THIS WEEK IN U.S. DOMESTIC MEDICAL TRAVEL™
Volume 2, Issue 14
On Thursday, October 27th, 2016, 9:00 am-4:00pm, CAPG - the leading professional association representing accountable physician organizations - is sponsoring the October Symposium: How to Thrive in Risk-Based Coordination Care, in Chicago, IL.
The program will feature speakers who have executed successful risk-based contracts and performed care coordination.
Read on to learn more about CAPG in this issue, as I had the pleasure of discussing the association with its Chief Medical Officer, Amy Nguyen Howell, MD.
As a result of the increasing cost of healthcare services for employers and employees, New World Medical Network™ has developed a one-of-a-kind initiative entitled: "One Price Healthcare™."
According to Terry Johnson, Managing Partner & CFO, New World Medical Network™, the program offers bundled pricing for select surgical procedures, and patients are aware of all medical and non-medical costs prior to undergoing treatment.
Currently, New World Medical Network™ works with providers in New York, Oklahoma and Georgia, with plans to expand its provider base in the future.
We’re starting to hear from many hospitals, independent surgi-centers and provider groups that want to be better positioned to serve self-funded employers offering medical/surgical travel options. If you have a good story to tell us, please be in touch! We want to boost opportunities for Centers of Excellence nationwide.
What distinguishes your service offering in terms of cost, patient experience and satisfaction, outcomes, or other quality indicators.
Send us your descriptor, including photos or charts, and we will evaluate for publication in this newsletter.
"Rising health insurance premiums, lack of transparency and increased awareness of how varied medical costs and quality vary dramatically between hospitals and across regions, have pushed consumers right into the arms of international and domestic medical travel. The growing industry provides the perfect solution for patients to receive the high-quality, cost-effective care that they need AND rightfully deserve!" - Laura Carabello, Executive Editor and Publisher, Medical Travel Today and U.S. Domestic Medical Travel.
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Editor and Publisher
SPOTLIGHT: Amy Nguyen Howell, MD, chief medical officer, CAPG
Amy Nguyen Howell, MD
Physician Groups Nationwide Benefit from CAPG October Symposium,
"How to Thrive in Risk-Based Coordinated Care"
October 27, 2016, Chicago, IL: Register here
About Amy Nguyen Howell, MD
Dr. Howell is a board-certified family practice physician. She is a family physician at Playa Vista Medical Center, and previously served as chief medical officer at Easy Choice Health Plan, a WellCare Company, where she oversaw clinical direction of medical services within appeals and grievances, care management, utilization management and quality improvement.
Since March 17, 2014, Dr. Nguyen has been chief medical officer of CAPG, the country’s leading association representing physician organizations practicing capitated, coordinated care.
CAPG is the nation’s leading association for and the voice of physician organizations practicing capitated, coordinated care. Its membership comprises approximately 250 multispecialty medical groups and independent practice associations (IPAs) across 41 states, the District of Columbia, and Puerto Rico. CAPG members strongly believe that comprehensive, accountable, risk-based coordinated care provides the highest quality, most efficient delivery, and greatest value for patients. Our members have successfully operated under this budget-responsible model for more than two decades. For more information, please visit www.capg.org.
The mission of CAPG is to assist accountable physician groups to improve the quality and value of healthcare provided to patients. CAPG represents and supports physician groups that assume responsibility for clinically integrated, comprehensive, and coordinated healthcare on behalf of our patients. CAPG and its member groups will continue to drive the evolution and transformation of healthcare delivery throughout the nation.
US Domestic Medical Travel (USDMT): Why does CAPG consider health systems and accountable physician organizations appropriate for membership in the organization?
Amy Nguyen Howell (AH): Most hospital systems have a medical group component affiliated with them on their ambulatory primary care side. These are the groups that would fit perfectly within CAPG’s membership structure, as long as they carried some sort of risk-based, coordinated model of care.
Further, our members’ successes are attributable to how well they manage both clinical and financial risk under capitated arrangements.
By knowing how to manage risk appropriately, they have prospered in population-based payments and risk-based arrangements.
USDMT: Does CAPG extend its reach nationwide?
AH: Most definitely.
We have a strong footprint in California, but currently have a presence in 41 states.
Three years ago, we began to extend our reach and share our expertise nationwide. Today, we continue to attract accountable physician groups and health systems throughout the country because of the tremendous value proposition that we offer to these organizations.
Our national and regional symposia are strategically scheduled to make them accessible and convenient for travel.
USDMT: What are the key benefits of membership in CAPG?
AH: Our members take advantage of several key pillars of our service platform that distinguish our organization from others in the marketplace, such as AMGA.
Advocacy is one important component, and CAPG federal advocacy focuses on advancing risk-based alternative payment models in traditional Medicare and Medicare Advantage. In recent years, the organization has seen significant achievement in advancing financial and clinical risk models.
Our achievements in 2015 demonstrate the strength of these initiatives.
CAPG is protecting and strengthening Medicare Advantage (MA), which we believe offers the best available option for physicians to advance capitated, coordinated care delivery models.
Despite its success, Medicare Advantage has faced cuts over a number of years, and these cuts flow to our physicians and their patients.
That’s why we established our organization as a leading physician voice protecting MA. Together with our advocacy partners, we have successfully reduced past proposed cuts. In 2015, the Administration proposed a 0.9% cut to Medicare Advantage.
CAPG engaged in an intense advocacy campaign to avert these cuts. We are pleased to report that the Administration instead finalized a 1.25 percent increase to MA rates.
We have also tackled the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
For years, we worked with Congress to encourage faster and more aggressive development of alternative payment models in Medicare. We are thrilled to see that the SGR repeal law, enacted in April 2015, included a 5 percent incentive payment for organizations participating in risk-based alternative payment models.
We have also promoted coordinated, capitated payment models in traditional Medicare, and play a substantial role in pushing for more capitated payment model options.
This year, the Administration announced that it would begin testing a capitated accountable care organization payment model, the Next Generation ACO. CAPG looks forward to continuing to work with the Administration to develop this and other models.
And we are especially gratified by our role in advancing value-based delivery models. Health & Human Services Secretary Sylvia M. Burwell announced ambitious value goals to transform Medicare from a volume-based system to a value-based system. In essence, the Secretary seeks to transform Medicare payments to the very model that CAPG members have been using for decades.
We look forward to working with the Administration to share best practices and provide valuable leadership in this critical transformation.
CAPG announced its own ambitious value goal: to move 90 percent of our members’ Medicare payments (Traditional Medicare and Medicare Advantage) to capitation by 2018.
Today, we just announced our support for the ACO Improvement Act of 2016, a bipartisan bill introduced by U.S. Representatives Diane Black (R-TN) and Peter Welch (D-VT).
The legislation is aimed at improving outcomes for Medicare beneficiaries by making improvements to the Medicare accountable care organization (ACO) program.
USDMT: Looking on your website, there’s a significant focus on education.
AH: In March 2016, CAPG launched its inaugural Educational Series, Essentials of Risk-Based Payment Models: Moving from Volume to Value. We recognized an ever-growing need for education on risk-based management and coordinated care for our leaders.
While national associations, consultants, health systems, state medical societies, and universities have identified the need for courses in leadership and population health management; until now, there is not a single organization that offers managed care tutelage and mentorship at a level of detail that can be operationalized by physician groups.
For example, at the recent CAPG Annual Conference attendees received hands-on knowledge and tools to navigate the brave new world of MACRA, MIPS, and APMs.
With MACRA right around the corner in almost three months, our members need to quickly address the impact of this game-changing initiative and others that are effectively making value-based payment mandatory for physician organizations.
As a result, they are better prepared for alternative payment arrangements with all payers: Medicare, Medicaid, and commercial.
Also, CAPG has recently announced support of a new national movement entitled, "A Call for Collaborative Action: Achieving Readiness for a Value Payment World," led by the Accountable Care Learning Collaborative (ACLC).
In an environment where old-school fee-for-service is being replaced by a risk-based care system that emphasizes value over volume to ensure healthier patient outcomes at lower costs, there’s no better time to build on this momentum. A Call for Collaborative Action will bring diverse industry stakeholders together to share their best practices for population health management.
In line with the Call for Action, CAPG has a new online hub, www.capg.org/accountablecompetencies, which centralizes the association’s educational resources on accountable care.
In adding its support to this influential cause, CAPG joins a number of other prominent healthcare notables including Mike Leavitt, former Utah Governor and U.S. Secretary of Health and Human Services, and Dr. Mark McClellan, director of the Robert J. Margolis Center for Health Policy at Duke University.
No other organization is providing this scope and depth of information, education, and training.
USDMT: Do you offer any consulting services?
AH: CAPG Consulting services are widely accessed throughout the year. They are positioned to serve those entities that are getting ready to take on risk or already in it, CAPG Consulting can help you accelerate your journey.
Our team is composed of executives with decades of success in risk-based care delivery at leading physician organizations.
With MACRA and other reforms, federal and state governments have confirmed an inevitable drive to alternative payment models. This movement is creating great demand for education and support on how to move into alternative payment models, or APMs.
At the same time, CAPG is fortunate to have a group of highly experienced, recently retired physician organization CEOs. They’ve learned what works and what doesn’t, sometimes the hard way. And they want to help others succeed-because they strongly believe risk-based care offers the best outcomes and highest value for patients.
NOTE: To learn more and get connected with one of the CAPG experts, contact my colleague Nelson Maldonado at 213.239.5041 or firstname.lastname@example.org.
USDMT: Does CAPG advocate any innovative models for direct contracting with payers?
AH: I’m glad you asked about this. CAPG continues to work to advance alternatives to Medicare ACOs for groups that are ready for higher levels of risk and reward. We call this alternative "A Third Option."
Here are the highlights:
- Clinically integrated organizations (CIO) would contract directly with CMS
- Beneficiary selects from traditional Medicare, CIO, or Medicare Advantage
- Beneficiary enrolls in the CIO and commits to stay within the CIO for one year
In this model, CIOs would report quality information. Beneficiaries would be able to compare quality across different Medicare options -- "apples to apples."
CIOs could receive incentives for quality performance (like Medicare Advantage 5 Star Ratings Program) and could tie individual physician payments to quality as desired.
Currently, we have groups like MemorialCare Health System who are doing exciting and innovative direct contracting with prominent employers and following the concept of the Third Option.
USDMT: Does CAPG provide guidance on bundled pricing?
We have active members like Providence Health Systems who created a bundle care package for elective total knee and hip replacements which helped to improve patient expectations, reduced length of hospital stays, and enhance clinical outcomes.
CAPG can facilitate formal and informal networking opportunities for those interested in getting more into bundled payments for their organization.
We have a contracts committee whose members often discuss topics like bundled pricing along with other financial contracting elements.
USDMT: How does CAPG help support the ACO movement?
AH: Recently, CAPG published a comment letter on the policy considerations in CMS/CMMI’s treatment of the interplay between the bundled payment initiatives (bundled payments for care improvement, BPCI, and the comprehensive care for joint replacement, CJR) and the accountable care organization programs (Medicare Shared Savings Program, MSSP, Pioneer, and Next Gen).
While we believe that there is great opportunity for these programs to support one another, we believe that current policy may disrupt and undermine the accountable care organization (ACO) programs.
This is occurring at the very time when CMS is trying to encourage participation in Advanced Alternative Payment Models, like Next Gen and Tracks 2 and 3 of MSSP.
In particular, we are concerned in cases where the ACO operates independently from the hospital participating in the bundled payment model. This is the case for many CAPG members.
To illustrate the overlap issue, we will use the CMS guidance for such situations between Next Gen ACOs and BPCI participants.
In the example in the guidance, the bundled target price is $10,000.
The hospital participating in the bundled payment initiative achieves an actual expenditure of $8,000.
The expenditure that is included in the ACO’s reconciliation is $10,000.
CMS pays the $2,000 in savings to the hospital, the ACO does not receive any of those savings.
Because that $2,000 in savings is credited only to the bundled hospital, the savings opportunity is taken from the ACO.
We see two problems with this treatment of overlap situations.
First, this approach makes it increasingly difficult for ACOs to achieve savings as compared to an historical benchmark.
Second, this approach treats the care associated with the bundled payment episode as separate and distinct from the activities of the ACO, rewarding only the hospital bundler for the savings associated with a bundled payment patient.
USDMT: Is capitation a dirty word?
AH: Ahh...to some perhaps.
At CAPG, this is our bread and butter. Having grown up in California, the land of the delegated, capitated model, we have thrived in pre-payment coordinate care, and we are well-positioned to educate the rest of America on how to prosper in alternative payment models.
As we all know, the healthcare delivery system is on a journey from volume to value.
A driving force of this change is the offering of new APMs in traditional Medicare.
To date, the Centers for Medicare & Medicaid Services (CMS) has offered several options with increasing levels of risk. Relevant to physician organizations, these models tend to be ACOs.
ACOs are groups of providers that come together with the goals of coordinating healthcare services to reduce costs and improve quality.
However, the delivery system reform options available today are largely focused on the "on-ramp to risk" (e.g., shared savings based on fee-for-service).
To continue to drive delivery system reform forward, especially since MACRA has become law, additional models are needed that enable physician organizations to gain experience in taking on more risk.
Legislation introduced in the U.S. House of Representatives would help to meet this growing need by testing a new model for patient care networks (PCNs) in Medicare Part A and Part B.
A patient care network (PCN) is a new model of integrated care that is made up of (1) a hospital, and (2) participating physician group practices that provide both primary and specialty care to patients in traditional Medicare.
Through a PCN physicians, at the group level, would be allowed to directly contract with CMS to negotiate capitated payments for their Part A and Part B patients - a model that does not exist in Medicare today - provided that they meet robust quality and performance standards.
The PCN model holds participating practitioners accountable for the quality, cost and overall care that the patients participating in their networks receive.
This new model achieves several important objectives.
First, it offers an additional option for physicians that want to pursue the advanced APM option under MACRA.
Second, it tests a new model of payment that has not yet been tested in traditional Medicare.
Third, it builds on the success of models in the commercial and Medicare Advantage space - models that have been proven to increase quality and lower cost for decades.
Concurrently, CAPG supports legislative efforts to institutionalize the PCN model, including a bipartisan bill introduced by Congressman Mike Kelly (R-PA) and Congressman Richard Neal (D-MA), H.R. 5841.
Terry Johnson, Managing Partner & CFO, New World Medical Network™
About Terry Johnson
Terry has 25+ years in healthcare management with strength in operations, financial oversight and sales. He has served as a VP of a large national service provider and holds his MS in Management from Rollins College.
U.S. Domestic Medical Travel (USDMT): Tell us about New World Medical Network™.
Terry Johnson (TJ): New World Medical Network™ facilitates low to moderate risk non-emergent surgical procedures in the U.S. at locations in GA, NY and OK. We market to third party administrators (TPAs), captives and benefit brokers - whose client employers have self-insured health plans.
Our network saves roughly 50 percent of regional costs for comparative services. We facilitate the care for the patient, including transportation and recuperation, and the employer does not pay until the service is used.
USDMT: Can you give our readers information about New World's initiative: One Price Healthcare™?
TJ: We have identified a growing problem in today's health benefits; the increasing cost of services to employers and employees.
We meet that need with select surgical procedures - using bundled charges - to allow all participants to save significant cost. As the only all-inclusive One Price Healthcare™ bundled offering, New World has uniquely positioned itself in the market.
Everyone involved in the process knows what the final price will be for each case because we have provided that information to them before they utilize the service. And with One Price Healthcare™ both the medical and non-medical costs are included.
USDMT: What can patients expect from their experience with New World?
TJ: Once a patient has submitted all of their medical information and is determined to be approved for a requested procedure, our staff handles all elements of travel and recuperation, both for the patient and the care companion - generally a relative or a friend - who travels with the patient to assist in aftercare while the patient is recuperating at one of our hotel locations.
USDMT: Does New World have a network of providers throughout the U.S.?
TJ: New World works with quality providers in Georgia, Oklahoma and New York. We are interviewing additional facilities for membership in our network, but it is not our intent to build a large network, just one that can accommodate our needs for quality, price and a volume capacity that will meet both our short and long-term needs.
USDMT: How is New World able to help the self-insured keep the costs of treatment down?
TJ: Each year, we meet with all of our network facilities and negotiate prices with the idea of obtaining attractive bundled charges from facilities with excess capacity and then meeting their volume need with a supply of patients from areas they never would have marketed to - very similar to the Hotels.com business model.
USDMT: What goal is New World looking to accomplish with its collaboration with HealthEZ?
TJ: As with all of our clients, we want to show HealthEZ that our service can both save the client money on health costs, and also share those savings with the employee. In doing so, we can create a very positive benefit to the employee by reducing his or her healthcare costs, as well.
This shared savings approach will help the employer in recruitment and morale building efforts moving forward, and it will help solidify the relationship between HealthEZ and its client base.
USDMT: What can we expect to see from New World in the future?
TJ: We will continue to focus on additional providers and expand our client base as quickly as we can through the use of both technology and through direct contacts with our customers to constantly seek to improve our performance.
USDMT: At this point is there anything else you would like to share with our readers?
TJ: We would like to reach out to any group involved in the provision of health benefits to the self-insured employers in the U.S., like the employers themselves, brokers, captives, consultants, and TPAs. We want them to know that New World is dedicated to providing quality medical services with transparent, bundled prices to the client members that will save both employers and employees significant cost and deliver a positive experience as well.
How to Thrive in Risk-Based Coordinated Care: Physician Groups Nationwide Benefit from CAPG October Symposium
October 27, 2016, Chicago, IL: Register here
Accountable physician organizations throughout the country will benefit from participation at the October Symposium: How to Thrive in Risk-Based Coordination Care, Thursday, October 27, 9:00 am-4:00 pm, Hyatt Regency O’Hare, Chicago, IL. Sponsored by CAPG, the leading professional association representing accountable physician organizations, the program features speakers who have executed successful risk-based contracts and performed care coordination.
"Risk-based delivery offers better healthcare and more value for patients," says Donald Crane, CEO and president, CAPG. "Our roster of expert presenters will share innovative solutions for moving into Alternative Payment Models (APMs), giving attendees what they need to know about taking on risk. Participants will walk away with salient pearls that can be operationalized at their organizational level. If you can choose one symposium to attend this quarter, the October symposium should be it. "
CAPG’s symposium will feature programs presented by:
Mariella Cummings, principal of Results Incorporated
Peggy O’Kane, founder and president of NCQA
Steve Valentine, vice president of West Coast Healthcare Management Consulting
Kathryn A. Bowen, area executive vice president of Arthur J. Gallagher & Company
Matthew M. Mazdyasni, former chief administrative and financial officer of HealthCare Partners.
CAPG symposia continue to attract C-level leaders from accountable physician organizations in virtually every state who seek valuable guidance from experienced experts.
Amy Nguyen Howell, M.D., chief medical officer, CAPG, says, "This symposium will revolutionize the way we take on risk. Our goal to improve the quality and cost-effectiveness of American healthcare starts with the hands-on knowledge that participants will gain at this symposium."
For program questions, contact Amy Nguyen Howell, 213.239.5051 or email@example.com.
For display inquiries, contact Lura Hawkins, 213.239.5046 or firstname.lastname@example.org.
CAPG is the nation’s leading association for and the voice of physician organizations practicing capitated, coordinated care. Its membership comprises more than 250 multispecialty medical groups and independent practice associations (IPAs) across 40 states, the District of Columbia, and Puerto Rico. CAPG members strongly believe that comprehensive, accountable, risk-based coordinated care provides the highest quality, most efficient delivery, and greatest value for patients. Our members have successfully operated under this budget-responsible model for more than two decades. For more information, visit www.capg.org.
Nathan Molinari; email@example.com
201.641.1911 x 22
To view the original release click here.
Large Variations in Payments for Hospital Outpatient Care to Injured Workers
by Richard Krasner
Back in April of this year, I wrote about a study by the Workers’ Compensation Research Institute (WCRI) in which it was found that fee schedules may increase the number of workers’ comp claims.
The WCRI released a new study that said that "hospital outpatient payments per surgical episode varied significantly across states, ranging from 69 percent below the study-state median in New York to 142 percent above the study-state median in Alabama in 2014," according to Dr. Olesya Fomenko, co-author of the study and economist at WCRI, and who also is mentioned in my previous post.
The report also stated that "variation in the difference between average workers’ compensation payments and Medicare rates for a common group of procedures across states was even greater-reaching as low as 27 percent (or $631) below Medicare in New York and as much as 430 percent (or $8,244) above Medicare in Louisiana."
Here are the major findings:
- States with no workers’ compensation fee schedules for hospital outpatient reimbursement had higher hospital outpatient payments per episode compared with states with fixed-amount fee schedules-63 to 150 percent higher than the median of the study states with fixed-amount fee schedules. Also, in non-fee schedule states, workers’ compensation paid between $4,262 (or 166 percent) and $8,107 (or 378 percent) more than Medicare for similar hospital outpatient services.
- States with percent-of-charge-based fee regulations had substantially higher hospital outpatient payments per surgical episode than states with fixed-amount fee schedules-32 to 211 percent higher than the median of the study states with fixed-amount fee schedules. Similar to non-fee schedule states, workers’ compensation payments in states with percent-of-change based fee regulations for common surgical procedures were at least $3,792 (or 190 percent) and as much as $8,244 (or 430 percent) higher than Medicare hospital outpatient rates.
- Most states with fixed-amount fee schedules and states with cost-to-charge ratio fee regulations had relatively lower payments per episode among the study states. In particular, for states with fixed-amount fee schedules, the difference between workers’ compensation payments and Medicare rates ranged between negative 27 percent (or -$631) and 144 percent (or $2,916).
Still think that workers’ comp is doing okay? Still think that keeping the status quo is the best option for injured workers? Still think that thinking outside the box, and considering alternatives to the ever increasing cost of medical care for workers’ comp is stupid, ridiculous and a non-starter?
Or do you believe, as Joe Paduda wrote about today in his blog, that workers’ comp is no longer needed for 90% of America’s employees, as the workplace has become safer than the non-occ environment.
The idea brought forth, and as Joe said, it is an intriguing, but wrong one, is that the medical care can be provided under health insurance, and the disability coverage can be added to long-term or short-term disability insurance.
Whichever way you look at the issue, workers’ comp is not going away, but it is getting more expensive to pay for medical care. The problem here is, too many Americans are slavishly wedded to outmoded ways of thinking, outmoded economic policies and models, as well as an outmoded economic ideology, to think rationally and seriously about alternatives.
Lastly, there are too many cooks (or should that be crooks) with their hands in the pot who have a vested interest in keeping things the way they are. If that is so, then the WCRI is only telling us what we should already know...injured workers are screwed and so are the carriers and employers. As long as outside interests have a hand in the system, and those who profit from higher costs block real change, this situation will only get worse.
I am sure glad it is not my money being wasted like this.
As always, to purchase the study click this link:
To view the original article click here.
CMS' Voluntary Bundled-Payments Program Delivers Mixed Results
by Elizabeth Whitman
Modernhealthcare.com-The first year or so of CMS' voluntary Bundled Payments for Care Improvement initiative has yielded a mixed bag of results, according to the program's evaluation report.
To view the original article click here.
Bundled Payment Success Requires Careful Administration
by Ron Shinkman
Fiercehealthcare.com-An overview of bundled payments by the president of the Commonwealth Fund suggests that while they hold promise for controlling healthcare costs, they are still far from being a universal cost-control measure.
To view the original article click here.
Study: Medicare Joint Replacement Program Should be Risk-Adjusted
by Ron Shinkman
Fiercehealthcare.com-Should Medicare's Comprehensive Care for Joint Replacement program be risk-adjusted for the patient's medical complexity?
To view the original article click here.
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