Bundled Payments in Healthcare – The Next Generation LIVE Webcast

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<p>Slide 1</p> <p> Speaker Firms and Organization:Association of American Medical CollegesJessica Walradt, M.S.Senior Payment Reform SpecialistThank you for logging into todays event. Please note we are in standby mode. All Microphones will be muted until the event starts. We will be back with speaker instructions @ 9:55am. Any Questions? Please email: Info@knowledgecongress.org Group Registration Policy</p> <p>Please note ALL participants must be registered or they will not be able to access the event. If you have more than one person from your company attending, you must fill out the group registration form. We reserve the right to disconnect any unauthorized users from this event and to deny violators admission to future events.</p> <p>To obtain a group registration please send a note to info@knowledgecongress.org or call 646.202.9344.Presented By:March 12, 20151Partner Firms:</p> <p>Pershing Yoakley &amp; Associates, P.C.Christopher WilsonSenior Manager</p> <p>Association of American Medical CollegesMarch 12, 20152 Follow us on Twitter, thats @Know_Group to receive updates for this event as well as other news and pertinent info. If you experience any technical difficulties during todays WebEx session, please contact our Technical Support @ 866-779-3239.</p> <p> You may ask a question at anytime throughout the presentation today via the chat window on the lower right hand side of your screen. Questions will be aggregated and addressed during the Q&amp;A segment.</p> <p> Please note, this call is being recorded for playback purposes. </p> <p>If anyone was unable to log in to the online webcast and needs to download a copy of the PowerPoint presentation for todays event, please send an email to: info@knowledgecongress.org. If youre already logged in to the online webcast, we will post a link to download the files shortly.</p> <p>If you are listening on a laptop, you may need to use headphones as some laptops speakers are not sufficiently amplified enough to hear the presentations. If you do not have headphones and cannot hear the webcast send an email to info@knowledgecongress.org and we will send you the dial in phone number.March 12, 20153About an hour or so after the event, you'll be sent a survey via email asking you for your feedback on your experience with this event today - it's designed to take less than two minutes to complete, and it helps us to understand how to wisely invest your time in future events. Your feedback is greatly appreciated. If you are applying for continuing education credit, completions of the surveys are mandatory as per your state boards and bars. 6 secret words (3 for each credit hour) will be given throughout the presentation. We will ask you to fill these words into the survey as proof of your attendance. Please stay tuned for the secret word.</p> <p>Speakers, I will be giving out the secret words at randomly selected times. I may have to break into your presentation briefly to read the secret word. Pardon the interruption.March 12, 20154Welcome to the Knowledge Group Unlimited Subscription Programs. We have Two Options Available for You:FREE UNLIMITED: This program is free of charge with no further costs or obligations. It includes:</p> <p>Unlimited access to over 15,000 pages of course material from all Knowledge Group Webcasts. Subscribers to this program can download any slides, white papers, or supplemental material covered during all live webcasts. 50% discount for purchase of all Live webcasts and downloaded recordings.</p> <p>PAID UNLIMITED: Our most comprehensive and cost-effective plan, for a one-time fee: Access to all LIVE Webcasts (Normally $199 to $349 for each event without a subscription). Including: Bring-a-Friend Invite a client or associate outside your firm to attend for FREE. Sign up for as many webcasts as you wish. Access to all of Recorded/Archived Events &amp; Course Material includes 1,500+ hours of audio material (Normally $299 for each event without a subscription).Free Certificate of Attendance Processing (Normally $49 Per Course without a subscription).Access to over 15,000 pages of course material from Knowledge Group Webcasts.Ability to invite a guest of your choice to attend any live webcast Free of charge (Exclusive benefit only available for PAID UNLIMITED subscribers).6 Month Subscription is $499 with No Additional Fees Other options are available.Special Offer: Sign up today and add 2 of your colleagues to your plan for free Check the Triple Play box on the sign-up sheet contained in the link below.</p> <p>https://gkc.memberclicks.net/index.php?option=com_mc&amp;view=mc&amp;mcid=form_157964</p> <p>March 12, 20155Knowledge Group UNLIMITED PAID Subscription Programs Pricing:Individual Subscription Fees: (2 Options)Semi-Annual: $499 one-time fee for a 6 month subscription with unlimited access to all webcasts, recordings, and materials. Annual: $799 one-time fee for a 12 month unlimited subscription with unlimited access to all webcasts, recordings, and materials. </p> <p>Group plans are available. See the registration form for details. </p> <p>Best ways to sign up:Fill out the sign up form attached to the post conference survey email.Sign up online by clicking the link contained in the post conference survey email. 3. Click the link below or the one we just posted in the chat window to the right. https://gkc.memberclicks.net/index.php?option=com_mc&amp;view=mc&amp;mcid=form_157964</p> <p>Questions: Send an email to: info@knowledgecongress.org with Unlimited in the subject.Partner Firm:March 12, 20156As a professional corporation with 30 principals, PYAs team of resources is more than 175 strong and continually growing. PYAs people have backgrounds and degrees in nursing, healthcare administration, public health, medicine, economics, finance, management, accounting, tax, and law. Several have extensive prior experience with other healthcare-related organizations, and have specialized training in clinical medicine, clinical coding, and regulatory matters.</p> <p>Because of PYAs focus on client service and the highly motivating environment in which it operates, PYA has been very successful in recruiting dedicated and experienced people from national consulting firms and healthcare organizations.</p> <p>Leveraging the diverse experience and expertise of its people allows PYA to gain a unique perspective on the industry and marketplace. PYA calls it Vision Beyond the Numbers. It uses this perspective to develop tools and methodologies that help its clients identify opportunities and creative solutions where other consultants have only found problems. PYA values most the integrity and objectivity of its people. These values enable PYA to continuously deliver and maintain the quality of service that clients require. Additionally, PYA offers the following compelling reasons for selecting the firm:PYA has built one of the largest dedicated healthcare consulting practices in the nation.PYA utilizes experienced professionals to achieve superior results in a cost effective and timely manner.PYA determines success not by completion of individual projects, but by the ultimate success of its clients. </p> <p>This, combined with PYAs unmatched knowledge of the strategies and operational goals being implemented today by healthcare providers and businesses, makes it the firm of choice. </p> <p>Partner Firm:March 12, 20157 Association of American Medical CollegesBrief Speaker Bios:Christopher Wilson</p> <p>Chris Wilson, JD, MPH, works with healthcare organizations to address strategic issues in an evolving market. He uses his unique combination of consulting and legal experience to design and implement clinical integration initiatives, public policy projects, mergers and acquisitions, and governance strategies. Chris also provides advisory services in the area of healthcare information technology and best practices in the delivery and measurement of evidence-based care for providers.March 12, 20158Jessica Walradt, M.S.</p> <p>Jessica serves as the AAMCs Alternative Payment teams policy content lead. In this role, she supports academic medical centers involvement in the Bundled Payments for Care Improvement initiative using data and policy analyses to explain financial trends and provide strategic advice regarding episode selection and risk mitigation. Jessica also utilizes the lessons from this work to inform AAMCs advocacy efforts.</p> <p>Prior to this, Jessica spent two years as a Health Policy Analyst helping providers to navigate federal ACA regulations and complex Medicare payment policy issues. She also completed graduate internships with the White House Office of Management and Budgets Health Division and Partners HealthCares Finance Department.Jessica holds an M.S. in Health Policy and Management from the Harvard School of Public Health and a B.A. in Political Science from the University of Richmond. For more information about the speakers, you can visit: http://theknowledgegroup.org/event_name/bundled-payments-in-healthcare-the-next-generation-live-webcast/ </p> <p>8A bundled payment is a single re-imbursement to a healthcare provider for all clinical services related to a single instance of medical care and away from fees-for-service.</p> <p>Bundling of payments to healthcare providers will be used more frequently to reduce the cost of healthcare in the United States. Theoretically, bundled payment schemes will improve the quality of care, reduce un-necessary care, and reduce variation in cost among payers. However, research results are varied. Pilot projects such as Prometheus have been slow to develop because of the difficulty of agreeing upon which services can be bundled.</p> <p>Provisions for bundled payments are included in both the Patient Protection and Affordable Care Act (PPACA) and the Affordable Health Care for America Act (AHCAA). The PPACA bill established a national Medicare program in 2013. The AHCAA bill requires reform of Medicare payments for post-acute services, including the bundled payments.</p> <p>Healthcare legal counsel face a number of legal and regulatory issues in structuring bundled and gain-sharing payment systems. The legal challenges arise from insurance, state laws, provider relationships, and fair market value dis-agreements. In the past, these arrangements were found potentially to violate the Anti-Kickback statute and Civil Monetary Penalties Act.</p> <p>Our panel of skilled practitioners will review bundled payment schemes and discuss the advantages and disadvantages of the schemes. The panel will discuss operational and regulatory concerns for healthcare providers, critical provision documentation, the effects of healthcare reform and other recent legislative, regulatory, and enforcement activities. Also addressed is gain-sharing.</p> <p>Key Topics include:</p> <p>Public and Private Bundled Payment Initiatives &amp; Gain-sharing ArrangementsBundled Payments Programs and Current CMS initiativesImplementation and Operational ChallengesAccountable Care Organizations (ACOs) and Bundled PaymentsMedicare Bundled Payments for Care Improvement (BPCI) InitiativeBundled Payment Transparency and Risk ArrangementsBundled Payment Documentation, Data Analysis, &amp; ReportingLegal and Regulatory Compliance IssuesMarch 12, 20159Featured Speakers:March 12, 201510SEGMENT 1:Christopher WilsonSenior ManagerPershing Yoakley &amp; Associates, P.C.</p> <p>SEGMENT 2:Jessica Walradt, M.S.Senior Payment Reform SpecialistAssociation of American Medical Colleges</p> <p>IntroductionChris Wilson, JD, MPH, works with healthcare organizations to address strategic issues in an evolving market. He uses his unique combination of consulting and legal experience to design and implement clinical integration initiatives, public policy projects, mergers and acquisitions, and governance strategies. Chris also provides advisory services in the area of healthcare information technology and best practices in the delivery and measurement of evidence-based care for providers.March 12, 201511SEGMENT 1:Christopher WilsonSenior ManagerPershing Yoakley &amp; Associates, P.C.</p> <p>AgendaBasics of Bundled PaymentsExample Program: Medicare Bundled Payment for Care Improvement Model 2 Gainsharing ExampleRegularity Waiver Example</p> <p>March 12, 201512SEGMENT 1:Christopher WilsonSenior ManagerPershing Yoakley &amp; Associates, P.C.</p> <p>Basics of Bundled PaymentsMarch 12, 201513The Basics Bundled PaymentsMarch 12, 201514AdmissionDischargeEnd of Episode 30/60/90 days post discharge$$$$$Total Cost of Care (TCC)Post-Acute / Other</p> <p>$= Reimbursement (Not Internal Costs)Basics of Retrospective Bundled PaymentsMarch 12, 201515$$$$Historic Episode TCCDiscounted Episode TCCActual Episode TCC w/ Net SavingsActual TCC w/ Net LossDiscount$= Distributed to Providers$= Repaid by Risk-bearing EntityPublic and Private Payer ActivityMarch 12, 201516Medicare Bundled Payment Opportunities: </p> <p>Bundled Payments for Care Improvement (BPCI) ProgramPhysician on-ramp toward alignment and value-based purchasing48 episodes availableClaims data for population health analyticsInfrastructure to build commercial contractsNew outpatient pilot in developmentCommercial Payer / Large Employer Opportunities: </p> <p>Vary by market, payer, and employer-sponsorFavor cardiac, orthopedic, and spine proceduresAccess to data for population health strategiesInfrastructure to build tiered or narrow networks</p> <p>Primary Bundled Payment OpportunitiesUnnecessary/Avoidable UtilizationReadmissionsPost-Acute AncillariesLower Cost Care SettingSNF v. IRF; HHA v. SNFBut strike the right balanceConsider Provider-Based Billing ImpactInternal Variable Costs e.g., supply chain, materials management</p> <p>March 12, 201517Bundled Payment Hospital Economic ROIMarch 12, 201518INVESTMENTSRETURNPrice Discount Program CostsForegone Revenue Possibility</p> <p>Net Payment Reconciliation AmountInternal Variable Cost ReductionsHospital GainshareSpillover Effects E.g., reduced LOSMarket Share GainsOften Significant Non-Economic, Strategic ReturnsHigh-Level Episode Selection Decision Guide (more to come) March 12, 201519Economic OpportunityStrategic OpportunityAvoidCost / Benefit / LearnCost / Benefit / LearnStrongly ConsiderEconomicStrategicEconomicStrategicEconomicStrategicEconomicStrategicEngaging Physicians in Bundled PaymentsEstablishing Trust Among PartiesCreating a Business Case for ParticipationFair Gainsharing ModelRecognizing Unique Challenges of Engaging PhysiciansIdentifying Physician LeadershipTiming Discussions is Critical</p> <p>March 12, 201520Example Program: Medicare Bundled Payment for Care Improvement Model 2March 12, 201521Medicare Bundled Payments for Care Improvement (BPCI)First group of applicants were enrolled on January 31, 2013; went live Q4 2013Largest voluntary Medicare payment innovation programPayment arrangements include financial and performance accountability for episodes of careEnables gainsharing among collaborating providersMarch 12, 201522Model 2: Inpatient Stay + Post-discharge ServicesEpisodes initiated through anchor DRGsEpisodes include the inpati...</p>