On the third annual US News Hospital tomorrow The Forum, a case study looked at the journey from fee-for-service to fee-to-value payments, and explained how healthcare systems can use tools built through analytics New reimbursement model, Resulted in improved health care.
The speaker was Gregory Kael, senior vice president of insurance and payer strategies at Leh Valley Health Network, Eastern Pennsylvania, and president and CEO of Populix; And Allison Yuddt, director of value-based contracts at Populix, an advanced analytics firm.
Both Keil and Yudt explained the importance of using predictive analysis to identify high-risk patient populations. Doing so informs strategies for coordination and care for these patients, he said, and leads to paid innovations.
KL cited LVHN’s employee health plan as proof of the concept of how well analytical tools work to create savings focused on clinical initiatives. “We’re not looking at the rearview mirror, we’re actually hitting targets,” he said. In the first year, he said, the goal was $ 3.1 million in savings, and his group “hit it out of the park.”
Data tools include clinical pathway analytics. Yud exemplified a patient with breast cancer, and briefly displayed a clinical-oncology dashboard, one of several partner organizations to consider treatment. Clinical partners have taken the lead in developing treatment guidelines.
Youdt describes the quality measures used in value-based contracts, and how a large number of measures can be complex and cumbersome for providers. The measure may not conform to payer contracts, she noted.
Populatics is working to align quality and usage measures, Eudt said. While it provides incentives to therapists aimed at improving performance, a simple, one-page report allows doctors to compare their performance with their peers.
To that end, Populytics shuts down the information flashing by analytical tools for the health care team. And LVHN deploys resources for health care providers, with high levels of resources dependent on the level of risk of patients.
Chronically ill patients with conditions such as congestive heart failure require more health management, and benefit from the community care team. Teamwork is important, the presenters said. Together, social workers, pharmacists, behavioral health specialists and care managers help streamline and improve the quality of care of the patient.
During the session, in a video showing a heart failure patient, a nurse care manager called her at home and asked her to investigate – to make sure her weight wasn’t suddenly increasing, and that she Was taking medicine properly. The care manager also helped the patient, who could no longer afford all the medicines, apply for a free-prescription program.