Health Innovation Media, Healthcare Costs, PopHealth Week

Arien Malec of Relay Health/McKesson at HiMSS 16 Discusses Interoperability and More

One issue of key importance discussed over and over at HiMSS was Interoperability. Arien Malec,  VP, Data Platform and Acquisition Tools at RelayHealth / McKesson joined me at HiMSS 16 to discuss RelayHealth and his work in this area. Arien is involved at a national policy level as a Co-Chair of the Health IT Standards Committee  and a member of the Interoperability Standards Advisory Task Force.  In this interview for Health Innovation Media Arien touches on a number of important topics including interoperability, HL7 FHIR, patient access to their medical records and McKesson’s recent participation in the White House Precision Medicine Initiative.

 

 

You can follow on twitter @RelayHealth @McKesson_HIT @McKesson

 

Leave a comment

Filed under Health Innovation Media

PopHealth Week June 3 – Sun Health Care Transitions Program

PopHealthWeek-logo-200

 

Listen to a recording of the show with Jennifer Drago here:

PopHealthWeek-logo-TWTTR-sq

Jennifer-Drago-Feb-2013_web-e138720682995811

PopHealth Week airing Wednesday June 3 at 12 pm eastern will feature Jennifer Drago, EVP of Population Health at Sun Health. This week’s show will focus on some of the innovative programs  that Sun Health offers in the seniors market including their Care Transitions  Program which has a CMS Community-based Care Transitions Program       (CCTP) contract. CMS just renewed the Sun Health CCTP contract and  increased the number of patients to be managed.

The CCTP  “tests models for improving care transitions from the hospital to other settings and reducing readmissions for high-risk Medicare beneficiaries.” There are currently 72 sites participating in the CCTP pilot.

Per CMS:

  • Approximately 2.6 million seniors, or 1 in 5 are readmitted within 30 days
  • The cost of these readmissions is over $26 billion per year
  • The goal is to reduce readmission 20% per year
  • The program is to run for 5 years
  • The budget was estimated at $300 million over 5 years
  • To date 29 of the total 101 CCTP-funded sites have withdrawn or been ended

The CMS First Annual Report stated that of the 48 programs started in 2012 only four programs made statistically significant gains in reducing the ratio of readmissions to discharges from the participating hospitals.

But there is more to this story.

As with other CMS programs there are some concerns regarding the study methodology. The argument against the current methodology, which measures readmissions within 30 days as a percent of discharges may penalize hospitals, or communities that have worked to reduce hospital discharges in total. Because of the reduction in discharges, these initiatives may not show a reduction in 30 day readmits as a percent of discharges but would better reflect this changes by looking at a population based measure of readmissions.

http://www.medicaringcommunities.org/medicaring-blog-cms-cctp-metrics-have-seious-flaws/

http://medicaring.org/2014/12/16/protecting-hospitals/

http://www.n4a.org/blog_home.asp?display=16

Join us at PopHealth Week this Wednesday at 12:30 eastern as we discuss Sun Health and their innovative approach to Senior Health, Care Transitions and the CCTP program. Remember you can always listen download the show later if you can’t make the live broadcast.

Leave a comment

Filed under PopHealth Week

Medicaid – a Community Based Approach to Fixing the Issue

Medicaid, a program for low-income Americans, is one of the largest health programs in the country and is  jointly administered by the Federal Government and the States.  With passage of the Affordable Care Act, Medicaid in many states will be adding millions of new beneficiaries to a program that is typically the first or second largest line item in the State’s budget.

It’s well-known that Medicaid has always struggled with poor payment and provider networks, managed care plans that sometimes work, and  ever-increasing  expenditures.  A recent study released by Gallup points to another problem known for years by those involved with Medicaid but which the current Medicaid system has little or no ability to address; the ever-increasing rate of preventable chronic diseases.

The Gallup Wellbeing Survey documents  the issue clearly if you look at the data for Diabetes, Obesity, High Blood Pressure or High Cholesterol. The reported rates of  these conditions are higher than just about any other group surveyed and the rate of Obesity is the highest of any group.   Medicaid beneficiaries  also report very high rates of smoking, exercise less often and are less likely to eat fruits and vegetables. As the article points out, there is a link between poor health and poverty. We have heard of the issues of “food deserts” and  getting exercise or feeling safe doing outdoor activities is not always possible in certain neighborhoods. Furthermore, access to physicians and other health services are a problem that has been well documented in many Medicaid programs.

To begin to solve this issue we must make a concerted effort to integrate Prevention into the Medicaid programs and expand our thinking about what it takes to “create health” versus what we do to “treat illness.” Medicaid today is structured to treat illness; you get sick, you go the doctor, you get treated, the doctor gets paid, and as is often the case in Medicaid, this does not occur well at any point in the process for a myriad of reasons.    But more importantly why should we be accepting of a higher rate of preventable chronic diseases, the costs of which will continue to grow and impact state budgets, while we narrowly focus on improving Medicaid’s “care system?”

The time is now, before we add millions of new beneficiaries, to revamp Medicaid to create a  comprehensive program targeting the lifestyle issues that create these higher rates of preventable chronic diseases while continuing efforts to improve the sick care system.  The way to do this is not to start by adding more funding to Medicaid but to lead by having Medicaid convene a community in which it operates, invite the beneficiaries, not for profit organizations, schools, religious institutions, providers,  government agencies and employers and develop a broad-based plan to address the issues impacting these lifestyle related diseases.

There are a myriad of disparate resources available throughout these communities that if harnessed, focused and integrated could create the synergies needed to improve upon the communities health and reverse these trends. These groups need to be brought together,  held accountable for their results and incentivized by offering a percentage of the savings. This type of Accountable Health system would create a healthier community.

To learn more or set up this process in your state or local community, contact me.

1 Comment

Filed under Uncategorized