Incentivizing Providers to Reduce Low-Value Care Key to Value Based Success: RowdMap, Inc. Contributes to Health Care Transformation Task Force White Paper

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RowdMap, Inc. Contributes to the Health Care Transformation Task Force white paper on succeeding in Pay for Value programs through sustainable payment models by targeting, incentivizing providers on Low-Value Care.

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A provider may improve outcomes for a patient, but if a disproportionate amount of low-value care is generated in the process, there will be no savings.

RowdMap Inc. is a proud participant on the Health Care Transformation Task Force, contributing to newly released white paper: “Payment to Promote Sustainability of Care Management Models for High-Need, High-Cost Patients.” The paper was published June 1st, 2016 and is available at: .

The Health Care Transformation Task Force (HCTTF) is a group of private sector stakeholders ranging from providers, health plans, employers, consumers, to academic institutions. Their common goal is to put 75% of their business into value based arrangements by 2020. Participating payers include Aetna, Blue Cross Blue Shield of Michigan, Blue Shield of California, Health Care Service Corporation (Blue Cross Blue Shield of Illinois, Montana, New Mexico, Oklahoma and Texas), and Blue Cross Blue Shield of Massachusetts while providers include Ascension, Catholic Health Initiatives (CHI), Dartmouth-Hitchcock Health, DIgnity Health, Montefiore, Partners Healthcare, SSMHealth, Trinity Health, and the Tucson Medical Center among other participants.

This white paper focuses on how to create sustainable payment models around pay for value programs and risk arrangements. A key consideration is Low-Value care, a point the paper makes with clarity and at length:

“Fee-for-service care management payments incentivize provision of care management services regardless of medical necessity. In fact, roughly 30 percent of each dollar paid for care goes to low/no-value care—care of a higher intensity, expense, and risk where lower intensity treatments yield the same outcomes at lower costs.”

The white paper goes on to add:

“With proper risk adjustment, population-based payment incents providers to find savings by managing care for those most in need, and re-allocating that savings to improve care in other areas. Low-value care is the single largest driver of unnecessary costs, roughly three percent of Gross Domestic Product (GDP), so mitigating low-value care creates an immediate, demonstrable financial impact. While provider incentive payments based on outcomes also incentivize care management for those patients most in need, providers are not at risk for the total cost of care, which reduces the incentive to control volume. A provider may improve outcomes for a patient, but if a disproportionate amount of low-value care is generated in the process, there will be no savings.”

This white paper is the third in the series from the High Cost Patients Work Group, of which RowdMap, Inc. is a participant. The first, “Proactively Identifying the High Cost Population,” highlighted how government benchmark population data, such as behavioral data from the Behavioral Risk Factor Surveillance System (BRFSS) is important for projecting costs and has been shown to out-perform claims based analysis. Using a population’s behaviors, as well as supply of providers versus the demand of the population informs the success and economic impact of value based programs versus Fee for Service models.

The second paper, “Developing Care Management Programs to Serve High-Need, High-Cost Populations,” focuses on using low-value and no-value care as criteria for evaluating a value-based program’s success in creating outcomes, reducing costs and improving patient experience and specifically calls on the Centers for Medicare and Medicaid Services (CMS) and private health plans and risk-owning providers to do the same.

And this final paper in the series, “Payment to Promote Sustainability of Care Management Models for High-Need, High-Cost Patients,” focuses on using low-value care as a means not only of evaluating a program’s success but establishing economic viability through economic impact to the risk owner and incentives to the participant providers.

About RowdMap, Inc. :

An Ernst and Young EY Entrepreneur Of The Year® winner, RowdMap’s Risk-Readiness® benchmarks help health plans, physician groups, and hospital systems identify, quantify, and reduce no-value care that physicians deliver—a central tenet of successful pay-for-value programs.

Through practice pattern and referral analysis, RowdMap’s benchmarks identify the health care entities that manage unwarranted and unexpected variation in care. This variation leads to more than $850 billion in no-value care annually. Payers and physicians use RowdMap’s physician and population health benchmarks to create strategies that put these highest performing physicians at the center of networks and then design products, organize clinical programs, and coordinate sales and marketing around them.

RowdMap’s platform comes preloaded with benchmarks for every physician, hospital, and zip code in the United States—no IT integration required. RowdMap’s Risk-Readiness® Platform works across all market segments and has significantly larger returns than traditional medical economics approaches.

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Joshua Rosenthal
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