Population Health in the Age of Health Care Reform Texas Association for Healthcare Financial Administration Seminar Series - Wichita Falls, Texas March 14, 2014. Joshua M. Weaver Polsinelli, PC (214)661-5514 [email protected] Ashley E. Johnston Gray Reed & McGraw, PC (469) 320-6061
Population Health in the Age of Health Care ReformTexas Association for Healthcare Financial Administration Seminar Series - Wichita Falls, TexasMarch 14, 2014
Joshua M. Weaver
Ashley E. Johnston
Gray Reed & McGraw, PC
What is Population Health?
Why the Focus on Population Health?
Potential Delivery Models
Sources: *Commonwealth Fund; Institute of Medicine, 2011; Medicare Office of Actuary; ** Kaiser Family Foundation
Total Healthcare Expenditure as % of GDP
United States vs. the World
(Source: World Bank)
Average spending on health per capita
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2011.
Total: Over 6% of total Medicare payments at risk !!!
Change will happen
Those who wait will be left behind
No single solution for everyone, but
Quality, satisfaction and lower cost required!
The “Triple Aim” is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which called the “Triple Aim”:
Improving the patient experience of care (including quality and satisfaction);
Improving the health of populations; and
Reducing the per capita cost of health care.
Current / Potential Delivery ModelsKey Considerations
Level of Integration
CIN Governance – Board and Committees Current Delivery Models?
CIN/ACO Entity (New)
HIE, Portals, Messaging, Care Management, Credentialing
CI and other contracts/ funds
Participation Agreements (provider services)CIN/ACO Example: Legal, Relationship & Governance Structure
Surgical Home JOC
Pediatric Head CT JOC
End of Life Care JOC
Clinical Ethics & Palliative Care
Employers Bearing More Risk, Turning to Providers as Allies Current Delivery Models?Why the Focus on NN/BPs?Shift to Self-Funding
Employer Interest in Provider-Oriented Strategies
Percentage of Self-Insured Employers
Partially or Completely Self-Insured
Adopt new accountable payment models
Contract directly with hospitals, physicians, ACOs
Offer incentives for care coordination
In Place in 2013
Planned for 2014
Offer performance-based payments
Employers want a reliable product with predictable and stable costs
Network Provider Agreement Current Delivery Models?
Group / Health System / Provider
Network Provider Agreement
Participating Network Provider Agreement
Discussion Current Delivery Models?
Joshua M. Weaver Current Delivery Models?