For a payer, the move from fee-for-service reimbursement to value-based payment can be a painstaking process—and not just for you, but also for the healthcare providers in your networks. But, with the right data and a proven strategy the transition to value-based care can be manageable—and ultimately successful.
3M™ Healthcare Transformation Suite helps healthcare payers implement and manage value-based care and population health programs collaboratively with providers. The suite addresses the core parts of implementing a successful value-based care initiative.
A foundation of timely, accurate and reliable data analytics is critical to a value-based care program. Having the right data makes it possible to assess your current situation, identify opportunities to improve performance, design an appropriate program and track your progress.
3M℠ Intelligent Data Asset is a claims-based data set. First, we aggregate, harmonize and cleanse claims data. Then, the data is processed so that it is risk-adjusted and made appropriate for providing metrics on cost and quality. It can be enhanced to include several other metrics, depending on your business goals.
3M has developed several methodologies to help you assess the value of care delivered. They have been operationalized for over 200 payers and health data organizations, helping them implement payment programs that lead to better patient care at lower costs. They include 3M™ Potentially Preventable Readmissions (PPRs), 3M™ Potentially Preventable Complications (PPCs), 3M™ Population-focused Preventables, 3M™ Clinical Risk Groups (CRGs), and the 3M℠ Value Index Score (VIS).
Our 3M℠ Payment Transformation Programs enables you to reduce payment variation for the purpose of aligning payment with the quality of a provider’s performance.
Total cost of care is the sum of all medical expenditures for a patient or group of individuals. It’s the total dollar cost of all services in the delivery of care, including what is paid by the insurers plus what’s paid by the patient.
By understanding where and how costs are incurred, providers can spot opportunities to shift care to more appropriate settings. Their ability to manage total cost of care is critical to remaining profitable under new payment models and competitive within their market.
Sustaining your value-based care program and positioning your organization for long-term success requires ongoing attention to several tasks, such as PCP attribution, setting and tracking benchmarks and goals, providing data to all stakeholders, and many others.
3M℠ Program Design and Performance Management combines consulting services, analytics and performance dashboards to support organizations with developing, implementing, and monitoring a value-based care program. Through performance dashboards, payers can measure specific key performance indicators, track progress toward their program strategy, and share data with providers to help them achieve shared goals.
The 3M℠ Strategic Opportunity Analysis is also used to identify your strategic opportunities to improve care and set appropriate financial and quality goals.
As health care moves quickly toward value-based care, payers and providers need a way to capture value—performance as it relates to cost. Other existing performance measures aren’t ideal for these new models. They don’t account for costs, shared accountability or the impact of the health system. Often, they tend to be process focused, expensive, burdensome and disease-specific. The 3M Value Index Score clearly quantifies how well a provider takes care of his or her entire patient population within a primary care system.
Nobody likes surprises when it comes to their health. We don’t want to be surprised by a diagnosis that we did not expect or treatment that we did not anticipate, and we certainly don’t want to be surprised by a bill we thought was too high or should have been paid by our health insurance company. Unfortunately, stories of patients receiving unexpected hospital bills, like the $109,000 heart attack bill that an insured patient received from a Texas hospital, are still common. Is this a situation that will continue for the unsuspecting patient, or is anything being done to address it?
Ready or not, Accountable Care Organizations (ACOs) will be expected to assume downside risk after two years according to a proposal announced by the Centers for Medicare and Medicaid (CMS) on August 9, 2018. This change would impact 460 ACOs in the Medicare Shared Savings Program (MSSP), or 82 percent of the 561 MSSP ACOs that currently have non-risk based agreements.
One of the most enlightening insights from a recent University of Washington research study is that pricing contributes to ever-escalating healthcare costs. Since 2003, the annual rate of growth of healthcare spending has averaged 4.5 percent, which is more than two and half times the average rate of inflation over that same period (1.9 percent).
The 3M℠ Healthcare Transformation Suite combines payment-related methodologies, program design, reporting and analytics tools, and consulting services to support payers with the move from fee-for-service to value-based payment.
3M℠ Program Design and Performance Management combines consulting services, analytics and software tools designed to support organizations through developing and implementing a population health or accountable care program.
The 3M Strategic Opportunity Analysis (SOA) is a comprehensive examination of health performance at the patient, clinician and system levels, which can help health plans make informed decisions and define priorities around value-based care initiatives.