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Top 10 Learnings for 2015

Posted on Tuesday, December 1, 2015 3:36 PM

When December arrives each year, I wonder – how did it come so quickly? And what did we learn this year about healthcare? Here are my top 10 learnings for 2015: 1) Consolidations in healthcare continue at a rapid pace: headlines this year included mergers between major health plans, large regional health systems, and national and regional home health and hospice providers. Scale is key to manage growth and infrastructure efficiencies. 2) Insurance is changing: insurance plan costs are going up, consumer costs are going up, and employers are shifting more costs to employees – your employees are very likely paying higher out-of-pocket deductibles. 3) Unprecedented growth in managed care in Medicaid and Medicare are leading to aligned incentives, better health outcomes and slower cost growth. Payers are looking for providers who can help them accelerate cost savings, improve outcomes and improve the patient experience. 4) Value-based care (VBC) is here: payers, providers and consumers are looking for positive outcomes at the lowest cost that provide the best patient experience. This is leading to aggressive targets for payers and providers to shift to risk based payment models. 5) Value-based service organization (VBSOs) – entities within health systems that focus on the shift from volume to VBC – designed to focus on shared savings, improve operating costs, increase population under risk, establish criteria for measurements. 6) Pay-for-performance (PFP) / Value-Based Purchasing (VBP) – ties pay to value. This payment model rewards physicians, hospitals, medical groups, home health agencies, and other providers for meeting certain performance measures for quality and efficiency, and penalizes providers for poor outcomes and increased costs. On January 2, 2016, the Home Health Value-Based Purchasing Model (HHVBP) goes into effect. home health agencies in nine states – MA, MD, NC, FL, WA, AZ, IA, NE, TN – payment will be tied to performance. https://innovation.cms.gov/initiatives/home-health-value-based-purchasing-model 7) Performance measurements: with a focus on P4P/VBC and VBP, the market is being riddled with new measurement tools – star ratings, home health compare, risk stratification, quality measures, patient satisfaction, YELP. Your outcomes are more transparent than ever so a focus on improvement is essential. 8) EMR Mandate for MDs and hospitals has shifted the focus to finding the best EMR in a risk based, population health focused delivery system: EPIC, athenahealth, NextGen Healthcare, Cerner, McKesson, Allscripts, eClinicalWorks, OptumInsight top the list of EMRs, with EPIC and Cerner taking health systems by storms. While there is no mandate for home health and hospice providers to implement an EMR, forward-thinking providers are adopting this essential technology to leverage best practices and partnership with health systems, physician groups, and payers. 9) Disruptive bedfellows – on demand services like Honor, CrowdMed, Amazon Home Services, UberAssist, Doctor On Demand, and Heal are disrupting home care providers and providing access and low cost services. 10) Providers are preparing. Some home care and hospice providers are ahead of the pack on preparing for these changes – some have created innovative programs, others have merged for scale, and yet others have integrated with large provider and payer delivery systems to assure their services are integral in the changing VBC environment. I hope these top 10 help you prepare for 2016 and beyond - to be a major player in your market and to assure the best outcomes for your patients, employees and other stakeholders. Have a wonderful holiday season and many best wishes for a great start to 2016!   Jeannee Parker Martin Go Back