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Driving Value-Based Reimbursement with Integrated Care Models
Driving Value-Based Reimbursement with Integrated Care Models
Driving Value-Based Reimbursement with Integrated Care Models
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The burgeoning fee-for-value environment is rewarding networks of providers who collaborate and coordinate care, bridging the gap between health systems and physicians and sparking dialog and care compacts between primary care and specialists.

Even top-performing Pioneer ACOs are rethinking the role of specialists in care coordination.

And after a successful pilot and system-wide rollout of its practice transformation initiative, WellPoint is poised to move to the next level, building a bridge between primary care and specialty practice transformation to create a medical neighborhood.

Driving Value-Based Reimbursement with Integrated Care Models examines WellPoint's practice transformation effort and the reimbursement models that support it, while providing a framework in which to evaluate the patient-centered medical neighborhood (PCM-N) model.

In this 45-page resource, Julie Schilz, director of care delivery transformation for WellPoint, and Terry McGeeney, MD, MBA, director of BDC Advisors, share their visions for this emerging care experience, from structuring incentives and reimbursement to reward high-quality and efficient care to identifying and engaging specialists in a medical home neighborhood.

This HIN special report provides details on the following:

  • Three key practice transformation roles developed by WellPoint that address the critical elements of transformation;
  • How the physician practice transformation program complements WellPoint's overall reimbursement strategy with fee-for-service and a shared savings component;
  • The Quality Gate for clinical and utilization metrics for WellPoint's shared savings arrangement;
  • Overcoming physician resistance to practice transformation, especially transformation driven by a healthcare payor;
  • The evolution of practice transformation, including its connection of primary care and specialists in care delivery collaborations;
  • Details on WellPoint's planned 2014 medical home neighborhood pilot with select specialties;
  • Key components of the medical home neighborhood;
  • How to identify and engage specialists to participate in a medical neighborhood;
  • How to help physicians understand the link between meaningful use, the patient-centered medical home and medical neighborhoods;
  • Care coordination across the neighborhood; and
  • Lessons learned in building medical neighborhoods.

Driving Value-Based Reimbursement with Integrated Care Models goes on to respond to more than 20 questions on these new horizons in care coordination, from details on the Primary Care-Specialist care compact in WellPoint's medical home neighborhood to clarifying the difference between an accountable care organization and a medical neighborhood.

Table of Contents

  • Aligning Value-Based Reimbursement with Physician Practice Transformation
    • 4-Part Payment Reform Overview
    • Elements of Transformation Program
    • 3 Transformation Program Roles
    • Primary Care Transformation Resources
    • Learning Opportunities
    • Performance Assessments
    • Patient Reports Available to Care Teams
    • Aligning with Government Initiatives
    • Challenge of Leaving No Primary Care Practice Behind
    • Looking Toward Patient-Centered Specialty Care
  • Medical Home Neighborhoods: Uplinking Specialists To Create Integrated Systems of Care
    • Healthcare Doing Business in a New Way
    • Features and Principles of the Patient-Centered Medical Home
    • Why Providers and Payors Should Care About the PCMH
    • Challenges to PCMH Success
    • Changing Expectations for Physician Practices
    • Introducing the Medical Neighborhood and Integrated Networks
    • 6 Key Features of the PCM-N
    • Clinically Integrated Networks
    • 10 Characteristics of Ideal Specialists for a PCM-N
    • Principles of a High-Functioning Healthcare Team
  • Q&A: Ask the Experts
    • Using Care Management Resources
    • Data Exchange to Facilitate Value-Based Reimbursement
    • Location of Practice Support Staff
    • Interacting with Specialists
    • Care Compact in Wellpoint Medical Home Neighborhood
    • Working with IPAs and PHOs
    • Wellpoint Care Team Reports
    • Incentives for Patient-Centered Goals
    • Working with Narrow Networks
    • Challenges to Practice Transformation
    • Wellpoint Medical Home Neighborhood
    • Wellpoint and the Comprehensive Primary Care Initiative
    • Identifying Providers for the Medical Neighborhood
    • Conveying Medical Neighborhood Structure to Patients and Plan Members
    • Difference between ACO and Medical Neighborhood
    • Examples of Effective Medical Neighborhoods
    • Features of a High-Functioning Medical Neighborhood
    • Meaningful Use and the Medical Neighborhood
    • Strategies to Build Practice Capacity
    • Improving Communication Across the Medical Neighborhood
  • Glossary
  • For More Information
  • About the Speakers
Publication Date: March 2014
Number of Pages: 45
ISBN 10: 1-941329-00-4 (Print version); 1-941329-01-2 (PDF version)
ISBN 13: 978-1-941329-00-9 (Print version); 978-1-941329-01-6 (PDF version)
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