Driving Value-Based Reimbursement with Integrated Care Models

The burgeoning fee-for-value environment is rewarding networks of providers who collaborate and coordinate care, bridging the gap between health systems and physicians and sparking dialog and care compacts between primary care and specialists. Even top-performing Pioneer ACOs are rethinking the role of specialists in care coordination. And after a successful pilot and system-wide rollout of its practice transformation initiative, WellPoint is poised to move to the next level, building a bridge between primary care and specialty practice transformation to create a medical neighborhood. This resource examines WellPoint's practice transformation effort and the reimbursement models that support it, while providing a framework in which to evaluate the patient-centered medical neighborhood (PCM-N) model. In this 45-page resource, the director of care delivery transformation for WellPoint, and the director of BDC Advisors, share their visions for this emerging care experience, from structuring incentives and reimbursement to reward high-quality and efficient care to identifying and engaging specialists in a medical home neighborhood. This HIN special report provides details on the following: * Three key practice transformation roles developed by WellPoint that address the critical elements of transformation; * How the physician practice transformation program complements WellPoint's overall reimbursement strategy with fee-for-service and a shared savings component; * The Quality Gate for clinical and utilization metrics for WellPoint's shared savings arrangement; * Overcoming physician resistance to practice transformation, especially transformation driven by a healthcare payor; * The evolution of practice transformation, including its connection of primary care and specialists in care delivery collaborations; * Details on WellPoint's planned 2014 medical home neighborhood pilot with select specialties; * Key components of the medical home neighborhood; * How to identify and engage specialists to participate in a medical neighborhood; * How to help physicians understand the link between meaningful use, the patient-centered medical home and medical neighborhoods; * Care coordination across the neighborhood; and * Lessons learned in building medical neighborhoods. This resource goes on to respond to more than 20 questions on these new horizons in care coordination, from details on the Primary Care-Specialist care compact in WellPoint's medical home neighborhood to clarifying the difference between an accountable care organization and a medical neighborhood. Table of Contents= * Aligning Value-Based Reimbursement with Physician Practice Transformation. * Medical Home Neighborhoods: Uplinking Specialists To Create Integrated Systems of Care. * Q&A: Ask the Experts. * Glossary. * For More Information. * About the Speakers.