physician engagement...• atlantic aco 102 • central jersey 114 • meridian 119 • atlantic...
TRANSCRIPT
Pathways for Successful
Accountable Care Organizations:
Physician Engagement
Thomas Kloos, MD
Jim Barr, MD
Atlantic ACO & Optimus Healthcare Partners ACO
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Helping providers Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
Topics:
Optimus and Atlantic ACO’s
Physician Engagement Models
Performance
Specialists
Hospitals
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
Health Care Delivery
Quality and Experience of Care • Lack of evidence-based, comprehensive, coordinated care
• Lack of emphasis on prevention and healthy behaviors
• Health insurance affordability
• Chronic disease impact will increase
Dysfunctional FFS Reimbursement System
Lack of Physician/Provider Satisfaction & Engagement
Lack of Patient Satisfaction & Activation
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
The Triple Aim
Better care for individuals.
Better health for populations.
Reducing per-capita costs.
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Helping providers Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
Atlantic & Optimus Healthcare Partners ACO’s
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
ACO Relationships C
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
75% 0f 353 ACO’s in PY2 did not achieve shared savings.
97 ACO’s earned bonus of $422M on $833M of shared
savings.
More experienced ACO’s tended to perform better
Overall ratio of ACO’s achieving savings similar to 2013
Pioneers:
• 11 paid bonus of 83M, 5 paid back 8M
MSSP 2014 Preliminary Results
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
214 ACO’s completed outcomes reporting nationally
NJ ACO rankings in national results: • Optimus 52 • Hackensack 72 • Advocare 81 • Virtua 89 • Atlantic ACO 102 • Central Jersey 114 • Meridian 119 • Atlantic Care 128 • ACO Health 130 • Barnabas Health 167
2014 MSSP Quality Results for NJ
• AACO scored 50.8 points . 87.68% overall, a 7.4% increase from 2013 • OHP scored 52.15 points. 90.46% overall, a 7.5% increase from 2013
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
2014 New Jersey ACO MSSP Participant Performance
ACO Doing Business As (DBA) or
Legal Business Name (LBN)
States Where
Beneficiaries
Reside
Agreement
Start Date
Total
Assigned
Beneficiarie
s
Expenditures
as % of Total
Benchmark
Generated
Savings
Earned Shared
Savings
Payments
Quality
Score
Optimus Healthcare Partners, LLC New Jersey 04/01/2012 23,542 3.98% $10,017,766 $4,440,296 90.46%
ACO Health Partners, LLC NJ, PA, FL 01/01/2013 12,703 4.35% $6,476,300 $2,715,442 85.57%
Hackensack Alliance ACO NJ, NY 04/01/2012 15,603 3.26% $6,464,895 $2,832,988 89.43%
Meridian AACO, LLC New Jersey 01/01/2013 41,202 1.84% - 86.45%
RWJ Partners LLC New Jersey 01/01/2014 8,456 .7% - P4R
Central Jersey ACO LLC New Jersey 01/01/2013 20,014 .63% - 86.84%
LHS Health Network, LLC NJ, PA 01/01/2014 22,375 .45% - P4R
NEPA ACO Company, LLC New Jersey 01/01/2014 6,972 .31% - P4R
Partners In Care ACO, Inc. New Jersey 01/01/2014 6,843 .26% - P4R
Barnabas Health ACO-North, LLC New Jersey 07/01/2012 12,646 -.36% - 81.29%
JFK Population Health Company New Jersey 01/01/2014 9,531 -1.2% - P4R
HNMC Hospital/Physician ACO New Jersey 01/01/2013 8,709 -1.65% - 79.49%
Atlantic ACO NJ PA 04/01/2012 70,550 -1.82% - 87.68%
NJ Physicians ACO New Jersey 01/01/2014 11,611 -2.81% - P4R
Advocare Well Network New Jersey 01/01/2013 15,121 -4.28% - 88.75%
Balance ACO NJ, NY 07/01/2012 8,165 -10.22% - 79.34%
VirtuaCare New Jersey 01/01/2013 15,837 -11.71% - 88.19%
AtlantiCare Health Solutions, Inc. New Jersey 01/01/2013 18,427 -11.9% - 85.65%
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ACO’s are in “Value Based Contracts”
The ACO’s do not negotiate fee for service rates with CMS
or commercial payers
ACO’s are paid additional dollars based on a value equation
Value = Quality/Cost
Cost is our performance against our benchmark and market
trend
Quality is how we do against national averages on quality
measures.
What is a Value Based Contract?
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Physician Engagement: The Time Problem
Based on various analysis (for 2,500 patients):
Time needed for chronic illness care = 10.6 hours per day
Time needed for preventive care = 7.4 hours per day
Time needed for acute care = 4.6 hours per day
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
Structure & Process
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
Population Management Workflow Support
Patient-Centered Medical Home Model
Qu
alit
y an
d s
afet
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anced
access
ACO Coordinated Care: Complex Care Coordinators, COE, Community
Personal provider
Office ACO Clinical Champions PCP & Spec: Population Management Activities
Provider-directed team
Whole-person orientation
Atlantic & Optimus ACO Services
Data Aggregation/Management (CMS, payers, labs, EMR)
Risk Stratification
o Wellness – access, patient engagement
o Rising Risk – evidence-based care, care coordination
o High Risk – complex care coordination, care transitions,
readmission prevention, COE, PAC
Quality Management – enterprise-wide Patient Registry
Cost Management – analytics, efficiency indexes, innovation
Provider Engagement & Practice Transformation
Provider Performance Management (transparency, accountability)
High Performance Network Development & Integration
Community & Patient Activation
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
Population Risk Stratification
High Risk
Rising Risk
Low Risk
Top 5%
15-35% (20% will
become high risk each year)
60-80%
Whole Person: risk stratify using risk factors, not just diseases
ACO Complex Care Coordinators, COE, Plan Case Managers
ACO Population Care Managers, Practice Clinical Champions, PCMH model, Specialists
Data – Data - Data
Analytics, Reports - Performance Metrics Tools & Interventions - Barriers - Incentives
Patient Portals, PHR, Apps
Physician Engagement & Patient Engagement
Data Sources & Aggregation
Data Sources
• EMR & Paper Patient Charts
• Practice Management Systems
• Hospital (ADT’s, lab, clinical)
• Claims, Lab, Pharmacy data
• Surveys, HRA’s
Data Aggregation
• Population Manager
• Risk Manager
• Lab, Pharma, Vendor Reports
• Payer Analytics
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Team-Based Care: Staff Roles (PCC)
VIP Management
• High & Rising Risk Identification
• Proactive Patient Care Plans
Gaps in Care
ER Management
Care Transitions
• Medication Reconciliations
• Follow-up Visits
Quality Reporting
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
> 50 points 50% of pmpm
ACO 2015 Incentive Program > 65 points 75% of pmpm
> 80 points 100% of pmpm
MINIMUM REQUIREMENTS: 1) Quality data reporting 2) Communication with ACO (phone, text, e-mails)
Quality IT Transformation Improvement Engagement
Identification and management of high
risk, rising risk & vulnerable patients within your practice
20 points
Use of Cortext, Relay Health/NJ Health
Connect, and McKesson
Population Manager 20 points
Population Management Office
Roles, Responsibilities &
Workflows 15 points
Office Performance Improvement
Process & Outcomes:
Plan-Do-Study-Act (PDSA)
20 points
Citizenship & Integration 25 points
PMPM Per Primary Care Physician Sample ACO Financial Proforma Practice Attribution Assumptions
**CONFIDENTIAL** Practice
Potential Actual Potential Actual # Patients 60%
Maximum Annual Paid Annual Paid Medicare 250 10%
CMS PMPM Amount Amount Amount Amount Cigna 100 4%
Performance Improvement PMPM $$ Horizon 625 25%
Shared Savings Horizon MA 25 1%
Aetna FI 100 4%
Cigna Aetna SI 200 8%
Performance Improvement PMPM $$ United 200 8%
Horizon Others 1,000 40%
Performance Improvement PMPM $$ 2,500
Horizon Medicare Advantage PMPM
Shared Savings
Aetna
Fully-Insured PIIP PMPM $$
Self-Insured PIIP PMPM $$
Shared Savings FI & SI
United
Performance Improvement PMPM $$
Shared Savings
Potential 2014 Actual 2014 Potential 2015 Actual 2015 **CONFIDENTIAL**
Total PMPM Payments= $$ $$
Total Shared Savings=
TOTAL 2014 $$ TOTAL 2015 $$
20152014
Shared Savings Distribution $$
30% ACO (operations and investment)
70% ACO Participants
• 5% Hospitals
• 95% Physicians
o 30% Specialists
– by episode volume
o 70% Primary Care Physicians
– 25% by attribution
– 25% by practice quality rating
– 50% by utilization performance & trend
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
Specialists
PCMH-Neighbor Guidelines
Centers of Excellence
Clinical Integration (referral management)
Shared Savings Distributions
Bundled Payments / Episodes of Care
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
Reports
Secure Access
Full Transparency
Performance Management Framework
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
ACO Provider Performance – Efficiency Index
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
ACO Provider Performance – KPI
Atlantic ACO PCP - Allowed PMPM
Period 4: January 1, 2014 - December 31, 2014 (4th Qtr, 2014)
Average # Members Risk Score Total Cost PMPM Total Prof PMPM Facility PMPM
Inpatient
Data Sharing Members Only Period 2 Period
3 Period
4 Period
2 Period
3 Period
4 Period
2 Period
3 Period
4 Period
2 Period
3 Period
4 Period
2 Period
3 Period
4
AACO (Weighted Averages) 30,541
35,896 41,080
0.99
0.97
1.02
$ 950
$ 953
$ 919
$ 367
$ 368
$ 356
$ 325
$ 324
$ 315
Milliman Benchmarks - Moderately Well Managed $925 $925 $925 $305 $305 $305 $315 $315 $315
Milliman Benchmarks - Well Managed $680 $680 $680 $220 $220 $220 $214 $214 $214
Practice Name Average # Members Risk Score Total Cost PMPM Total Prof PMPM
Facility PMPM Inpatient
Practice A 99
98 96
0.56
0.57
0.54
$ 1,065
$ 807
$ 761
$ 436
$ 412
$ 418
$ 446
$ 211
$ 150
Practice B 79
81 84
0.92
0.86
0.81
$ 679
$ 681
$ 753
$ 310
$ 333
$ 346
$ 149
$ 107
$ 122
… 54
52 51
0.97
0.90
1.14
$ 1,230
$ 1,088
$ 1,071
$ 363
$ 357
$ 338
$ 546
$ 419
$ 494
90
95 98
1.01
1.01
0.92
$ 1,198
$ 1,057
$ 961
$ 475
$ 419
$ 401
$ 379
$ 351
$ 299
356
402
444
0.98
1.07
1.23
$ 1,043
$ 1,029
$ 974
$ 331
$ 306
$ 272
$ 371
$ 406
$ 427
380
381
381
0.56
0.55
0.63
$ 1,207
$ 1,101
$ 996
$ 517
$ 487
$ 426
$ 357
$ 297
$ 292
206
215
222
1.13
1.10
1.21
$ 1,009
$ 1,073
$ 960
$ 277
$ 287
$ 254
$ 473
$ 485
$ 435
182
180
177
1.58
1.54
1.62
$ 944
$ 917
$ 832
$ 251
$ 248
$ 239
$ 460
$ 428
$ 375
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
ACO Provider Performance – Integration
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
ACO Specialist Integration Detail
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
Cardiologist A B C D E F G H
Episode Efficiency
Episodes by Provider
Specialty: Cardiovascular Disease
PROVIDER # EPISODES AMT ALLOWED AMT ALLOWED/EPI
CM EI EI STAT SIGNIF
IMPACT
A 1,744 $1,020,142 $585 1.06 1.09 Y $82,714
B 1,683 $891,084 $529 1.11 0.94 N ($52,349)
C 1,678 $1,008,048 $601 1.05 1.13 Y $113,600
D 1,434 $468,957 $327 0.65 0.99 N ($3,546)
E 1,347 $750,372 $557 1.06 1.03 N $24,994
F 1,219 $563,405 $462 0.97 0.94 N ($35,648)
G 1,125 $723,941 $644 1.16 1.10 Y $66,526
H 1,102 $562,205 $510 0.92 1.09 Y $48,212
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
Case Mix
Efficiency Index
Performance Management Framework
If performance level is: <50% 50-59% 60-69% 70-79% 80-84% 85-89% >90%
Improvement Needed By Next Reporting
Period = 40% 15% 10% 6% 3% 0% 0%
Examples: Base
Compliance 9 mos 12 mos 18 mos 24 mos 30 mos 36 mos
Practice "A" 50% 58% 66% 73% 77% 82% 84%
Practice "B" 25% 35% 49% 69% 75% 80% >85%
Practice "C" 80% 82% 85% 85% 85% 85% 85%
Your Practice enter value
calculate
Alignment & Collaboration
Hospitals
Payers
Employers
Unions
IT
Pharma
Labs
Medical Device / Vendors
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
Barriers
Capitalization of PCMH and ACO models
FFS vs Unfamiliar Compensation Model
IT, Data and Analytics
Predictive Modeling
Management & Leadership
Culture
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
“Care Better” Helping physicians “Care Better” for their patients
Helping patients “Care Better” for themselves
Helping people “Care Better” for each other
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.
Thank You
Q & A
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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.