Population health management (PHM) education tools
By Shauna Kapsner | April 5, 2024 | All providers
Care Providers of Minnesota and the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) have many resources and links available regarding population health. It is not just for SNF/NFs anymore. Need some guidance and ideas? We have some for you!
Care Providers of Minnesota resource
Provider driven network opportunities
Over the past year, the Care Providers of Minnesota’s Population Health Management Committee has conducted “pre-development” work—understanding the development, process, and key considerations for a provider-driven network. We are now ready to move ahead with a membership assessment of interest in working collaboratively to establish a provider-owned/provider-driven network. Benefits of participation:
- Increased value from Association membership through expanded opportunities and leverage with health plans
- Opportunity to demonstrate quality improvement to health plans and residents by raising the bar through metrics, best practices dissemination, and performance
- Access to network management/contracting expertise in managed care contracting
- Efficiencies from sharing costs/resources created by AHCA/NCAL and used with multiple states to include contract negotiating services on non-price items such as claims processing time, audit restrictions, prior authorization terms, etc.
American Health Care Association/National Center for Assisted Living resources
Population Health Management Fundamentals
Population Health Management (PHM) is a term that describes the application of various interventions and strategies aimed at improving health outcomes and managing the costs of a targeted group of individuals. PHM models vary based on the degree of risk, degree to which payment is tied to quality, reliance on data analytics, and level of care coordination. Historically population health models have been led by hospitals, health systems, physician groups and large insurance organizations. More recently long-term care (LTC) and post-acute care (PAC) providers have been assuming a leadership role in developing and employing some PHM models.
Assisted Living Population Health Management Webinar – The importance of value-based care
Nisha Hammel, Associate Vice President, Population Health Management, AHCA/NCAL, will give an overview of value-based care and the importance of providers preparing their assisted living operations and business model for population health management.
Accountable Care Organizations
Accountable Care Organizations (ACOs) are one of the largest alternative payment models in Medicare, and they also exist in Medicaid and commercial payors. ACOs are networks of physicians, hospitals, and other healthcare providers that voluntarily come together to coordinate care and manage the total costs of a defined population, sharing in the financial risks and rewards of performance against benchmarks and on patient outcomes.
ACO Toolkit
Accountable Care Organizations (ACOs) are part of the Centers for Medicare and Medicaid’s value-based payment strategy aimed at improving quality and reducing costs. ACOs are networks of doctors, hospitals, and other health care providers, coming together to deliver high value, coordinated care and payment for Medicare beneficiaries. ACOs are financially incentivized to meet quality outcomes and focus on preventative and primary care. The Medicare Shared Savings Program (MSSP) is one of CMS’s largest value-based payment models.
Bundled Payments
Bundled payments are a type of alternative payment model designed to incentivize high quality, cost-effective care. Bundled payments, also known as episode-based payments, are single payments for all care and services provided, which could include multiple settings, for a single condition over a defined period of time (episode of care).
Managed Care
Managed care involves a healthcare delivery system that encompasses care, services, and payment and seeks to control costs and enhance quality through the establishment of provider networks and employment of utilization management strategies.
Provider Networks
Provider networks are a joint venture of independent providers that come together to focus on the benefits for the residents, enhance quality outcomes, and work on value-based reimbursement.
PHM Innovation Lab
Population Health Management (PHM) is a term that describes the application of various interventions and strategies aimed at improving health outcomes and managing the costs of a targeted group of individuals. Historically population health models have been led by hospitals, health systems, physician groups and large insurance organizations. More recently long-term care (LTC) and post-acute care (PAC) providers have been assuming a leadership role in developing and employing some PHM models. The Population Health Management Innovation Lab has been developed to educate LTC/PAC providers on the different PHM models and opportunities for participation and leadership within them.
Shauna Kapsner | Director of Education & Events |
skapsner@careproviders.org | 952-851-2490