Value based Reimbursement Essay 3

Describe the issues that were researched in the two selected Peer reviewed articles and how it enriches or relates to Value based Reimbursement.

– Include a summary of the articles and then your personal and team approach/comments (listed below) supported by the two peer-review articles

—Personal & team Approach:

***** As a team we feel as though all organizations should adopt value based reimbursement because it is more consumer friendly and is patient centered instead of organization centered. Long term Value based reimbursement will create better outcomes.*****

Attached are the two peer reviewed selected articles: PLEASE READ BOTH ARTICLES TO ASSIST IN WRITING THE TWO PAGES

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B e c k y K u h n , FACHE, a n d C h u c k L e h n S u m m a r y • Many organizations in healthcare are moving rapidly to adopt value-based reimbursement (VBR) models that reward value instead of vol ume. By shifting a significant percentage of clinical and financial risk from payers to providers, VBR programs can help reduce costs significantly, improve the quality of care, and increase efficiency. The experience of Banner Health Network (BHN) with VBR in commercial and government plans indicates that a large health system can transition to VBR with renewed focus on quality, cost efficiencies, population health management tactics, and member engagement.

In December 2011, BHN was selected in a competitive bid process as one of 32 organizations to participate in a Centers for Medicare & Medicaid Ser vices (CMS) value-based demonstration initiative called the Pioneer account able care organization (ACO). As a Pioneer ACO with consistent and positive results, BHN, based in Phoenix, Arizona, has demonstrated that VBR can lead to results that are beneficial to the member, the healthcare organization, and the community. BHN has been a top performer in returning shared savings to Medicare while improving appropriate service utilization and performance on quality metrics.

The development of simultaneous commercial ACO products was a re quirement of the Pioneer agreement with CMS, as well as a clear goal for BHN. The initial period of ACO partnership formation revealed an uncomfortable re ality: Payers and providers would need to collaborate and share information as never before. Further, many payers were uncertain about working closely with providers who were working simultaneously with other payers on similar part nerships. Before long, however, there were enough successful VBR arrange ments to allay these initial payer anxieties. Today, BHN has high-value network arrangements with nearly every major payer in Arizona. Value based Reimbursement Essay 3

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Becky Kuhn, FACHE, is executive vice p re s id e n t f o r c o m m u n i t y delivery at Banner Health

in Phoenix, A r iz o n a . Chuck Lehn is executive vice p re s id e n t o f s tra te g ic g ro w th at Banner H ealth .

B e c k y K u h n , F A C H E , a n d C h u c k L e h n • 17

After moving steadily toward value- based reimbursement (VBR) for more than a decade, BHN has amassed a m em bership of about 350,000 covered lives. Moreover, 92 percent of BHN’s member ship is insured through a risk-bearing relationship.

BHN’s strategies and tools for VBR range from clinical to technical. Engaged provider partners have been an essential component without whom success would not be possible. Banner Health care m an agement teams working with our provid

ers are focused on the development and imple mentation of evidence- based clinical practices across the enterprise to make sure that members receive the most expedi ent and efficient care with the fewest complications.

Facility-based and community-based nurse case management allows members to re ceive the guidance, education, and clinical support they need to achieve the highest possible level of personal wellness and avoid unnecessary hospital admissions. Enabling technologies, such as telehealth, are showing great potential in creating virtual connections between patients and their caregivers. Claims data and an inter nal enterprise data warehouse drive popu lation health tactics and feed electronic health records (EHRs) to enable provi sion of the best possible care. Finally, a new area of focus for BHN is a post-acute strategy to ensure that the continuum of care does not end abruptly when members transition to post-acute care providers in the community.

Although the move to VBR requires a commitment to meeting cost and qual ity benchmarks, integration of care at

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all levels, and a significant information technology (IT) infrastructure, BHN’s ex perience demonstrates a clear potential for organizations that successfully navigate the gap between a fee-for-service (FFS) world and VBR.

I n t r o d u c t i o n After several years of slow but steady adop tion, VBR models appear to be on their way to replacing FFS as the predominant reimbursement system in US healthcare. McKesson (2014) estimates that VBR will overtake FFS by 2020, with 90 percent of payers and 81 percent of providers already using some mix of both. In the first score- card on payment reform released in March 2013 by the not-for-profit Catalyst for Payment Reform (2013), only 11 percent of payments to providers were not under an FFS model. One year later, the second report card (Catalyst for Payment Reform and Health Care Incentives Improvement Institute 2014) reported that 40 percent of commercial health plan payments were made through methods designed to improve quality and reduce waste (see Exhibit 1 for details about waste in the U S healthcare system). Value based Reimbursement Essay 3