Healthcare Intelligence Network
Audio Conferences
Accountable Care Organizations
Best Sellers
Behavioral Healthcare
Benchmarking
Bundled Payment
Care Transitions
Case Management
Coaching
Coding
Coming Soon
Community Health
Compliance
Consumer-Driven
Credentialing
Cultural Diversity
Diabetes Management
Directories & Databases
Disease Management
Disease Management Dimensions
Dual Eligibles
e-Books
eHealthcare
Emergency Medicine
Financial Management
Grant Funding
Health Care Management
Health Information Management
Health Insurance Exchange
Health Risk Assessments
Healthcare Reform
Healthcare Trends
HIN Benchmark Reports
HIN Special Reports
HIPAA
Home Health
Hospice
Hospital
Hospital Readmissions
Hospitalist
Human Resources
ICD-10
Infection Control
Information Technology
Long-Term Care
Managed Care
Marketing
Medicaid
Medical Guidelines
Medical Home
Medical Home Open House Training
Medical Practice
Medical Records
Medicare
Medication Adherence
mHealth
Nurse Management
Occupational Health
On Demand
Palliative Care
Patient Registry
Pay for Performance
Pharmaceutical
Physician Practice Transformation
Physician Organizations
Physician Quality Reporting Initiative
Podcasts
Population Health Management
Predictive Modeling
Pre-Publication
Prospective Payment System
Quality Improvement
Reimbursement
Revenue Cycle Management
Safety
Star Quality Ratings
Telehealth
Training DVDs
Transparency
Webinars
Wellness
What's New
Women's Healthcare
Subscribe to the Free
'Healthcare Business Weekly Update' e-Newsletter and receive the latest trends, news and analysis in healthcare.
Email:

Click here to view this week's issue
Home > e-Books
Case Study in Physician Practice and Payment Transformation: The CDPHP Experience
Case Study in Physician Practice and Payment Transformation: The CDPHP Experience
Recommend this resource to a colleague Be the first to review this item
Price
Your Price:
$89.00
Choose Format and Quantity
Format Recommended: Print and Instant PDF Download
Print
Instant PDF Download
Save with Multi-User Discount* (based on PDF price; please call for discounts on print/print-PDFs). Contact us for orders of 25+ copies.
Quantity Price Per Copy
2-5 $57.85
6-10 $48.95
11-25 $22.25
Contact us if you would like to order more than 25 copies.
Quantity
Add to Wish List
Description
Like the convenience of getting a PDF the same business day but still want a hard copy? Order both versions and save 35 percent!

Setting the dual intentions of improving the value of healthcare while enhancing compensation for its primary care physicians may seem like a formidable goal; nevertheless, CDPHP set out to do just that when it launched a two-phase pilot in 2008 to reform both the practice of primary care in its network and payment to these physicians.

Case Study in Physician Practice and Payment Transformation: The CDPHP Experience chronicles the clinical and financial journeys of this network model health plan, sharing practical strategies and lessons learned from this two part-process.

Illuminating Phase I, Bruce Nash, MD, MBA, and CDPHP senior vice president, medical affairs, and chief medical officer, describes how CDPHP met the challenge of developing a novel risk adjustment methodology that would drive a global payment combined with a significant bonus structure. The approach was successful in both attracting physician participation and encouraging future growth by medical students to enter primary care. Dr. Nash explains the motivation for the medical home pilot and presents preliminary findings from the three practices in the pilot cohort.

In Phase Two, CDPHP built its clinical transformation to a patient-centered medical home — renamed Enhanced Primary Care — around case managers embedded in physician practices. CDPHP's Lisa Sasko, MA, MBA, director of clinical transformation, and Charlene Schlude, director of case management, describe the expansion of the effort to 24 practices and share additional results from Year 2 of the effort.

They also share the business case for an embedded case management program to bring healthcare organizations to the new level of care required in today's healthcare delivery system, and describe the day-to-day interactions of embedded case managers with providers in a practice.

This 45-page report provides details on the following:

  • Motivations for the CDPHP Medical Home project;
  • Readying for practice and payment reform;
  • Analyzing the risk-adjusted FFS model and the bonus models:
  • The business case for embedded case managers in the physician practice;
  • The role of case managers in delivering accountable care in the medical home;
  • The impact of embedded case managers on hospital re-admissions, ER visits and care transitions;
  • The operational and cultural issues critical to the success of the program;
  • Results from the two-year analysis of the CDPHP program;
  • Planned enhancements of the initiative;
and much more.

Table of Contents

  • Rewarding Primary Care Practice Reform with Physician Payment Reform
    • Motivations for Medical Home Project
    • Payment Reform
    • FFS Still Works for Certain Conditions
    • Risk-Adjusted Comprehensive Base Pay Bonus Payment Model
    • Preliminary Findings
    • Creating Even Larger Bonus Opportunities
  • The Role of the Embedded Case Manager in Clinical Transformation
    • History of the Enhanced Primary Care Program
    • Steps to Practice Transformation and Payment Reform
    • Analyzing Savings in a Pilot Practice
    • Implementing Embedded Case Management
    • Incorporating the Triple Aim Initiative
    • Expanding Programs and Practices
    • 5 Criteria for Practice Selection
    • Impact of Practice Transformation
    • Stratification and Prioritization
    • Primary Day-to-Day Nurse Roles and Responsibilities
    • Reducing Gaps in Care
    • Case load and Schedules of an Embedded Case Manager
    • Collaboration with Pharmacies
    • High-Risk Populations and Dual Diagnosis Care
    • Identifying Desired Outcomes
    • Costs Associated with Embedded Case Managers
    • Outcomes and Lessons Learned
  • Q&A: Ask the Experts
      Funding RN Case Managers
    • Training the First Nurse Case Managers
    • Productivity Benchmarks for Embedded Case Managers
    • Prehuddle Reviews
    • Cost Savings from Case Managers
    • Physician Incentive Models
    • Patient Risk and Acuity Levels
    • Case Management Certification
    • Relative Readmission Index
    • Evidence-Based Teaching Tools
    • Factoring in Observation Stays
    • Primary Care Partnerships
    • Payor Incentives for Case Management
    • Translating Model to Specialist Practices
    • Readmissions Metrics
    • Bon Secours Demographics
    • Prioritizing Case Management Resources
    • Case Management Outreach
    • MyChart Patient Portal
    • Payment Models
    • Skills for a Successful Case Manager
    • Hiring the Right Embedded Case Manager
    • Care Plan Management Tools
    • Health IT and EHRs in the Practice
    • CDPHP Demographics
    • Case Manager Communication Tools
    • ROI Methodology
    • Expanding the Touch of the Practics
    • Measuring Member Satisfaction and Service
    • Cost to Patients
  • Glossary
  • For More Information
  • About the Speakers
Publication Date: December 2011
Number of Pages: 45
ISBN 10: 1-937229-39-4 (Print version); 1-937229-40-8 (PDF version)
ISBN 13: 978-1-937229-39-9 (Print version); 978-1-937229-40-5 (PDF version)
We Also Recommend
Medical Home Reimbursement Models: Funding Patient-Centered Care with Multi-Stakeholder Collaborations
Medical Home Reimbursement Models: Funding Patient-Centered Care with Multi-Stakeholder Collaborations
Your Price: $157.00
Buy
Guide to Physician Engagement
Guide to Physician Engagement
Your Price: $299.00
Buy
Case Study in Clinical Integration: The Advocate Physician Partners Experience
Case Study in Clinical Integration: The Advocate Physician Partners Experience
Your Price: $49.00
Buy
Browse Similar Items
Quality Improvement
Community Health
Physician Organizations
Medicare
Medicaid
Managed Care
HIN Special Reports
Medical Home
Disease Management
Medical Practice
Reimbursement
Healthcare Reform
Hospital
Bundled Payment

Population Health Framework: 27 Strategies to Drive Engagement, Access & Risk Stratification
Healthcare Operations Management, Second Edition
Case Managers in the Primary Care Practice: Tools, Assessments and Workflows for Embedded Care Coordination
Home Visits for High-Risk Patients: Tools, Timing and Outcomes
Population Health Management Tools for ACOs: Technologies and Tactics to Support Accountable Care

Copyright Healthcare Intelligence Network. All Rights Reserved. eCommerce Software by 3dcart.