Value-Based Healthcare and Payment Models: Including Frontline Strategies for 20 Clinical Subspecialties

NEW GUIDE DECODES VALUE-BASED CARE AND PAYMENT MODELS

As value-based care is coming of age, deciding how to start can be an overwhelming task. Risks are high and success with the new models is challenging and time consuming. This book fills an important need by providing concrete and proven strategies to aid in an organization s successful transformation.

The book is filled with practical, no-nonsense advice on the shift to value-based care in both the private and public healthcare sectors. This is the time when healthcare stakeholders need to rethink their own added-value strategies in a manner that best serves patients and providers alike.

In the complicated world of payment and delivery system reform, this book deconstructs the most challenging concepts for the novice yet provides sophisticated insights for even the most seasoned executive.

BONUS! The authors also lay out high-value strategies for 20 different subspecialties with specialty-specific changes in the way medicine is practiced and paid for.

From the Foreword

With this manual, leaders of health systems and medical groups can achieve these goals and align their physicians, management, care teams, payers, and patients to deliver exceptional care that will improve quality while lowering costs, resulting in better care, better patient experience, and more affordable health care. Jerry Penso, MD, MBA, President and Chief Executive Officer, AMGA

Table of Contents

Chapter One: Introduction How Did We Get Here? The New Healthcare Is a Team Game The Move to Value Is Not Going Away Change Is Hard

Chapter Two: Elements of Value-Based Healthcare Components of Delivery Systems

Chapter Three: The Thorniest Problems Facing ACOs, and Solutions to These Challenges Challenge 1: Changing the Culture Challenge 2: Obtaining Actionable Data Through Technology Challenge 3: Integrating Care Models and Business Models

Chapter Four: A Deeper Dive into Building Sustainable Value-Based Care Assessing Organizational Readiness Characteristics of a High-Performing Health System Culture and Systems Thinking Leadership Professionalism Strategy Innovation and Design Thinking Change Management Execution Implementing New Models of Care Population Health Clinical Model Design and Management Core Clinical Technology Infrastructure Financial and Network Management Integrated Data and Secure Information Exchange Patient Engagement Population and Clinical Risk Management Components of Patient Care Redesign Development of Care Models Information Integration

Chapter Five: Value-Based Payment Models Categories of Payment Models Payment Model Redesign Design Considerations in Value-based Payment Models

Chapter Six: Optimizing Value Social Determinants of Health Strategic Partnerships Community Ecosystems and Reinvestment

Chapter Seven: Frontline Strategies From Subspecialists Anesthesiologists Cardiologists Child Psychiatrists Dermatologists Emergency Medicine Physicians Gynecologists Hospitalists Nephrologists Neurologists Obstetricians Oncologists Pediatricians Primary Care Physicians Pulmonologists Radiologists Rheumatologists Urologists

Chapter Eight: Conclusion

Grace E. Terrell, MD, MMM, CPE, FACP, FACPE, is CEO of Eventus Whole Health, a company focused on integrated value-based behavioral medicine and primary care in the long-term care space. She is a national thought leader in healthcare innovation and delivery system reform, and a serial entrepreneur in population health outcomes driven through patient care model design, clinical and information integration, and value-based payment models. She is the former CEO of Cornerstone Health Care, one of the first medical groups to make the move to value by lowering the cost of care and improving its quality for the sickest, most vulnerable patients; the founding CEO of CHESS, a population health management company; and the former CEO of Envision Genomics, a company focused on the integration of precision medicine technology into population health frameworks for patients with rare and undiagnosed diseases. Dr. Terrell currently serves on the U.S. DHHS Physician-Focused Payment Model Technical Advisory Committee and on the board of the AMGA, and is a founding member of the Oliver Wyman Health Innovation Center.

Julian D. Bo Bobbitt, Jr, JD, is head of the value-based health law practice group at the Smith Anderson law firm in Raleigh, NC, where he serves as Of Counsel. He is also founder and president of Value Health Partners, LLC, a value-based care and payment strategic consulting firm. In these capacities he provides experienced strategic and legal counsel to healthcare stakeholders across the country who are making the transition to integrated population health with performance payment. Bobbitt speaks nationally to both legal and medical audiences and is regularly published on emerging policy and health law issues in value-based delivery and regulation. He has formed and/or provided strategic and business direction to dozens of integrated entities, whether ACOs, CINs, IPAs or merged entities.