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Discern, LLC 1501 Sulgrave Avenue, Suite 302 Baltimore, Maryland 21209 (410) 542-4470 phone (410) 542-9990 fax
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DISCERN NEWS
April 2010 Discern Developing P4P Program for Transitions of Care Poor health outcomes among patients recently discharged from the hospital are well documented. In many cases, these poor outcomes lead to hospital readmissions or other health complications, generating increased costs. Yet, few purchasers have implemented pay-for-performance (P4P) programs that specifically target this important opportunity to improve care.
Discern has received funding to develop specifications for a physician P4P program focused on transitions of care. This program will be one of the first national models for P4P in effectively transitioning care from the inpatient to outpatient setting. With the guidance of an expert clinical advisory panel, Discern is developing a set of quality measures, a scoring system, recommended rewards amounts, and a technical white paper to support program implementation. Some of the quality measures will apply to all patients as they are discharged from the hospital, and Discern will also develop measure modules for specific clinical areas.
In other project news, Discern recently completed development of a P4P program designed to improve care delivered to patients with COPD. The program has been adopted by Bridges to Excellence as the COPD Care Link. Click here to learn more about Discern's involvement with COPD P4P program development or to read the paper “COPD Pay-for-Performance White Paper and Technical Specifications."
Discern Welcomes Maria Nikol as Project Manager The Discern staff continues to grow with the addition of project manager Maria Nikol. Maria will provide project management services, including project design and coordination, research and analysis, and communications outreach, for various client initiatives. She will use her experience in marketing to develop client communication materials, including educational toolkits, print brochures, and Web-based materials.
Before joining Discern, Maria was the implementation manager and coordinator at Harmony Medical, where she created training materials and educated staff and physicians about practice management and electronic medical records. She also founded and served as the president of A+ Promotions, an independent marketing agency, for more than three years. In this role, Maria managed and trained staff for point-of-sale promotions and tradeshows, mainly within the food services industry.
Maria received a bachelor of science in pharmaceutical marketing and management from the University of Sciences in Philadelphia. She speaks fluent Russian and is an avid ice skater. Please join us in welcoming Maria! Click here to learn more about Maria.
March 2010 Discern To Develop Online Tools for Payment Reform Discern is working with the Health Care Incentive Improvement Institute, Inc. (HCI3) to develop a Web site and technical assistance tools that will support implementations of Bridges to Excellence (BTE) and PROMETHEUS Payment, two leading payment reform strategies. Discern will develop tools that providers, employers and health plans can use to analyze data and explore potential savings and quality improvements associated with different payment systems.
Technical assistance tools for health plans will include an ECR (episode case rate) estimator that examines claims data and calculates savings opportunities, an ROI estimator, and guides for implementation. Providers will be able to access decision tools, identify best-fit performance assessment pathways, and estimate costs and benefits associated with different payment structures. In addition, the Web site will be an educational hub for payment reform and will provide technical information to support program implementations.
The updated Web site at www.HCI3.org is slated to go live late this summer, and is supported by a grant from the Robert Wood Johnson Foundation to HCI3.
Predictive Modeling News Features Guy D'Andrea's Patient-Centered Medical Home Model The February issue of Predictive Modeling News highlights an analytical model that Discern President Guy D'Andrea created to explore how episode payment can work in the patient-centered medical home. The tool simulates a population of chronically ill patients with various risk factors and co-morbidities being treated in a primary care practice and estimates costs and payment under both fee-for-service and episode payment. Overall, the results of the model support the idea that PROMETHEUS Payment can align incentives so that physicians have an incentive to keep patients healthy and out of the hospital; adjust for risk so that physicians do not have an incentive to avoid riskier patients; and increase physician payment while yielding net savings from fewer complications. D'Andrea's model was originally published in the paper "Sustaining the Medical Home: How PROMETHEUS Payment® Can Revitalize Primary Care,” which was funded by the Robert Wood Johnson Foundation.
Discern Taps David Wollner as Project Director David Wollner recently joined the Discern team as Project Director. David has more than ten years of experience working in leading health care organizations, including CVS Caremark, Aetna and Takeda Pharmaceuticals. Much of his work has focused on contracts and pricing, managed markets, network relationships and medical claims. At Discern, David will provide clients with a range of consulting services and will be responsible for financial and decision model development, data analysis and research, and project management.
David received a BS in finance from Miami University and a MBA with a concentration in health care management from Loyola University Chicago Graduate School of Business. He is a member of Beta Gamma Sigma and the American College of Healthcare Executives. Most recently, he earned designation as a Certified Professional Contracts Manager from the National Contract Management Association. Please join us in welcoming David! Click here to learn more.
Discern Adds New Affiliate Consultant Marilyn Wolff Diamond, a health care consultant in private practice, has joined Discern's roster of affiliate consultants and will be available to work on special projects, as needed. Ms. Diamond specializes in health care quality, health policy, reproductive medicine and public health issues. Prior to launching Diamond Health Consulting, Ms. Diamond was the Director of Quality Initiatives at The New York Business Group on Health. In this role, she managed the Multi-Payer Physician Data Reporting Project called One Voice and led local efforts for the Leapfrog Hospital Survey and the eValue8 health plan evaluation. Ms. Diamond received a MS in health policy and management from the Harvard School of Public Health. To learn more about Ms. Diamond or Discern's affiliate consultants, please click here.
November 2009 P4P for COPD to be Highlighted at NBCH's Annual Conference Discern President Guy D'Andrea will speak about "The Next Generation of Bridges to Excellence: A Case Study on COPD Pay-for-Performance" on November 9 at the NBCH conference in Phoenix. Along with Francois de Brantes and Edison Machado of Bridges to Excellence, and Tom Parry of the Integrated Benefits Institute, D'Andrea will discuss a new pay-for-performance program designed to improve care delivered to COPD patients. Development of the program was made possible with financial support from Boehringer Ingelheim.
COPD is among the leading causes of death in this country. In 2007, the total estimated cost of COPD nationwide ranked third among chronic diseases, at $42.6 billion. Similar to other chronic diseases, poor outcomes and costs associated with COPD could be reduced through improved health care management, which is the goal of the new pay-for-performance program. Click to learn more about Discern's involvement with the COPD program or to read the paper "COPD Pay-for-Performance White Paper and Technical Specifications."
Please Visit Discern's Exhibit Booth at NBCH The Discern team will be at the NBCH Annual Conference in Phoenix in exhibit booth 44 from November 8-10. Please stop by to say hello and learn more about the new COPD pay-for -performance program, as well as Discern's other activities and capabilities that support value-based purchasing initiatives.
Discern Teams with IncentOne to Create Integrated Incentives Platform Discern is working with IncentOne, a New Jersey-based provider of incentive solutions to the health care industry, to develop a platform that aligns consumer and physician incentives into a single, coordinated system. The model will be among the first of its kind in today's health care marketplace, where incentive programs for patients and providers typically operate separately from each other.
As part of the project, Discern will develop a return-on-investment framework that will be central to the new incentive model. The ROI tool will measure the potential value and impact of specific incentive programs, identifying opportunities for health system improvement and cost savings. To create the framework, Discern will use IncentOne's extensive health incentives database. The result will be an incentives platform that seamlessly integrates consumer incentives with physician and provider pay-for-performance programs. Click here for more information.
Discern’s Guy D’Andrea to Speak with Leapfrog Group CEO at Health Benefits Conference & Expo Discern President Guy D’Andrea and the Leapfrog Group will present “The ROI of Hospital Pay-for-Performance: Case Studies” at the Health Benefits Conference & Expo (HBCE). The conference is schedule for January 26 and 26 in Clearwater Beach, Florida. For more information, please visit HBCE’s Web site at www.hbce.com.
September 2009 P4P Concepts Featured at German Managed Care Association ConferenceDiscern President Guy D'Andrea and National Business Coalition on Health President Andy Webber will presenthealth care financing solutions as the keynote speakers at the German Managed Care Association's annualconference. The conference will take place in Berlin, Germany, on October 20 and 21. Both speakers willshare strategies and best practices for incorporating pay-for-performance and value-based purchasing initiatives into broader payment reform strategies occurring in countries throughout the world. The conference will focus on health care management and financing strategies, featuring topics like diseasemanagement, health information technology, population health and P4P. Guy and Andy will share health carereform efforts in the United States, including the history of the nation's health care system, U.S. policies, currentpayment solutions in practice, case studies and the evolving health care landscape. For more information, pleasevisit the conference Web site
August 2009 Discern Announces New Projects Discern is excited to work on new projects in the areas of:
Benefit Design Discern is developing an implementation toolkit for a PBM's consumer incentive program that focuses on improving chronic conditions through educational support and benefit design.
P4P Measures Discern is developing technical specifications for measures to be used in the evaluation of care for COPD patients.
Diabetes Management Strategies Discern is developing a workshop to educate employers about effective strategies to improve care and outcomes for patients with diabetes.
Hospital-Acquired Conditions Discern recently completed work on a toolkit that health care purchasers can use to implement policies similar to CMS's non-payment for hospital-acquired conditions.
Discern Contributes to Paper on Episode Payment for the Medical Home Implementing appropriate payment structures is critical to the adoption of the patient-centered medical home. Episode payment offers a possible solution to this challenge, because it aligns incentives with the goals of the medical home - investing in prevention and primary care in order to avoid health complications that lead to poor outcomes and higher costs.
A recent paper entitled "Sustaining the Medical Home: How PROMETHEUS Payment® Can Revitalize Primary Care" describes and analyzes how episode payment can work in a medical home setting. For the paper, which was funded by the Robert Wood Johnson Foundation, Discern president Guy D'Andrea created a financial model that simulates a population of chronically ill patients with various risk factors and co-morbidities being treated in a primary care practice. The model estimates costs and payment under both fee-for-service and episode payment.
Overall, the results of the model support the idea that PROMETHEUS can align incentives so that physicians have an incentive to keep patients healthy and out of the hospital; adjust for risk so that physicians do not have an incentive to avoid riskier patients; and increase physician payment while yielding net savings from fewer complications.
The paper is available here. The section describing the primary care financial model begins on page 45
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