HIMSS18 Keynote - Creating Strategic Alignment for a Value-based World
- 1. 1 Creating Strategic Alignment for a Value-Based World Keynote Leigh Williams, Administrator of Business Systems, UVA Health Justin Barnes, Director, Justin Barnes Advisors
- 2. 2 Agenda • Major legislative and policy factors • Clinical and financial stakeholders • Best practices for strategic alignment • Facilitated discussion
- 3. 3 Learning Objectives • Assess the major legislative and policy factors impacting the ongoing shift from fee-for-service to value-based care model and how these will affect reimbursement in 2018 • Demonstrate skills to align financial and clinical stakeholders to achieve success as reimbursement methods change and organizations depend financially on patient outcomes • Discuss best practices for fostering engagement from both clinical and financial stakeholders on issues that intersect those two disciplines
- 4. 4 Bountiful fishing and VBC analogy…
- 5. 5 The Current Legislative Landscape • Quality Payment Programs: MACRA, MIPS and other pushes towards tying reimbursement to outcomes • Continuation of Value-Based Purchasing • Disconnect between physician and hospital quality reporting/metrics • Heightened focus and support for interoperability, Open API’s and patient ID matching
- 6. 6 Medicare ACO Landscape • New CMS voluntary bundled payment model called Bundled Payments for Care Improvement Advanced – BPCI Advanced starts 10/1/18 – Qualifies as an Advanced APM • There are now 561 shared savings ACOs participating in Medicare's lowest-risk accountable care model. • ACOs serve 10.5M Medicare patients – Increase of 1.5M over 2017
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- 8. 8 Think Tank Value-based Care Key Takeaway’s • Create organization-wide glidepath from fee-for-service (FFS) to value-based care model – Scrutinize cost vs reimbursement, update policies, review business models • i.e. Quality Payment Program (QPP) is 95% FFS and 5% VBC – Pay close attention to find proper alignment between acute and ambulatory incentives • 80/20 Rule – Success relies on 80% process, 20% technology and on 100% culture • Be cognizant of barriers to portability and scalability of best practices – Culture, Human Behavior, Policies, Incentives, Payer Mix, Patient Population, Technology, etc.) • Use data and allocate assets to address topologies of diseases – Area deprivation index – “colder” areas have higher health-spend rates – Example – Understand communities that have spikes in certain diseases such as cancer, CHF, diabetes, etc.. and then deploy a proactive (instead of reactive) care engagement strategy
- 9. 9 Think Tank Value-based Care Key Takeaway’s •Leverage community resource to facilitate patient needs – i.e., community wellness programs and local grocery store nutritionist for diabetic care •Payer models need to reimburse more openly outside of their network to rightly support the patient and their needs (Best practice for both Value-Based and Virtual Care) •Research how the Direct Primary Care model is evolving locally and regionally •Examine reward and penalty system for physicians to improve outcomes – lead physicians to explore their office team structures – shared savings and shared risk (CPC+) •Be clear of patients’ end of life decisions (CPC+)
- 10. 10 Keeping the Patient at the Center • Weave value-based care or other quality outcomes priorities into operational considerations • Cascade outcomes goals from organizational priorities • Keeping the patient at the center focuses everyone Operation s Value- Based Care Priorities Patient
- 11. 11 Think Tank Future VBC Best Practice Goals •Some recommend providers be willing to take on more risk, others recommend providers hire appropriate staff/services to help address and assess risk •Additional physician and provider-led organization recommendations: – Take on more risk (a “best practice” recommended by most) – Learn to modify work flows to support value-based care and be in the “wellness business” – Create enhanced teams to delegate simple patient care, office management, patient care management (i.e., patient navigators, behaviorists, HIT-enhanced support), etc., to ensure that physicians maximize their time •Need to understand resource costs to produce true facility/ practice “costs” and not just what payers reimburse •Wearables/IoT need to improve provider workflows and create actionable data
- 12. 12 Think Tank Future VBC Best Practice Goals •Recommend both physician-led (bottom up) and health-system led (top-down) components to healthcare business models that offer the right input and flexibility •Recommend that physicians think in terms of value, as employers and not employees…this should start in medical school •Improve inter-organization communication, i.e., get discharge summary to PCP same day of hospital discharge and schedule follow-up •Recommend that C-Suite members better leverage each other and work seamlessly together as one unit; one goal for organization.
- 13. 13 Questions Leigh Williams ltwilliams@virginia.edu @leightw linkedin.com/in/leighwilliams Please complete an online session evaluation Justin Barnes justin@justinbarnes.com @HITAdvisor linkedin.com/in/justintbarnes