3. Allina Health
Integrated 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 Allina home and
24 hospital based clinics community services
• Hospice, care
60 physician clinics
management, home care,
5 ambulatory care home oxygen and medical
centers equipment, senior care
transitions
15 community pharmacy
sites
4. 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
5. Case for Change
Health care expenditures
Waste in health care cost
Poor coordination of care/transitions
Harm during care
Lack of patient involvement
6. 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
8. Process of Care Measures – FY 2013
Measures Number Scoring
AMI X2
HF X1
PN X2
Achievement
X5 and
SCIP
(one 2014) Improvement
SCIP VTE X 2
SCIP CARD
9. Patient Experience – FY 2013
Measure Scoring
Overall rating
Nursing communication
Physician communication
8 Measure Scores
Communication about medications
and
Staff responsiveness
Consistency
Environment
Pain management
Discharge instructions
10. Outcome Measures – FY 2014/2015
Measure
AMI 30 day mortality
HF 30 day mortality
PN 30 day mortality
AHRQ PSI
Central Line Infection
Efficiency – FY 2015
Measure
Total Medicare spending per beneficiary
11. Measures of success in transformed care
Better care for individuals
Better health for the community
Reduction in the trend of health care costs
12. Changing Paradigms
Discipline specific care Care teams
Quality
Quality reporting and
mandates, consistency, rel
improvement
iability
Selective reporting Data transparency
Pay for quality outcomes
Pay for volume
and value
Alignment across
Silos of care
continuum
Reimbursement pressure Total cost of care
13. 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