How Value-Based Purchasing Works and Affects Your Hospital
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Transcript of How Value-Based Purchasing Works and Affects Your Hospital
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How Value-Based Purchasing Works and Affects Your Hospital
Jennifer P. Lundblad, PhD, MBA, CEOVicki Tang Olson, RN, MS, Program Manager
Trustee PresentationJanuary, 2014
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Session GoalTo provide an orientation to hospital trustees about the shift from volume to value in U.S. health care and the role of value-based purchasing, leading to understanding of the role of a hospital board trustees in a value-driven environment.
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The Stratis Health Perspective• Independent, nonprofit Minnesota organization
founded in 1971– Mission: Lead collaboration and innovation in health care
quality and safety, and serve as a trusted expert in facilitating improvement for people and communities
• Working at the intersection of research, policy, and practice– Federally designated roles as the Medicare QIO and HIT
Regional Extension Center– Develop and lead quality improvement projects
and campaigns across care continuum– Inform federal and state policy
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The Healthcare Reform Environment
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A National Health Care Quality Strategy• The federal health reform legislation passed
in 2010 called for the first ever National Quality Strategy (NQS) in health care.
• NQS is built on the “Triple Aim”:– Better Care– Better Health – Lower Cost
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Federal Push to Value-Based Purchasing (VBP)• Transforming Medicare from a passive payer
to an active purchaser of high-quality, efficient health care– Improve quality of care and health of beneficiaries– Reduce adverse events, improve safety– Encourage coordination of patient care– Avoid unnecessary costs– Stimulate investments in structural systems– Make performance results transparent
and meaningful
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Medicare Hospital Value-Based Purchasing Program• Federal health reform law established a
hospital value-based purchasing program under which value-based incentive payments are made each year to hospitals that meet the performance standards for that year
• Program began in FY 2013, now in third year
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The Shift to ValueWhat types of
measures do we have… Process Outcome Patient experience Spending
…to tell us about quality and value:
Cost/efficiency– Overuse– Underuse– Appropriate use
Percentage of patients receiving evidence-based practice
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Why Does it Matter?• Opportunities and Risks to the hospital based
on performanceCommunity and patient perceptionComparisons to peers and competitorsPayment from public and private purchasers
increasingly tied to performanceMeeting your mission…doing the right thing
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How Does the Medicare VBP Program work?
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Measures Measure score Domain and weighting
Total Performance
Score
Payment adjustment
factor
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Measures
Clinical
Process
12
13
12
8
Patient Experience
8
8
8
8
Outcome
0
3
5
8
Efficiency
0
0
1
1
FY2013
FY2014
FY2015
FY2016
20
24
26
25
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Measure Score
Improvement points Achievement points
Two ways to get points:
0-9 points 0-10 points
Whichever is greater
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Domains
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Domains
Performance period over. Will get results Summer 2014.
Performancemeasured in 2014. Results available Summer 2015.
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Minnesota Hospitals: 2013 Total Performance Scores
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Minnesota Hospitals:2014 Total Performance Scores
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Minnesota Payment Adjustment Factor
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U.S. Payment Adjustment Factor
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What is the Hospital Board Trustee Role?
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Know Your Numbers
• Establish quality and value as an organizational priority
• Determine senior leadership accountability• Proactively plan for and monitor
performance on federal, state, and commercial VBP programs
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Set the Bar High
• Make evidence-based practice the way you deliver care
• Set expectation with physicians and staff to make it happen
• Establish bold goals for your performance in quality and value
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Support a Learning Culture• Understand systems thinking• Make it safe to share problems…and
expect every failure to be evaluated • Use insight from errors, near misses,
patient feedback to make improvements• Help clinicians, quality staff, finance staff to
be working together toward shared goals to be successful in a value-driven environment
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Build Community Partnerships• Recognize that VBP measures
increasingly reflect the importance of care coordination and transitions
• Know and leverage your community health needs assessment results
• Encourage your hospital to partner with other health care and community-based organizations to provide seamless care
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Stay Current
• Stay informed using resources available to you– Stratis Health VBP fact sheet
• Updated annually and available Stratis Health website:
http://www.stratishealth.org/documents/VBP_factsheet.pdf
– MHA resources, CMS resources
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Questions?
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Questions?
Jennifer Lundblad, President & CEO
952-853-8523 or 877-787-2847
Vicki Olson, Program Manager
952-853-8554 or 877-787-2847
www.stratishealth.org
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Stratis Health is a nonprofit organization that leads collaboration and innovation in health care quality and safety, and serves as a trusted expert in facilitating improvement for
people and communities.
www.stratishealth.org
Prepared by Stratis Health, the Medicare Quality Improvement Organization for Minnesota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 10SOW-MN-C7-13-158 123113