hospitals & health systems macra strategies · 2016-12-06 · scale alliance of ~3,750 (78%)...
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PROPRIETARY & CONFIDENTIAL – © 2016 PREMIER, INC.
Hospitals & Health Systems MACRA Strategies
Blair Childs, Senior Vice President, Premier healthcare alliance
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PROPRIETARY & CONFIDENTIAL – © 2016 PREMIER, INC.2 PROPRIETARY & CONFIDENTIAL – © 2016 PREMIER, INC.
Transforming Healthcare Together
SCALEAlliance of ~3,750 (78%) hospitals, ~130,000 non- acute providers and 1.2 million cliniciansIntegrated clinical, financial, operational data – insights into ~40%
of U.S. health system discharges Approximately $44 billion in supply chain spendManage ~2,000 contracts from ~1,100 suppliers
ALIGNMENTMembers own ~74% of equity*10 health system board members Premier field force embedded in member hospitals
COMMITMENTMember owner average tenure ~15 years (80% at 10+) Members view Premier as strategic partner
CO-INNOVATIONCo-develop solutions with membersCommittees composed of ~163 member hospitals~1,200 hospitals in performance improvement collaboratives
Note: Data as of June 30, 2015.
Premier is a provider-driven healthcare performance improvement company. We co-innovate solutions with our members to reduce costs,
improve quality, and produce better patient outcomes.
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PROPRIETARY & CONFIDENTIAL – © 2016 PREMIER, INC.3 PROPRIETARY & CONFIDENTIAL – © 2016 PREMIER, INC.
Sally Hartman, Senior Vice President, Riverside Health System
John M. Colmers, SVP, Health Care Transformation and Strategic Planning
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PROPRIETARY & CONFIDENTIAL – © 2016 PREMIER, INC.4 PROPRIETARY & CONFIDENTIAL – © 2016 PREMIER, INC.
MACRA reform timeline (Medicare Access and CHIP Reauthorization Act of 2015)
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025Permanent repeal of SGRUpdates in physician
payments
APM participating providers exempt from MIPS; receive annual 5% bonus (2019-2024)
Merit-Based Incentive Payment System (MIPS) adjustments 2019
+/-4%2020
+/-
5%2021
+/-
7%2022 & beyond
+/-
9%
20184%
PQRS pay for reporting2015-1.5%
2016 & beyond-2.0%
Meaningful Use Penalty (up to %)2015-1.0%
2016-2.0%
2017-3.0%
2018-4.0%?
Value-based Payment Modifier 2015
± 1.0%2016
± 2.0%2017
+2/±4.0%
MIPS exceptional performance adjustment; ≤
10% Medicare payment (2019-2024)
2026
0.5% (7/2015-2019) 0% (2020-2025)
0.75% update
2017-3.0%
2018±2/±4.0%
Measurement period
Measurement period
0.25% update
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Riverside snapshot
5
primary markets, with
services in two others
8,000
square miles
10,000 team members
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Riverside Health System Footprint
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3 divisions
Acute Care Services5 acute care hospitals754 beds
3 specialty hospitals222 beds
Lifelong Health 10 nursing homes943 beds
3 PACE centers Helping 600 nursing‐home eligible participants stay in their homes
In‐home health
•Home Health
•Home‐enabling technology
•House calls
Riverside Medical
GroupMedical home model
•110 practices•565+ providers•35 specialties
45% 25% 30%
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Market Characteristics
• One dominant commercial payer
• Physicians predominantly aligned/employed by health systems or
part of large multispecialty physician groups
• Significant differences within sub markets within service area –
Examples: demographics, rural vs. urban, competitors vary, differing
health and social issues
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MACRA Work in Progress at Riverside• Physician alignment strategies
• Compensation plan redesign• Incentive redesign
• Re‐organizing into Community Health Networks by geography• Focus on cost containment• Clinical process improvement and standardization• PCMH recertification (NCQA)• Epic EHR implementation• MACRA Roadmap in development
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Future/Strategic Decisions for Riverside
• Attribution Strategy• Should we participate in MSSP? Which track? What is the future of
this program?
• With effectively one commercial payer, how do we want to think
about commercial insurance risk?
• Should we change the way we evaluate new MD hires relative to
quality profiles?
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• Johns Hopkins School of Medicine
• Johns Hopkins Alliance for Patients (JMAP) –
ACO • 6 member hospitals• 820,000 annual patient visits
via Johns Hopkins Community Physicians at 39 primary and specialty care practices
• 130,000 adults and children in central MD treated by Johns Hopkins Home Care Group
• 345,000 people covered by Johns Hopkins Healthcare’s managed care plans
• Johns Hopkins School of Medicine
• Johns Hopkins Alliance for Patients (JMAP) –
ACO • 6 member hospitals• 820,000 annual patient visits
via Johns Hopkins Community Physicians at 39 primary and specialty care practices
• 130,000 adults and children in central MD treated by Johns Hopkins Home Care Group
• 345,000 people covered by Johns Hopkins Healthcare’s managed care plans
Johns Hopkins Medicine Overview
Source: JHM Fast Facts
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4,500+ international patients and 5,700+ out-of-state patients
facilitated by Johns Hopkins Medicine International
Johns Hopkins Medicine InternationalReach
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Johns Hopkins Medicine: Fast Facts
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Employed Physicians
•2,700 full-time faculty
•1,250 part-time faculty
•360 Johns Hopkins community physicians
•70 specialty physicians
Member Hospitals
•Johns Hopkins Hospital
•Johns Hopkins Bayview Hospital •Howard County General Hospital•Sibley Memorial
Hospital•Suburban HospitalJ h H ki All
Statistics
•$8 billion in operating revenues
•2.8 million-plus annual outpatient visits
•360,000-plus annual ER visits
•150,000-plus annual hospital admissions
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In Maryland…Things are Different
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An all payer system that is accountable for the total cost
of care on a per capita basis is an effective model for
establishing policies and incentives to drive system
progress toward achieving the three part aim.
Maryland All-Payer Model •All-payer global budget for hospital inpatient and outpatient care•Medicare beneficiary savings of .5%/year - $330 M within 5 years
• 55% of Medicare Parts A+B covered•Medicare total cost of care guard rail•Quality metrics…. Expectation is to develop total cost of care model by 2019
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Hospital Care Improvement Program (HCIP)• Designed for hospitals and providers practicing at hospitals• Focus on efficient inpatient care and effective transitions of
care• Goal: Facilitate improvements in hospital care that result in
care improvements and efficiencyComplex and Chronic Care Improvement Program (CCIP)
• Designed for hospitals and community providers and practitioners
• Focus on complex and chronic patients• Goal: Enhance care management
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Care Redesign Amendment- Change to the current waiver
Two initial care redesign programs aim to align hospitals and other providers
• Hospitals can select which program to participate in
• Goal to reduce potentially avoidable readmissions
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• Reduce rate of growth in Medicare total cost of care (Parts A&B)
• Primary care model aligned to CPC+
• Dual eligible model– Dual Eligible ACO/PCMH– Medicaid leading state workgroup
• Geographic model– Very early stage– Geographic vs. attribution
• Design efforts to be MACRA compliant - leading to treatment as an advanced Alternative Payment Model (APM)
• Plan due to CMS 12/31/16
Progression Plan- Phase 2 of the waiver
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Preparing for MACRA
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QUESTIONS?
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