STRATEGIES TO ELEVATE YOUR ACOBEFORE YOUR 3RD PERFORMANCE YEAR

H Y M I N Z U C K E R M D , C M O &

K E L LY A . C O N R O Y , C E O

T R I P L E A I M D E V E L O P M E N T G R O U P

S E P T E M B E R 3 0 , 2 0 1 4

ACTION AND STRATEGIES TO ELEVATE YOUR ACOConga Line

It’s a combined Team Effort!!!Everyone pulling towards the same GoalWhat are You doing differently ?

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P2

ELEVATE YOUR ACOWhere are you right now?

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P 3

Proactive

Reactive

PROACTIVE OR REACTIVE APPROACH• Proactive approach incorporates policies, procedures,

principles and standardization of processes.

• Reactive approach analyzes what has already occurred and results in process changes

Where are you?

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P 4

REACTIVE

What reports do you use?QUERCCLFAssignments

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P 5

REACTIVE APPROACH-NEW PATIENT LIST(S)

1.Ensure all new patients have a subsequent near term PCP office visit

2.Ensure all new patients get “ACO Welcome package” including “”Opt Out” letter

3.Ensure all new patients get an Annual Wellness VisitTie to ACO biggest opportunity to bend curve designated population.

4.Opportunity to discuss ACO participation

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P6

REACTIVE APPROACH-LOST PATIENT LIST(S)

Utilize newly printed data sets to stratify• Beneficiary did not receive plurality by PCP• No physician visit with an ACO Provider

*Perform a “Root Cause” analysis on those who were lost by plurality or lack of visit

These forms do not require anything else to do.• Beneficiary had interrupted Part A or B Coverage

• In MA plan or other part of the year• Non- resident in USA• In other shared savings program

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P7

CMS 6 REASONS BENEFICIARY DROPPED

Reason(s) Beneficiary Not Currently Assigned1

(1) (2) (3) (4) (5) (6)

Beneficiary did not receive

the plurality of his/her primary

care services4 from the

ACO5

Beneficiary had at least one month of Part A-

Only Or Part B-Only

Coverage6

Beneficiary had at least one month in a

group health plan7

Beneficiary does not reside in the United

States8

Beneficiary included in

other Shared Savings

Initiatives9

Beneficiary did not have a physician visit with an

ACO provider10

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P 8

CMS Tab 1-5

REACTIVE APPROACH - PATIENTS NOT SEEN IN 9 MONTHS (REGISTRY FUNCTION)

• Ensure every Beneficiary on this list is called (excluding those who expire or knowledge exist of why they left the practice)

*You cannot control Quality and Cost if you are not seeing the patient in 9 months.

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P

9

REACTIVE PROACTIVE APPROACH

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P 10

PROACTIVE APPROACH

Starts with a Belief!“If you believe in something, BELIEVE in it all the

way”

Walt Disney

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P11

PROACTIVE – SET EXPECTATIONS5%- 10% savings

Areas of Savings:Part A

InpatientSNFHHA- Home HealthOutpatient Institutional

Part B

Where does this leave YOU, above MSR????

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P 12

BASED ON STANDARDIZED PROCESSES TO ENSURE EVERY PATIENT ACCESS, SAFETY, INTENDED OUTCOMES AND

SATISFACTION1. Set guidelines for all patients with chronic disease:

have 4 OV/year + wellness visit; all others 2 OV a year plus AWV and Subsequent follow-up.

2. Patients are scheduled for subsequent appointments after each OV.

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P13

Proactive Approach:

PROACTIVE APPROACH CONT’D3. Patients who leave the service area greater than 2

months are identified and scheduled for a wellness visit prior to departure:Ensure all prescriptions are written to cover the time awayCalled 30 days after departure to confirm patient is well with attention to providing medical records if patient intends to see physicians OOS

Remind patient to return to the office when they return to the area and schedule an appointment

Remind patient that PCP is available to discuss issues that may arise while they are away

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P 14

PROACTIVE APPROACH CONT’D4. Patients who miss appointments are diligently rescheduled.

5. Identify all healthcare services the patient has accessed between PCP office visits and include in the subsequent discussion and care plan.

6. Identify all patients who are in hospital and call them after several days to inquire on their status and discuss the Transitional Care visit (TCM).

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P 15

PROACTIVE APPROACH CONT’D7. Identify all patients who are in a SNF and call them after 7

days to inquire on their status and discuss the Transitional visit upon discharge.

8. Ensure all patients who are seen in PCP office who are diagnosed with acute illness be contacted for subsequent visit to confirm health status. (resolution of illness)

9. Ensure all patients discharged from hospital or SNF to home have a transition of care management OV within 7 days.

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P16

PROACTIVE APPROACH CONT’D10.Utilize my “Call my doc card” that request all treating physicians to

contact the patients PCP for additional pertinent medical information (CMS now has approved ACO ID card-see the portal)

CMS Card approval language• My doctor, <DOCTOR NAME>, is part of <ACO NAME>, a Medicare ACO. Call

my doctor at <DOCTOR PHONE NUMBER> or call <ACO NAME and NUMBER> to get and share any needed medical information that helps coordinate my care.

<ACO LOGO>

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P17

DON’T FORGET!CREATE VALUE IN OFFICE VISIT!!

• Create an office that functions to “WOW” the patient at every opportunity from multiple approaches

• Consider whether your office would be acceptable to you if your mother was a patient

• Patient satisfaction is the primary driver in the reduction of leakage/Proactive Approach

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P18

HOW DO YOU DO THIS?

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P19

A Motivated ACO

• Believes• Is Proactive

Not a Motivated ACO

• Non Believer• Is Reactive

• Work around “Doctor & Patient” Relationship

• Choice- Work on “Doctor & Patient” Relationship (Tactics & Policies)

TIME IS TICKING- COUNT DOWN TO ACTION!!

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P 20

92 Days

3 minutes

32 seconds

11 hours

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P 21

LOOK INTO THE FUTURE

CVS says its new brand complements its goals as a "new entrant" in the healthcare provider services market. "We are taking an active and supportive role in shaping the future of healthcare through our programs in medication adherence, delivery of care by walk-in medical clinics, and support of patients with chronic and complex conditions."

CVS Health says it will offer: Programs to help manage chronic disease Programs to connect patients with pharmacists to help them stay on their prescribed medications Digital capabilities to supplement those programs

It also plans to forge strategic alliances with physicians and health plans through both CVS/pharmacy and CVS/minuteclinic to provide clinical support, medication counseling, chronic disease monitoring, and wellness programs.

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P 22

Behind the CVS Health Rebranding StrategyChristopher Cheney, for HealthLeaders Media , September 8, 2014

CALL KELLY A. CONROY, CEO OR HYMIN ZUCKER MD, CMO AND FOUNDING PARTNERS OF TRIPLE AIM DEVELOPMENT GROUP AT 561.444.3000

WWW.TRIPLEAIMDG.COM

C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P

23