creating strategic alignment for a value-based world

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Creating Strategic Alignment for a Value-Based WorldSession 415, March 8, 2018

Leigh Williams, Administrator of Business Systems, UVA Health

Justin Barnes, Director, Justin Barnes Advisors

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Leigh Williams, MHIIM, CPHIMS

Has no real or apparent conflicts of interest to report.

Conflict of Interest

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Justin Barnes, FHIMSS

Advisory Boards: Gozio Health and ePatientFinder

Ownership Interest: Advantum Health

Other Interests: This Just In Radio Show

Conflict of Interest

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Agenda• Major legislative and policy factors

• Clinical and financial stakeholders

• Best practices for strategic alignment

• Facilitated discussion

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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

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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

• Reduced overall budget

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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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Think Tank Value-based Care Key Takeaways

•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

•Leverage community resource to facilitate patient needs – e.g., community wellness programs and local grocery store nutritionists for diabetic care

•Payer models need to reimburse more openly outside of their network to rightly support the patient and their needs

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Think Tank Value-based Care Key Takeaways

•Reward and penalty system for physicians to improve outcomes

– led physicians to explore their office team structures

– shared savings and shared risk (CPC+)

•Research how the Direct Primary Care model is evolving in communities

•Be clear of patients’ end of life decisions (CPC+)

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Think Tank Value-based Care Key Takeaways

Future Best Practice Goals

•Care providers / physicians should:

– Take on more risk (recommended by some) or hire appropriate staff/services to help address risk

– Learn to change their workflows to support value-based care and be in the “wellness business”

– Create enhanced teams to delegate simple patient care, office management, patient care management (e.g., patient navigators, behaviorists, HIT-enhanced supports), etc., to ensure that physicians maximize their time

•Need to know resource costs to produce true “cost” and not just what payers pay

•Wearables need to improve provider work flows and create actionable data

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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

Operations

Value-Based Care

Priorities

Patient

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Future Best Practice Goals• Need both physician-led (bottom up) and health-system led

(top-down) components to healthcare business models that offer the right input and flexibility

• Need to get physicians to think in terms of value, as employers and not employees starting in med school

• Improve inter-organization communication (e.g., get discharge summary to PCP same day of hospital discharge and schedule follow-up)

• C-Suite members need to leverage each other and work seamlessly together as one unit

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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