Problem

I can't get my head around the CMS Plan for healthcare reform and how it will change my world.

There are nearly 20,000 pages of regulations in the ACA. We’re here to help you understand the essentials for success.

It starts with an Operational Analysis…

Scroll to See How

WHAT IS TRIPLE AIM?

Tri-ple Aim

/'tripel ām /

1The Institute for Healthcare Improvement has developed a framework for optimizing health system performance. It is commonly known as “Triple Aim”:

Customer Satisfaction

Readmissions

Functional Improvement

Quality

At Consonus, we aid our customers in achieving the triple aim through our analytical reporting tools for Customer Satisfaction, Readmissions, Functional Improvement, and Quality. Monitoring a customer’s progress in these key areas is only half the battle. Consonus offers consulting guidance in each category to help our customers outperform the competition and thrive.

what are the future payer sources & the payment models?

Payer Sources

  • Institutional Special Needs Program

    A Medicare Advantage product available to populations served by SNF, ALF, and HH for at least 90 days.

  • Dual Eligible Special Needs Plans

    A type of Medicare Advantage plan that enrolls only individuals dually eligible for Medicare and Medicaid.

  • Accountable Care Organization

    A payment and care delivery model that connects provider reimbursements to quality metrics and reduced the total cost of care for patients.

  • Dual Eligible Special Needs Plans

    A private company that contracts with Medicare to manage Part A and Part B benefits.

  • Dual Eligible Special Needs Plans

    An entity that may or may not take risk in the care of Medicare patients by partnering with acute and/or post acute providers for selected diagnosis groups.

  • Patient Driven Payment Model

    Replaces the proposed RCS-1, with implementation scheduled for Oct. 1, 2019


Payment Models

There will be different Payment Models

Traditional Fee for Service Model

Pre Admission Services
Part a Hospital
Part B Inpatient
Post Acute Costs
Readmissions

Bundle Payment Model

A single lump payment, usually by diagnosis, paid to multiple providers within a continuum

Pre Admission Services
Part a Hospital
Part B Inpatient
Post Acute Costs
Readmissions

Episodic Payment Model

Similar to the hospital DRG model. A lump sum payment paid to a single provider (SNF & Home Health) for an episode of care.

How does the value based purchasing market work?

Funding

In order to fund the incentive payment pool,

When does this all happen?

Implementation happens in stages

  • FY 2016

    Resolved Denials Timeline
    10/01/16
    • The Secretary of Health and Human Services (HHS) must specify a SNF all-cause, all-condition readmission measure by October 1, 2015.
  • FY 2017

    Resolved Denials Timeline
    10/01/17
    • The Secretary must then specify an all-condition, risk-adjusted potentially preventable hospital readmission rate by October 1, 2016.
  • FY 2018

    Resolved Denials Timeline
    10/01/18
    • Public reporting of readmission measures appear on Nursing Home Compare.
  • FY 2019

    Resolved Denials Timeline
    10/01/19
    • SNFs’ Medicare payment rates will be based on (in part) their performance scores beginning on October 1, 2018.

A fun tool for educating your staff about Healthcare reform

Summary

Healthcare reform is changing the game, understanding these changes will be critical to succeeding in the future.