1. Planning Challenges in a Value Based
Purchasing (VBP) Environment
Bonnie Senst, M.S., R.Ph., FASHP
Director of Pharmacy
Allina Health

2. Disclosure
Bonnie Senst reports no relevant financial relationships

3. Allina Health
Integrated health system in MN and Western WI
Mission: We serve our communities by providing
exceptional care, as we prevent illness, restore health and
provide comfort to all who entrust us with their care.
 11 hospitals  Allina home and
 24 hospital based clinics community services
• Hospice, care
 60 physician clinics
management, home care,
 5 ambulatory care home oxygen and medical
centers equipment, senior care
transitions
 15 community pharmacy
sites

4. Objectives
 Describe Medicare’s Value Based Purchasing (VBP)
program
 Review VBP clinical and patient experience measures
and timelines
 Discuss paradigm changes resulting from VBP and
Accountable Care Organization (ACO) models
 Identify implications for pharmacy of VBP and ACOs

5. Case for Change
 Health care expenditures
 Waste in health care cost
 Poor coordination of care/transitions
 Harm during care
 Lack of patient involvement

6. CMS Medicare Value Based Pricing
 Redistributes acute hospital fee-for-service (FFS)
payments between hospitals based on quality
performance scores
 Hospital funding reduced by 1% in FY 2013. Rises to
2% by FY 2017.
 Hospital incentives to achieve clinical and patient
experience care quality measures
 Yearly reset of clock

7. 2013
2014
Weighted Domains and Impact: 2013, 2014 & 2015*
45% 30% 25%
2015
30% 20%
20% 30%
* FY 2015 measures and weights proposed

8. Process of Care Measures – FY 2013
Measures Number Scoring
AMI X2
HF X1
PN X2
Achievement
X5 and
SCIP
(one 2014) Improvement
SCIP VTE X 2
SCIP CARD

9. Patient Experience – FY 2013
Measure Scoring
Overall rating
Nursing communication
Physician communication
8 Measure Scores
Communication about medications
and
Staff responsiveness
Consistency
Environment
Pain management
Discharge instructions

10. Outcome Measures – FY 2014/2015
Measure
AMI 30 day mortality
HF 30 day mortality
PN 30 day mortality
AHRQ PSI
Central Line Infection
Efficiency – FY 2015
Measure
Total Medicare spending per beneficiary

11. Measures of success in transformed care
 Better care for individuals
 Better health for the community
 Reduction in the trend of health care costs

12. Changing Paradigms
Discipline specific care Care teams
Quality
Quality reporting and
mandates, consistency, rel
improvement
iability
Selective reporting Data transparency
Pay for quality outcomes
Pay for volume
and value
Alignment across
Silos of care
continuum
Reimbursement pressure Total cost of care

13. Implications
 Significant pharmacy demand and potential impact
 Working in current world and new world concurrently
 Skills and technical support systems required for TCOC
 Coordination of care beyond walls and health systems
 Placement of resources at optimal points in care continuum
 Compete and collaborate simultaneously
 Actively engage patients in their care