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Business of Medicine/Practice Management

Otolaryngology Alignment Within Value-Based Health Care: Cost, Quality, and Reality

Tuesday, October 3, 2023
1:00 PM - 2:00 PM East Coast USA Time
Location: 106A

    Lead Presenter(s)

  • Will C. Harrill, MD FACS

    Carolina Ear Nose & Throat Sinus and Allergy Center, PA
    Clinical Professor Dept Otolaryngology Wake Forest Baptist Health and UNC School of Medicine
    Hickory, NC, United States

    • Co-Presenter(s)

  • CW

    Charles R. Woodard, MD

    Associate Professor, Chief Facial Plastic & Reconstructive Surgery, Residency Program Director
    Duke University Medical Center
    Durham, NC, United States

    • Mentor(s)

  • JG

    James T. Gera, MBA

    Board Chairman
    BridgepointMD
    St. Charles, MO, United States

Disclosure(s):
Charles R. Woodard, MD: No relevant relationships to disclose.
James T. Gera, MBA: No relevant relationships to disclose.
PROGRAM DESCRIPTION: Value-Based Healthcare (VBH) is the most transformative healthcare reform effort in decades, dramatically changing how physicians engage and are compensated within patient care. CMS has targeted conversion of Medicare and Medicare Advantage plans to be 100% alternative payment models within for specialists and primary care by 2030. CMS has launched a value based care reboot in 2023 and will be presenting voluntary and mandatory programs for specialist value-based payment participation that will roll out between 2025 - 2029. CMS is designing a platform to collect data on specialists to "inform referrals" within ACO's and primary care that will be value-based to enhance shared savings program performance. Within APM's, specialist episode-of-care costs will increasingly impact referrals as value is measured and reported within alternative payment models. Otolaryngology is not presently on the forefront of VBH change, however value-based accountable care organizations and CMS are collecting claims data that will determine future referrals.

Understanding the concepts within VBH and proactively identifying areas of opportunity to engage this evolving process will be important to prevent third-party determination of future Otolaryngology value-based care (VBC) models. The goals of this presentation are to explore the components of VBH, highlight the current and future VBC strategies and programs from payers, and discuss areas within otolaryngology where research efforts and strategic planning can proactively develop Otolaryngology VBH opportunity zones.

OUTCOME OBJECTIVE 1: Understand the basics of Value-Based Healthcare (VBH) and how it is driving healthcare payment reform

OUTCOME OBJECTIVE 2: Understand the VBH integration goals and timelines of payers, engagement and reimbursement strategies

OUTCOME OBJECTIVE 3: Review strategic approach Otolaryngology should consider to build out the relevant Value-Based data strategies for engagement in future alternative payment models

BACKGROUND STATEMENT: CMS has launched a value based care reboot that is focusing on Specialty engagement within APM's and is collecting claims data to "inform referrals" for primary care providers within ACO's. CMS estimates that Medicare and Medicare Advantage will be 100% alternative payment (APM) by 2030