You're too damn insulated in your doctor bubble. The value is that patients get results rather than a service or procedure. Think for a little bit about your patients.You're a bit too quick to go into blame the victim mode.
http://medcitynews.com/2016/07/value-accountable-care/?utm_source=hs_email
Accountable care is supposed to be about paying for value. But six
years after passage of the Affordable Care Act heralded the shift away
from fee-for-service, Dr. Greg Carroll, corporate clinical leader of GOHealth Urgent Care, has an important question: “Where’s the value?”
That was the subject of a lively panel discussion at MedCity CONVERGE this week in Philadelphia.
“We really need to get to the level of what motivates behavior
change,” said Carroll. After all, everybody is a little bit different in
what motivates them, Carroll explained, and the movement to
performance-based payment requires behavior change on multiple levels.
Those paying the bulk of the bills in healthcare for patients not old
enough for Medicare — employers, via insurance premiums — don’t seem to
get value-based healthcare yet.
Christina M. Miles, senior vice president for delivery system transformation at human resources consulting firm Aon Hewitt,
presented some eye-opening data from a 2015 company survey. Just 11
percent of respondents said they “fully understand” healthcare provider
performance from a cost perspective, while 9 percent said the same about
provider performance from a quality standpoint.
In each case, more than 31 percent were not even aware of clinically
integrated performance initiatives within their company plan’s
healthcare networks, Miles said. “In most cases, the majority of
employers just aren’t there.”
Those in on the front lines are not discouraged, though. “Value-based contracting is one of our key corporate pillars at Aetna,” said David Van Houtte, of the payer’s Accountable Care Solutions division.
Aetna currently puts about 40 percent of its total healthcare dollars
into value-based contracts, Van Houtte said. The goal is to have that
at 75 percent by 2020.
That aggressive shift parallels efforts at the federal level. The Centers for Medicare and Medicaid Services has said
it wants 85 percent of all Medicare fee-for-service reimbursements tied
to quality or value by the end of 2016, including shifting 30 percent
of reimbursements to alternative payment models — think bundled payments
or Accountable Care Organizations. The goals rise to 90 percent and 50 percent, respectively, by 2018.
Miles said to “be encouraged” that for the first time, CMS is driving much of the evolution.
It has providers rethinking what they do, for sure.
“My full-time job is basically change management,” said Dr. Katherine Schneider, president and CEO of Delaware Valley ACO,
comprising Main Line Health, Jefferson University and Hospitals, Holy
Redeemer Health System, Doylestown Health, and Magee Rehab in the
Philadelphia area. It’s one of 77 ACOs contracting with Aetna, she said,
and the organization also participates in the Medicare Shared Savings Program.
The hope for Delaware Valley ACO was to get 5,500 lives in MSSP in
its first year. The organization actually enrolled 35,000 the first
year, and now is above 130,000, plus 100,000 more commercially insured
members in ACO programs. Participating organizations earned $6.5 million
from CMS for saving Medicare $13 million last year, Schneider said.
She offered some words of advice to those contemplating their own
ACOs. “The ACO is all about the C. It’s the care model that matters,”
Schneider said.(So I guess results mean nothing?)
“We’re very primary care-centric even though we’re part of an integrated health system,” she added.
Miles also emphasized primary care and prevention. “The hospital bed
becomes a cost center rather than a profit center,” she said. The same
is true about the emergency department.”
“We tend to forget the patient,” Miles said. “They’re the end user.”
Miles noted that employers today are hesitant to require their
employees to choose a PCP, a throwback to the unpleasant HMO era. She
surmised that it may be time to go there again.
“We have to keep our eyes on the True North here,” Miles said. That’s the Triple Aim of safer care, improved population health and lower costs.
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