©AAHCM

HEALTH SYSTEM PERSPECTIVES

©AAHCM

No Conflicts

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©AAHCM

The Era of Commercial Insurance Increases Making Up for Medicare and Medicaid Losses is Ending

Privileged and Confidential: Prepared in accordance with New York State Public Health Law 2805 j through m; New York State Education Law 6527; & Federal Law 109-4.

©AAHCM

Fee For Service Rates Will Not Keep Up With Expenses

Privileged and Confidential: Prepared in accordance with New York State Public Health Law 2805 j through m; New York State Education Law 6527; & Federal Law 109-4.

©AAHCM

FEE-FOR-SERVICE PAYMENT FOR VALUE

ELIMINATE WASTE

IMPROVE QUALITY

MANAGE POPULATIONS

FROM TO

ComponentsIntegrated Delivery Systems

Clinically Integrated Networks

Care Management Systems

Novel Provider Payer Relationships

Centers of Excellence

9

PAY FOR PERFORMANCE

BUNDLED PAYMENTS

SHARED SAVINGS

PARTIAL RISK

FULL RISK

PENALTY AVOIDANCE

10

TRANSITIONAL CARE

COMMUNITY BASED EPISODIC CARE

COMMUNITY BASED PRIMARY CARE

SPECIALIZED CONDITIONS

GENERAL POPULATIONS

11

HOUSE CALLS

HOME CARE PROVIDERS

HOME BASED PRIMARY CARE

HOUSE CALL DOCTORS

HOME CARE PHYSICIANS

REDUCING READMISSIONS

MAINTAINING PATIENTS IN THE LOWEST COST SETTING

MOVING PALLIATIVE CARE UPSTREAM

MITIGATING OVERTREATMENT

MANAGING THE COSTLIEST MEMBERS

FROM TO

QUESTIONS