are you future proof?are you future proof? how bundled payment can help us rethink healthcare 0...
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ARE YOU FUTURE PROOF?How bundled payment can help us
rethink healthcare
0
Bundled Payment SummitOctober 13, 2011Susan DeVorePresident and CEO
Begin with the end in mind…
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The context: Unsustainability
•
Projected deficits•
Medicalization of social issues
•
Compounding demographics•
Fragmentation
•
Jobs•
Income
•
Politics
2
How do we get THERE from here?
3
How to Future-Proof in a time of transition
4
Radically Different Mindset
Stress Test
Re-craft Care
Delivery
Scale Innovate
5
Stakeholder Value Model
CUSTOMER“Better health,
lower cost, and a good experience for the patient”
POPULATION NEEDS
DELIVERY PROMISEON THE
DELIVERY TEAMS
Build…Test…Scale…Along the road to value
6
Value Based Purchasing
Preventable harm, readmissions,
mortality
Medical Home
Re-crafted care delivery system
Risk-assuming re-
crafted care
delivery system
Predictable capitated care
delivery systemBundled Payment
Care model must fundamentally change
Process, Outcomes, Population Health
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Process Improvement (Evidence-Based Care)
Systematic improvement (Inpatient/outpatient value)
Population total value
Payer Partners
► Insurers
► Employers
► States
► CMS
Bundled Payment
Advanced measures framework - DRAFT
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Goal:
Value =Health (time)
Experience
Expenditures
+
Drivers
Primary Secondary Tertiary Quaternary
•
Healthy Days (Patient reported)
•
Physical•
Mental•
Both•
Other (Social)
Patient….•
Pain•
Mobility•
Symptoms•
Lifestyle Risks
Clinical…•
Biometrics•
Past medical history…•
Outcomes (Population specific)
Care Delivery Processes•
Disease-specific•
Care model•
Care paths•
Transitions of care
Overall patient experience
•
Satisfaction•
Confidence (self)•
Confidence (care team)
•
Setting-specific surveys•
Provider-specific surveys•
Disease-specific surveys
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Patient engagement/ activation
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Provider culture
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Health delivery expenditures
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Non-HC delivery cost (opportunity cost)
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Payor•
Patient and lost wages
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Productivity•
Absenteeism•
Employer-sponsor health programs
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Wellness-
Incentives
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(RE) Admission•
ER visits•
Provider costs•
Rx cost/utilization•
Post-acute care•
Utilization-
Diagnoses-
Procedures- Surgery
•
Home health network (Primary care)-
Care team
•
Disease specific cost of care
•
Focused measures of waste and overuse
•
Focused measures of harm and treatment failures
NQF High-Impact Clinical Conditions by Priority
Considerations for bundled payment
•
Which conditions should be considered?
•
What providers and services should be included in the bundle?
•
How are provider accountabilities determined?
•
What is the appropriate timeframe?
•
What infrastructure does the organization need to administer the bundled payment?
•
What fundamental changes in care delivery need to be occur?
•
How will payments be set?•
How will payments be distributed?
•
What risk adjustments need to be considered?
•
What measurement tools need to be put into place to understand results post-
implementation?
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Making the leap to bundled payment What we can learn from a car dealership
Key Drivers
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Financial imperative
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Accountability
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Risk
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Productivity & Quality
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Payment & Profitability
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Ability to Drive Desired Effects/Outcomes
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Mindset change from volume to value –
longer warranties require better quality control along entire value chain.
•
Preventing and identifying defects
•
Assigning accountability
•
Intermingled incentives require stronger relationships, shared vision, trust, and structured way to resolve conflicts
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Factors contributing to successful implementation of bundled payments
•
Board and physician leadership
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Organizational structure•
Pricing methodology for bidding
•
Evidence-based medical practice guidelines with detailed clinical metrics and decision support to measure quality and case progression
•
Supply (implants) cost management
•
Process efficiency and length-of-stay management
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Clinical IT•
Proactive, aggressive case management
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Business development and marketing strategy
•
Financial management system
12Source: HFMA April 2011
Consequences
Intended•Encourages providers to coordinate care•Reduction in fragmented care for patients.•Standardization of clinical process•Better clinical outcomes•Reduced cost•Aligned incentives between providers•Better care experience•Data driven care management•Shared savings anti trust clearance•Lower readmissions•Drives additional market share.
Unintended•Volume spikes as unit price declines•Market concentration•Reduction in choice•Administrative cost increases•Fixed cost shifting•Additional measurement requirements•Significant profit erosion•Payor
involvement in implant procurement
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WILL YOU BE FUTURE PROOF?
THANK YOUFor questions or comments:
Susan_DeVore@Premierinc.com
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