“No Outcome, No Income”: How Population Health Management Powers the Transformation from Volume to Value

Abhinav Shashank
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What is the current state of healthcare? Where does the healthcare stand today? Are we ahead of what people think or do we still have to long way to go?

Healthcare is changing and there is no doubt about that. Not only do we spend too much on healthcare, but we also have one of the shortest lifespans than any other developed economy across the globe.

Source: CMS

The last Tuesday, David B. Nash MD, MBA, Founding Dean, Jefferson College of Population Health and Paul Grundy MD, MPH, FACOEM, FACPM, Founding President of the Patient-Centered Primary Care Collaborative (PCPCC), got together to share some great insights for healthcare organizations to succeed in the changing landscape of healthcare and stay financially stable.

Improving the quality of care delivered for every dollar spent

One instance that Dr. Grundy shared was when he asked one doctor about how many women over 55 years of age did not have a breast exam on file, and he received an astonishing reply. The doctor didn’t have any idea of how many women were over 55, let alone if they’ve had a breast exam.

Population health management and value-based care go hand-in-hand. Right PHM strategies drive the pay for performance success. After all, most payments are linked to performance targets for quality, process, and utilization.

63.53% of respondents believe that they understand PHM and have implemented some of its aspects

The growing surge of Alternative Payment Models in the US

With CMS launching its “Pathways to Success,” there is no denying that the flame is not just turned up for Medicare ACOs but every provider organization for adopting downside risk. This trend has led to the rising significance of risk-sharing.

While there are multiple APMs that organizations can participate in, bundled payments, accountable care organizations, and Medicare Advantage are, arguably, the most popular ones. The ACO model, too, is experiencing a major shift, courtesy CMS’ new regulations. While at the same time, Medicare Advantage plans are emerging to be one of the most successful and popular alternative payment models (APMs).

According to a poll conducted in the webinar, 71.52% of organizations are delivering care under one or the other MA contract

Bundled payment contracts are a new avenue in advancing care coordination and standardizing care pathways. Bundle risk holder reconciles costs with CMS quarterly and can lose millions if they are not able to hit the financial targets.

One major element that is a major contributor to the success or failure of organizations is the social determinants data. Paying attention to such factors and addressing them is a clear differentiator for organizations.

37.32% of respondents believe they are hitting their bundled payments journey and achieving financial targets

Succeeding in the changing landscape: Trends driving value-based payment contracts

Considering the growth of risk-taking trend, the healthcare space is drastically changing for payers and providers alike. They are being promoted to focus on two primary values:

  • Decreasing waste during the care-delivery process
  • Shifting towards consumerization

“No Outcome, No Income”: The watchword for the future

FFS payments accounted for only 37.2% of provider reimbursement during the year 2016 to 2018 and are projected to fall below 26% by 2021. Most APMs and value-based care contracts include a significant pay-for-performance component. In the future, there will be just one rule- “No Outcome, No Income.” Lower measure scores will result in lower pay while hitting the bull’s eye and achieving the measure targets will be the only key to receiving higher pay.

 

To know more about how you can prepare yourself for the changing landscape of payments with a data activation platform, get a demo.

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To understand how you can activate your clinical and non-clinical interventions and drive an enduring difference in the way care you care for your patients, go through our research on the impacts of social risk on populations, down to a ZIP code level.

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