/ en Fri, 25 Apr 2025 21:07:44 -0500 Tue, 29 Oct 24 15:17:14 -0500 /2024-10-30/aligning-payers-and-partners-value-based-care <div> </div>header.jumbotron {display:none} <div> /* center_body */ .center_body { /*margin-top:50px;*/ /* margin-bottom: 50px;*/ } .center_body h3 {} .center_body p { font-size: 16px } p.center_Intro { color: #002855; line-height: 1.2em; font-size: 30px; margin: 10px 0 25px 0; font-weight: 700; font-size: 2em; } @media (max-width:768px) { p.center_Intro { line-height: 1.2em; font-size: 23px; font-size: 1.45em; } } .center_body .center_Lead { color: #63666A; font-weight: 300; line-height: 1.4; font-size: 21px; } /* center_body // */ /* Banner_Title_Overlay_Bar */ .Banner_Title_Overlay_Bar { position: relative; display: block; overflow: hidden; max-width: 1170px; margin: 0px auto 25px auto; } .Banner_Title_Overlay_Bar h1 { position: absolute; bottom: 40px; color: #003087; background-color: rgba(255, 255, 255, .8); width: 100%; padding: 20px 40px; font-size: 3em; box-shadow: 0 3px 8px -5px rgba(0, 0, 0, .6); } @media (max-width:991px) { .Banner_Title_Overlay_Bar h1 { bottom: 0px; margin: 0px; font-size: 2.5em; } } @media (max-width:767px) { .Banner_Title_Overlay_Bar h1 { font-size: 2em; text-align: center; text-indent: 0px; padding: 10px 20px; } } @media (max-width:530px) { .Banner_Title_Overlay_Bar h1 { position: relative; background-color: #63666A22; } } /* Banner_Title_Overlay_Bar // */ <header class="Banner_Title_Overlay_Bar"><img src="/sites/default/files/2024-10/KnowEx_CorroHealthh_Medicaid_banner_1170x250.png" alt="Banner Image" width="1170" height="250"><div><h1>Aligning Payers and Partners for Value-based Care</h1></div></header>/* CntMenuSub */ .CntMenuSub{ margin:20px 0px; padding-bottom: 5px; color: #afb1b1; letter-spacing: 1.5px; font-weight: 400; font-size: .7em; } .CntMenuSub .CntMenuBar{ border-bottom: 1px solid lightblue; } .CntMenuSub .CntMenuBar a:after{ content: "|"; padding: 0 3px 0 6px; color: #555; } .CntMenuSub .CntMenuBar a:last-child:after{ content: ""; } .CntMenuSub .CntMenuSubHome, .CntMenuSub .CntMenuSubParent{ text-transform: uppercase; color: #555; opacity: .9; } .CntMenuSub .CntMenuSubParent{ } .CntMenuSub .CntMenuSubChild{ } .CntMenuSub .CntMenuSubCurrent{ opacity: .7; } .CntMenuSub .CntMenuSubHome:hover, .CntMenuSub .CntMenuSubParent:hover{ text-transform: uppercase; color: #d50032; } /* CntMenuSub // */ <div class="container CntMenuSub"><div class="col-md-1"> </div><div class="col-md-10 row CntMenuBar"><a class="CntMenuSubHome" href="/education-events/aha-virtual-executive-dialogues">AHA Knowledge Exchange</a> <span class="CntMenuSubChild" id="CntMenuSubChild">Aligning Payers and Partners for Value-based Care</span></div><div class="col-md-1"> </div></div><div class="row spacer"><div class="col-sm-3"><div><a href="#DownloadFile" target="_blank"><img src="/sites/default/files/2024-10/KnowEx_CorroHealthh_Medicaid_cover_910x1220.jpg" alt="AHA Knowledge Exchange | Aligning Payers and Partners for Value-based Care" width="100%" height="100%"></a></div></div><div class="col-sm-9 center_body">.sponsortype { color: #9d2235; font-size: 1.5em; margin: 0px; font-weight: 700; } <p class="sponsortype">AHA Knowledge Exchange</p> xxxxxx </p> --> Intro.............. </p> --><h2>Hospitals and payers are compelled to align goals and expectations across the care continuum</h2><p>As the health care field adopts value-based care models, hospitals, providers and payers are compelled to align goals and expectations across the care continuum to increase access to evidence-based, preventive and equitable care. Regulatory and market changes are impacting organizations’ value-based care strategies, calling attention to both challenges and opportunities. Data and analytics measure how initiatives influence consumer experience, patient satisfaction, quality and cost of care. This Knowledge Exchange e-book provides insights on how hospital and health system leaders are investing and partnering in this evolving landscape to create sustainable value for their communities.</p><div class="row">@media (min-width:768px){ .EDsponsorFloat{ float:right; } } @media (max-width:767px){ .EDLinkFloat{ position:relative; left:27%; } .EDsponsorFloat { text-align:center } } <div class="col-sm-6"><a class="btn btn-wide btn-primary EDLinkFloat" href="#DownloadFile" title="AHA Knowledge Exchange | Aligning Payers and Partners for Value-based Care" data-view-context="top-level-view">Download the Report</a></div><div class="col-sm-6"><div class="EDsponsorFloat">Sponsored by: <a href="https://corrohealth.com/" target="_blank" rel="noopener nofollow"><img src="/sites/default/files/2024-07/CorroHealth_logo_transparent_834x313.png" alt="CorroHealth Logo" width="100%" height="100%"></a></div></div></div></div></div>.sp_CTA5_holder { margin-top:0px; border-bottom: solid 1px #555; 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font-size: 28px; } .sp_CTA5_section{ margin-top: 25px } .sp_CTA5_ImgShadow { /*background-color:green;*/ /* just a visual */ text-align: center } .sp_CTA5_ImgShadow { padding-bottom:75px; /* must match the padding on the img*/ margin: 0px; } .sp_CTA5_ImgShadow img{ width: calc(100% - 35px - 15px); -webkit-box-shadow: 50px -75px 0px 0px rgba(185, 217, 235, 1); -moz-box-shadow: 50px -75px 0px 0px rgba(185, 217, 235, 1); box-shadow: 50px -75px 0px 0px rgba(185, 217, 235, 1); position: relative; top: 75px; max-width: 490px; } @media (max-width:990px){ .sp_CTA5_ImgShadow img{ max-width: 350px;} } @media (max-width:990px){ .sp_CTA5_ImgShadow { padding-bottom:75px; /* must match the padding on the img*/ margin: 0px; margin-right: 40px } } <div class="row spacer sp_CTA5_holder sp_CTA5_holder_last"><div class="col-md-12"><h3>8 steps hospital and health system leaders are taking toward value-based care</h3><div class="sp_CTA5_section"><ul><li>Determine areas that could benefit from value-based models such as those with lower outcomes, higher costs, and unwarranted variation in process or supplies.</li><li>Align on outcomes measures and benchmarks and carefully formulate and define accountability across systems and partners in value-based contracting.</li><li>Build sufficient volume to support the necessary data analytics, organizational structure and case management function.</li><li>Change workforce culture to support wellness and support care delivered effectively and efficiently outside the hospital.</li><li>Identify clinical champions and incentivize physicians and other providers to improve outcomes and standardize clinical care.</li><li>Engage patients in supporting their own health; work with other community leaders to support a healthier population.</li><li>Strive to better meet the expectations of your patients and the entire community, learning from data and conversations how your hospital is viewed now, and what they wish could be better.</li><li>Identify and use robust analytic strategies and risk-based stratification to understand the critical opportunities to improve community health.</li></ul></div></div></div><h2>Participants</h2>/* people */ .people { margin-top: 50px; } .people img:nth-child(1) { border-radius: 200px; -moz-border-radius: 200px; -webkit-border-radius: 200px; margin-bottom: 10px; max-width:200px; /* for Transformation Talks */ display:block; /* for Transformation Talks */ margin:auto; /* for Transformation Talks */ } .people img:nth-child(1):hover { opacity: .7 } @media (max-width:991px) { .people { margin: auto; } .people p { text-align: center } } .ci_profile { margin-bottom: 30px; display: block; text-align:center /* this is for the "Executive Dialogue" page */ } @media (max-width:991px) { .ci_profile { text-align: center } } .ci_profile p { margin: 0 0 7px 0 } .ci_profile_name { font-weight: 700; font-size: 20px; } p.ci_profile_name { font-size: 1.5em; line-height:1.2em; margin-top:10px } .ci_profile_title { 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.rowEqual_768 { display: -webkit-box; display: -webkit-flex; display: -ms-flexbox; display: flex; flex-wrap: wrap; } .people .rowEqual_768>[class*='col-'] { -ms-flex: 1; /* IE 10 */ flex: auto; width: calc((100% / 2) - 2px) /*Adjust % for the number per row, will override the bootstrap - Also needed for Safari*/; } } p.ci_profile_name { font-size: 1.5em; line-height:1.2em; margin-top:10px } .people .ci_profile_combined{ font-size:14px; line-height: 18px; } .people .ci_profile_combined span{ font-style: italic; } .people .ci_profile_combined:before{ content:""; border-bottom: solid 1px #55555522; display: block; clear: both; width: 85%; margin: 5PX auto 10px; } <div class="people"><div class="row rowEqual_768"><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Blaber_Reginald_300x300.png" alt="Reg Blaber" width="300" height="300"><p class="ci_profile_name">Reg Blaber, M.D., MBA</p><p class="ci_profile_title">Executive Vice President and Chief Clinical Officer</p><p class="ci_profile_company">Virtua Health</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Burwell_David_300x300.png" alt="David Burwell" width="300" height="300"><p class="ci_profile_name">David Burwell, M.D., MBA</p><p class="ci_profile_title">Vice President of Medical Affairs and Chief Quality Officer</p><p class="ci_profile_company">UPMC</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Casey_Susan_300x300.png" alt="Susan Bleasdale Casey" width="300" height="300"><p class="ci_profile_name">Susan Bleasdale Casey, M.D., FACP, FIDSA</p><p class="ci_profile_title">Vice President and Chief of Quality and Safety</p><p class="ci_profile_company">University of Maryland Medical Center</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Chessare_John_300x300.png" alt="John Chessare" width="300" height="300"><p class="ci_profile_name">John Chessare, M.D., MPH</p><p class="ci_profile_title">President and CEO</p><p class="ci_profile_company">GBMC HealthCare</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Chung_Jimmy_300x300_0.png" alt="Jimmy Chung" width="300" height="300"><p class="ci_profile_name">Jimmy Chung, M.D., MBA, FACS, CPE</p><p class="ci_profile_title">Chief Medical Officer</p><p class="ci_profile_company">Advantus Health Partners<br>Bon Secours Mercy Health</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Fattig_Marty_300x300.png" alt="Marty Fattig" width="300" height="300"><p class="ci_profile_name">Marty Fattig</p><p class="ci_profile_title">CEO</p><p class="ci_profile_company">Nemaha County Hospital</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Hino_Raymond_300x300.png" alt="Raymond Hino" width="300" height="300"><p class="ci_profile_name">Raymond Hino</p><p class="ci_profile_title">CEO</p><p class="ci_profile_company">Southern Coos Hospital & Health Center</p></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Kao_Cheng_300x300_0.png" alt="Melinda Muller" width="300" height="300"><p class="ci_profile_name">Cheng-Kai Kao, M.D.</p><p class="ci_profile_title">Chief Medical Information Officer</p><p class="ci_profile_company">UChicago Medicine</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Ketelsen_Carey_300x300_1.png" alt="Carey Ketelsen" width="300" height="300"><p class="ci_profile_name">Carey Ketelsen, RHIA, CRC</p><p class="ci_profile_title">Senior Vice President, Coding Solutions</p><p class="ci_profile_company">CorroHealth</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Koekkoek_Doug_300x300%20%281%29.png" alt="Doug Koekkoek" width="300" height="300"><p class="ci_profile_name">Doug Koekkoek, M.D., FACP, SFHM</p><p class="ci_profile_title">Chief Physician and Clinical Executive</p><p class="ci_profile_company">PeaceHealth</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Merz_Steve_300x300.png" alt="Stephen Merz" width="300" height="300"><p class="ci_profile_name">Stephen Merz, FACHE</p><p class="ci_profile_title">Chief Operating Officer</p><p class="ci_profile_company">Sheppard Pratt Solutions</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Morrissey_Jerilyn_300x300.png" alt="Jerilyn Morrissey" width="300" height="300"><p class="ci_profile_name">Jerilyn Morrissey, M.D.</p><p class="ci_profile_title">Chief Medical Officer</p><p class="ci_profile_company">CorroHealth</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Muna_Esther_300x300.png" alt="Esther Muña" width="300" height="300"><p class="ci_profile_name">Esther Muña, Ph.D., MHA, FACHE</p><p class="ci_profile_title">CEO</p><p class="ci_profile_company">Commonwealth Healthcare Corp.</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Nester_Brian_300x300.png" alt="Brian Nester" width="300" height="300"><p class="ci_profile_name">Brian Nester, D.O., MBA</p><p class="ci_profile_title">President and CEO</p><p class="ci_profile_company">Lehigh Valley Health Network</p><div class="ci_profile_social"> </div></div><div class="col-md-4 col-sm-6 ci_profile"><img src="/sites/default/files/2024-10/Ogden_Lesley_300x300.png" alt="Lesley Ogden" width="300" height="300"><p class="ci_profile_name">Lesley Ogden, M.D., MBA</p><p class="ci_profile_title">CEO</p><p class="ci_profile_company">Samaritan North Lincoln and Pacific Communities Hospitals</p><div 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.article.views-row { display: inline-block; transition: 1s; } .feedEmbedImg .views-element-container img { float: left; margin-right: 15px; max-width: 200px; transition: 2s; } .feedEmbedImg .resource-block .resource-view .views-row:hover { transform: scale(1.02); } .feedEmbedImg .resource-block .resource-view .views-row:hover img { opacity: .6; transition: 1.5s; } .feedEmbedImg .resource-block .resource-view .views-row:hover a { color: #307fe2; } .feedEmbedImg .feedEmbedImg .views-element-container .more-link { font-size: 1.3em; text-align: right; } .feedEmbedImg .more-link { text-align: right } @media (max-width:550px) { .feedEmbedImg .views-element-container img { float: unset; display: block; margin: 0 auto; max-width: 100% } .feedEmbedImg .views-field.views-field-created { clear: both; margin-top: 10px; } }  <div class="views-element-container"> <section class="top-level-view js-view-dom-id-5fa82d456b183428572c77475146c82499b4db757e2780e3b3a8e487fcc8237d resource-block"> <div class="resource-wrapper"> <div class="resource-view"> <div class="article views-row"> <div class="views-field views-field-field-page-title-background"> <div class="field-content sed-thumb"> <a href="/member-knowledge-exchange/2024-12-11/resilient-health-system-operating-model" hreflang="en"><img loading="lazy" src="/sites/default/files/styles/small_200x200/public/2024-12/VED_Accenture_Governance_620x381.jpg?itok=viVBuq-l" width="200" height="123" alt="VED_Accenture_Governance_620x381-image" /> </a> </div> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-12-10T16:11:13-06:00">Dec 10, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/member-knowledge-exchange/2024-12-11/resilient-health-system-operating-model" hreflang="en">The Resilient Health System Operating Model</a></span> </div><div class="views-field views-field-body"> <div class="field-content">Health system leaders are building a robust governance and resilient operating model to transform health care delivery models for the future.</div> </div></div> <div class="article views-row"> <div class="views-field views-field-field-page-title-background"> <div class="field-content sed-thumb"> <a href="/member-knowledge-exchange/2024-12-06/optimize-your-hospitals-revenue-cycle-efficient-patient-centered-operations" hreflang="en"><img loading="lazy" src="/sites/default/files/styles/small_200x200/public/2024-12/KnowEx_RI_RevenueCycle_620x381_rev1.jpg?itok=42C41VMq" width="200" height="123" alt="KnowEx_RI_RevenueCycle_620x381_rev1" /> </a> </div> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-12-05T14:26:53-06:00">Dec 5, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/member-knowledge-exchange/2024-12-06/optimize-your-hospitals-revenue-cycle-efficient-patient-centered-operations" hreflang="en">Optimize Your Hospital’s Revenue Cycle for Efficient, Patient-Centered Operations</a></span> </div><div class="views-field views-field-body"> <div class="field-content">Optimizing hospital’s revenue cycle for efficient, patient-centered operations and enhancing critical KPIs using AI and robotic process automation.</div> </div></div> <div class="article views-row"> <div class="views-field views-field-field-page-title-background"> <div class="field-content sed-thumb"> <a href="/2024-11-14/empowering-patient-engagement-and-behavior-change-improve-health-and-reduce-disparities" hreflang="en"><img loading="lazy" src="/sites/default/files/styles/small_200x200/public/2024-11/VED_PatientPoint_Engagement_620x381.jpg?itok=dHKIfRK6" width="200" height="123" alt="PatientPoint_Engagement_620x381" /> </a> </div> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-11-13T15:51:45-06:00">Nov 13, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/2024-11-14/empowering-patient-engagement-and-behavior-change-improve-health-and-reduce-disparities" hreflang="en">Empowering Patient Engagement and Behavior Change to Improve Health and Reduce Disparities</a></span> </div><div class="views-field views-field-body"> <div class="field-content">Empowering patient engagement and leveraging customized communication and education via digital technologies to improve health and reduce disparities.</div> </div></div> <div class="article views-row"> <div class="views-field views-field-field-page-title-background"> <div class="field-content sed-thumb"> <a href="/2024-10-30/aligning-payers-and-partners-value-based-care" hreflang="en"><img loading="lazy" src="/sites/default/files/styles/small_200x200/public/2024-10/KnowEx_CorroHealthh_Medicaid_620x381.jpg?itok=HS9Y48c8" width="200" height="123" alt="KnowEx_CorroHealth_Medicaid" /> </a> </div> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-10-29T15:17:14-05:00">Oct 29, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/2024-10-30/aligning-payers-and-partners-value-based-care" hreflang="en">Aligning Payers and Partners for Value-based Care</a></span> </div><div class="views-field views-field-body"> <div class="field-content">As value-based care models grow, hospitals, providers and payers need to align goals and incentives to improve patient outcomes and reduce costs.</div> </div></div> <div class="article views-row"> <div class="views-field views-field-field-page-title-background"> <div class="field-content sed-thumb"> <a href="/2024-09-26/transforming-behavioral-health-journey" hreflang="en"><img loading="lazy" src="/sites/default/files/styles/small_200x200/public/2024-09/Iris-Telehealth-banner-620x381.jpg?itok=QQ9C-7Mp" width="200" height="123" alt="Iris-Telehealth-banner-620x381" /> </a> </div> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-09-25T14:49:38-05:00">Sep 25, 2024</time> </span> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/2024-09-26/transforming-behavioral-health-journey" hreflang="en">Transforming the Behavioral Health Journey</a></span> </div><div class="views-field views-field-body"> <div class="field-content">Transforming the behavioral health journey with strategic initiatives to build a sustainable and coordinated behavioral health services continuum.</div> </div></div> </div> </div> <div class="more-link"><a href="/aha-knowledge-exchange-archive">View All: AHA Knowledge Exchange</a></div> </section> </div> </div></div> Tue, 29 Oct 2024 15:17:14 -0500 Value-based payment <div class="container"><div class="row"><div class="col-md-8"><p>The Centers for Medicare & Medicaid (CMS) Aug. 1 <a href="https://www.govinfo.gov/content/pkg/FR-2024-08-28/pdf/2024-17021.pdf" target="_blank" title="New Mandatory Payment Model">finalized</a> a new mandatory payment model that will bundle payment to acute care hospitals for five types of surgical episodes. The Transforming Episode Accountability Model (TEAM), included as part of the fiscal year (FY) 2025 inpatient and long-term care hospital (LTCH) prospective payment system (PPS) final rule, expands upon previous episode-based payment models like the Comprehensive Care for Joint Replacement (CJR) and the Bundled Payments for Care Improvement Advanced (BPCI-A) models. The <a href="/advisory/2024-08-14-inpatient-pps-final-rule-fy-2025" target="_blank">inpatient</a><a href="/advisory/2024-08-14-inpatient-pps-final-rule-fy-2025"> </a>and <a href="/advisory/2024-08-27-long-term-care-hospital-prospective-payment-system-final-rule-fy-2025" target="_blank">LTCH</a> PPS provisions in the final rule are covered in separate <a href="/advisories" target="_blank">AHA advisories.</a> </p><div class="panel module-typeC"><div class="panel-heading"><h2>Key Highlights</h2><p>CMS' Team will: </p><ul><li>Hold acute care hospitals responsible for the quality and costs of all services provided during select surgical episodes, from the date of inpatient admission or outpatient procedure through 30 days post-discharge.</li><li>Require inpatient PPS hospitals to participate in 188 core-based statistical areas (CBSAs).</li><li>Run for five years, from Jan. 1, 2026, through Dec. 31, 2030.</li><li>Include five surgical episode categories: coronary artery bypass graft (CABG), lower extremity joint replacement (LEJR), major bowel procedure, surgical hip/femur fracture treatment (SHFFT) and spinal fusion.</li><li>Provide fee-for-service payments as usual but retrospectively reconcile payments against a target price.</li><li>Provide a one-year glide path to two-sided risk. Safety-net hospitals will have a three-year glide path to downside risk.</li><li>Include stop-loss and stop-gain policies.</li><li>Include waivers for the SNF three-day rule and telehealth originating and geographic sites.</li><li>Link reconciliation payments to quality through performance on hospital-wide all-cause readmissions, CMS patient safety and adverse events composite, and total hip/total knee arthroplasty patient-reported outcome measures.</li><li>Conduct separate rulemaking for policies like low-volume thresholds, hierarchical condition category (HCC) lookback periods, and hospital transfers, which were not finalized in this rule. </li></ul></div></div><h2>AHA TAKE </h2><p>While the AHA has long supported the adoption of value-based and alternative payment models to deliver high-quality care at lower costs, the rule’s mandatory bundled payment model for five different surgical episodes will not advance these objectives. Not only is the model extremely similar to other bundled payment approaches that have failed to meet the statutory criteria for expansion, as they have not reduced program costs or generated net savings, but it also puts at particular risk many hospitals that are not of adequate size or in a position to support the investments necessary to succeed. </p><p>We are particularly disappointed that, despite evidence to suggest that mandatory participation may increase disparities, CMS decided to move forward with its proposal to require certain hospitals to participate in the model. Requiring all hospitals in certain regions to take on large, diverse bundles may require more risk than they can manage, threatening their ability to maintain access to quality care. </p><h2>WHAT YOU CAN DO </h2><ul><li><strong>Watch </strong>for additional materials including additional TEAM proposals from CMS on issues like low-volume thresholds not finalized in this rule.</li><li><strong>Determine </strong>if your organization is included in the list of <a href="https://www.cms.gov/team-model-participant-list" target="_blank">hospitals selected for participation.</a></li><li><strong>Share </strong>this advisory with your chief financial officer, other senior management team members, key physician leaders and nurse managers to examine potential changes for your hospital.</li><li><strong>Assess </strong>the potential impact of the payment and quality changes on your Medicare revenue and operations.</li><li><strong>Register for the AHA member-only </strong><a href="https://aha-org.zoom.us/webinar/register/WN_aWjexSB8SF6GqfmFFx3FPw" target="_blank"><strong>webinar</strong></a><strong> on Sept. 19 at 1 p.m. ET. </strong><em><strong> </strong></em></li></ul><h2>FURTHER QUESTIONS</h2><p>Please direct questions to Jennifer Holloman, AHA’s senior associate director of physician and alternative payment policy, at <a href="mailto:jholloman@aha.org" target="_blank" title="Holloman email"><u>jholloman@aha.org</u></a>. </p></div><div class="col-md-4"><a href="/system/files/media/file/2024/09/transforming-episode-accountability-model-final-rule-advisory-9-16-2024.pdf"><img src="/sites/default/files/inline-images/cover-transforming-episode-accountability-model-final-rule-advisory-9-16-2024.png" data-entity-uuid="d1a17d7b-d718-4eee-9d40-81da2fed8bfd" data-entity-type="file" alt="Regulatory Advisory Image" width="640" height="828"></a></div></div></div> Mon, 16 Sep 2024 10:55:58 -0500 Value-based payment <div class="container"><div class="row"><div class="col-md-8"><p>The Centers for Medicare & Medicaid Services (CMS) Aug. 1 issued its hospital inpatient prospective payment system (PPS) and long-term care hospital (LTCH) PPS <a href="https://www.federalregister.gov/public-inspection/2024-17021/medicare-medicaid-and-childrens-health-insurance-programs-hospital-inpatient-prospective-payment" target="_blank" title="the final rule">final rule</a> for fiscal year (FY) 2025. This Special Bulletin reviews highlights of provisions related to the inpatient PPS as well as the Center for Medicare and Medicaid Innovation (CMMI) Transforming Episode Accountability Model (TEAM) alternative payment model, which will begin Jan. 1, 2026. LTCH PPS provisions are covered in a separate Special Bulletin.</p><p>The rule finalizes a net 2.9% increase for inpatient PPS payments in FY 2025. This update reflects a hospital market basket increase of 3.4% as well as a productivity cut of 0.5%. CMS expects overall payments to increase by $2.9 billion, which it says includes a $200 million decrease in disproportionate share hospital (DSH) payments (due to a decrease in the uninsured rate), a $300 million increase in new medical technology payments, and a $400 million decrease in rural health payments if the Medicare-dependent hospital and enhanced low-volume adjustment programs are not extended by legislation.</p><div class="panel module-typeC"><div class="panel-heading"><h2>Key Highlights</h2><p>CMS’ final policies will:</p><ul><li>Increase inpatient PPS payment rates by a net 2.9% in FY 2025.</li><li>Establish a new mandatory CMMI model, the TEAM, that will provide bundled payment for five surgical procedures.</li><li>Create a separate inpatient PPS payment for small, independent hospitals to establish and maintain access to essential medicines.</li><li>Distribute new graduate medical education slots under section 4122 of the Consolidated Appropriations Act of 2023.</li><li>Modify the questions and sub-measures in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.</li><li>Increase the Promoting Interoperability Program’s performance threshold score and update the program’s Antimicrobial Use and Resistance Surveillance measure.</li><li>Modify and make permanent the condition of participation (CoP) requiring hospitals and critical access hospitals (CAHs) to report certain data to the Centers for Disease Control and Prevention (CDC) on acute respiratory illnesses</li></ul></div></div><h2>AHA TAKE </h2><p>CMS’ payment updates for hospitals will exacerbate the already unsustainable negative or break-even margins many hospitals are already operating under as they care for their patients. The AHA is deeply concerned about the impact these inadequate payments will have on patient access to care, especially in rural and underserved communities. In addition, while the AHA has long supported widespread adoption of meaningful value-based and alternative payment models to deliver high quality care at lower costs, the rule’s mandatory bundled payment model for five different surgical episodes will not advance these objectives. Not only is the model extremely similar to other bundled payment approaches that have failed to meet the statutory criteria for expansion as they have not reduced program costs or generated net savings, it puts at particular risk many hospitals that are not of an adequate size or in a position to support the investments necessary to succeed. <strong>See AHA’s full </strong><a href="/press-releases/2024-08-01-aha-statement-fy-2025-final-ipps-ltch-payment-rule" target="_blank" title="AHA Statement"><strong>statement</strong></a><strong> that was shared with the media. </strong></p><p>Highlights of the rule follow.</p></div><div class="col-md-4"><p><a href="/system/files/media/file/2024/08/cms-releases-hospital-inpatient-pps-final-rule-for-fiscal-year-2025-bulletin-8-1-2024.pdf" target="_blank" title="Click here to download the Special Bulletin: CMS’ Hospital Inpatient PPS Final Rule for FY 2025 PDF."><img src="/sites/default/files/2024-08/cover-cms-releases-hospital-inpatient-pps-final-rule-for-fiscal-year-2025-bulletin-8-1-2024.png" data-entity-uuid data-entity-type="file" alt="Special Bulletin: CMS Releases Hospital Inpatient PPS Final Rule for Fiscal Year 2025 cover." width="NaN" height="NaN"></a></p></div></div></div> Fri, 02 Aug 2024 14:59:03 -0500 Value-based payment /aha-center-health-innovation-market-scan/2024-05-28-3-keys-hospitals-achieve-sustainable-financial-stability <div class="container"><div class="row"><div class="col-md-8"><p><img src="/sites/default/files/inline-images/3-Keys-for-Hospitals-to-Achieve-Sustainable-Financial-Stability.png" data-entity-uuid="75291288-19b0-4b25-bb1f-efeaf6fded22" data-entity-type="file" alt="3 Keys for Hospitals to Achieve Sustainable Financial Stability. A calculator sits on a surgical table surrounded by forceps, scalpels, and other surgical tools." width="100%" height="100%"></p><p>No one said it would be easy for hospitals and health systems to achieve financial sustainability in today’s ecosystem.</p><p>The nation’s aging patient base, rising costs, staffing shortages and evolving reimbursement models represent a handful of major challenges plaguing providers.</p><p>So, what will C-suite executives need to do in the coming years to create a foundation for long-term financial sustainability? And what kind of savings should organizations target between now and then?</p><p>For starters, organizations will need to realize cost reductions of 15% to 20% by 2030, a new <a href="https://www.oliverwyman.com/our-expertise/perspectives/health/2024/april/5-ways-hospitals-can-cut-costs-achieve-long-term-stability.html" target="_blank" title="Oliver Wyman: 5 Ways Hospitals Can Cut Costs, Achieve Long-Term Stability">Oliver Wyman analysis</a> suggests.</p><h2><span>Persisting Revenue Uncertainty Poses a Huge Challenge</span></h2><p>That’s a sizable percentage under any circumstances, but doubly so with revenue uncertainties mounting.</p><p>The end of stimulus funds and reimbursement enhancement from public health emergencies will reduce safety valves, the report notes, while the restart of Medicaid redetermination has pushed millions of patients out of that program. This could lead to greater long-term costs associated with preventable emergent care.</p><p>The long-term impact to future net revenue due to the large number of Americans shifting out of commercial insurance to Medicare is another huge issue to consider. Before the pandemic, 59% of America’s insured population were enrolled in commercial plans, the report states. By 2030, this figure is projected to drop to 55% as Medicare enrollment swells.</p><p>That 4% difference will have a significant negative impact on health care organizations’ revenues as tens of millions of patients opt into Medicare coverage when they become eligible. Combined underpayments from Medicare and Medicaid were nearly $130 billion in 2022, up from $76 billion in 2019, notes an <a href="/fact-sheets/2022-05-25-fact-sheet-majority-hospital-payments-dependent-medicare-or-medicaid" target="_blank" title="Fact Sheet: Majority of Hospital Payments Dependent on Medicare or Medicaid">AHA Fact Sheet</a> released earlier this month.</p><h2><span>3 Key Savings Areas in Need of Innovative Strategies</span></h2><h3><span>1</span> <span>|</span> Optimizing high-value operations.</h3><p>Traditional process redesign in four core areas — staffing, perioperative services, length of stay and administrative functions — will be effective. However, leaders should target annual savings beyond the traditional 5% to 7% range due to broad changes in the field.</p><p>Perioperative services are often rife with value-generation opportunities that can be captured through greater throughput. Focus areas could include operating room specialization, eliminating unused block time in schedules or turnover-time reduction. Enhancing sepsis detection, managing toward a discharge date, standardizing discharge rounds and optimizing the post-acute network are all high-impact levers for reducing length of stay.</p><h4><span>Takeaway</span></h4><p>Staffing poses the most immediate challenge. Redesigning key processes and team-based care can bring relief to a tired workforce and reset the cost structure, the report states. In nursing, for example, organizations can create specialized teams or designate individuals to facilitate higher volumes of task repetition. This will result in greater familiarity and efficiency. These teams can get more done at a higher-quality level.</p><p>For example, a centralized virtual nurse hub to manage the discharge process across multiple units or hospitals can result in significantly shorter time to discharge for patients and higher satisfaction for floor nurses.</p><p>Other areas to explore include automating standard processes and leveraging hybrid teams across roles and modalities to provide a new avenue to pool resources. Telesitting, for example, reduces the need for in-person sitters while reducing falls, and virtual stroke teams can provide 24/7 consultation while reducing shift coverage requirements for physicians.</p><h3><span>2</span> <span>|</span> Rethink and redeploy sites to align with changing care delivery and payment models.</h3><p>Care continues to shift out of traditional cost centers as less-invasive treatments develop, payer pressures intensify and new technological developments enhance feasibility of care at home. As a result, health systems should reframe how they deploy and plan for future brick-and-mortar locations.</p><h4><span>Takeaway</span></h4><p>Three groups of sequential tactics can reshape the use and scale of physical care delivery sites while generating estimated savings of 7% to 8%, the authors note.</p><ul><li>Shift care to the best, lowest-cost site.</li><li>Create focused centers of excellence where volume allows.</li><li>Optimize bed mix and consolidate footprint based on utilization trends.</li></ul><h3><span>3</span> <span>|</span> Treat value-based care like a service line.</h3><p>Executing against all the cost transformation challenges you face will be difficult, especially given the variability of each organization’s starting point. Value-based care models can help close the gap.</p><h4><span>Takeaway</span></h4><p>Build a chassis around prevention and wellness. The goal should be to keep patients out of expensive inpatient settings. Designing care models and investing in the right capabilities enables systems to achieve long-term sustainability. A system managing the care of 50,000 Medicare patients, generating savings of $2,000 per member per year, produces $100 million in incremental revenue opportunities, the report explains.</p><p>Additional insights are available in the <a href="https://www.oliverwyman.com/our-expertise/perspectives/health/2024/april/5-ways-hospitals-can-cut-costs-achieve-long-term-stability.html" target="_blank" title="Oliver Wyman: 5 Ways Hospitals Can Cut Costs, Achieve Long-Term Stability">full Oliver Wyman report</a>.</p></div><div class="col-md-4"><p><a href="/center" title="Visit the AHA Center for Health Innovation landing page."><img src="/sites/default/files/inline-images/logo-aha-innovation-center-color-sm.jpg" data-entity-uuid="7ade6b12-de98-4d0b-965f-a7c99d9463c5" alt="AHA Center for Health Innovation logo" width="721" height="130" data-entity- type="file" class="align-center"></a></p><p><a href="/center/form/innovation-subscription"><img src="/sites/default/files/2019-04/Market_Scan_Call_Out_360x300.png" data-entity-uuid data-entity-type alt width="360" height="300"></a></p></div></div></div>.field_featured_image { position: absolute; overflow: hidden; clip: rect(0 0 0 0); height: 1px; width: 1px; margin: -1px; padding: 0; border: 0; } .featured-image{ position: absolute; overflow: hidden; clip: rect(0 0 0 0); height: 1px; width: 1px; margin: -1px; padding: 0; border: 0; } Tue, 28 May 2024 06:15:00 -0500 Value-based payment /news/headline/2024-04-12-maryland-program-specialist-physicians-reports-initial-medicare-savings <p>The voluntary Episode Quality Improvement Program for specialist physicians saved Medicare $20 million in its first year, the Maryland Health Services Cost Review Commission <a href="https://hscrc.maryland.gov/Documents/EQIP/EQIP%20Press%20Release.pdf">announced</a> April 11.</p><p>EQIP was developed in collaboration with the Maryland Hospital Association, Maryland State Medical Society (MedChi) and state-designated health information exchange (CRISP) as part of the <a href="https://www.cms.gov/priorities/innovation/innovation-models/md-tccm">Maryland Total Cost of Care Model</a>. This value-based payment program allows participants to earn a portion of the Medicare savings they create from delivering efficient and high-quality care.</p><p>“The Maryland Hospital Association has valued partnering with the HSCRC, MedChi and CRISP to develop innovative care redesign programs such as EQIP,” said MHA President and CEO Melony Griffith. “We’re pleased to collaborate on this important work with our partners to build healthier communities.”</p> Fri, 12 Apr 2024 14:56:37 -0500 Value-based payment /value-based-payment/navigating-value-based-payment <div class="container"><div class="row"><div class="col-md-8"><p>Traditionally, Medicare has paid for services based on volume through fee for service structures. Given the significant financial pressures facing hospitals and health systems – from inflation, staffing shortages, supply chain disruptions, and aging patient populations – operating strictly in the legacy fee-for-service environment may not be possible long term for all organizations. Many are migrating portions of their services to value-based payment models, where organizations assume risk for the outcomes of a population, including through Alternative Payment Models (APMs) established by the Center for Medicare and Medicaid Innovation (CMMI), 1115 Medicaid waivers, and payer-specific programs.</p><p>Value-based payment models can be aligned based the level of financial risk assumed by providers, and the types and scope of services included in the model. Risk within these models range from “upside only” risk that includes bonus payments (where organizations do not face penalties), to “full risk” for managing health for a covered population through a flat rate or capitated budget (where organizations can reallocate any cost savings but must cover any shortfalls internally).</p><p>Below are resources on value-based payment models by type of risk:</p> #borderroundedcorners { border-radius: 25px; border: 2px solid #003087; padding: 20px; height: 300px; margin-right: 2px; } .icon-image { border: solid black 2px; border-radius: 50%; } <div class="row"><div class="col-md-1"><p> </p></div><div class="col-md-2" id="borderroundedcorners"><img class="icon-image" src="/sites/default/files/inline-images/Pay-for-Reporting-Icon-320x320.png" data-entity-uuid="3abf1bcd-36e4-4b4a-a499-a89ab152cd68" data-entity-type="file" alt="Pay for Reporting icon." width="320" height="320"><p><strong>Pay for Reporting</strong></p></div><div class="col-md-2" id="borderroundedcorners"><img class="icon-image" src="/sites/default/files/inline-images/Icons-320x320-Shared-Savings-Risk.png" data-entity-uuid="0491d950-6417-459f-8eaf-e4f0a432ddd6" data-entity-type="file" alt="Shared Savings and Shared Risk icon." width="320" height="320"><p><strong>Shared Savings & Shared Risk</strong></p></div><div class="col-md-2" id="borderroundedcorners"><img class="icon-image" src="/sites/default/files/inline-images/Icons-320x320-Bundled-Payment-Model.png" data-entity-uuid="33e01800-58db-4c85-b723-4130d78f3b43" data-entity-type="file" alt="Bundled and Episode-Based Payment Models icon." width="320" height="320"><p><a href="/bundled-payment/bundled-payment"><strong>Bundled & Episode-Based Payments Models</strong></a></p></div><div class="col-md-2" id="borderroundedcorners"><img class="icon-image" src="/sites/default/files/inline-images/Accountable-Care-Organizations-icon-320x320.png" data-entity-uuid="5f4b0ceb-5ae0-459a-a51e-c7fe3ec3373c" data-entity-type="file" alt="Accountable Care Organizations icon." width="320" height="320"><p><a href="/accountable-care-organizations-acos/accountable-care-organizations"><strong>Accountable Care Organizations</strong></a></p></div><div class="col-md-2" id="borderroundedcorners"><img class="icon-image" src="/sites/default/files/inline-images/Icons-320x320-Global-Budget-Models.png" data-entity-uuid="c75847c6-bf5a-41e4-b360-a0759c81322d" data-entity-type="file" alt="Capitated and Global Budget Models icon." width="320" height="320"><p><a href="/capitated-and-global-budget-models/capitated-and-global-budget-models"><strong>Capitated & Global Budget Models</strong></a></p></div><div class="col-md-1"><p> </p></div></div><p>Additionally, models can be aligned by clinical area. Below are resources on value-based payment models by type of care:</p> .gridbox { border: solid black 1px; } <div class="row"><div class="col-md-4"><h3 class="gridbox"><a href="/primary-care/primary-care-value-based-payment-models" target="_blank" title="AHA: Primary Care Value-based Payment Models landing page."><img src="/sites/default/files/inline-images/VBP-Primary-Care-600x400-text.jpg" data-entity-uuid="1c8ea177-78b0-46f3-97c3-89706aca7cf4" data-entity-type="file" alt="Primary Care" width="600" height="400"></a></h3></div><div class="col-md-4"><h3 class="gridbox"><a href="/advocacy/access-and-health-coverage/access-behavioral-health" title="AHA: Behavioral Health landing page"><img src="/sites/default/files/inline-images/VBP-Behavioral-Health-600x400-text.jpg" data-entity-uuid="784b8cf7-527e-4d51-a4cc-5f68ff0322c3" data-entity-type="file" alt="Behavioral Health" width="600" height="400"></a></h3></div><div class="col-md-4"><h3 class="gridbox"><a href="/advocacy/maternal-and-child-health" title="AHA: Maternal and Child Health landing page."><img src="/sites/default/files/inline-images/VBP-Maternal-Health-600x400-text.jpg" data-entity-uuid="69e1f1f9-0619-4589-80df-8f7b0dfa08f1" data-entity-type="file" alt="Maternal Health" width="600" height="400"></a></h3></div></div><div class="row"><div class="col-md-4"><h3 class="gridbox"><img src="/sites/default/files/inline-images/VBP-Chronic-Conditions-600x400-text.jpg" data-entity-uuid="c8b476a8-949b-4c1c-9579-a704a5b56ec3" data-entity-type="file" alt="Chronic Conditions" width="600" height="400"></h3></div><div class="col-md-4"><h3 class="gridbox"><img src="/sites/default/files/inline-images/VBP-Procedure-Based-Models-600x400-text.jpg" data-entity-uuid="63da3c24-c2af-45cf-963b-03ceb41528bc" data-entity-type="file" alt="Procedure-Based Models" width="600" height="400"></h3></div><div class="col-md-4"><h3 class="gridbox"><img src="/sites/default/files/inline-images/VBP-Prescription-Drugs-600x400-text.jpg" data-entity-uuid="b3e40e64-dfb0-4ef5-8547-7d92dffab7a6" data-entity-type="file" alt="Prescription Drugs" width="600" height="400"></h3></div></div><h2>Key Resources</h2><p><a href="https://hcp-lan.org/workproducts/apm-refresh-whitepaper-final.pdf" target="_blank"><strong>Health Care Payment Learning and Action Network (HCP LAN) Alternative Payment Model (APM) Framework</strong></a> — Established in 2016, this framework classifies APMs based on level of financial risk attributed to quality.</p><p><a href="https://hcp-lan.org/workproducts/HCPLAN_Accountable_Care_Curve_User_Guide.pdf" target="_blank"><strong>HCP LAN Accountable Care Curve</strong></a> — In 2022, the HCP LAN created an accountable care curve to support organizations in their transition to accountable care.</p><p><a href="/lettercomment/2023-06-22-aha-advises-congress-how-advance-macra-payment-models"><strong>MACRA Payment Models Comment Letter</strong></a> — In a letter submitted to the House Energy and Commerce Subcommittee on Oversight and Investigations for a hearing on challenges implementing value-based and alternative payment models under the Medicare Access and CHIP Reauthorization Act of 2015, AHA encouraged certain statutory and regulatory policies to advance and flexibly implement these models.</p><p><a href="/lettercomment/2022-11-02-aha-comments-re-request-feedback-stabilizing-medicare-payment-system"><strong>MACRA RFI Response</strong></a> — Responding to House members asking how Congress could improve physician payment under the Medicare Access and CHIP Reauthorization Act of 2015, the AHA encouraged statutory and regulatory efforts to advance and flexibly implement value-based and alternative payment models.</p><p><a href="/news/headline/2023-07-27-bill-would-extend-strengthen-macra-incentives-advanced-apms"><strong>Value in Health Act Support Letter</strong></a> — Letter in support of Value in Health Act, which would extend 5% advanced APM incentive payments, remove revenue thresholds, improve APM financial benchmarks, establish a voluntary higher risk track in MSSP and would grant CMS the authority to adjust qualifying APM thresholds.</p><p><a href="/news/headline/2023-12-14-senate-companion-aha-supported-macra-incentives-bill-introduced"><strong>Value in Health Act Introduction</strong></a> — A bipartisan group of senators introduced AHA-supported legislation that would extend the 5% Medicare payment incentives for advanced Alternative Payment Models under the Medicare Access and CHIP Reauthorization Act.</p><h2>Other Related Resources</h2><p><a href="/education-events/realizing-success-payvider"><strong>Realizing Success as a Payvider — Hackensack Meridian Health Drives Value-Based Programs</strong></a><br><a href="https://www.youtube.com/watch?v=CKgLve7f7_E" target="_blank" title="YouTube: AHA Webinar: Realizing Success as a Payvider — Hackensack Meridian Health Drives Value-Based Programs"><strong>Watch webinar recording</strong></a></p><p><a href="/system/files/media/file/2023/05/Lumeris_AligningHealthEV_exedialogue_052423.pdf"><strong>Aligning Health Equity and Value-based Programs</strong></a></p><p><a href="/aha-transformation-talks/s2-ep3-advanced-data-strategies"><strong>Advanced Strategies for Optimizing Value-based Care</strong></a></p><p><a href="/interview/2023-01-12-value-based-payment-support-health-equity"><strong>Value-based Payment to Support Health Equity</strong></a></p><hr><div id="webform"> <div data-entity-type="webform" data-entity-uuid="ac706cee-f862-4dda-97db-daf7cf28b194" data-embed-button="webform_embed" data-entity-embed-display="view_mode:webform.token" class="align-left embedded-entity" data-langcode="en" data-entity-embed-display-settings="[]"> <div id="edit-processed-text" class="js-form-item form-item js-form-type-processed-text form-item- js-form-item- form-no-label"> <h2>Share Your Experience</h2><p>We want to hear 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Similarly, please do not send us any information or data that cannot be made public.</strong></p> </div> <div class="webform-element-help-container--title webform-element-help-container--title-after js-form-item form-item js-form-type-textfield form-item-hospital-health-system-organization-name js-form-item-hospital-health-system-organization-name"> Hospital/Health System/Organization Name<span class="webform-element-help js-webform-element-help" role="tooltip" tabindex="0" aria-label="Hospital/Health System/Organization Name" data-webform-help="<div class="webform-element-help--title">Hospital/Health System/Organization Name</div><div class="webform-element-help--content">Please enter the name of the organization about which you are sharing a story.</div>"><span aria-hidden="true">?</span></span> </div> <span class="visually-hidden fieldset-legend js-form-required form-required">Submitter's Name</span> <div class="fieldset-wrapper"> <div class="js-form-item form-item js-form-type-textfield form-item-submitter-s-name-first js-form-item-submitter-s-name-first"> First </div> <div class="js-form-item form-item js-form-type-textfield form-item-submitter-s-name-middle js-form-item-submitter-s-name-middle"> Middle </div> <div class="js-form-item form-item js-form-type-textfield form-item-submitter-s-name-last js-form-item-submitter-s-name-last"> Last </div> </div> <div class="webform-element-help-container--title webform-element-help-container--title-after js-form-item form-item js-form-type-email form-item-submitter-s-email js-form-item-submitter-s-email"> Submitter's Email<span class="webform-element-help js-webform-element-help" role="tooltip" tabindex="0" aria-label="Submitter's Email" data-webform-help="<div class="webform-element-help--title">Submitter's Email</div><div class="webform-element-help--content">Please enter your email address here.</div>"><span aria-hidden="true">?</span></span> </div> <div class="js-form-item form-item js-form-type-textarea form-item-what-is-your-story-please-keep-your-story-or-caption-to-250-word js-form-item-what-is-your-story-please-keep-your-story-or-caption-to-250-word"> What is your story? Please provide a summary of what you would be interested in sharing with broader membership in terms of your organization's transition from volume to value. (Please keep your story or caption to 250 words or fewer.) <div> </div> </div> <div id="ajax-wrapper"><div class="webform-element-help-container--title webform-element-help-container--title-after js-form-item form-item js-form-type-webform-image-file form-item-upload-image js-form-item-upload-image"> Upload Image<span class="webform-element-help js-webform-element-help" role="tooltip" tabindex="0" aria-label="Upload Image" data-webform-help="<div class="webform-element-help--title">Upload Image</div><div class="webform-element-help--content">If you have an image about your story, please upload it here.</div>"><span aria-hidden="true">?</span></span> <div id="edit-upload-image" class="js-webform-image-file webform-image-file js-form-managed-file form-managed-file"> </div> <div class="description"> <div id="edit-upload-image--description" class="webform-element-description">One file only.<br>100 MB limit.<br>Allowed types: gif, jpg, png, svg. </div> </div> </div> </div><div id="ajax-wrapper--2"><div class="webform-element-help-container--title webform-element-help-container--title-after js-form-item form-item js-form-type-webform-video-file form-item-upload-video js-form-item-upload-video"> Upload Video<span class="webform-element-help js-webform-element-help" role="tooltip" tabindex="0" aria-label="Upload Video" data-webform-help="<div class="webform-element-help--title">Upload Video</div><div class="webform-element-help--content">If you have a video about your story, please upload it here.</div>"><span aria-hidden="true">?</span></span> <div id="edit-upload-video" class="js-webform-video-file webform-video-file js-form-managed-file form-managed-file"> </div> <div class="description"> <div id="edit-upload-video--description" class="webform-element-description">One file only.<br>100 MB limit.<br>Allowed types: avi, mov, mp4, ogg, wav, webm. </div> </div> </div> </div><div class="webform-element-help-container--title webform-element-help-container--title-after js-form-item form-item js-form-type-url form-item-share-url js-form-item-share-url"> Share URL<span class="webform-element-help js-webform-element-help" role="tooltip" tabindex="0" aria-label="Share URL" data-webform-help="<div class="webform-element-help--title">Share URL</div><div class="webform-element-help--content">If there is information about your story on a website, copy and paste the address here.</div>"><span aria-hidden="true">?</span></span> </div> <div id="edit-processed-text-01" class="js-form-item form-item js-form-type-processed-text form-item- js-form-item- form-no-label"> <h3>Disclaimer</h3><p>By submitting this form I hereby grant to the ���������� Association (AHA) and its representatives, employees, agents and assigns, the irrevocable and unrestricted right to use, re-use, display, distribute, transmit, copy, reproduce, publish, or re-publish, either in whole or in part, my submission, which may include text, data, documentation, memoranda, audio/visual recordings, photographs, portraits and videos (hereinafter called “Submission”), through any media including, but not limited to any and all of its publications and website entries, for editorial, promotional, educational and/or informational purposes, internal use, art, entertainment, trade, advertising or any other purpose; and to copyright in its own name and/or publish, and/or market, and/or assign the same without payment or any other consideration or further authorization by me.</p><p>I also grant AHA all rights in such Submission, including the rights to reproduce and disseminate such Submission, as well as to use such Submission in whole or part as part of derivative works and/or supporting materials in conjunction with my organization’s name. I understand that information disclosed pursuant to this authorization may be re-disclosed and used in a webcast and in other media outlets. I hereby waive the right to inspect and/or approve the finished publication, video/audio tape or stream, print, or any other materials that may be used in connection with my Images, or the use to which they may be applied so long as such use shall be lawful.</p><p> </p><p>I represent that I am over the age of eighteen (18) years and that I have read the foregoing and fully understand its contents and am authorized to sign this waiver on behalf of my organization. This release shall be binding upon my organization and its representatives, employees, agents and assigns. I hereby release and discharge AHA and its representatives, employees, agents and assigns from any and all claims, actions, demands, and liability arising out of or in connection with the use of said Submission, including without limitation any and all claims for invasion of privacy, right of publicity, misappropriation of trade secrets, and defamation.</p><p> </p> </div> <div data-drupal-selector="edit-captcha" class="captcha captcha-type-challenge--recaptcha"> <div class="captcha__element"> <div class="g-recaptcha" data-sitekey="6LdrgGsUAAAAALv69a9FuEinoebfHzaoYXy5Hq8b" data-theme="light" data-type="image"></div> </div> </div> <div data-drupal-selector="edit-actions" class="form-actions js-form-wrapper form-wrapper" id="edit-actions"> </div> </div></div></div><div class="col-md-4"><div class="views-element-container"> <section class="top-level-view js-view-dom-id-ac9a5da928b1079b65a380472921edd9c26c025ed83e4ce39a7364a1bd39e6dc resource-block"> <h3>Latest on Value-based Payment</h3> <div class="resource-wrapper"> <div class="resource-view"> <div class="article views-row"> <div class="views-field views-field-title"> <span class="field-content"><a href="/2024-10-30/aligning-payers-and-partners-value-based-care" hreflang="en">Aligning Payers and Partners for Value-based Care</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-10-29T15:17:14-05:00">Oct 29, 2024</time> </span> </div></div> <div class="article views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-member" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/279" hreflang="en">Member</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/advisory/2024-09-16-transforming-episode-accountability-model-team-final-rule" hreflang="en">Transforming Episode Accountability Model (TEAM) Final Rule</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-09-16T10:55:58-05:00">Sep 16, 2024</time> </span> </div></div> <div class="article views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-member" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/279" hreflang="en">Member</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/special-bulletin/2024-08-02-cms-hospital-inpatient-pps-final-rule-fy-2025" hreflang="en">CMS’ Hospital Inpatient PPS Final Rule for FY 2025</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-08-02T14:59:03-05:00">Aug 2, 2024</time> </span> </div></div> <div class="article views-row"> <div class="views-field views-field-title"> <span class="field-content"><a href="/aha-center-health-innovation-market-scan/2024-05-28-3-keys-hospitals-achieve-sustainable-financial-stability" hreflang="en">3 Keys for Hospitals to Achieve Sustainable Financial Stability</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-05-28T06:15:00-05:00">May 28, 2024</time> </span> </div></div> <div class="article views-row"> <div class="views-field views-field-title"> <span class="field-content"><a href="/news/headline/2024-04-12-maryland-program-specialist-physicians-reports-initial-medicare-savings" hreflang="en">Maryland program for specialist physicians reports initial Medicare savings</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-04-12T14:56:37-05:00">Apr 12, 2024</time> </span> </div></div> </div> </div> <div class="more-link"><a href="/topics/value-based-payment">More on Value-based Payment</a></div> </section> </div> </div></div></div> Wed, 20 Mar 2024 14:18:40 -0500 Value-based payment /news/headline/2024-01-02-panel-considers-potential-changes-home-health-model <p>The Centers for Medicare & Medicaid Services Dec. 29 released a <a href="https://www.cms.gov/files/document/hhvbp-exp-tech-exp-panel-rpt.pdf">report</a> on the Expanded Home Health Value-Based Purchasing Model that summarizes input from the first two meetings of a technical advisory panel considering potential refinements to the model’s methodology, measures and approach to health equity. Launched in 2022, the expanded model includes Medicare-certified home health agencies in all 50 states and in U.S. territories. The model’s measure set currently uses data already reported by HHAs through the Home Health Quality Reporting Program or Medicare claims and Home Health Care Consumer Assessment of Healthcare Providers and Systems surveys. </p> Tue, 02 Jan 2024 15:03:00 -0600 Value-based payment /news/headline/2023-11-30-apply-participate-eight-state-primary-care-model-dec-14 <p>In response to stakeholder feedback, the Centers for Medicare & Medicaid Services has <a href="https://www.cms.gov/priorities/innovation/innovation-models/making-care-primary">extended</a> through Dec. 14 the application deadline for the Making Care Primary Model, a new value-based payment model beginning next July in Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, upstate New York, North Carolina and Washington. <a href="/news/headline/2023-06-08-cms-launch-new-primary-care-model-8-states">Announced in June</a>, the voluntary 10.5-year model aims to strengthen coordination between patients’ primary care clinicians, specialists, social service providers and behavioral health clinicians to prevent chronic disease, reduce emergency room visits and improve health outcomes. Participating organizations must have at least 125 Medicare patients and over half of their primary care sites in a participating state. <br />  <br />  </p> Thu, 30 Nov 2023 16:07:00 -0600 Value-based payment /aha-center-health-innovation-market-scan/2023-09-19-will-walgreens-walmart-value-based-care-plays-pay <div class="container"> <div class="row"> <div class="col-md-8"> <p><img alt="Will Walgreens, Walmart Value-based Care Plays Pay Off? Clinicians in white lab coats with stethoscopes around their neck wear ID badges with Walgreens and Walmart logos on them." data-entity-type="file" data-entity-uuid="f1ff7c7a-8d0e-44a1-945e-38d7462fa61b" src="/sites/default/files/inline-images/Will-Walgreens-Walmart-Value-based-Care-Plays-Pay-Off.png" width="620" height="381"></p> <p>Walgreens last week entered into a <a href="https://news.walgreens.com/press-center/news/walgreens-and-pearl-health-announce-strategic-partnership-to-advance-value-based-care-delivery.htm" target="_blank" title="Walgreeens: Walgreens and Pearl Health Announce Strategic Partnership to Advance Value-Based Care Delivery">strategic partnership</a> with <a href="https://pearlhealth.com/" target="_blank">Pearl Health</a>, a technology platform for primary care physicians in value-based care arrangements. The companies will help community-based primary care physicians manage value-based care in <a href="https://www.cms.gov/priorities/innovation/innovation-models/aco-reach" target="_blank" title="CMS.gov: ACO Reach landing page">ACO Reach</a>, Medicare’s accountable care program, starting in 2024 and eventually plan to expand to Medicare Advantage and potentially commercial payers and Medicare in the future.</p> <p>Just days earlier, <a href="https://www.bloomberg.com/news/articles/2023-09-09/walmart-is-said-to-explore-buying-majority-stake-in-chenmed" target="_blank" title="Bloomberg: Walmart Explores Buying Majority Stake in ChenMed">Bloomberg reported</a> that Walmart was exploring the purchase of a majority stake in <a href="https://www.chenmed.com/" target="_blank" title="ChemMed homepage">ChenMed</a>, a value-based care organization of more than 125 primary care clinics in 15 states focused on treating older adults. If the deal goes through, it will cost Walmart several billion dollars, the report notes.</p> <h2><span>Will the Value Plays Work?</span></h2> <p>The respective moves have some analysts questioning just how much the retailers could gain from these initiatives given that the companies have had difficulty to date showing positive financial returns for their hefty health care investments. Moreover, the timing of the initiatives is curious.</p> <p>Walmart largely has remained on the sidelines over the past several years as some of its competitors were planning and scaling their primary care operations through acquisitions. In February, Amazon closed on its acquisition of the primary care company One Medical for $3.9 billion and CVS Health expanded its primary care footprint by completing its purchase of Oak Street Health for $10.6 billion. And now, Walgreens has a majority interest in primary care provider VillageMD, and bought primary, specialty and urgent care provider Summit Health+CityMD for $8.9 billion in November.</p> <p>ChenMed is seen as one of a rapidly shrinking list of large, primary care assets that still can be acquired. But the company is going through a major leadership change after Steve Nelson took over as president in August. Nelson, a former UnitedHealthcare CEO, most recently served as CEO of JenCare, within the ChenMed family of companies, and before that was co-chair and CEO of Duly Health and Care, an Illinois-based multispecialty physician group.</p> <p>Walgreens also experienced a major leadership shakeup after Rosalind Brewer, CEO, stepped down earlier this month as part of a mutual agreement with the board of directors after just two years at the helm. Brewer came to Walgreens after serving as chief operating officer and group president for Starbucks. Now, the retailer says it is seeking someone with a strong health care background to lead the company.</p> <h2><span>3 Questions Raised by the Walgreens and Walmart Moves</span></h2> <h3><span>1</span> <span>|</span> Can they compete effectively in the value-based care market?</h3> <p>Both companies face steep competition not only from other retailers, but also from payers like UnitedHealth Group’s Optum, which has vast data and experience as well as what many see as the deepest and most diversified health care services portfolio among power players trying to transform health care.</p> <h4><span>Key Takeaway</span></h4> <p>Hospitals and health systems that have demonstrated success in value-based care models have a significant advantage over outside competitors and will need to continue advancing efforts to improve quality and population health management while making care more affordable. Other health systems may look for opportunities to establish a relationship with these power players to lower the cost of care, increase downstream market capture and focus on core specialty services while remaining connected to the patient.</p> <h3><span>2</span> <span>|</span> Will the Pearl Health partnership pay off?</h3> <p>If successful, the partnership could bring significant benefits to Walgreens, including helping the retailer to be less reliant on fee-for-service volume. Pearl also has grown its provider and patient panels and can identify patients who can benefit most from care management interventions, Kate Festle, director of health care and life sciences at the Chicago consulting firm West Monroe, told MedCity News.</p> <h4><span>Key Takeaway</span></h4> <p>Walgreens brings complementary services to the partnership, including prescription fulfillment, medication adherence, immunizations, care gap closure and diagnostic testing. Walgreens also will work with providers to help patients discharged from the hospital transition to home. Walgreens is positioning itself as the partner of choice for providers and health systems looking to transition quickly to value-based care and improve community health. It bears watching how quickly this partnership will evolve and what impact it may have on referrals to and partnerships with hospitals.</p> <h3><span>3</span> <span>|</span> Can the companies demonstrate ROI in value-based care?</h3> <p>Both Walmart and Walgreens have ambitious growth goals for their health care operations, and expanding their reach with value-based care makes sense. This could lead to greater engagement with patients, payers and providers while broadening the payment models in which the companies participate. But as we’ve seen in the past, particularly with Walgreens, companies can’t buy their way to profitability in health care.</p> <h4><span>Key Takeaway</span></h4> <p>In late June, Walgreens cut its full-year earnings guidance to a range of $4.00 to $4.05 per share, down from its previous forecast of $4.45 to $4.65. Among other factors, the company cited slower-than-expected profit growth for its U.S. health care segment. The question now is whether the next person to lead Walgreens’ health care operations can change the company’s trajectory in the sector.</p> </div> <div class="col-md-4"> <p><a href="/center" title="Visit the AHA Center for Health Innovation landing page."><img alt="AHA Center for Health Innovation logo" data-entity- data-entity-uuid="7ade6b12-de98-4d0b-965f-a7c99d9463c5" src="/sites/default/files/inline-images/logo-aha-innovation-center-color-sm.jpg" type="file" class="align-center"></a></p> <a href="/center/form/innovation-subscription"><img alt data-entity-type data-entity-uuid src="/sites/default/files/2019-04/Market_Scan_Call_Out_360x300.png"></a></div> </div> </div> .field_featured_image { position: absolute; overflow: hidden; clip: rect(0 0 0 0); height: 1px; width: 1px; margin: -1px; padding: 0; border: 0; } .featured-image{ position: absolute; overflow: hidden; clip: rect(0 0 0 0); height: 1px; width: 1px; margin: -1px; padding: 0; border: 0; } Tue, 19 Sep 2023 06:00:00 -0500 Value-based payment /news/headline/2023-08-15-cms-requests-applications-new-primary-care-payment-model <p>The Centers for Medicare & Medicaid Services Aug. 14 released a request for <a href="https://innovation.cms.gov/media/document/mcp-rfa">applications</a> to participate in the Making Care Primary Model, a new value-based payment model beginning next July in Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, upstate New York, North Carolina and Washington. Announced in <a href="/news/headline/2023-06-08-cms-launch-new-primary-care-model-8-states?utm_source=newsletter&utm_medium=email&utm_campaign=aha-today">June</a>, the voluntary 10.5-year model aims to strengthen coordination between patients’ primary care clinicians, specialists, social service providers and behavioral health clinicians to prevent chronic disease, reduce emergency room visits and improve health outcomes. Participating organizations must have at least 125 Medicare patients and over half of their primary care sites in a participating state. The model also plans to engage state Medicaid agencies and private payers. <br />  <br /> CMS will host an Aug. 21 <a href="https://deloitte.zoom.us/webinar/register/WN_-W2vUFQzR9y1bVdxqWRDDw#/registration">Office Hour</a> to answer questions about the model and plans to open the application portal later this month. The agency encourages organizations that are interested but unsure whether to apply to submit a nonbinding <a href="https://app1.innovation.cms.gov/MCPLOI/s/">letter of intent</a>. For more information, visit the <a href="https://innovation.cms.gov/innovation-models/making-care-primary">CMS Innovation Center</a>.   </p> Tue, 15 Aug 2023 14:20:46 -0500 Value-based payment