Presentation on APMs to AACE

248 Pages·2016·5.38 MB·English

by  Harold Miller

CREATING A PHYSICIAN-LED
HEALTHCARE FUTURE
Designing Alternative Payment Models
for Better Care, Lower Cost,
& Financially Viable Physician Practices
Harold D. Miller
President and CEO
Center for Healthcare Quality and Payment Reform
www.CHQPR.org
How Do You Control Growing
Healthcare Spending?
$
TOTAL
TOTAL
TOTAL HEALTH
TOTAL HEALTH
HEALTH CARE
HEALTH CARE
CARE SPENDING
CARE SPENDING
SPENDING
SPENDING
TIME
Center for Healthcare Quality and Payment Reform www.CHQPR.org 2
Typical Strategy #1:
Cut Provider Payments
$ SAVINGS
TOTAL
TOTAL HEALTH Cut
TOTAL HEALTH CARE Provider Pmts
HEALTH CARE SPENDING
CARE SPENDING
SPENDING
TOTAL
HEALTH
CARE
SPENDING
BY
PAYERS
Center for Healthcare Quality and Payment Reform www.CHQPR.org 3
Typical Strategy #2:
Shift Costs to Patients
$
SAVINGS
TOTAL
TOTAL HEALTH
TOTAL HEALTH CARE
HEALTH CARE SPENDING
CARE SPENDING
SPENDING
TOTAL
HEALTH
CARE
SPENDING
BY
PAYERS
Higher
Cost-Share &
Deductibles
Center for Healthcare Quality and Payment Reform www.CHQPR.org 4
Results of the Typical Strategies
• Small providers forced out of business
• Consolidation of providers to resist cuts in fees
• Shifts in care to higher-cost settings
• Increases in utilization to offset losses in revenue
• Patients avoiding necessary care due to high cost-sharing
• Large increases in health insurance premiums
• Inability to afford health insurance
Center for Healthcare Quality and Payment Reform www.CHQPR.org 5
Results of the Typical Strategies
• Small providers forced out of business
• Consolidation of providers to resist cuts in fees
• Shifts in care to higher-cost settings
• Increases in utilization to offset losses in revenue
• Patients avoiding necessary care due to high cost-sharing
• Large increases in health insurance premiums
• Inability to afford health insurance
IS THERE A BETTER WAY?
Center for Healthcare Quality and Payment Reform www.CHQPR.org 6
The Right Focus: Spending
That is Unnecessary or Avoidable
$
AVOIDABLE
AVOIDABLE
SPENDING
AVOIDABLE
SPENDING
AVOIDABLE
SPENDING
SPENDING
NECESSARY NECESSARY NECESSARY NECESSARY
SPENDING SPENDING SPENDING SPENDING
TIME
Center for Healthcare Quality and Payment Reform www.CHQPR.org 7
Avoidable Spending Occurs
In All Aspects of Healthcare
$
AVOIDABLE
SPENDING
NECESSARY
SPENDING
Center for Healthcare Quality and Payment Reform www.CHQPR.org 8
Avoidable Spending Occurs
In All Aspects of Healthcare
SURGERY
•Unnecessary surgery
$
•Use of unnecessarily-expensive implants
•Infections and complications of surgery
•Overuse of inpatient rehabilitation
CANCER TREATMENT
AVOIDABLE •Use of unnecessarily-expensive drugs
SPENDING •ER visits/hospital stays for dehydration
and avoidable complications
•Fruitless treatment at end of life
•Late-stage cancers due to poor screening
CHEST PAIN DIAGNOSIS/TREATMENT
•Overuse of high-tech stress tests/imaging
•Overuse of cardiac catheterization
NECESSARY •Overuse of PCIs, high-priced stents
SPENDING
CHRONIC DISEASE
•ER visits for exacerbations
•Hospital admissions and readmissions
•Amputations, blindness
Center for Healthcare Quality and Payment Reform www.CHQPR.org 9
Avoidable Spending Occurs
In All Aspects of Healthcare
SURGERY
•Unnecessary surgery
$
•Use of unnecessarily-expensive implants
•Infections and complications of surgery
•Overuse of inpatient rehabilitation
HOW BCIAGNCER TREATMENT
AVOIDABLE •Use of unnecessarily-expensive drugs
SPENDING •ER visits/hospital stays for dehydration
and avoidable complications
ARE THE
•Fruitless treatment at end of life
•Late-stage cancers due to poor screening
OPPORTCHUESNT PAIITN DIIEAGNSOS?IS/TREATMENT
•Overuse of high-tech stress tests/imaging
•Overuse of cardiac catheterization
NECESSARY •Overuse of PCIs, high-priced stents
SPENDING
CHRONIC DISEASE
•ER visits for exacerbations
•Hospital admissions and readmissions
•Amputations, blindness
Center for Healthcare Quality and Payment Reform www.CHQPR.org 10