August 2020

Pharmacy Pop Health Tip

Why 90-day home delivery prescriptions move the needle

Half of Americans have used at least one prescription in the last 30 days. OHN partners are improving medication adherence through 90-day prescriptions and home delivery services - a win-win for improving patient experience and meeting pop health quality metrics.

Since COVID-19 restrictions have changed the way consumers shop, patients are now enjoying the convenience and savings associated with 90-day prescriptions for long term drugs and home delivery services. To date, more than 2,000 OHN Benefits Collective members have converted to home delivery.

Here’s the value prop for your patients:

No fighting traffic.
Big money savings, up to 90%.
Most insurances cover.
No hassle, especially for chronically ill patients.
Auto-renewal guarantees supply.
Good customer service – online, email and phone reminders.

OHN regional partners should check with local pharmacies for e-prescribing 90-day prescriptions with home delivery services. For Epic providers, click here for instructions.

Stagnation or Risk: CEO Warner Thomas on the Shape of Things to Come

by David Shifrin

Taking on risk today is the only way to make it tomorrow.

That’s the underlying message from Warner Thomas when giving his perspective on the long-term outlook for the healthcare industry.

Thomas, president and CEO of Louisiana-based Ochsner Health since 2012, has just rotated off MedPAC after serving on the committee for a six-year term. MedPAC is a nonpartisan legislative branch agency that provides Congress with advice and analysis on the Medicare program.

In both of his roles, Thomas has had a front-row seat to observe, assess and lead the evolution of healthcare through moments of significant change. From that, he has evolved a worldview of a future that requires flexibility and creativity and is rooted in these assumptions:

Stagnation is riskier than risk
Scale is necessary
Growth must have a purpose

Taking on risk

From his MedPAC experience, Thomas knows the Medicare numbers don’t work. His data is nothing shocking or new. Life expectancy has risen significantly while the age of eligibility has held at 65. Meanwhile, the number of workers (to fund the benefit) per Medicare enrollee has dropped by almost half.

“It’s a very unsustainable situation,” he said. “It’s pure math that doesn’t work.”

Read on, or listen to the podcast.

Strength in numbers

Lobbying to improve payor regulation and rulings

OHN’s provider advocacy efforts promote regulatory and reimbursement improvements like fee schedules, 340B-drug payments, outpatient supervision, ASC and physician-owned hospital guidelines, and rating methodologies. Below recaps a handful of our ongoing efforts and results to date:

CMS Outpatient and Quality Payment Programs
Recently, CMS released its Outpatient Prospective Payment System (OPPS) and Quality Payment Program (QPP) proposed rules, and the fact sheets can be found here. OHN will submit comments on behalf of the network and its providers prior to the October deadline.

In other COVID-19 relief efforts, OHN promoted the following changes to both Medicare’s Shared Savings Program and Advantage programs, and we continue tracking results in anticipation of continued pressures caused by the global pandemic:

Medicare Advantage Program Updates

Recommendation	Status
Establish emergency risk mitigation program to ensure stable, adequate funding for MA plans	Ongoing.
Permit all telehealth diagnoses to count toward risk adjustment in 2020 and beyond	CMS is considering telehealth visits with a video component, which otherwise would have met CMS guidelines, for risk adjustment. Although temporary, there has been an Executive Order signed encouraging CMS to make this permanent.
Apply hold harmless guidelines for MA Star Ratings for 2021-22	CMS has released guidance reducing the burden on MA payors.
Adjust MA payment rates to ensure increased resources for COVID-19- related care	Although payment rates have not directly changed, there have been several improvements in risk arrangement payment methodology to ease the burden of COVID related costs for both the patient and provider.

Medicare Shared Savings Program Updates

Recommendation	Status
Convert downside risk arrangements to no-risk model for 2020	Any losses would be reduced by the portion of the year that we are under the public health emergency (PHE), currently declared until late October. ACOs would be responsible for approximately 1/6 of their incurred losses.
Apply both 2019 and 2020 diagnoses towards 2020 risk scores	Ongoing.
Allow telehealth Annual Wellness Visits (AWVs) in 2020 and beyond	CMS is temporarily allowing for AWVs to occur via telehealth; diagnoses found in these encounters are to be considered for risk adjustment. Additionally, there is an Executive Order asking CMS, among other agencies, to make this permanent.
Permit all telehealth diagnoses to count toward MSSP attribution and risk adjustment in 2020 and future	Telehealth diagnosis with a video component will count towards risk adjustment.
Suspend MSSP quality reporting 2020	CAHPS reporting is suspended and full credit offered for 2020. ACOs will be granted the higher of their quality score and the mean ACO quality score.
Additional Direct Contracting Model period to start in 2022	2022 entry point has been added.

Power-packed CME in 3 hours – healthcare’s new face

Interactive, virtual Value Summit this Fall

Get the latest from healthcare’s leading experts on value-based care amidst the new era of COVID-19 at Ochsner’s Value Summit – an all-new virtual CME - coming this November. Click here for more on hot topics, panels discussions, and featured thought leaders.

Value Summit 2020
Virtual Event: Friday, November 13, 2020
7:30 a.m. until 11:15 a.m.

Keynote Address: Value-Based Care in the Era of COVID-19

David Carmouche, MD
President, OHN
Senior Vice President, Community Care, Ochsner Health
Executive Director, Ochsner Accountable Care Network

SESSION 1: Panel Discussion - Innovations in Care Delivery; Reflections on the Corona Virus Pandemic

PRESENTER/FACILITATOR:
Anna Thomas
Vice President, The Kinetix Group

PANELISTS:
Robbert Vorhoff
Managing Director, Head of Global Healthcare, General Atlantic
Henry Wei, MD
Medical Director, Google Health

SESSION 2: The New Face of Primary Care

PRESENTER/FACILITATOR:
Julian Harris, MD, MBA
Partner, Healthcare Services & Technology Investment Team,
Deerfield Management

PANELISTS:
Robert Accordino, MD
Chief Mental Health Officer, Quartet Health
Elli Kaplan, MBA
Co-Founder and Chief Executive Officer, Neurotrack

SESSION 3: The Future of Value

PRESENTER/FACILITATOR:
Jerry Penso, MD, MBA
President & Chief Executive Officer, AMGA

PANELISTS:
David Carmouche, MD
President, OHN
Senior Vice President, Community Care, Ochsner Health
Executive Director, Ochsner Accountable Care Network

Tell us your success!

OHN to highlight partner pop health success stories

OHN seeks to share partner success stories from around our region. Tell us your “wins” in quality, population health and value-based care so that we can feature in upcoming publications. Contact our editor.