Per Member Per Month Pmpm Cost PowerPoint PPT Presentations

Using Predictive Modeling Tool to Identify at Risk Patients who has a chance of becoming users of High-Cost Healthcare service and subsequently Reducing PMPM (Per Member Per Month) Costs While Increasing Member Satisfaction.

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.

Register here: http://bit.ly/1UreKDz Speakers: R. Scott Vaughn, CPA, President and CEO, GlobalHealth Jay Reddy, CEO, VitreosHealth David Thompson, Senior Vice President and COO, GlobalHealth Date & Time: 11:00 AM – 12:00 PM EST, Friday, June 10, 2016 | (Duration: 1 hour) Key Learning Points: • An 18 percent reduction in emergency room encounters and emergent hospital admissions • Seen a 22 percent reduction in readmissions • And achieved a per-member per-month (PMPM) reduction in medical cost of about 6 to 8 percent, spread across all members Who should attend: • Any payer with Medicare and Medicaid populations. • Any payer with population health management programs currently using or hoping to use predictive analytics within these programs. • Any payer incorporating value based care financial models

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

Complete Survey Results Reported to Practice Site ... 9- 10,000 Visits per Month to Find A Doctor. Best Performing Physicians Attract 4x Members ...

The University of Massachusetts Medical School ... Diagnostic Grouper: Chronic Illness and Disability Payment System (CDPS) 8. 8 ...

Healthcare Cost Differences in the 1990s - Lawrence University

The Massachusetts Picture The Last Twelve Months

An opportunity to improve care and contain costs for everyone in the ... Diagnostic. Imaging. Payer Based Health Record. Electronic Medical Record. LouHIE ...

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 ...

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.

An opportunity to improve care and contain costs for everyone in the greater Louisville area ... Consumers receive services from multiple providers ...

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 ...

... CM Savings PMPM 85 $ 140 $ Total CM Savings 42,005 $ 99,560 $ Admin Cost 29,399 $ 26,749 $ Evaluate Care Management Interventions Predictive Modeling Non ...

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

Significant reductions in readmission rates and hospital days through 3 months ... Trend toward reduced SNF admissions between TCM vs. controls. 0-3 months, 5 ...

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

Achieving the Triple Aim: The Simultaneous Pursuit of Population Health Enhanced Individual Care Controlled Costs David Labby MD PhD Medical Director

Arizona Health Care Cost Containment System ... Strategic Planning Logic Map. Map of Strategic Outcomes for EHR Adoption Efforts ...

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

Includes all non - radiology, non - lab outpatient costs ... Radiology 1.35. C. Episode-Based. Specialty care and ... Radiology 10% 1.35 0.135. Episode-Based ...

SOURCE: Kaiser Family Foundation, statehealthfacts.org. 3. Medicaid Payments Per Enrollee, ... SOURCE: Kaiser Family Foundation, statehealthfacts.org. 4 ...

A few facts about health status, healthcare costs, and personal income in ... Associations (1,230), MSU Health Team (104), Sparrow Family Medical Services (45) ...

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 ...

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

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

BCBSNM HMO Program Highlights 27. BCBSNM POS Program Highlights 37 ... Noteworthy utilization increases were observed in the areas of pharmacy, ...

The ICD9 Trigger list included Asthma, Diabetes, High Risk OB, AIDs, Cancer, CHF, COPD etc ... Select key MEDai measures to construct a composite score ...

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

Completely confidential and voluntary ... Address co-morbids. Prevention-focused ... Changes in ED and Hospital Utilization. Regression to the Mean ...

Depression and the Employer William McPeck Maine State Government March 2002 Depression Fast Facts Estimated 11 17 million Americans Estimated 5 10 % of ...

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

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

Application of Disease Management Principles to Pregnancy and ... Neonatology. Postpartum. complications. Respiratory Labs. Pharmacy Nutrition ...

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

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

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

Working to improve health in the central Appalachian region through the collaborative use of health information Worst Health Status in U.S. Drives Estimated $2,400 ...

Depression and the Employer William McPeck Maine State Government March 2002 Depression Fast Facts Estimated 11 17 million Americans Estimated 5 10 % of ...

... Are you still asking about, ordering, documenting health maintenance services? - Does your MA or Corpsman copy forward the PMH and Med list for you?

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

Georgia Department of Community Health. 7. Quality Indicators ... New Revenue (Medicaid) Georgia Department of Community Health. 9. Percent of All New Revenue ...

ValueOptions Integrated Care Initiatives

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

Overview of why reports are wrong and how to fix them. ... this one pass the Sniff test? Question 16: Does this pass the sniff test for diabetes? Question 18: ...

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

Managed Care ppt

The I PiCC Program (Integrated Patient Centered Care) Karyn Rizzo RN, CHPN, GCNS A primary care system on the verge of crisis Annual US healthcare expenditures have ...

The SCAN Foundation Defining the Business Case for Targeted Care Coordination Congratulations, you have logged in successfully! Audio: Audio for the entire webinar ...

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 ...

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 ...

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

What behaviors need changing among your covered lives? ... Combined with medication, DM, coaching, EAP, psychotherapy. 8. Welcome to the Revolution ...

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. ...

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 ...

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