In 2019, the State of Maryland implemented an advanced primary care model that works across hospitals, physician practices, and the health care continuum in which the state is held fully at risk for Medicare TCoC.
- Align performance measures and incentives for all providers with TCoC goals and discuss the use of:
- A per capita, population-based payment for care management
- A performance-based incentive to reduce unnecessary hospitalizations
- Ensure availability of tools and resources provided by Care Transformation Organizations (CTOs)
- Discuss anticipated impacts on primary care and specialty physicians, SNFs, independent clinical labs, and other participating organizations
- Understand the similarities, differences, and interplay of the model with existing APMs
- Discuss results to-date and a future opportunity to align the model with Medicaid and Medicare Advantage
Executive Director, Maryland Primary Care Program(MDPCP), Department of Health
State of Maryland
Vice President and Chief Population Health Officer
With the advent of new and upcoming payment models, post-acute care must shift modalities of care in order to achieve maximum reimbursement, likely leading to a drastic change in the makeup of the clinical staff at most facilities.
- Expand recruitment efforts to accommodate new payment models
- Manage existing staff in the wake of changing care modalities
Director, Rehabilitation Services, Program Director, Post-Acute Services
Memorial Hermann Hospital - Texas Medical Center
Success in a value- based care contracts requires the development of a focused post-acute strategy to drive performance and improve patient care management, experience, and outcomes. Close coordinated care efforts between facilities eliminate communication gaps and lower the likelihood of ED readmissions due to error.
- Find the gaps in communication in order to create a more efficient system
- Optimize use of tools and team-based care to ensure that the patient and the provider have all necessary information
- Set realistic expectations for patients and providers for their care
Senior Director, Population Health
Emerson Physician Hospital Organization
Emerson Physician Hospital Organization
In order for value-based health care to achieve everyone’s needs both clinically and financially, all stakeholders must collaborate and take a joint approach to care that breaks down the traditional silos of care.
- Include all relevant stakeholders in program development, to determine clinical and financial objectives, and as possible, to help inform the negotiation process
- Take a collaborative approach to care improvement efforts by working with each other’s strengths and weaknesses
Senior Medical Director, Accountable Care
Johns Hopkins Medicine
System Vice President, Post-Acute Services
Memorial Hermann Health System
For years, value-based care has worked to align health care payments with health care value by using incentives to reduce spend, increase quality or both. Much of the value-based care research performed to date has focused on how these programs reduce costs or improve quality, but few have evaluated the correlation between the two.
However, new research to be released by Harvard this summer, and performed in collaboration with UnitedHealthcare, explains that successful value-based programs have three core dimensions. The first two are the financial incentives commonly used as rewards for reduced spending and improved quality. But it’s the third dimension that’s the potential diamond in the rough – the non-financial infrastructure supports that care providers may receive in their work with payers. Learn more about these infrastructure supports.
- Identify organizational structures and operational best practices, such as data sharing capabilities, increased focus on care management
- Enable payer-provider relationship transformation through collaboration, shared values, and mutual benefits
- Understand the long-term commitment from leadership necessary, including big investments and real risk required dedication from the top down
Catalyst Health Network
Senior Vice President, Population Health Management