Presentation to AMA State Legislative Strategy Conference

240 Pages·2015·3.47 MB·English

by  Harold Miller

WIN-WIN-WIN APPROACHES
TO ACCOUNTABLE CARE
Payment and Delivery Reforms
That Can Improve Patient Care,
Control Healthcare Spending, and
Support Successful Physician Practices
Harold D. Miller
President and CEO
Center for Healthcare Quality and Payment Reform
www.CHQPR.org
In the U.S.,
A Historic Legislative Success
ACA
Affordable Care Act
Goal:
Every citizen should have affordable healthcare
Method for Achieving the Goal:
Give all citizens insurance that would cover the cost
of healthcare services when needed
© 2009-2015 Center for Healthcare Quality and Payment Reform www.CHQPR.org 2
How to Control Spending on Care
When Insurance Is Paying?
© 2009-2015 Center for Healthcare Quality and Payment Reform www.CHQPR.org 3
How to Control Spending on Care
When Insurance Is Paying?
Pay for Parts?
© 2009-2015 Center for Healthcare Quality and Payment Reform www.CHQPR.org 4
What’s the Real Problem With
Fee for Service Payment?
FFS
“Rewards Volume, Not Value”
© 2009-2015 Center for Healthcare Quality and Payment Reform www.CHQPR.org 5
What’s the Real Problem With
Fee for Service Payment?
“I wish I could stop ordering more tests,
but I can’t control myself”
© 2009-2015 Center for Healthcare Quality and Payment Reform www.CHQPR.org 6
The Real Problem is the Barriers
FFS Creates to High-Value Care
BARRIERS IN FFS TO
HIGH QUALITY, AFFORDABLE CARE
LACK OF
FLEXIBILITY
•No payment for
phone calls or emails
with patients
•No payment to
coordinate care
among providers
•No payment for non-
physician support
services to help
patients with self-
management
•No flexibility to shift
resources across
silos
© 2009-2015 Center for Healthcare Quality and Payment Reform www.CHQPR.org 7
The Real Problem is the Barriers
FFS Creates to High-Value Care
BARRIERS IN FFS TO
HIGH QUALITY, AFFORDABLE CARE
LACK OF PENALTY FOR
FLEXIBILITY QUALITY/EFFICIENCY
•No payment for •Lower revenues if
phone calls or emails patients don’t make
with patients frequent office visits
•No payment to •Lower revenues for
coordinate care performing fewer tests
among providers and procedures
•No payment for non- •Lower revenues if
physician support infections and
services to help complications are
patients with self- prevented instead of
management treated
•No flexibility to shift •No revenue at all if
resources across patients stay healthy
silos
© 2009-2015 Center for Healthcare Quality and Payment Reform www.CHQPR.org 8
Most Current “Payment Reforms”
Don’t Fix The Problems with FFS
P4P Shared Savings
PMPM
Shared Savings
FFS
FFS
FFS
FFS
•No payment
for services
that will benefit
patients
•Lower
revenues from
reducing
avoidable
costs
© 2009-2015 Center for Healthcare Quality and Payment Reform www.CHQPR.org 9
Medicare is Slowly Cutting FFS
Without Actually Changing It
2014 2015 2016 2017 2018 2019
-4%
-5.5-6.5%
-8%
-11%
-12%+
-13%+
FFS
FFS
FFS
FFS
FFS
FFS
+
+
+
+
+
MU MU +
MU
MU
MU
+ + MU
+
+
+
PQRS PQRS +
PQRS
PQRS
PQRS
+ + PQRS
+
+
+
VBM VBM +
VBM
VBM
VBM
VBM
© 2009-2015 Center for Healthcare Quality and Payment Reform www.CHQPR.org 10