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Park Nicollet Health Services A Medicare Pioneer Accountable Care Organization

Author: dangmien

Post on 09-Jul-2018




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  • Park Nicollet Health Services

    A Medicare Pioneer Accountable Care Organization

  • Agenda

    1 Park Nicollet Health Services Background

    2 Park Nicollet Pioneer ACO Overview

    3 Pioneer ACO Financial and Quality Model

    4 Upside and Downside to Pioneer ACO Data & Analytics

    5 Questions and Discussion


    Accountable Care Organization

    ACO Team:

    Daniel Trajano, MD, MBA, Sr. Med Dir. of Quality, Innovation, Population Health

    Eva Gallagher, RN, PHD, Sr. Nursing Director of Quality, Innovation, Population Health

    Mark Skubic, VP Government Relations

    Megan Cox, Dir. Medicare Products

    Sam VanNorman, Dir. Business Intelligence

    Gregg Teeter, Dir. Business Analytics

    Kody Koepke, Dir. Pricing & Data

    Maddy Emahiser, Project Manager

  • Park Nicollet Accountable Care Organization

    Located in the West Metro of Minneapolis/St. Paul

    Serves ~500,000 Unique Patients/Year

    Employs 8,300 People, 1,300 are Providers

    1 Hospital (~22K inpatient admissions/yr)

    25+ Locations with Primary, Specialty and Surgical Specialty

    Care Clinics (~2.2M ambulatory visits/yr)

    Accountable Care Contracts with All Major Payers

    PNC Fun Fact: 2011 TOUR DE CLINIC CAMPAIGN David Abelson, CEO and avid cyclist, spent 3 days riding his bike 200+ miles to 21 of our PNC sites, raising more than $55K



  • Pioneer ACO Program Overview: PGP Demo Sites

  • Pioneer ACO Program Overview: Pioneer ACO Sites

  • Pioneer ACO Program Overview: The

    Regulatory Relationship

    Lessons Learned from PGP Demonstration

    Setting the Metrics

    When negotiating with CMS you need to be aware

    of the person behind the curtain.

    Office of the Actuary


    Demo consultants


  • Pioneer Program Benefited from Scars of PGP Demo

    10 systems 32 Systems

    Local Benchmark National

    2+% Savings rate 1% Savings

    Only Share Above First Dollar

    Little/Late Data Monthly

    No risk of loss Up and down

  • Pioneer ACO Program Overview

    32 players with variable structures and interests in the ACO Program.

    The Twin Cities players

    Integrated systems w/hospital

    Medical Group

    Independent Practice Associations (IPAs)

    Virtual Systems

    Low Cost Systems $18,000 per member per year



  • Pioneer ACO Bonus Payment Overview How Do We Get Paid?

    Cost Savings

    (must be at least 1% to qualify)

    Contracted Shared Risk


    Quality Measure % (must meet quality

    performance standards to qualify)

    Park Nicollet Bonus


    $6 M 75% 75% $3.4 M

    Hypothetical Scenarios:

    Model Overview

    $10 M 75% 90% $6.8 M

  • Pioneer ACO Expenditure Benchmark Cost Savings

    The trended benchmark will be based on trends in national, not local, expenditures

    To earn the shared savings bonus payments, Park Nicollets per-capita expenditures (for assigned beneficiaries) must be less than the yearly target by at least 1%

    -3 -2 -1 0 1 2 3


    l Co



    Trended Benchmark

    Park Nicollet Cost

    Shared Savings

    Cost Savings Contracted Shared Risk


    Quality Measure %

    Park Nicollet Bonus


  • 25% Patient & Caregiver Experience

    1. Timely care, appointments, and information

    2. How well your doctor communicates

    3. Patients rating of doctor

    4. Access to specialists

    5. Health promotion and education

    6. Shared decision making

    7. Health status/functional status

    25% Care Coordination & Patient Safety

    8. Risk standardized, all cause readmission

    9. Ambulatory Care Sensitive AdmissionsCOPD

    10. Ambulatory Care Sensitive Admissions--CHF

    11. Percent of PCPs who qualify for EHR incentive

    12. Medication reconciliation after discharge

    13. Screening for falls risk

    25% Preventative Health

    14. Influenza immunization

    15. Pneumoccal vaccination

    16. Adult weight screening and follow-up

    17. Tobacco use assessment and tobacco cessation intervention

    18. Depression screening

    19. Colorectal cancer screening

    20. Mammography screening

    21. Proportion of adults 18+ who had blood pressure measured in preceding 2 years

    25% At Risk Populations

    22. Diabetes Composite A1C< 8

    23. Diabetes Composite LDL < 100

    24. Diabetes Composite BP9)

    28. HTN blood pressure control

    29. Ischemic Vascular Disease (IVD) LDL



  • The Upside to Data & Analytics

    We have 3 years (and growing monthly) of all CMS claims

    data for our assigned members

    This will allow us to track all patient expenditures and

    quantify the amount of services these patients are

    receiving outside of Park Nicollet

    Unlike many of the other Pioneers, were on a single,

    integrated platform

  • The Downside to Data & Analytics

    The expenditure benchmark target is still not finalized and the

    details (methodology and when we will receive them) are unclear

    This is troubling as we are nearly halfway through 2012 and we

    dont have a clear understanding where we are at in reducing

    expenditures by 1%

    Several quality metrics, which we are required to report on

    annually, have slightly different definitions from other CMS

    required reporting (PGP and MU)

    This will require extra time & resources to modify and report on


    Park Nicollet needs to push CMS to fully standardize detail

    As with PGP, the burden of Quality Reporting significant


  • Data & Analytics : What we need to do

    For us to make significant improvement in lowering cost and improving

    quality, we need to know where we are at so we can identify opportunities

    There are significant analytic challenges (as we dont know our reality)

    Educate CMS on the realities healthcare and what it takes to support this


    Park Nicollet should be the best poised to succeed in the Pioneer ACO

    model (given our PGP experience and organizational structure) and this

    is going to be very difficult

    Lobby CMS (ideally in partnership with Allina, Fairview, and Other

    Advance Pioneer ACOs)

    Leverage our analytics infrastructure wiselyand know when to buy vs.


    Understand that Epic is not built to support population health

    managementcurrently. We need to decide whether were going to stumble

    along with Epic until we install 2012 or buy another tool.

  • Questions and Discussion

    1 Park Nicollet Health Services Background

    2 Park Nicollet Pioneer ACO Overview

    3 Pioneer ACO Financial and Quality Model

    4 Upside and Downside to Pioneer ACO Data & Analytics

    5 Questions and Discussion