Value Based Purchasing ACO Total Cost of Care ASHP 12 12
-
Upload
bonnie-senst-rph-ms-fashp -
Category
Documents
-
view
395 -
download
0
description
Transcript of Value Based Purchasing ACO Total Cost of Care ASHP 12 12
Planning Challenges in a Value Based Purchasing (VBP) Environment
Bonnie Senst, M.S., R.Ph., FASHP
Director of Pharmacy
Allina Health
Disclosure
Bonnie Senst reports no relevant financial relationships
Allina HealthIntegrated health system in MN and Western WI
Mission: We serve our communities by providing exceptional care, as we prevent illness, restore health and
provide comfort to all who entrust us with their care.
11 hospitals 24 hospital based clinics 60 physician clinics 5 ambulatory care
centers 15 community pharmacy
sites
Allina home and community services• Hospice, care
management, home care, home oxygen and medical equipment, senior care transitions
Objectives
Describe Medicare’s Value Based Purchasing (VBP)
program
Review VBP clinical and patient experience measures
and timelines
Discuss paradigm changes resulting from VBP and
Accountable Care Organization (ACO) models
Identify implications for pharmacy of VBP and ACOs
Case for Change
Health care expenditures
Waste in health care cost
Poor coordination of care/transitions
Harm during care
Lack of patient involvement
CMS Medicare Value Based Pricing
Redistributes acute hospital fee-for-service (FFS)
payments between hospitals based on quality
performance scores
Hospital funding reduced by 1% in FY 2013. Rises to
2% by FY 2017.
Hospital incentives to achieve clinical and patient
experience care quality measures
Yearly reset of clock
Weighted Domains and Impact: 2013, 2014 & 2015*2013
2014
2015
45% 30% 25%
20% 30%30% 20%
* FY 2015 measures and weights proposed
Process of Care Measures – FY 2013
Measures Number Scoring
AMI X 2
Achievementand
Improvement
HF X 1
PN X 2
SCIPX 5
(one 2014)
SCIP VTE X 2
SCIP CARD
Patient Experience – FY 2013
Measure Scoring
Overall rating
8 Measure Scoresand
Consistency
Nursing communication
Physician communication
Communication about medications
Staff responsiveness
Environment
Pain management
Discharge instructions
Outcome Measures – FY 2014/2015Measure
AMI 30 day mortality
HF 30 day mortality
PN 30 day mortality
AHRQ PSI
Central Line Infection
Efficiency – FY 2015Measure
Total Medicare spending per beneficiary
Measures of success in transformed care
Better care for individuals
Better health for the community
Reduction in the trend of health care costs
Changing Paradigms
Care teamsDiscipline specific care
Quality mandates, consistency, reliability
Quality reporting and improvement
Data transparencySelective reporting
Pay for quality outcomes and valuePay for volume
Alignment across continuumSilos of care
Total cost of careReimbursement pressure
Implications
Significant pharmacy demand and potential impact
Working in current world and new world concurrently
Skills and technical support systems required for TCOC
Coordination of care beyond walls and health systems
Placement of resources at optimal points in care continuum
Compete and collaborate simultaneously
Actively engage patients in their care