aco accelerated development learning session case study 3 ...€¦ · aco accelerated development...
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ACO Accelerated Development Learning Session
San Francisco, CA September 15-16, 2011
DISCLAIMER. The views expressed in this presentation are the views of the speaker and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services. The materials provided are intended for educational use, and the information contained within has no bearing on participation in any CMS program.
Francis J. Crosson, MD Director, Public Policy
The Permanente Medical Group Kaiser Permanente
Case Study 3: Building an ACO on the Foundation of an Integrated Delivery System
Date: September 15, 2011 Time: 10:00–10:20 a.m.
DISCLAIMER. The views expressed in this presentation are the views of the speaker and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services. The materials provided are intended for educational use, and the information contained within has no bearing on participation in any CMS program.
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America’s Largest Nonprofit Health Care Organization
• Fully integrated health care delivery system
• 8.6 million members
• 15,000+ physicians
• 166,000 employees
• 8 regions serving 9 states and DC
• 35 hospitals and medical centers
• 441 medical offices
• 450,000 surgeries
• 85,000 deliveries
• $45 billion annual revenue (2011)
DISCLAIMER. The views expressed in this presentation are the views of the speaker and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services. The materials provided are intended for educational use, and the information contained within has no bearing on participation in any CMS program.
Kaiser Foundation Health Plan
Kaiser Foundation Hospitals
Permanente Medical Groups
Health Plan Members
Medical Service Agreement
Hospital Service Agreement
Group / Individual Contracts
Operating Budgets Capitation to the Group
REVENUE
EXPENSE
------------------------------------------------------------------------------------------------------------
Kaiser Permanente
POPULATION
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DISCLAIMER. The views expressed in this presentation are the views of the speaker and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services. The materials provided are intended for educational use, and the information contained within has no bearing on participation in any CMS program.
Kaiser Permanente Experience— Six Prerequisites for Success
• A common vision and sense of purpose
• Integration
• Trusted governance
• Physician leadership
• An effective management structure
• Aligned financial incentives
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DISCLAIMER. The views expressed in this presentation are the views of the speaker and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services. The materials provided are intended for educational use, and the information contained within has no bearing on participation in any CMS program.
A Common Vision and Sense of Purpose
• Should be more than financial
• Should connect to quality of care and other professional values (the Physician Charter)
• Should contain a sense of common destiny and common responsibility for performance
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DISCLAIMER. The views expressed in this presentation are the views of the speaker and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services. The materials provided are intended for educational use, and the information contained within has no bearing on participation in any CMS program.
Delivery of Care in the United States
• Single MDs
• Small groups
• Single hospitals
– Kaiser Permanente
– Group health cooperative
Fully integrated systems
Hospital/staff
Some faculty practices
IPAs
Single specialty groups
Hospital chains
LESS INTEGRATED SYSTEMS
– Henry Ford
– Mayo
– Geisinger
– Ochsner
Integrated delivery systems
MORE INTEGRATED SYSTEMS
Multi-specialty group practices with hospital affiliations – Marshfield Clinic
– Harvard Vanguard
– Vanderbilt University
– California groups
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DISCLAIMER. The views expressed in this presentation are the views of the speaker and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services. The materials provided are intended for educational use, and the information contained within has no bearing on participation in any CMS program.
Levels of Integration
Multi-specialty group practice
(MSGP) Incr
eas
ing
inte
grat
ion
MSGP and hospital Delivery system
integration
MSGP, hospital, and insurance
Fully integrated
system
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DISCLAIMER. The views expressed in this presentation are the views of the speaker and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services. The materials provided are intended for educational use, and the information contained within has no bearing on participation in any CMS program.
Types of Integration
• Clinical—shared responsibility for quality
• Financial—shared responsibility for costs
• Functional—shared capabilities
• Structural—shared governance and management
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DISCLAIMER. The views expressed in this presentation are the views of the speaker and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services. The materials provided are intended for educational use, and the information contained within has no bearing on participation in any CMS program.
Trusted Governance
• Principled
• Participatory
• Perceived as equitable
• Persistently focused on strategy
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DISCLAIMER. The views expressed in this presentation are the views of the speaker and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services. The materials provided are intended for educational use, and the information contained within has no bearing on participation in any CMS program.
Physician Leadership
• Multi-level
• Multi-knowledgeable
• Selected, developed, and trained
• Supported by “followership”
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DISCLAIMER. The views expressed in this presentation are the views of the speaker and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services. The materials provided are intended for educational use, and the information contained within has no bearing on participation in any CMS program.
An Effective Management Structure
• Multi-level
• Matrixed (administrative and clinical)
• Supported by accurate and timely data
• Persistently focused on performance
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DISCLAIMER. The views expressed in this presentation are the views of the speaker and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services. The materials provided are intended for educational use, and the information contained within has no bearing on participation in any CMS program.
Aligned Incentives
• Mission
• Quality
• Reputation
• Sustainability
• Career and professional enhancement
• Financial
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DISCLAIMER. The views expressed in this presentation are the views of the speaker and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services. The materials provided are intended for educational use, and the information contained within has no bearing on participation in any CMS program.
ACA Shared Savings Model
California “Delegated Model” Full Risk
Capitation
Corridor
Capitation
FFS +/-
“Bonus”
FFS +
“Bonus”
FFS Only
Bundled Payment
Medicare Group Practice Demo
PCMH
Primary
Care
Specialty
Care
Admin.
RK (B)
Referral
Costs
Non
Referral
Costs
Hospital
Costs
Prescr.
Rx (D)
“Breadth” of Risk
“Dep
th”
of R
isk
Permanente Medical Groups
A Schematic of ACO Risk Assumption
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DISCLAIMER. The views expressed in this presentation are the views of the speaker and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services. The materials provided are intended for educational use, and the information contained within has no bearing on participation in any CMS program.
Tools and Resources
• Crosson, FJ, The Accountable Care Organization: Whatever Its Growing Pains, the Concept is Too Important to Fail, Health Affairs 30:7 (2011) 1250–1255
• Partners in Health: How Physicians and Hospitals Can Be Accountable Together (Crosson, F and Tollen, L, editors.) Jossey Bass (Wiley), San Francisco, 2010
• Kirch, DG, and Vernon, DJ, The Ethical Foundation of American Medicine: In Search of Social Justice, JAMA (2009) 301(14): 1482–1484
• Medical Professionalism in the New Millennium: A Physician Charter (2005), ABIMF, ACPF and EFIM
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DISCLAIMER. The views expressed in this presentation are the views of the speaker and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services. The materials provided are intended for educational use, and the information contained within has no bearing on participation in any CMS program.
Francis J. Crosson, MD
Director, Public Policy
The Permanente Medical Group
Kaiser Permanente
Case Study 3: Building an ACO on the Foundation of an Integrated Delivery System