This presentation highlights the rapid shift to value-based care that's occurring in the healthcare industry and was originally presented at Premier's annual Governance Conference.

1. The Expansion and Acceleration of
Value-Based Care
Joe Damore, Service Line Vice President, Population Health, Premier, Inc.
PANELISTS:
Blair Childs, Senior Vice President of Public Relations
Mark Hiller, Vice President of Engagement and Delivery, Innovative Consulting
Ariann Polasky, Senior Director of Provider Products
MODERATOR:

2. Agenda
• Welcome/Introductions
• Overview of Value-Based Care
• Understanding MACRA
• The expansion of Bundled Payments/CJR
• Measurement reporting: preparing for change
• Question & answer session
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3. Explaining the acceleration to value-based care
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Federal government commitment to move from volume to value
• Secretary Burwell’s announcement (1/26/15)
• MACRA bi-partisan approval
• CJR bundled program required in 67 markets (approx. 800 hospitals)
• Additional MSSPs/Next Gen ACOs
National commercial health plans are moving ahead with new value based payment models
Early results look promising
• Bending the Medicare cost curve
• Several states are reporting early success(MD, Oregon)
• United Healthcare PCMH “white paper”
State Medicaid value based reform is growing
• DSRIP (NY, CA, TX, NJ, VA, etc.)
• Episode of Care model (AK, TN, OH)
• ACO Model (CO, OR, AL)

4. Medicare Access & CHIP Reauthorization Act of 2015
On 3/26, the House passed
H.R. 2 by 392-37 vote.
On 4/14, the Senate passed the
House bill by a vote of 92-8, and
the President signed the bill.
“MACRA” Replaces the 1997 SGR formula, which
capped Medicare physician per beneficiary spending
growth at GDP growth rate
• Overwhelming bipartisan support.
• Provides new tools in implementing payment reforms.
• Applies to MD, DO, PA, NP, Clinical nurse specialist, CRNAs
• 2021 includes therapists, psychologists, social workers,
audiologists, and dieticians.
• Creates clear timetable/benchmarks.
• Two options for physicians/providers
• Merit Based Incentive Payment system (MIPS)
• Alternative Payment Models (APMs)

5. MACRA reform timeline
(Medicare Access and CHIP Reauthorization Act of 2015)
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6. Value-based reimbursement across payment silos
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7. Track 1: MIPS program and measures weighting
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8. 8
Track 2: 5% bonus for qualifying APMs

9. Nationwide adoption of Bundled Payment
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Bundled Payment for Care
Improvement :
1,618 participants in 4 models
Comprehensive Care for Total
Joint Replacement:
800 hospitals in 67 MSAs

10. • Mandatory 5-year program
• Begins April 1, 2016
• Focused on hip and knee replacement
• Hospital held accountable for quality and cost
of care from admission to 90 days post-
discharge
• Downside financial risk begins in PY2
Comprehensive Care for Joint Replacement (CJR) Model

11. Succeeding in bundles: What should we be doing now?
Program oversight and
financial risk elements
Cross continuum care
pathways / care models
Post-acute
partnerships Provider engagement
Bundled payment analytics,
reporting & reconciliation
Quality performance
measurement
Interaction with other
payment models
(ACO, MSSP, etc)

12. For more information please contact us:
population_health@premierinc.com