flaacos 2014 conference - the healthcare movement - survival on the aco frontier
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The Healthcare Movement - Survival on the ACO Frontier presented by John Schmitt, Ph.D. at the FLAACOs Fall 2014 ConferenceTRANSCRIPT
The Healthcare Movement
=Survival on the ACO Frontier=September 29, 2014
RELIANCE CONSULTING GROUP
Presented by :
John P. Schmitt, Ph.D. RCG Managing
Director
• Introduction
– The Healthcare Movement
– Frontier Successes & Disasters
• 5 Key ACO Success Factors
• 5 Key ACO Operational Changes
• Pathway to Shared Savings
• ACO Tools and Resources
• Q & A
AGENDA
2
3
INTRODUCTION
The Westward Movement
The Healthcare Movement
4
INTRODUCTION
The Homestead Act of 1862 required a three step process:
1. File an Application2. Improve the Land3. File for deed of title
Requirements:• Must be at least 21 years old or the head of
a household• Must have never taken up arms against the
U.S. Government• Must reside on land for five years• Must show evidence of having made
improvements
MSSP ACO Process:
1. File an Application2. Improve Population
Health3. Attribute Patient Panel
5
INTRODUCTION
Successes…
Donner Party
and Disasters
MSSP: First-Year Performance Results
Successes• CMS reported 53 of 204 MSSP-ACOs (26%)
achieved bonus payments of $300M+ (of those 12 in FL earned $52M)
• On average, the ACOs showed overall improvement on 30 of the 33 quality measures
Disasters• 4 of the ACOs forfeited $22M+ by failing
quality reporting requirements • 1 ACO overspent its target by $10M and
owed shared losses of $4M
Source: “Fact Sheets: Medicare ACOs Continue to Succeed in Improving C are, Lowering Cost Growth”, www.CMS.gov September 16, 2014
INTRODUCTION
6
Pioneer ACO Report: Program Defections
• With the withdrawal of Sharp Healthcare, 10 of the original 32 Pioneer ACOs (31%) have left the program after two years of participation.
• 13 of the original 32 Pioneer ACOs (40%) generated enough savings to keep $76.1 million
“The results were promising but hardly definitive. What I take from that is not that we will be successful, but that we
can be” - Michael Chernew, Harvard University professor of healthcare policy
Source: “Will More Pioneer ACOs Defect?”, HealthLeaders Media, September 2, 2014
INTRODUCTION
7
CMS Report: Results of MSSP ACOs (activated in 2012)
• 60 of the 114 CMS ACOs (53%) reported no decrease in health spending below targets during their first 12 months.
• 29 of the 114 CMS ACOs (25%) reduced spending enough during the first 12 months to keep some of the savings
INTRODUCTION
8
Source: “ACOs Show Uneven Progress”, Greg Freeman, HealthLeaders Media, April 7, 2014
# 1: Practice Growth2004: Expand market share, broaden services, exert pricing leverage, secure physicians and increase utilization
2014: Expand covered lives, establish alliances, compete on outcomes, minimize total cost, and increase access hours
5 KEY ACO SUCCESS FACTORS – 2004 vs 2014
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2004
2014
#2: Performance Metrics
2004: Service line volume, FFS revenue, pricing growth, process efficiency, practice cost/RVS
2014: Share of covered lives, geographic reach, risk-based revenues, evidence-based outcomes, total cost of care, PCMH/PCSP measures
5 KEY ACO SUCCESS FACTORS – 2004 vs 2014
10
2004
2014
#3: Contracting Targets
2004: Government purchasers, commercial payer reps, individuals
2014: Government ACA programs (MSSP ACOs), commercial payer population health managers (Commercial ACOs), self-insured employers, narrow networks
5 KEY ACO SUCCESS FACTORS – 2004 vs 2014
11
2004
2014
#4: Critical Infrastructure
2004: Office staff, ambulatory surgery centers, ancillary services, clinical technology
2014: Physician-led care teams, care management staff & systems, health IT analytics, contracted specialists, hospitalist relationships, community resources, pharmacist collaborators
5 KEY ACO SUCCESS FACTORS – 2004 vs 2014
12
2004
2014
#5: Competitive Strategies
2004: Service line competition, referral channels, physician member loyalty
2014: Provide comprehensive care, patient satisfaction surveys, gaps-in-care reduction, total cost performance, medical home recognition
5 KEY ACO SUCCESS FACTORS – 2004 vs 2014
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2004
2014
VALUE-BASED CONTRACTING CULTURE POSITIONING
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ACO Operational Changes
Source: “Primary Care Redesign” by Michael Zeis, HealthLeaders, April 2014
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5 Key ACO Operational Changes
#1: Mission Commitment: Triple Aim
• Medicare Shared Savings Program (MSSP) rewards participants that:– Lower their healthcare costs– Meet performance standards on quality of
care– Improve population health
Source: https://www.cms.gov/Medicare/Medicare-Fee-For-Service-Payment/sharedsavingspr
ogram/index.html
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# 2: Physician Culture Change(Engagement & Commitment)
• Representation: Governance / Board of Directors• Membership: Medical committees• Appointments: CMOs, regional MD directors, MD
department chairs• Participation: Operational meetings & conference
calls • Commitment: Culture change (PCMH readiness)
Detractors
NegativePositive
Champions
# of ACO Physicians
PCM
H R
ecep
tivity
5 Key ACO Operational Changes
17
SIX THINGS PAYERS WANT
#3: Population Health Management
(System Components & Tools)
Source: Accountable Care Solutions Group (ACSG) & the American Health Data Institute (AHDI)
1.) Dashboards
2.) Patient Registries
3.) Best Practices
4.) Care Coordinators
5.) Patient Engagement Surveys
5 Key ACO Operational Changes
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PATIENT POPULATION
GOAL OF SERVICE INTERNAL CARE TEAM
INFORMATIONAL RESOURCES EXTERNAL CARE TEAM
Healthy Patients Preventative Care
PCP Mid-Level provider RN LPN/MA PSR
Self Management Tool EMR IT Reports Quality Data Patient Feedback N/A
Acute Patients Episodic Care
PCP Mid-Level provider RN LPN/MA PSR Care Coordinator
E-Visit Feedback Medication Management EMR IT Reports Quality Data Patient Feedback
Specialists ER & Urgent Care Hospitalists Home Health Providers Social Workers Mental Health Providers Community Resources
Chronic Patients Chronic Care
PCP Mid-Level provider RN LPN/MA PSR Care Coordinator
E-Visit Feedback Medication Management EMR IT Reports Quality Data Patient Feedback
Specialists ER & Urgent Care Hospitalists Home Health Providers Social Workers Mental Health Providers Community Resources Case Managers
End of Life Patients Palliative Care
PCP Mid-Level provider RN LPN/MA Caregiver Care Coordinator
E-Visit Feedback Medication Management EMR IT Reports Quality Data Patient Feedback
Specialists Home Health Providers Social Workers Mental Health Providers Community Resources
#4: Medical Home Infrastructure
Copyright 2013 RCG Intellectual Property. All rights reserved
5 Key ACO Operational Changes
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#5: Quality & Cost Reporting Systems
• EMR & MU: Input & protocol compliance
• Dashboard Implementation: Tracking & reporting
• Action Plans: Development & execution
• Quality Metrics Reporting: ACO 33 measures
• Continuous System: Results & improvement
5 Key ACO Operational Changes
Tracking & Reporting Feedback
ACO INFORMATION & REPORTING
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ACO Members
practice2
practice3
practice1
ACO Payers
Commercials Self Insured EmployersCMS State &
Others
IT Data WarehouseClaims Data EMR Clinical Data
ACO Membership
Reports
Care Management
Reports
= PCMH Recognition == Cost & Quality Data =
ACO Administration
Reports
PATHWAY TO SHARED SAVINGS
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Operational Resources Triple Aim Mission Support Operational Contribution
PCMH Teams & External Team support
Delivery of cost-effective & quality healthcare at practice sites
Meet cost & quality performance requirements at site level
IT Data: EMR, EHR, HIE, & MU
Cost & quality data reporting: Dashboards, registries, & reports
Medical Expense:Quality of Care:Population Health:
Care Management Program: Care Coordinators & Social Workers
Population Health Management: Patient-specific transitions, compliance, follow-ups, etc.
Patient & Provider- specific interventions
Governance & Administration: Board members, CEO, CMO, CFO, COO, etc.
Policies & Procedures: Clinical standards, MSE management, patient-centric culture, physician comp. & payer contracting
Operational & Financial decision making
Result:SHARED SAVINGS DISTRIBUTIONS
• st
“We struck shared savings!!”
PATHWAY TO SHARED SAVINGS
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Shared Savings PotentialThere are four main reimbursement models used by accountable care organizations, according to a survey conducted by Healthcare Intelligence Network:
1. Fee for service, care coordination and shared
savings: 37%
2. Shared savings: 22.2%
3. Pay for performance: 11.1%
4. Fee for service and care coordination: 11.1%
5. Bundled/episodic payment: 3.7%
Survey data based on responses from 138 healthcare organizations participating in ACOs
Source: Heather Punke, “Top 4 Reimbursement Models”, Beckers Hospital Review, December 31, 2013
59.2%
PATHWAY TO SHARED SAVINGS
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Commercial Payer: Shared Savings Model
PATHWAY TO SHARED SAVINGS
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ACO Tools & Resources
Westward Movement Tools
Healthcare Movement Tools
1864
2014
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ACO TOOLS & RESOURCES
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Always Open
Always Current
AlwaysFREE
ACOExhibitHall.com
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Q & A
RELIANCE CONSULTING GROUP
For more information about ACO Development/Contracting, visit Reliance Consulting
Group at: www.RelianceCG.com
Or Contact Dr. Schmitt directly: [email protected]
The Healthcare Movement
=Survival on the ACO Frontier=