Presentation to AMA State Legislative Strategy Conference PDF
Preview Presentation to AMA State Legislative Strategy Conference
WIN-WIN-WIN APPROACHES TO ACCOUNTABLE CARE Payment and Delivery Reforms That Can Improve Patient Care, Control Healthcare Spending, and Support Successful Physician Practices Harold D. Miller President and CEO Center for Healthcare Quality and Payment Reform www.CHQPR.org In the U.S., A Historic Legislative Success ACA Affordable Care Act Goal: Every citizen should have affordable healthcare Method for Achieving the Goal: Give all citizens insurance that would cover the cost of healthcare services when needed © 2009-2015 Center for Healthcare Quality and Payment Reform www.CHQPR.org 2 How to Control Spending on Care When Insurance Is Paying? © 2009-2015 Center for Healthcare Quality and Payment Reform www.CHQPR.org 3 How to Control Spending on Care When Insurance Is Paying? Pay for Parts? © 2009-2015 Center for Healthcare Quality and Payment Reform www.CHQPR.org 4 What’s the Real Problem With Fee for Service Payment? FFS “Rewards Volume, Not Value” © 2009-2015 Center for Healthcare Quality and Payment Reform www.CHQPR.org 5 What’s the Real Problem With Fee for Service Payment? “I wish I could stop ordering more tests, but I can’t control myself” © 2009-2015 Center for Healthcare Quality and Payment Reform www.CHQPR.org 6 The Real Problem is the Barriers FFS Creates to High-Value Care BARRIERS IN FFS TO HIGH QUALITY, AFFORDABLE CARE LACK OF FLEXIBILITY •No payment for phone calls or emails with patients •No payment to coordinate care among providers •No payment for non- physician support services to help patients with self- management •No flexibility to shift resources across silos © 2009-2015 Center for Healthcare Quality and Payment Reform www.CHQPR.org 7 The Real Problem is the Barriers FFS Creates to High-Value Care BARRIERS IN FFS TO HIGH QUALITY, AFFORDABLE CARE LACK OF PENALTY FOR FLEXIBILITY QUALITY/EFFICIENCY •No payment for •Lower revenues if phone calls or emails patients don’t make with patients frequent office visits •No payment to •Lower revenues for coordinate care performing fewer tests among providers and procedures •No payment for non- •Lower revenues if physician support infections and services to help complications are patients with self- prevented instead of management treated •No flexibility to shift •No revenue at all if resources across patients stay healthy silos © 2009-2015 Center for Healthcare Quality and Payment Reform www.CHQPR.org 8 Most Current “Payment Reforms” Don’t Fix The Problems with FFS P4P Shared Savings PMPM Shared Savings FFS FFS FFS FFS •No payment for services that will benefit patients •Lower revenues from reducing avoidable costs © 2009-2015 Center for Healthcare Quality and Payment Reform www.CHQPR.org 9 Medicare is Slowly Cutting FFS Without Actually Changing It 2014 2015 2016 2017 2018 2019 -4% -5.5-6.5% -8% -11% -12%+ -13%+ FFS FFS FFS FFS FFS FFS + + + + + MU MU + MU MU MU + + MU + + + PQRS PQRS + PQRS PQRS PQRS + + PQRS + + + VBM VBM + VBM VBM VBM VBM © 2009-2015 Center for Healthcare Quality and Payment Reform www.CHQPR.org 10
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