Accountable Care Organizations

(ACOs) & Telehealth

Angelo Sinopoli, MDVP, Clinical Integration & Chief Medical Officer,

Greenville Health System

President, Care Coordination Institute

President, MyHealth First Network

Health Care Spending Growing Out of Control

$1,735 $1,855$1,981

$2,113

$2,241$2,379

$2,510$2,624

$2,770$2,931

$3,111

$3,313

$3,541

$3,790

$4,062

$4,353

15.8%15.9% 15.9%

16.0%

16.2%

16.6%

17.6%17.7%

17.9%18.0%

18.2%

18.5%

18.9%

19.3% 19.8%

20.3%

15.0%

16.0%

17.0%

18.0%

19.0%

20.0%

21.0%

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

$5,000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

National Health Expenditures (billions)

National Health Expenditures as a Percent of Gross Domestic Product

CMS Projections for National Healthcare SpendingCY 2003 - 2018(Amount in Billions)

Source: Centers for Medicaid & Medicare Services - NHE Projections 2008-2018, Forecast Summary and Selected Tables

Beyond the Medical Home

Accountable Communities(Nutrition, Prevention, Physical

Fitness, Healthy Living)

Community Resources(Supportive Housing, Social

Services, Eligibility Programs, etc.)

Medical Neighborhoods(Specialists, ER, EMS, Fire

Department Medical Personnel, Employer Work

Sites, MD 360, Pharmacists, Home Health, School Nurses)

Providers(Physicians, Home Health, Care Managers, Office Staff, Family

Members)

Duke Innovation Grant

• $2.7 million grant for delivery innovation

– Medicaid clinic and subsequently unfunded population

– Stratification based on ED and hospital utilization

• Results (year one):

– 26% decrease in ED visits, 55% decrease in inpatient days

– Number of diabetics with HgA1c high values (>9%) decreased 14%

– LDL-C Abnormal values decreased 15%

– Number of Hypertension, Non-Diabetic patients with readings within 140/80 parameters improved approximately 13%

– Number of asthmatic patients appropriately receiving corticosteroid/acceptable alternative therapy improved approximately 11%

• Active Case Management

• Connecting to a Medical Home

• Addressing socio-economic determinants of health

ED Care Management

Awarded a $300,000 grant to reduce unnecessary ED and EMS utilization by:

• Creating an innovative nurse triage call center that is currently being used in only two other locations in the US

• Providing care coordination to ED and EMS high utilizers so they receive the right care at the right time and place

• Developing patient-centered medical neighborhoods within the community

GHS/EMS Partnership

Collaboration between GHS, GCEMS, and Greenville City Fire Department to create patient-centered medical neighborhoods within the Greenville Community.

Community Care Outreach

Results (2013-2014) compared to year prior (2012):

• Inpatient utilization/1000 decreased 25%

• ED utilization/1000 decreased 33%

• 30-day all-cause readmissions decreased 20%

• Wellness/preventative visits per member increased 300%

• Script/member decreased 14%

• Percent generic utilization increased 8%

• Significant shared savings realized at 2013 & 2014 years end

BlueChoice Medicaid Partnership

Wellness Programs Pharmaceutical Management On-site Clinics

Care Coordination and Management GHS Community Offerings

Business Health Services

Bradshaw AutomotiveCytec Carbon FibersErhardt and LeimerFitesa Simpsonville

Integrated Support Services (ISS)Laurens CPW

NCEESProtective Life

Smith Moore LeatherwoodStaubli Corporation

TEI Construction ServicesYMCA

Pierburg US

City of EasleySouthern Weaving

OCONEE COUNTY

GHS partners with more than 95 employers for business health

Business Health Partners

Legislative Reform

Payment Reform

AMBULATORYCommunity

FacilitiesCommunityPhysicians

PHYSICIANS

PAYORS & EMPLOYERS

Community Hospital(s)

Community Facilities

Provider Network

• Enhance Care Coordination• Eliminate Waste and Inefficiencies• Standardize Protocols and Care

Pathways• Reduce Variance• Define, Measure and Report Quality• Manage Utilization

Moving Toward Provider Networks

Hospital System vs. Healthcare Delivery System

Full Service Health System Integrated Delivery System

Employed

Medical Staff

Faculty

Clinically Integrated

Employed Physicians and Outpatient Services

Payers

Post Acute Services

Diagnostic Center ASC

Post Acute Services

Payers

http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html

Paying Providers for Value, Not Volume

The Shift To Alternative Payment Models (APMs)

• 89 new MSSP ACOs in 2015

• 424 total ACOs

• 405 MSSP, 19 Pioneer

• Serving 7.92 million beneficiaries in 49 states plus Washington, DC

and Puerto Rico

• 2,115 BPCI participants in 2015

Alan Balch, PhD CEONational Patient Advocate Foundation

Roy Beveridge, MD SVP and CMO, Humana

Reid Blackwelder, MD, FAAFP Chair, Board of DirectorsAmerican Association of Family Physicians

Carmella Bocchino, RN, MBA EVP, Clinical Affairs and Strategic Planning America’s Health Insurance Plans

Ann Boynton, MS Deputy Executive OfficerBenefit Programs Policy and Planning CalPERS

Thomas Buckingham, BSN, MBA EVP, Select Medical

Antonios (Tony) Clapsis, MA VP and Chief of Staffto President, Chairman, and CEOCaesars Entertainment

Patrick Conway, MD, MSc Acting Principal Deputy AdministratorDeputy Administrator, Innovation and QualityCMO, Centers for Medicare & Medicaid Services

Patrick Courneya, MD EVP & CMO

Kaiser Foundation Hospitals & Health Plan, Inc.

Charles Fazio, MD, MS SVP & Medical Director, HealthPartners, Inc.

William Golden, MD Professor of Medicine and Public HealthUniversity of Arkansas for Medical SciencesMedical Director, Arkansas DHS/Medicaid

Michael Hales, MS Deputy Director, Utah Department of Health

David Lansky, PhD CEO, Pacific Business Group on Health

Wright L. Lassiter, III, MA President, Henry Ford Health System, Inc.

Nancy LeaMond, MA Chief Advocacy and Engagement OfficerAARP, Inc.

Elizabeth Mitchell President and CEONetwork of Regional Healthcare Improvement

Debra Ness, MS PresidentNational Partnership for Women and Families

Sam Nussbaum, MD EVP, Clinical Health Policy and CMO,Anthem, Inc.

Stephen L. Ondra, MD SVP and Enterprise CMOHealth Care Service Corporation

Frank Opelka, MD, FACSEVP, Louisiana State University System Medical Director, Quality and Health PolicyAmerican College of Surgeons

Lewis Sandy, MD, MBA SVP, Clinical AdvancementUnitedHealth Group

Angelo Sinopoli, MD VP, Clinical Integration and CMOGreenville Health System

Guiding Committee Members

Mark D. Smith, MD, MBAClinical Faculty MemberUniversity of Californiaat San Francisco

Mark McClellan, MD, PhDSenior Fellow and DirectorThe Brookings Institution

Work GroupsThe LAN will form multi-stakeholder work groups charged with developing practical, actionable, operationally meaningful recommendations on issues and models that represent the best opportunity for accelerating adoption of APMs. Work groups will:

• Build on existing successes.

• Identify and address critical barriers to adoption to accelerate progress.

• Address key technical components of selected payment models (e.g., risk adjustment, attribution, performance measures and data).

• Harvest and share best practices (e.g., implementation, bearing risk, patient/ consumer engagement and functional capabilities).

• Incorporate perspectives of patients and consumers as models are defined and recommendations are developed.

APM Framework & Progress Tracking

Outcomes: • Common APM framework and

associated definitions• Plan for monitoring the progress of APM

adoption

Clinical Episode Payment Model

“ACO” Payment Modelname likely to change

Future work groups will be established as need arises.

MyHealth First Network

Mission and Vision

Vision: Enhance the quality of life for every patient.

Mission: Transform care. Promote value.

Enrich the patient experience.

Upstate Network

Governance Structure

Future Vision of Statewide Network

Greenville

Columbia

Charleston

Florence

Redefining “Rural”

• Telehealth can bridge distances between health care providers and rural communities

• Defined as outside of an urban area

• Social determinants often create equivalent barriers to access

• Rural can be across the state or simply across town

Source: The Advisory Board Company - Telehealth Industry Trends 2015

Low Medical Visit Need:

• Diagnoses, treatments follow reliable, standard evidence-based protocols

• Suggested therapies nearly always effective

• Physical exam not required, visual exam adds nominal value

High Medical Visit Need:

• Diagnoses, treatments more complex, may vary within disease category

• Therapies may need careful selection and monitoring

• Physical exam or diagnostic test required to identify issue, select treatment

• Intervention required (i.e., immunization)

Remote Care (e.g. Prescription refill, minor cough/cold)

In-Person Care(e.g. Physical exam,

fracture, complex infection)

Virtual Care

Emerging Area

Management, Maintenance

• Chronic disease checkups, follow-ups

• Care plan updates

• Specialist consults

Diagnosis, Treatment

• Remote diagnostics

• Self-guided interventions

Case-Based Continuum of Care Options

Extended Access

Source: The Advisory Board Company - Telehealth Industry Trends 2015

Reduced admissions/ readmissions

Reduced ED visits

Improved chronic disease-related mortality

Improved care coordination

Improved Outcomes & Quality

Remote care/ disease management

Rural access to care

24/7 coverage

Remote communication with other providers

Reduced Costs

Low-cost alternative to traditional primary care

Reduction in face-to-face specialist consults

Increase in available time and panel size

Reduced healthcare spend per person

Benefits of Telehealth

3 Channels of Engagement

Patients

CommunitiesProviders

Clinical Services

Infrastructure Synergies

Digital Communication

Physician Referrals & Consultation

Telehealth’s Role in Access to Care • Effective use of current telemedicine tools could

displace:– 15% of office visits

– 15% of ED visits

– 37% of urgent care visits

• Patients are receptive:– 76% of patients find access to care more important

than physical human contact with their healthcare provider

Sources: Towers Watson analysis of MarketScan data; Cisco survey, 2013http://www.themonitordaily.com/wp-content/uploads/2015/07/doctors-visits-through-skype.jpg

The Industry is Responding

• Market for telemedicine technologies:– $17.8 billion in 2014

– Anticipated 18.4% growth per year during 2014-2020

• Over one-third of employers offer telemedicine services, another 12% plan to next 2 years

• Telehealth could deliver over $6 billion per year in health care savings to employers

Sources: Global Telemedicine Market Outlook 2020; 2015 Towers Watson Employer-Sponsored Health Care Centers Survey; Towers Watson analysis, 2014http://www.medicalpracticeinsider.com/news/american-well-digitalizing-doctor-visit

Telehealth Shifting Healthcare Delivery

Banner Health:

• At-home telehealth pilot program with Philips for patients with multiple chronic conditions

• 27% reduction in total health care costs

• 32% reduction in acute and long-term costs

• 45% reduction in hospitalizations

The Future of Health Care is Here

The best way to predict the future… is to create it.