Presentation on APMs to AACE PDF
Preview Presentation on APMs to AACE
CREATING A PHYSICIAN-LED HEALTHCARE FUTURE Designing Alternative Payment Models for Better Care, Lower Cost, & Financially Viable Physician Practices Harold D. Miller President and CEO Center for Healthcare Quality and Payment Reform www.CHQPR.org How Do You Control Growing Healthcare Spending? $ TOTAL TOTAL TOTAL HEALTH TOTAL HEALTH HEALTH CARE HEALTH CARE CARE SPENDING CARE SPENDING SPENDING SPENDING TIME Center for Healthcare Quality and Payment Reform www.CHQPR.org 2 Typical Strategy #1: Cut Provider Payments $ SAVINGS TOTAL TOTAL HEALTH Cut TOTAL HEALTH CARE Provider Pmts HEALTH CARE SPENDING CARE SPENDING SPENDING TOTAL HEALTH CARE SPENDING BY PAYERS Center for Healthcare Quality and Payment Reform www.CHQPR.org 3 Typical Strategy #2: Shift Costs to Patients $ SAVINGS TOTAL TOTAL HEALTH TOTAL HEALTH CARE HEALTH CARE SPENDING CARE SPENDING SPENDING TOTAL HEALTH CARE SPENDING BY PAYERS Higher Cost-Share & Deductibles Center for Healthcare Quality and Payment Reform www.CHQPR.org 4 Results of the Typical Strategies • Small providers forced out of business • Consolidation of providers to resist cuts in fees • Shifts in care to higher-cost settings • Increases in utilization to offset losses in revenue • Patients avoiding necessary care due to high cost-sharing • Large increases in health insurance premiums • Inability to afford health insurance Center for Healthcare Quality and Payment Reform www.CHQPR.org 5 Results of the Typical Strategies • Small providers forced out of business • Consolidation of providers to resist cuts in fees • Shifts in care to higher-cost settings • Increases in utilization to offset losses in revenue • Patients avoiding necessary care due to high cost-sharing • Large increases in health insurance premiums • Inability to afford health insurance IS THERE A BETTER WAY? Center for Healthcare Quality and Payment Reform www.CHQPR.org 6 The Right Focus: Spending That is Unnecessary or Avoidable $ AVOIDABLE AVOIDABLE SPENDING AVOIDABLE SPENDING AVOIDABLE SPENDING SPENDING NECESSARY NECESSARY NECESSARY NECESSARY SPENDING SPENDING SPENDING SPENDING TIME Center for Healthcare Quality and Payment Reform www.CHQPR.org 7 Avoidable Spending Occurs In All Aspects of Healthcare $ AVOIDABLE SPENDING NECESSARY SPENDING Center for Healthcare Quality and Payment Reform www.CHQPR.org 8 Avoidable Spending Occurs In All Aspects of Healthcare SURGERY •Unnecessary surgery $ •Use of unnecessarily-expensive implants •Infections and complications of surgery •Overuse of inpatient rehabilitation CANCER TREATMENT AVOIDABLE •Use of unnecessarily-expensive drugs SPENDING •ER visits/hospital stays for dehydration and avoidable complications •Fruitless treatment at end of life •Late-stage cancers due to poor screening CHEST PAIN DIAGNOSIS/TREATMENT •Overuse of high-tech stress tests/imaging •Overuse of cardiac catheterization NECESSARY •Overuse of PCIs, high-priced stents SPENDING CHRONIC DISEASE •ER visits for exacerbations •Hospital admissions and readmissions •Amputations, blindness Center for Healthcare Quality and Payment Reform www.CHQPR.org 9 Avoidable Spending Occurs In All Aspects of Healthcare SURGERY •Unnecessary surgery $ •Use of unnecessarily-expensive implants •Infections and complications of surgery •Overuse of inpatient rehabilitation HOW BCIAGNCER TREATMENT AVOIDABLE •Use of unnecessarily-expensive drugs SPENDING •ER visits/hospital stays for dehydration and avoidable complications ARE THE •Fruitless treatment at end of life •Late-stage cancers due to poor screening OPPORTCHUESNT PAIITN DIIEAGNSOS?IS/TREATMENT •Overuse of high-tech stress tests/imaging •Overuse of cardiac catheterization NECESSARY •Overuse of PCIs, high-priced stents SPENDING CHRONIC DISEASE •ER visits for exacerbations •Hospital admissions and readmissions •Amputations, blindness Center for Healthcare Quality and Payment Reform www.CHQPR.org 10
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