Marys Medicine

Powerpoint presentation

Value-Based Payment:
Where Are We?
Where Do We Need to Go?
Earl Steinberg, MD, MPP
EVP, Innovation & Dissemination, GHS
CEO, xG Health Solutions
April 2, 2015

Where Are We?
• We are in the very early stages of healthcare
– Still primarily FFS – Much of what is called VBP is upside only • Forces for change vary markedly market by market
– Structure; Payer, employer, provider behavior • Providers are aware of waste, but their current
business model depends on volume
• If providers wanted (or had reason) to reduce cost of care, they could. Payment change is key! Confidential property of xG Health Solutions, Inc.
Re-creation or delivery to another party in any format is strictly prohibited.

Where Are We? (cont.)
• It's not all just about VBP – Providers are being pressured to deliver lower cost and higher quality care, regardless of pace of shift from FFS to performance- or risk-based payment – FFS payment rates are steady or being rolled back, rather – There's competition to be included in narrow networks of providers who are lower cost and higher quality – Increase in cost borne by patients is making consumers more discriminating • States vs Feds vs Commercial Insurers• VBP models (e.g., ACOs, shared savings, BP) have to be financially sustainable for providers • Need multi-payer solutions Confidential property of xG Health Solutions, Inc.
Re-creation or delivery to another party in any format is strictly prohibited.

Success Under Value-Based Payment Requires:
Changes in provider behavior
• Culture
• Staffing
• Data
• Standardized ‘best practices'
• Clinical workflow facilitation
• Decision support
Changes in patient behaviors
• Informed decision making
• Motivational interviewing
• Care coordination and navigation
Confidential property of xG Health Solutions, Inc.
Re-creation or delivery to another party in any format is strictly prohibited.
• Most providers don't know how to move
from ‘volume' to ‘value' without undermining their financials.
• Most providers lack the capabilities to
succeed under risk-based payments.
Confidential property of xG Health Solutions, Inc.
Re-creation or delivery to another party in any format is strictly prohibited.
Providers Are Struggling with Multiple Variables in the
Transition to Value-Based Payment
• Which payer(s)?
– Self-insured employer; Medicare; commercial fully insured, ASO; Medicaid; 1 or >1 • Which patients?
– All; adults or peds; procedures; Dx • Which providers?
– Facilities; MDs • How do I do it?
– Organization; management; data analytics; re-engineering of care • How much risk should I take?
– None (upside only); shared upside/downside;full; establish own health plan Confidential property of xG Health Solutions, Inc.
Re-creation or delivery to another party in any format is strictly prohibited.
Challenges & Opportunities
Tools and platforms alone are
Know-how and ‘support services'
not sufficient to produce results
are needed as well
Data analyses need to probe below Need to be able to recognize highest
the surface & inform the user ROI actionable opportunities
How you use results of analyses Need to integrate results into
workflows and know how to intervene
is what matters most Providers need payer-agnostic Providers need to practice
the same way regardless of payer
Providers won't embark on a suicide
Financial stability is critical march; Payment models have to be
financially sustainable for providers
Breaking things down will facilitate a less
Simplify the complexity
overwhelming "volume-to-value" roadmap
Confidential property of xG Health Solutions, Inc.
Re-creation or delivery to another party in any format is strictly prohibited.
xG Health Was Created to Generalize and Scale
Geisinger Innovations and Know-How
PRODUCT DEVELOPMENT
& SERVICE DELIVERY
CORE OPERATIONS
Mission: Execute Core Business/Innovate
Geisinger
Reduced Cost
Health Plan
Quality &
Improved
Quality and
xG Health
Improved
Geisinger
Clinical
Clinical
Innovation &
Improved Patient &
Confidential property of xG Health Solutions, Inc.
Re-creation or delivery to another party in any format is strictly prohibited. Confidential property of xG Health Solutions, Inc. - Re-creation or delivery to another party in any format is strictly prohibited.
Systematic Approaches + Integration of
Actionable Insights into Workflows
Actions By
xG Health Tools
& Support
Superior
• Proven care redesign
Clinical &
solutions
Financial
• Experienced personnel
• Online learning
• CM Software
• "Apps" that interface
with EHRs
• Claims
• Portal with pre-defined
drill downs
• Patient-
• Patient engagement
Confidential property of xG Health Solutions, Inc.
Re-creation or delivery to another party in any format is strictly prohibited.
We've Productized and Generalized and We're Now
Doing Things at Scale
2013 / 2014
Implementing at Scale
Transformed and enhanced
"raw" Geisinger IP and
Advanced PCMHs and training
Adapted Geisinger approaches
to various environments
evidence-based best practices
Proved they work in
- Bundled payment for episodes
- Actionable cost and care
Developed scalable approaches
Integrating results of data
analyses into clinical workflow
Confidential property of xG Health Solutions, Inc.
Re-creation or delivery to another party in any format is strictly prohibited.
Interoperable Software Apps Will Transform
Care Delivery
The EHR World
The Future
Data dispersed, not easy Data are extracted, re- organized and presented Useless text copied and in a user-friendly way pasted repeatedly Workflow facilitated via Workflows not efficient or clinical logic; results of Improves quality of care analyses are integrated Decision support based Little analytically on analysis of data supported clinical outside and inside the expensive to employ decision support Difficult to implement Increases HCC scores create new modules Confidential property of xG Health Solutions, Inc.
Re-creation or delivery to another party in any format is strictly prohibited.
Transforming Care Through Software Apps
Launching in Summer 2015
Brief Clinical History
Mr. Bean is a 72 year old man with a hx of CAD, COPD, HTN last
seen primary care by Dr. Spock 4 months ago (5/14/13). Last
seen by me 1 year ago (8/13/12). Mr. Bean is due for evaluation
of his CAD (last check 3/15) and COPD (last check 2/18).
Assessment & Plan
CKD STAGE 3: Kidney disease, chronic, stage III (GFR 30-59 ml/min);
DM type 2 causing CKD stage 3
ACCUPRIL 20 MG PO TABS (starts today)
Procedures: NEPHROLOGY REFERRAL OP Previous Plan as of 9/24/2014
GFR decrease is concerning. Stopped metformin ok to continue metformin for dm for DM, Patient referred to Nephrology for consult. Started Accupril. Confidential property of xG Health Solutions, Inc.
Re-creation or delivery to another party in any format is strictly prohibited.
Envision a Portfolio of EHR-Agnostic Software
Apps That Improve Quality and Reduce Cost
D/C Planning & TOC
Management of
Confidential property of xG Health Solutions, Inc.
Re-creation or delivery to another party in any format is strictly prohibited.
• No turning back from value-based • More providers signing risk-based • More providers accepting reduced • States, as employers and Medicaid plans, will likely lead the way • Medicare Advantage margins • Providers will need to deliver lower cost of care to survive

Source: https://conferences.naacos.com/sp2015/pdf/Wednesday/Steinberg_Earl.pdf