PHM Innovation Lab

Population Health Management (PHM) is a term that describes the application of various interventions and strategies aimed at improving the health outcomes and managing the costs of a targeted group of individuals.  Historically population health models have been led by hospitals, health systems, physician groups and large insurance organizations.  More recently long-term care (LTC) and post-acute care (PAC) providers have been assuming a leadership role in developing and employing some PHM models.  

The Population Health Management Innovation Lab has been developed to educate LTC/PAC providers on the different PHM models and opportunities for participation and leadership within them.  

 

Models covered include:
Managed Care: Medicare Advantage, Medicaid managed care

A healthcare delivery system that encompasses care, services and payment and seeks to control costs and enhance quality through the establishment of provider networks and employment of utilization management strategies.

 

Accountable Care Organizations: Medicare Shared Savings Program, Next Generation ACOs

Networks of physicians, hospitals and other healthcare providers that voluntarily come together to coordinate care and manage the total costs of a defined population, sharing in the financial risks and rewards of performance against benchmarks and on patient outcomes.  ACOs are one of the largest alternative payment models in Medicare, but also exist in Medicaid and commercial payors.  

 

Bundled Payments: Bundled Payments for Care Improvement (BCPI), BCPI Advanced

A single payment for all care and services provided for a patient over an episode of care.  An ‘episode of care’ is the services performed by multiple providers for a single procedure or medical condition over a specified period of time.

 

Emerging Models: Direct Contracting

CMMI continues to push delivery system reform through new and innovative models driving providers into two-sided risk sooner and capitated models.   

Direct Contracting (DC) builds of lessons learned from the Medicare Shared Savings Program (MSSP) and Next Generation ACOs and leverages innovative approaches from Medicare Advantage (MA) and private sector risk-sharing arrangements.  CMMI has created different tracks to broaden participation and emphasizes complex, chronically ill and seriously ill populations.


Provider Networks: Integrated Care Networks

Providers come together to negotiate value-based reimbursement that focuses on efficiency and quality outcomes.

The Lab general content includes pre-recorded webinars and/or information briefs on each model.  Future content will include self-assessments, targeted in depth training for your leadership and facilities, roadmaps for initial due diligence and strategic planning. 

NCAL AHCA