Multiple Chronic Conditions Blog

Population Based Health

Monday, 14 December 2015 03:37 / by Dr Kim Kuebler

Did you know:

  • The United States spends more money on healthcare then Canada spends annually to manage their country?
  • America spends 3 Trillion Dollars on healthcare and yet, register as 42nd in the world for life expectancy – equal to Costa Rica and Pakistan?
  • If the US continues on its current rate of healthcare spending, in 2046, 100% of the Gross Domestic Product will be for healthcare?
  • Currently, there are 742 Accountable Care Organizations (ACOs) in the US, Texas has the largest number and 56% of the population live near an ACO with 14% of the population receiving health care from an ACO?

The need for action was enacted by Congress in 2010 with the Affordable Care Act's goal for: Better Health, Better Care and Reduced Cost. By the end of 2018, 90% of Medicare and Medicaid reimbursement will be tied to quality – with at-risk contracts with providers and healthcare organizations – in the form of Accountable Care Organizations, Medical Homes and Bundled Services. In 2020 75% of Commercial plans will be value-based.

THIS IS THE MOST DISRUPTIVE CHANGE IN US HEALTH CARE HISTORY

The new era of population based health will reimburse on three tracks:

  • Penalty based – up to 11% penalty for practices that do not measure quality and demonstrate value
  • Incentive based – utilizing the chronic care model, transitional care model, telemedicine and patient-centered medical home
  • Risk based contracts with ACO's – three tiers of reimbursement based upon amount of risk for meeting quality measurements (50%, 60%, 75% in savings payment).

ACOs are required to report quality, evaluate loss and benchmark outcomes against the quality measurements. High risk patients are those with multiple chronic conditions (MCC) or more than one chronic disease – these patients will require special attention when quantifying quality measurements and reducing excessive costs to the ACO.

Learn more about Population Health and Value-Based Reimbursement at the:
National Health Policy and Clinical Practice Conference at the Westin Harbor Resort and Spa April 1-2, 2016.

This interdisciplinary conference has collaborated with the US Department of Health and Human Services, Agency for Health, Research and Quality's SHARE Decision Making Train-the-Trainer Program, March 31, 2016 at the Savannah Westin Harbor and Golf Resort – SIGN UP NOW FOR THIS FREE OFFERING – SEATING IS LIMITED!

Dr Kim Kuebler

Dr Kim Kuebler

Dr. Kim Kuebler, DNP, APRN, ANP-BC, Founder and Director Multiple Chronic Conditions Resource Center, CEO Advanced Disease Concepts LLC, Savannah, GA. Provider, Asante Physician Partners, Orthopedics and Sports Medicine, Asante Three Rivers Medical Center, Grants Pass, OR