As we move into the second month of the new year, CozevaⓇ is gearing up for a new round of healthcare conferences, where industry leaders gather to conduct innovative discussions and give birth to new ideas and collaborative thought processes. This February, Cozeva will start its conference season at IHA’s 11th National Value-Based Payment and Pay for Performance Summit in San Francisco, which brings value-based care and payment reform to the forefront of discussion amongst pivotal healthcare leaders, vendors and decision-makers in the California market. Cozeva is excited to engage in these conversations that continue to shape the healthcare landscape.
Here’s a look at what Cozeva’s Vice President of Business Development, Joyce Lignell, believes are a few important topics that will impact the healthcare industry in 2016: CMS today covers 100 million people through Medicare, Medicaid and the Insurance Exchanges. While CMS supplies health coverage, that is not their only goal. They have set out to achieve higher quality health care at a lower cost all while improving the health of their recipients. We know this today as the triple aim. The healthcare industry at large follows the lead of CMS, who announced in early 2015 that their goal was to transition reimbursements for healthcare from largely fee-for-service to in some cases nearly 80% over to value-based-payments by 2018. As we’ve seen the last five years have been focused on the piloting of new payment models, new care delivery models and the rolling out of quality measures and initiatives across the continuum of health care. As we move into 2016 we are seeing a more solid shift towards including cost and utilization, additional levers in the value-based environment being included in all of CMS’ initiatives and programs. Some examples of this shift include: Next Generation ACO’s On January 11, 2016 CMS announced the participants who have been selected to participate in the Next Generation ACO model. The purpose of this newest model is to set predictable financial targets, enable providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care. Participants of this model are expected to be operating successfully in an ever-increasing value-based environment and participate in both the upside and downside risk. Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) MACRA is important to understand as it will impact physicians who service Medicare Part B directly. CMS intends to further align payment/reimbursements between Medicare Parts B and C to continue to shift providers towards value-based practices. The MACRA makes three important changes to how Medicare pays those who give care to Medicare beneficiaries. These changes include:
Ending the Sustainable Growth Rate (SGR) formula for determining Medicare payments for health care providers’ servicesMaking a new framework for rewarding health care providers for giving better care not just more careCombining the existing quality reporting programs into one new system
Bundled Payments for Care Improvement Initiatives (BPCI) While bundled payments are focused on the hospital side, it points to CMS’ overall strategy towards controlling costs and utilization. Bundled payments are designed to encourage care coordination and collaboration with the intention that through this coordination, utilization will be dispersed appropriately and will encourage alignment around the patient and better patient outcomes. Market Impacts Cozeva supports our clients as they continue to experience an ever-increasing pressure to shift over to a value-based eco-system. This pressure has crystallized the need for better tools, workflows and access to data in the following ways:
Decision-making The traditional healthcare system is often matrixed and committee driven. However, the value-based marketplace requires a faster, more iterative environment in which to test and launch new payment models and care delivery models.
Proliferation of measure sets and goals A multitude of payer pay-for-value initiatives and measures creates a workflow nightmare at the point of care.
Better, more intuitive use of real time, prospective and retrospective and predictive data More intuitive, real time data better supports clinical decisions at the point of care.
Visibility on value-based payments and reimbursements Real time, prospective and retrospective views are necessary to help a health plan, physician or practice track where the payments or reimbursements are at any given time. As fewer dollars are available on the claim, new ways of displaying and calculating payments and reimbursements are critical.
Patient experience Patient experience continues to grow as an area of focus for CMS, not only from a healthy outcomes perspective, but also on the overall patient experience within the healthcare system. Patients are also encouraged to exercise their ability to choose their doctors and compare them against other physician performance.
Cozeva Commitment to Innovation Cozeva will continue along our development trajectory of providing our clients with the most innovative, easy-to-use, workflow friendly solutions that address each of the pain-points mentioned earlier. We will continue to focus on robust analytics that are not only designed to illuminate macro issues such as the state of your population and performance of your network, but micro clinical data points that are like looking for a very expensive needle in a haystack. We will continue to develop tools that support a time-sensitive, risk-bearing environment while communicating through on-the-fly visualizations where those risks are and how it relates to cost, utilization and revenue. What does the healthcare landscape look like from your perspective? Share your thoughts with Cozeva at booth #15 at the 11th National Value-Based Payment and Pay for Performance Summit in San Francisco, February 17-19, 2016. And, while you’re there, join Cozeva’s Chief Medical Officer, Dr. Wayne Pan who will be speaking with Hawaii Medical Service Association’s Senior Vice President and Chief Medical Officer, Dr. Mark Mugiishi, on The Journey from FFS to Value-Based Care: the Health Plan Perspective – A Case Study with Hawaii Medical Service Association (HMSA) at Mini-Summit III on February 18, 2016 at 4:30pm. Perhaps we’ll see you at another conference too. Click here for a list of the conferences Cozeva will be attending in 2016.