Population Health Management; A Strategy and Delivery Model

It’s clear that healthcare reform, population health management and  value-based payment trends are leading payors, hospitals, health systems and medical groups to consider new delivery models and strategies to enhance their capabilities in providing value-based care, reducing cost  and improving quality and efficiency.

CMS and payors are looking to accelerate the transition from volume to value and population health through targeted incentives. Going forward, healthcare leaders need to understand population health management concepts and should pay close attention to evolving federal and commercial payment structures so they can position their organizations for financial success in the new value-based world.

A refined and comprehensive population health management strategy can advance important goals for an anesthesia group and their affiliated health care organization:

  • Enhancement of quality of care and improvement of patient outcomes;
  • Promotion of safe medical practices;
  • Sharing of best clinical practices;
  • Increased efficiency in care delivery;
  • Facilitation of appropriate utilization of services; and
  • Alignment of financial incentives.

Mastering these population health concepts will be a must for anesthesia groups that want to stay in sync with their hospital administrators, who are looking to position their organizations for success in this new value-based world.

Value Based Payments for Physicians

H.R.2 – Medicare Access and CHIP Re-authorization Act of 2015 was passed by the House on March 26, 2015 and the Senate on April 14, 2015.  While the title of the law indicates one of the topics of the bill (removing the sustainable growth rate (SGR) methodology from the determination of annual conversion factors in the formula for payment for physician services), the title is not representative of a major change that could affect all physicians.  Under the Medicare Access and CHIP Reauthorization Act of 2015, the Secretary of Health and Human Services is directed to consolidate components of the three specified existing performance incentive programs into a new Merit-based Incentive Payment (MIP) system under which physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists, would receive annual payment increases or decreases based upon their performance as measured by standards the Secretary shall establish according to specified criteria. 

Additionally, the Government Accountability Office (GAO) is directed to examine similarities and differences in the use of quality measures under the original Medicare Fee for Service program, Medicare Advantage Program, selected state medical assistance programs (Medicaid), and private payer arrangements and make recommendations on how to reduce the administrative burden on applying such measures.

The pace of changing from fee for service to value based payment models is likely to accelerate in the next coming 1 to 3 years.  It is critical when considering an incentive payment structure to do two things  – (1) review lessons learned and (2) complete a baseline assessment of your practice.  Numerous lessons have been learned from Accountable Care Organization providers and providers who are participants in Value Based Programs.  These lessons are critical to review before entering into incentive based programs.  Additionally it is important to complete a baseline measurement for applicable quality measures and review possible methods of improvement prior to making a contractual commitment.

Authored by Valerie ShahriariFlorida Healthcare Law Firm Blog