Value Based Purchasing

What is MACRA

The Medicare Access and CHIP Reauthorization ACT of 2015 (MACRA) is a bipartisan legislation signed into law on April 16, 2015

explain HDHPs

if consumers have to pay more out of pocket, they shop around more. look at all of your options before you get something.

accountable care contracts vs lives covered over time have gone up or down?

up

Description of the Value-Based Purchasing (VBP) Model

"Value Based-Purchasing" refers to a range of activities initiated by public and private purchasers of health care to use comparative performance information to publicly recognize, select, and financially reward health care vendors, particularly health plans and providers. The goal of value-based purchasing is to improve the quality, safety, and affordability of health care services.

VALUE-BASED PURCHASING" STRATEGIES THAT ARE DISRUPTING HEALTH CARE

1)Using Data and Promoting Transparency 2)Value-based Insurance Design 3)Waste Reduction: non-coverage, tiered structures 4)Group Purchasing 5)Direct Contracting with Providers 6)Payment Reform 7)Consumer Engagement (HDHP's and other strategies) Population Health Management

What is an ACO?

ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients.

What does the Quality Payment Program created by MACRA do?

Repeals the Sustainable Growth Rate formula Changes the way that medicare rewards clinicians for value over volume Streamlines multiple quality programs under the new Merit Based Incentive Payments System (MPS) Gives bonus payments for participation in eligible alternative payment models (APMs) MACRA also required us to remove SSNs from all Medicare cards by April 2019.

What is the hospital readmissions reduction program?

The Hospital Readmissions Reduction Program (HRRP) is a Medicare value-based purchasing program that reduces payments to hospitals with excess readmissions. The program supports the national goal of improving healthcare for Americans by linking payment to the quality of hospital care.

what is the HAC

The Hospital-Acquired Condition (HAC) Reduction Program is a Medicare pay-for-performance program that supports the Centers for Medicare and Medicaid Services (CMS) effort to link Medicare payments to healthcare quality in the inpatient hospital setting to encourage eligible hospitals to reduce HACs

What is value directly related to

•Value INCREASES if: - just Quality increases - just Costs decrease -Quality increases and costs decrease

what does it mean by transparency?

lets say you undergo a procedure, or get a healthcare service. Do you really know the actual price of it and what value we are getting from it. what do we get for our money.

Hospital Readmissions

•30 day readmission rates calculated for select conditions -Acute MI, CHF, and pneumonia since 2012. -COPD and hip and knee replacements added for 2015 •Hospitals with excessive readmission rates can be penalized up to 3% of Medicare revenue

The Triple Aim

•Better Care (Quality and Patient Experience) •Better Health (Individual and Population) •Lower Cost •Quadruple Aim adds Better Provider Experience

Hospital VBP Program

•Complex algorithm: -Patient experience (H CAHPS) (30%) -Clinical process measures (20%) - Efficiency measures (20%) -Outcomes mortality, complications, infections (30%) •Points awarded for achievement, improvement, and consistency •Up to 1.5% of Medicare payment at risk

CMS Hospital VBP Programs

•Hospital Readmissions Reduction Program •Hospital VBP Program •Hospital-Acquired Condition Reduction Program --- Hospitals derive 44% of their revenue from Medicare. CMS has economic power.

Value-based Pricing of Pharmaceuticals

•Shift from paying for volume to paying for value •Value is determined by appropriateness and effectiveness (outcome) •Pricing may be partially or fully rebated if expected outcome not achieved, or manufacturer may receive "bonus" for outcomes achievement

HAC Program

•Up to 1% penalty for hospitals in the top quartile of HAC rates as measured on Hospital Compare