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MORE Medical Home Reimbursement Models: ROI from Risk Adjustment, Shared Savings and Multi-Payor Partnerships
Healthcare Intelligence Network, June 2010, Pages: 45
The newly enacted Patient Protection and Affordable Care Act is rife with incentives, pilots and demos to improve healthcare delivery and efficiency — many of which are directly tied to team-based, integrated care approaches such as the patient-centered medical home (PCMH).
The newest strategies for generating revenue from the PCMH are documented in MORE Medical Home Reimbursement Models: ROI from Risk Adjustment, Shared Savings and Multi-Payor Partnerships.
In this 45-page resource, learn how the identification of high-risk patients, meaningful distribution of healthcare data and collaborations with like-minded organizations are increasing medical home profitability for three healthcare organizations - including one that has been touted as 'the gold standard for healthcare reform:'
- Get inside details on Grand Junction, Colorado's shared savings model - an approach that first gained notoriety when The New Yorker contrasted its low-cost, high-quality delivery with one of the most expensive healthcare systems in the country. Grand Junction hospitalist, family physician and healthcare consultant Dr. David West shares the four strategies that have helped to hone the area's cost efficiencies in the face of physician shortages, high numbers of uninsured and many of the same challenges faced by healthcare systems around the country.
- Dr. Jeff Schiff, medical director of Minnesota healthcare programs for the Minnesota Department of Human Services, describes the state's risk-adjusted reimbursement model for medical homes. Dr. Schiff dissects the risk-adjusted methodology at work in Minnesota, where health plans are required by law to include healthcare or medical homes in their networks. The delivery system has a built-in payment reform that reflects the patient's complexity and the time required by the medical home to care for complex patients. This novel approach to management of chronic disease is showing early returns of improved outcomes and reduced costs.
- Sharing lessons learned from Colorado's nearly three years of participation in a multi-state multi-payor medical home pilot is Julie Schilz, co-chair of the Center for Multi-Stakeholder Demonstrations and IPIP manager for the Colorado Clinical Guidelines Collaborative. Ms. Schilz describes four key considerations for a multi-payor medical home program - from establishing demonstration guidelines and gaining stakeholders' support to considerations for payment reform and alignment of demonstration goals.
Drawing upon the benefits of her experience since initially presenting the multi-payor pilot in 2007, Ms. Schilz also addresses the practicalities of practice recruitment and screening, the pilot's three-pronged reimbursement model and the challenges of integrating participating practices into a medical home neighborhood.
In addition to funding fundamentals from these innovative models, this resource describes other program aspects supporting cost-efficient care delivery, including:
Colorado's learning collaborative and quality improvement coach;
- Grand Junction's secrets to reducing readmissions of Medicare patients;
- How Grand Junction is capitalizing on the competitive nature of physicians and peer review to bring healthcare costs in line;
- Minnesota's consideration of some non-medical complexity factors that can increase the amount of time required from the care team;
and much more.
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Reimbursement Models for Medical Homes: From Pilot to Practice, a September 24, 2008 webinar on CD-ROM
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