Pay Member Per Month Pmpm Cost PowerPoint PPT Presentations

e-Prescribing s Impact on Cost and Quality: Implications for Pay-for-Performance Initiatives HIT Summit West March 7, 2005 Leo M. Barbaro Regional Vice President ...

It is now fairly common knowledge that Care Management (CM) programs have had mixed success in reducing the Per Member Per Month (PMPM) cost for a population. There are many publications that site case studies and compile savings and ROI numbers for care management programs across the country in the last 5 years. The results are all over the place. These research publications conclude that most CM programs that are successful are those that are highly integrated, high touch programs.

... framework for Medicaid capitation that takes such ... Provide a fixed capitation rate per-member-per-month. Provide a risk-adjusted capitation rate PMPM ...

These types of bonus incentive schemes are based on the idea that work output, ... Choice Care Cincinnati Ohio offer P4P to its physicians in 1975 under Dr Bob Ides. ...

100000.00 2034.00 35.80 6.20 10.20 3.60 20.00 2.50 4.80 8.50 18.30 9.10 -17.50 180.40 18.30 23995.00 $1.49. 100000.00 $2.45. 100000.00 $0.86. 100000.00 $0.60.

... payment (physician initiated) X ... Enhances social support and accountability. Lowers direct intervention costs by 50-85 ... Time to ROI for payer 2 years ...

Pre-Conference I: Pay for Performance for Newcomers. Barbra Rabson, MPH Dolores Yanagihara, MPH ... Massachusetts Health Quality Partners Integrated Healthcare ...

Healthcare Cost Differences in the 1990s - Lawrence University

By the time a man realizes that maybe his father was right, ... GE, Verizon, Hannaford Bros., NY. Boeing nationwide. Healthcare 21, TN. Blue Shield of California ...

According to capitated contract payments agreed by a health insurance company and a medical provider is called Capitation payment in healthcare. This payment is fixed, pre-arranged monthly payments received by a physician, clinic or hospital per patient enrolled in a health plan, or per capita. The United States of America currently ranks highest among developed nations in per-capita healthcare spending.

Total health care spending represented 16 percent of the gross domestic product (GDP) ... Discounts/coupons, etc. (e.g. fitness club) Physician/Hosp. Benefits ...

From Yesterday's New York Times. Methods Used by Insurers Are Questioned. By Robert Pear ... rate of 4-5,000 members per week. 13. Medicare Supplement / Select ...

... of prescription drug expenditures has ... Maximize use of generic drugs. Utilize patient cost-sharing programs ... Control cost of drugs & overall health care ...

Provides benefits for over 20% of population. Pays for 60% of ... Palmetto Medical Home Network. 26. SC Medicaid. Coordinated Care Enrollment. MCO plans 112,144 ...

Empower your patients through education, setting goals, and the teaching of self ... Pay for Performance Programs provide an incentive for providers to deliver ...

Upfront Cash for Admin Fees May Not Be Offset By Incremental ... Fees Paid By Employers and Payers Could Go UP, Not Down (If Pricing Discounts are Not Supplied) ...

Technical Produce a given quantity of output using the least ... 44,700 cataracts over 5 years at cost neutral price to NHS. Better clinical outcomes than NHS ...

Medi-Cal Managed Care Pay-for-performance Programs Elaine Batchlor, MD, MPH L.A. Care Health Plan P4P Programs in Medi-Cal The majority of Medi-Cal health plans (12 ...

3. Current Approved Rates (MCD, MCR, Capitation - PMPM and Specialty Care Visits) ... adjustments and bad debt, excluding managed care capitation] divided by 365 days) ...

President, The Commonwealth Fund. Third Annual National Pay for Performance Summit ... Source: L. Allen Dobson, MD, presentation to ERISA Industry Committee, ...

Health care strategy, finance, and data consulting firm ... 18' American Girl dolls. 6. UTLA Health Crisis Symposium. Analysis of LAUSD Claims Data ...

Provides health care coverage to 1.9 million consumers (14% of ... PIKE. MedPLUS Gateway. AmeriHealth. LUZERNE. AmeriHealth. MedPLUS Gateway. MONROE. MedPLUS ...

Coach Medical Home Strategies & tools to support patient-centered medical home transformation MODULE 2: Recognition and Payment This table provides a high-level ...

MEDICAID REDESIGN AND EXPANSION TECHNICAL ASSISTANCE INITIATIVE Draft Environmental Assessment + Feedback on Medicaid Redesign Options [INSERT DATE AND LOCATION]

Early Retiree Group Healthcare Coverage. Challenges and Issues. Bill Derech. Aetna. 2. Agenda. Introduction. Employee Needs. Employer Needs ...

Steer to 'Infusion Centers', free standing surgery centers for better rates and service ... Steer to better value providers. Drugs: 48% higher. Good ...

... 4 star quality rating 5% benchmark bonus could be the difference Relies on good relationships with providers for HEDIS ... overall rating of health care ...

... effect change in accounting principle, OPM credits, bank fee write-offs ... excludes impairment, disposition, restructuring, OPM and other charges/credits ...

... in Tampa, FL. Highlights in 3Q ... Hot topics in health insurance. Health actuarial application ... in Health Insurance. Product development ...

Lifestyle Options (diet, exercise, smoking, safety) Self-help, self care ... City of Mesa, AZ; General Mills; General Motors; Johnson & Johnson; Pacific Bell; ...

Managed Care ppt

10,000 businesses (IBM, Verizon,Wal-Mart) 600,000 lives ... High speed Internet access. Technology upgrades. Personal Computers ...

Pricing Medical Insurance Individual and Group Meeting-cum-Seminar on Preparedness Towards De-tariffing in Non-life Insurance Hyderabad, March 14, 2006

Physician compensated by risk pools created from withholds if can reduce ... MCOs and Physician Conduct ... Physician has an incentive to restrict # of patient ...

* Introduction CEO of Health Insurance Risk-Sharing Plan (HIRSP) Authority, which administers Wisconsin s 30 year-old state high-risk pool. Board Chair, National ...

If the case management services provided by your agency are not covered, then ... 100% of FPL may not be charged for service provided under the grant ...

Health Centers and CSI-RI. RIHCA participated in Steering Committee from its ... RICCC serving as the training arm of CSI-RI allowed for a level of familiarity ...

Managed Care * Calculation steps: 1.Projected growth by geo105 X 18 age X 2 gender groups : pop2011/pop2006-1 2.Provincial distribution of acute RIW by 18 age X 2 ...

Health Services. CCMP program design. AmeriChoice Statewide care management ... Fitness and obesity, diet and nutrition, prevention of diabetes. Smoking cessation ...

'However, we recognize that when a capitated payment is made to an MCO or a PHP, ... it with the requirement for States to set Actuarially Sound Capitation Rates. ...

... support services: Transportation, personal care, education ... Employer-Based Health Insurance Among Workers with Disabilities in MassHealth (Adults 18 64) ...

Senior Health Policy & Strategy Consultant. Med-Vantage, Inc. San Francisco ... Existing P4P program with MVP health plan ... Improve health maintenance compliance ...

Sandy H. Yoo May 5, 2006 The Rise of Managed Care Organizations (MCO) The cost of healthcare has skyrocketed in the last few decades The components of healthcare have ...

Aiming Higher State Coverage Initiatives Workshop for State Officials Anne Gauthier Senior Policy Director Commission on a High Performance Health System

When prior utilization data is unreliable ... overcome high utilization issues - specialty ... Issue to accept shared risk: Can utilization be controlled ...

Primary Care Case Management: A New Approach to Primary Care in Medicaid ... 3 managed care plans Aetna's Better Health, AmeriChoice by United Healthcare, ...

This presentation may contain forward-looking statements. ... JCAHO accredited, 420-bed hospital in Culver City, CA $1 million investment ...

TO DETERMINE POSTIONS IF YOU COULD, WOULD YOU..? ... sex and case mix/severity of illness Budget Feedback Disease Management Success factors Implementation ...

Title: BSC Review and Analysis Author: Darryl Crowe Last modified by: billybob Created Date: 2/9/2006 9:51:15 PM Document presentation format: On-screen Show

Governor Rendell has Reduced Statewide Administrative Spending. Dollars in millions ... incremental increase in DSH and Med Ed payments for DSH qualifying hospitals ...

Title: PowerPoint Presentation Author: ktope Last modified by: Thomas R. Lussier Created Date: 11/21/2005 2:43:06 PM Document presentation format

SOS Post Offer Employment Testing (POET) Core Strength ... Ryan Derby, MD, MPH, Jessica Simmons, MS, Lisa Hollien, BS, Megan Fox, RN, Megan ...

Since 2003, there have been a series of federal legislative and regulatory ... Step 1: Think about Mark Twain's quote, 'Denial ain't just a river in Eqypt. ...

Tom Anderson. Gorman Health Group, LLC. February 27, 2004. Today's Agenda ... Cut to the Chase! Medicare Advantage will expand in 2004. ...

Galveston County

Title: Doing Business with UTEP Author: Ken Rivera Last modified by: Hall,Robert (HHSC) Created Date: 2/11/1998 12:31:46 PM Document presentation format