BETTER CARE FOR ARTHUR WAS JUST A PHONE CALL AWAY
Alternative Payment Models Help Medicare Patients Overcome Barriers to Care
Value-based care models pay hospitals and providers, in part, on the quality of services delivered and outcomes achieved. These models enable healthcare organizations like Baycare Health Partners in Springfield, Massachusetts to embed care managers in clinical practices. They perform home visits, making it more likely that the non-medical factors that affect a person’s health are addressed.
For healthcare providers nationwide, this kind of personal care is only possible because of Medicare’s alternative payment model program.
Arthur’s story:
After many unanswered calls and missed appointments, Tasneem showed up at Arthur’s house. Arthur told the care manager with Baycare Health Partners that he had trouble remembering appointments and keeping his life in order due to recent memory issues that he hadn’t told anyone about. He was afraid that if people knew about his challenges, they would put him in a nursing home.
Tasneem suggested looking at Arthur’s phone—a simple task that made a big difference.
Over 90 minutes, Tasneem sat with Arthur and deleted old voicemails, so new messages could be accepted. She taught him how to retrieve messages, adjust the volume on his phone, and confirmed that he could now answer the phone and hear messages. She added contact information so he could easily reach his providers and taught him how using the maps feature could help him get to his appointments.
She placed a new calendar on his refrigerator, marking key medical appointments.
She gave him a small whiteboard and wrote, “Check your recent cell phone calls and voicemails in the morning and at night before you go to bed.” She placed the whiteboard next to his favorite recliner and told him to never erase it.
The result? Arthur made it to his next medical appointments.
Because value-based care focuses on outcomes, healthcare organizations like Baycare use the incentive payments to help their patients be healthy, regardless of challenges they face. Without the AAPM incentive payments, patients like Arthur may not get the support or care they need.
IMPROVING TRANSITIONS FROM HOSPITAL TO HOME
Alternative Payment Models Help Patients Stay Healthy After a Trip to the Hospital
Value-based care models pay hospitals and providers, in part, on quality and outcomes of care. These models help healthcare organizations like UnityPoint in Iowa to ensure patients recently discharged from the hospital or a long-term care setting get the care and resources they need to stay healthy once they return home.
For healthcare providers nationwide, these critical services are only made possible through Medicare’s alternative payment model program.
UnityPoint’s story:
The 5% incentive payment for participation in alternative payment models created by MACRA in 2015 enables UnityPoint to enhance its strong foundation of care coordination and population health strategies.
UnityPoint uses the incentive payment to expand services to patients discharged from the hospital or a long-term care setting to ensure the transition goes smoothly. Patients in the system’s accountable care program receive valuable care management visits following an in-patient stay. These visits allow clinicians to better manage the patient’s medications, assess their home for safety risks, and coordinate follow-up care.
Nearly 3,000 home visits were performed in 2020 for eligible patients in Cedar Rapids, Central Iowa, Waterloo, and the Quad Cities. Thanks to congressional support of the program, UnityPoint brings high-quality, coordinated care to patients in the place they feel safest—their home.
Because value-based care focuses on outcomes, healthcare organizations like UnityPoint use the incentive payments to help their patients stay healthy following a hospital stay. It helps patients avoid costly return trips to the hospital.
A CARE TRANSITION LED MICHAEL TO SAFER HOUSING AND BETTER HEALTHCARE
Advanced Alternative Payment Models Address Patients’ Social Determinants of Health
Value-based care models pay hospitals and providers, in part, on quality and outcomes of care. These models help healthcare organizations like NW Momentum Health Partners (NWMHP) in Washington state ensure patients’ needs are looked after once they are discharged from the hospital or long-term care setting.
Personal attention to patients’ healthcare and the social circumstances that shape their health is possible thanks to Congress’s investment in Medicare’s advanced alternative payment models.
Michael’s story:
Michael has Multiple Sclerosis and needed skilled nursing following an inpatient stay related to a fall. He was discharged to his apartment and was supposed to receive home health services, but the home health agency could not reach him by phone. NWMHP’s persistent nurse care manager, Heather, ultimately contacted Michael’s caseworker, who got permission to work with NWMHP.
Heather found Michael living in a converted hotel infested with roaches. Michael had numerous personal items stolen by other tenants and experienced debilitating falls without anyone to help. Heather ultimately helped Michael locate a safer home, a low-cost phone, and arrange for transportation and support for his move. She even helped Michael transition to another care provider and transfer his medications to his new address.
Thanks to Heather and NWMHP, Michael found a clean and safe space to live, with caregivers who support his health and wellbeing.
Value-based care models benefit Medicare patients in many ways, from closely coordinating care delivered by healthcare providers to improving social circumstances that shape patients’ health and wellbeing. Without the AAPM incentive payments, patients like Michael may not get the support or care they need.
HEALTHIER LIVING FOR ANNA WAS MADE POSSIBLE BY VALUE-BASED CARE
Alternative Payment Models Help Medicare Patients Afford Their Medications and Manage Chronic Conditions
Value-based care models pay hospitals and providers, in part, on the quality of services delivered and outcomes achieved. These models enable healthcare organizations like CHESS Health Solutions in Winston-Salem, North Carolina to help patients manage and afford multiple medications for chronic conditions.
For healthcare providers nationwide, this kind of personal care is only possible because of Medicare’s Alternative Payment Model (APM) program.
Anna’s story*:
Anna was diagnosed with a new chronic condition after living with diabetes for five years. Managing her diabetes was already challenging enough given the price of her medication, and she was prescribed multiple medications for the newly diagnosed condition, which she could not afford.
After realizing that Anna’s second prescription was never filled, CHESS reached out to Anna to provide assistance. She told CHESS that she could not afford the prescription and was planning on not taking it, rather than following up with her doctor.
CHESS went to work for Anna – calling her primary care physician, working with Medicare to secure free trials for her prescriptions, and monitoring Anna to look for signs of improvement.
CHESS was able to call in a 30-day free trial for Anna’s blood thinner and helped her qualify for patient assistance programs. CHESS also helped Anna better manage her diabetes by switching her to a new medication completely covered by her insurance.
Anna now has the proper medication to manage her chronic illnesses and can continue to do the things she loves, like spending time with her grandchildren.
Because value-based care focuses on outcomes, healthcare organizations like CHESS use the incentive payments to support their patients in managing their conditions and affording their medications. Without the APM incentive payments, patients like Anna may not get the support or care they need.