Care Transformation Center Blog

The insights, tools, and resources you need to take on population health management

Specialty pharmacy, explained

Lindsay Conway February 22, 2018

Specialty pharmacy continues to be a hot topic for health system leaders. To help you get up to speed, I've provided answers to some of your most frequently asked questions.

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The downside risk cliff: What the 82 ACOs about to be forced into downside risk should do right now

by Hunter Sinclair and Rebecca Nolan February 15, 2018

With last month's addition of 17 new organizations to the Next Generation ACO program, 26% of all Medicare ACOs now participate in a downside-risk model (including the Medicare Shared Savings Program's (MSSP) Track 1+, Track 2, and Track 3), up from 17% in 2017.

While 2018 is shaping up to be a big year for ACOs making the transition to risk, 2019 could be even bigger. In fact, next year 82 ACOs that have been in the MSSP Track 1 since 2013 must either take on downside risk or leave the program. Organizations that haven't decided whether to continue participating face a rapidly approaching application deadline this summer. CMMI will not accept Next Generation ACO applications for 2019, so these organizations should focus on which downside risk MSSP track (if any) makes the most sense for them.

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HCC: The 3-letter word that can build payer-provider trust and improve quality

Rodrigo Martinez, MD February 13, 2018

As the shift toward value-based care and risk-based contracting progresses, it will become even more important for health plans and those who deliver care to collaborate.

Yet health plans and providers often fail to take advantage of the ample opportunities to operationalize "win-win" programs that offer financial, operational, and quality gains for both organizations, which are also wins for their patients. Why? One major factor is that, historically, payers and providers have had a challenging relationship based on mistrust, misunderstanding, and perceived differences in goals.

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4 steps for managing rising-risk patients

Tomi Ogundimu , Petra Esseling February 8, 2018

Every provider engaged in risk-based contracts agrees that effective care management for high-risk patients is a universal starting point. But while it's a necessary first step in any successful population health strategy, a strict focus on high-risk patients alone is insufficient.

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4 lessons for reinvigorating your med rec process

by Rebecca Tyrrell February 1, 2018

An estimated 70% of patients have errors in their medication lists at hospital admission or discharge—and often have 5 to 7 errors at once. The consequences are profound, and include everything from adverse drug events, increased readmission rates, and increased length of stay to excess drug spending.

Medication reconciliation is designed to prevent these errors from occurring in the first place. However, the process has historically been viewed by many executives and frontline staff as a task to complete, rather than a patient safety imperative, and as such, is often poorly understood and under-resourced.

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How to pace your population health investments

by Laurie Sprung, Ph.D., and BJ Millar, MBA January 31, 2018

Based on what we've seen throughout both of our careers, we couldn't have imagined the speed at which certain markets have tipped to value-based payment models. We saw providers, payers, or sometimes large employers, in parts of the country that seemed steadfast in their commitment to fee-for-service upend the market's status quo and replace it with an entirely new model in as little as six months.

But while impressive, moving towards population health at such a quick speed can be risky.

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How a shooting's aftermath changed a 3-health-system transportation project—and where they're going from here

by Josh Zeitlin, Senior Editor, and Darby Sullivan, Analyst January 30, 2018

Each year, 260 babies die before their first birthday in St. Louis.

"We lose what would be the equivalent of 15 classrooms of kindergartens every year in St. Louis from infant mortality," said Kendra Copanas, executive director for Generate Health, which works to improve birth outcomes and community health in the St. Louis area via education and advocacy. "It's particularly remarkable when you consider that St. Louis is also home to world class medical care and groundbreaking health research."

March 7 webconference: How a hospital's community partnerships are transforming housing and health care for the homeless

Generate Health has evolved over 20 years as a long-standing maternal and infant health consortium, and in 2015, they formed the FLOURISH St. Louis initiative—a focused strategy that allowed its broad coalition of community organizations, from health systems to nonprofits—to come together to tackle the complex problem of infant mortality. In 2017, FLOURISH partners spent months laying the groundwork for a collaborative, full-scale effort to address transportation issues that hinder access to medical care, healthy foods, employment, and social services for low-income mothers, particularly for women of color—all of which can lead to greater infant mortality.

Then, just as they were ready to launch, the aftermath of a local tragedy forced them to shift perspective.

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How one provider got serious about identifying health disparities (and you can, too)

by Tomi Ogundimu and Darby Sullivan January 25, 2018

Provider organizations involved in all types of payment models have a role to play in addressing health disparities—it's a $77 billion problem, and most hospitals don't have money to spare. But even the most progressive health systems under full-risk struggle with approaching the entrenched and often structural causes of health disparities. They get caught up on the first step—identifying their communities' most pressing disparities.

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