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TRANSCRIPT
Accountable Care
Communities
What About The Data?
January 30, 2014
Clarence Williams
Accountable Care Solutions
Vice President
Regional Head of Sales/Client Strategy
Shift to Accountable Care
ACC’s will benefit all stakeholder…data?
EMR – a key element, but only one piece
of the puzzle
The health neighborhood
Open discussion
2
Today’s discussion topics
2
A shift is underway from volume to value
A Transformational Model…
More than 250 providers have partnered to
form ACO’s, which together will serve more
than 4 million Medicare beneficiaries…
“These transformational models are no longer isolated
pilots, they are becoming the face of American Medicine.”
- Kathleen Sebelius,
Health & Human Services Secretary
All stakeholders win with value-based care
Reimbursement incentives
aligned with efficient,
quality care based on
measures and patient
satisfaction
Technology enhancement
supporting care
coordination
Provider
Cost savings
Sustainable solution
Improved quality
Enhanced wellness and
care management
Competitive billing rates
Payer
Enhanced patient
experience
Lower out-of-pocket costs
Quality-based,
coordinated care
Tools to support a healthy
lifestyle
Patient
A solution to reduce cost, improve care quality, and the patient experience has
key benefits for all major stakeholders in the health system.
What About The Data?
?
What About The Data?
?
Committed resources and technology
Health care Technology
Health Information Exchange
(HIE)
Data Services
Care Management Workflow
Clinical Decision Support/
Analytics
Quality/ Efficiency Reporting
Patient Portal
Automated Patient Outreach
Care Management
Embedded CM Telephonic CM Disease Management Wellness Community Resources/Programs
Business Services
Practice Transformation Informatics/ Analytics Reporting (i.e. Clinical Quality) Performance-based Contracting Patient Engagement
Physician Organizations
Aligned Incentives and Operational Accountability
CMS Medicare Shared Savings Program (MSSP)
Commercial
Medicare Advantage
Local self-funded employers
Payer-neutral Infrastructure All Patient Populations
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ACC’s create a unique opportunity…
Dynamics / Challenges / Requirements
• Close collaboration with high-quality providers required
• Building an ACC may mean “choosing” partners
• Different approach for payers – historical focus on network breadth, not quality or value
• Challenging dynamics with multiple ACO products/partners in a market
• Very different relationship w/providers – for Counties and for Payers
• Health plans must share data with providers
• Provide advanced risk assessment & performance management tools
• Support clinical transformation and organizational change.
Cost is driven by the sickest of the sick
75% Healthy, minor health issues
20% At-risk for major procedures
(e.g. cardiology, oncology)
5% Polychronic
$ $ $ $ $ $
$ $
$ $ $ $
$ $ $ $
$
45% ER visits, overutilization,
high care variation, noncompliance
35% Infections, complications,
re-hospitalizations
20% Minor
issues
Patient Population Cost
Treatment Needs to
be Efficient,
Effective, non-
Wasteful
Need to Mitigate and
Manage Risks
Need Healthy
Behaviors
Finding them and intervening is the challenge
• Great to capture encounter
• Record of patient care
• A key clinical tool
• Limited view of patient care
Electronic Medical Record
Looking through a straw…
Understanding total health care is key to success
ED Visits Hospital Readmissions
Specialist 1
Visits
Rehabilitation
Services
Imaging and
Diagnostics
Inpatient Admissions
Specialist 2
Visits
Prescriptions
Lab orders
and results
Information today is often limited to the physician’s office –
but you still need to know about…
Identify High
Cost Providers
Identify Gaps
in Care
The right information enables effective, targeted care team activities
Identify High Cost
Settings
Risk Stratify the
Population
Create Advanced
Registries
Understand
Utilization Patterns
Identify Waste
in the System
Identify Clinical
Alerts
…Allows providers to understand and manage populations
?
Who is driving up
costs and
weighing down
your quality
improvement?
Population Risk
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Large Payers have made significant investments in Accountable Care enablement
Together, we can drive better health, better care and better cost
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Financial & Operational Reporting –
aggregate performance tracking, monitoring & reporting. Compare providers or clinics against peer group. Cost management & shared savings results.
Population Health Analytics - stratify risk, care gaps, disease registry, etc.
Clinical Data & Reporting – quality metrics,
efficiency measures, outcomes, patient engagement.
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Accountable Care is evolving…
Collaboration
Early stage
PCMH
Patient centered medical home
Physician focused
Savings based on quality and efficiency
ACO Attribution
Usually hospital system-wide collaboration
Savings based on quality and efficiency
ACO Plan Design
3-tier plan design
Savings based on price reduction, quality and efficiency
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Creating Value for Employers
Key Considerations
How do you anticipate improving quality measures across the providers in your community?
Regional HIE support – is there an initiative? Can you support providers who want to participate?
How will you make use of payer claims data?
What incremental technology will be required to execute population health analytics across the community?
Better health, better care, better cost An enhanced ACO care model that spans the entire health neighborhood, creating a health system that works harder for everyone
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The health neighborhood
Wellness Hospice Long Term Care
Home Care
Post Acute Care
Hospitals PCPs Specialists Ancillary Public Health
Agencies Pharmacy
Trusted relationships enabled by robust technology and member engagement
Goal: transform the way health care is delivered, enhancing the member
experience
Aetna Inc. A strategy for transforming health care
Open Discussion
Thank You…
Clarence Williams
Vice President
Regional Head of Sales/Client Strategy
206.792.9051
@Healthcare_4All