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While others wait for the healthcare industry to complete its transition to value-based reimbursement, Bon Secours Medical Group has already aligned itself with payment reform, leveraging its care team and providers and automating workflows
to enjoy immediate rewards from its patient-centered approach.
Positioning for Value-Based Reimbursement: Leveraging Care Management for Clinical and Financial Outcomes
describes how this 600-provider medical group has primed its providers to employ a broad mix of team-based care, technology and retooled care delivery systems to maximize quality and clinical outcomes and reduce spend associated with its managed patients.
In this 25-page resource, Jennifer Seiden, administrative director, population health, Bon Secours Medical Group, and Lu Bowman, population health market program manager, Bon Secours Medical Group, share how a reframed approach to care transition management and chronic care management pays off in improved population health and decreased spend.
In Positioning for Value-Based Reimbursement: Leveraging Care Management for Clinical and Financial Outcomes, Ms. Seiden and Ms. Bowman review the following:
- Medical home principles at the heart of BSMG's accountable care approach;
- Reshaping the care team to include EMTs, pharmDs, community workers, and others;
- Adopting a population health mindset that encompasses the full practice panel instead of just patients seen daily;
- Technologies to identify and manage patients 'below the waterline';
- Use of nurse navigators to manage care for high-complexity patients;
- The return on investment equation that builds a business case for team-based care and protects this valuable investment;
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Practical considerations for billing via Medicare's new Chronic Care Management codes—eligibility, reporting, exclusions, and others;
- Care coordination responsibilities in BSMG's advanced patient-centered medical home model;
and much more, including program results and ROI and the role BSMG envisions for skilled nursing facilities in coordinating patient transitions across the care continuum.
Table of Contents
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Bon Secours Medical Group Workforce Development for Transitional Care, Chronic Care Management
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Evolution to Value-Based Contracting
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Medical Home Principles Form Care Foundation
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Profiting from Healthcare's Transition to Value-Based Care
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Stratifying Below the Water Line
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Moderate- Versus High-Complexity Patients
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Return on Investment Equation
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Care Management Services
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Billing with Medicare Chronic Care Management Code
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Chronic Care Management Reporting
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Care Team in Advanced Patient-Centered Medical Home
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Results and ROI
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Q&A: Ask the Experts
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Using EMTs in Team-Based Care
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Educating Patients on Chronic Care Management Codes
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Telehealth CPT Codes for Commercial Payors
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Documenting Care Coordination
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Role of SNFs in Bon Secours Continuum
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Use and Benefits of Patient Registries
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Remote Monitoring in Chronic Care
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Using Respiratory and Physical Therapists
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Glossary
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For More Information
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About the Contributors
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