Volume-to-Value Transition:
How to Get Paid While You're Waiting

Despite CMS's aggressive agenda for moving Medicare to a value-based payment structure, it will take time before alternative reimbursement approaches are adopted across the healthcare continuum. So how can healthcare get paid in the meantime?

Bon Secours Medical Group isn't waiting for CMS to fully transition Medicare to pay-for-performance reimbursement models to get paid for providing value-based healthcare.

Instead, the 600-provider medical group has aligned itself closely with healthcare payment reform, applying a broad mix of patient-centered team-based care, technology and retooled care delivery systems to maximize quality and clinical outcomes and reduce spend associated with its managed patients.

In Positioning for Value-Based Reimbursement: Workforce Development for Transitional Care, Chronic Care Management, a new HIN resource, Jennifer Seiden, administrative director, population health, and Lu Bowman, population health market program manager explore Bon Secours' patient-centered approach. Learn more online at:
http://store.hin.com/product.asp?itemid=5019

"The HHS's historic announcement [of Medicare's value-based payment timeline] was a clear signal to the industry and to the market that we better align ourselves and set ourselves up for it," noted Ms. Seiden.

As far back as 2009, the prescient medical group had several pay-for-performance programs in place; in 2015, Bon Secours Good Health accountable care organization (ACO) is one of the largest participants in CMS's Medicare Shared Savings Program (MSSP).
Jennifer Seiden
Jennifer Seiden

Lu Bowman
Lu Bowman

Today, most Bon Secours tactics emanate from the principles of the patient-centered medical home (PCMH), she said, with a focus on taking a population-wide view and closely managing "below-the-waterline" patients, guiding them to the most appropriate care settings and following up on them post-discharge.

The multidisciplinary care team is so essential to this patient-centered approach Bon Secours has constructed a business case to justify the team, she added, using a "Back to Basics" ROI equation developed by Robert Fortini, vice president and chief clinical officer.

Lauding Fortini's efforts, Seiden explained the motivation behind his formula. "We had to develop a return on investment equation for the care team, because if you're an independent practice or even if you're employed, you've got to justify the expense of that additional overhead. That labor is not cheap."

Results, revenue and key metrics like the number of post-discharge office visits and readmissions are tracked via electronic dashboards and rolled into the ROI equation.

In Positioning for Value-Based Reimbursement: Workforce Development for Transitional Care, Chronic Care Management Ms. Seiden and Ms. Bowman share how a reframed approach to care transition management and chronic care management pays off in improved population health and decreased spend. Order your copy today online at:
http://store.hin.com/product.asp?itemid=5019

You may also be interested in these resources on value-based reimbursement: