Planning Challenges in a Value Based Purchasing (VBP) Environment

Bonnie Senst, M.S., R.Ph., FASHP

Director of Pharmacy

Allina Health

Disclosure

Bonnie Senst reports no relevant financial relationships

Allina HealthIntegrated health system in MN and Western WI

Mission: We serve our communities by providing exceptional care, as we prevent illness, restore health and

provide comfort to all who entrust us with their care.

11 hospitals 24 hospital based clinics 60 physician clinics 5 ambulatory care

centers 15 community pharmacy

sites

Allina home and community services• Hospice, care

management, home care, home oxygen and medical equipment, senior care transitions

Objectives

Describe Medicare’s Value Based Purchasing (VBP)

program

Review VBP clinical and patient experience measures

and timelines

Discuss paradigm changes resulting from VBP and

Accountable Care Organization (ACO) models

Identify implications for pharmacy of VBP and ACOs

Case for Change

Health care expenditures

Waste in health care cost

Poor coordination of care/transitions

Harm during care

Lack of patient involvement

CMS Medicare Value Based Pricing

Redistributes acute hospital fee-for-service (FFS)

payments between hospitals based on quality

performance scores

Hospital funding reduced by 1% in FY 2013. Rises to

2% by FY 2017.

Hospital incentives to achieve clinical and patient

experience care quality measures

Yearly reset of clock

Weighted Domains and Impact: 2013, 2014 & 2015*2013

2014

2015

45% 30% 25%

20% 30%30% 20%

* FY 2015 measures and weights proposed

Process of Care Measures – FY 2013

Measures Number Scoring

AMI X 2

Achievementand

Improvement

HF X 1

PN X 2

SCIPX 5

(one 2014)

SCIP VTE X 2

SCIP CARD

Patient Experience – FY 2013

Measure Scoring

Overall rating

8 Measure Scoresand

Consistency

Nursing communication

Physician communication

Communication about medications

Staff responsiveness

Environment

Pain management

Discharge instructions

Outcome Measures – FY 2014/2015Measure

AMI 30 day mortality

HF 30 day mortality

PN 30 day mortality

AHRQ PSI

Central Line Infection

Efficiency – FY 2015Measure

Total Medicare spending per beneficiary

Measures of success in transformed care

Better care for individuals

Better health for the community

Reduction in the trend of health care costs

Changing Paradigms

Care teamsDiscipline specific care

Quality mandates, consistency, reliability

Quality reporting and improvement

Data transparencySelective reporting

Pay for quality outcomes and valuePay for volume

Alignment across continuumSilos of care

Total cost of careReimbursement pressure

Implications

Significant pharmacy demand and potential impact

Working in current world and new world concurrently

Skills and technical support systems required for TCOC

Coordination of care beyond walls and health systems

Placement of resources at optimal points in care continuum

Compete and collaborate simultaneously

Actively engage patients in their care