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ACOs and the Impact on Supply Chain
Today’s PresentersDennis Orthman, CMRP•Senior Director
•SMI - Strategic Marketplace Initiative
Thomas M. Lubotsky, FACHE•Vice President Supply Chain and Clinical Resource Management
•Advocate Health System
Adventist Health SystemCeleste West, Carole OwensAdvocate Health CareThomas LubotskyAllina Hospitals and ClinicsCheryl HarelstadAscension Health AllianceMichael GrayAvera Health*Steve HuckabaaBaptist Health SystemSherry WiningerBayCare Health SystemJudith LipscombBeth Israel Deaconess Medical CenterSteve CashtonBJC HealthCare*Nancy LeMasterCHE Florence DoyleCatholic Health InitiativesKevin Kakuda, Bev SlateCatholic Health PartnersCalvin Wright, Ed PryorChildren's Hospital of PhiladelphiaJoni RittlerCHRISTUS HealthEd HardinCleveland ClinicSimrit SandhuDana-Farber Cancer InstituteJohn WilliDenver Health and Hospital AuthorityPhilip Pettigrew, Stewart LayheDuke University Health SystemJane PleasantsFairview Health ServicesLeAnn BornFletcher Allen Health CareCharles Miceli
FMOL Health SystemWilliam MosserGeisinger Health System*Deborah Petretich Templeton, Joel MeckleyGreenville Hospital SystemJohn MatekaGroup Health CooperativeDavid EfroymsonInova Health SystemCharles NeikamIntermountain Healthcare*Brent JohnsonJohns Hopkins Health SystemBill KennettKaiser PermanenteLaurel JunkKettering Health NetworkTrisha OsbornLHP Hospital GroupAndrew MontgomeryLifespanNicholas Dominick, Ed BonettiMayo Clinic*James FrancisMercy / ROi*Vance Moore, Gene KirtserMethodist Hospital System, TheGary WagnerNorth Shore Long Island Jewish Health SystemDonna DrummondNorthwestern Memorial HealthCareGary FennessyNovant HealthMark WelchOchsner Health SystemMichael LouviereOhio State University Medical CenterRosalind ParkinsonOrlando HealthRandy Hayas, Rosaline Parson
OSF Healthcare SystemJohn HorneParallon Business SolutionsJay KirkpatrickParkland Health & Hospital SystemJoe VelasquezPartners HealthCareLisa, Scannell, Mark FaulknerPresbyterian Healthcare ServicesMatthew PehrsonProvidence Health & ServicesDavid HunterRoper St. Francis HealthcareScott FergusonSanford HealthThomas HarvieuxScottsdale HealthcareMichael HildebrandtSentara HealthcareDoug Farley, Nancy GrunewaldSSM Health CareMichael RosenblattSt. Luke's Health SystemCameron MarloweTexas Health ResourcesJohn GaidaThomas Jefferson University HospitalsRobert BurkholderUAB Health SustemBob TaylorUniversity Kentucky HealthCareLorra MiracleUnityPoint HealthPeggy Samuels, Sandra EricksonUPMCJames Szilagy, David HargravesVirginia Mason Medical CenterMilrose MercadoYale New Haven Health SystemPam Scagliarini
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3M Health CareBruce Bald, Paul Heerwald, Matt SchroerAbbott LaboratoriesSteve Christian, Jay Sullivan, Hal Lowe, David PacittiAesculapMark Meyer, Janelle BegoleAmerican Contract SystemsDavid ThomsonBaxter Healthcare CorporationAlan Mavis, Brad NewmanBecton, Dickinson & Company (BD)*Stephen Gundersen, Dennis BlackBoston Scientific CorporationLawrence Strauss, Jim MayberryBSN Medical, Inc.Mike RichardsC.R. Bard, Inc.*Carol Stone, Brian KellyCardinal HealthKenneth Kohler, Eric NelsonCare Line Industries, Inc.David LoveCarefusionMaryann Restino, David DahleColoplast Corporation*Keith JohnsonCook Medical IncorporatedDavid ReedCovidienArmin Cline, Matt Gattuso, Bill FallonDeRoyalBill Pittman, Greg HodgeGeorgia-Pacific CorporationDave Chybowski, Joe Sandora
Global Healthcare Exchange (GHX)*Bruce Johnson, Karen Conway, Derek SmithHill-Rom Company, Inc.*Susan Schuette, David CoriglianoInfor (previously Lawson)*Keith Lohkamp, Michelle RobbinsIntegrated Medical Systems International (IMS)Kevin McMillen, James Mundy IIIJohnson & Johnson Health Care Systems, Inc.Larry Malloy, Fred Wagner, Bill DonatoKimberly-Clark Health CareKeith Kuchta, Kelly PawlowskiManagement Health Solutions (AtPar)Michael FerrisMcKesson Healthcare CorporationMary Jo Ellis, Scott Pruyn, Jeff BennishMedical Action Industries, Inc.Chris CorpMediclick, Inc.Mike Merwarth, Nick ToscanoMedline Industries, Inc.Tim Jacobson, Tom EganMedSpeedGail NelsonMolnlycke Health CareRon SpinuzziOmnicell, Inc.James Taylor
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Owens & Minor, Inc.Charles Colpo, Joe AlexPAR Excellence Systems, Inc.Richard FelgerRoundTable Healthcare PartnersJohn McConachieSage ProductsWilliam HowesSciQuestDavid ForlenzaSeneca Medical, Inc.Lisa HohmanSmith & NephewRandolph Williams, Larry DooleySmiths MedicalRegina McIntosh, Connie PettijohnStaplesSusan LouisSterilMed, Inc.Randy MarkerSTERIS CorporationTim Chapman, Cary MajorsStryker CorporationLara Latham, Walker LambiotteSuture ExpressBrian ForsytheTECSYSNancy Pakieser, Peter BreretonThermo Fisher Scientific - Fisher HealthCare DivisionDavid Bespalko, Dino AlfanoVUEMEDLana MakhanikW.L. Gore & Associates, Inc.Gene Tierney
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This Executive Briefing and
other free SMI Tools are
available at
www.smisupplychain.com
Slide 6
ACOs: Foundational Keys:
• MDs are the decision-makers and leaders whose buy-in is crucial for an accountable care program to succeed.
• Payment models incentivize providers to become successful episodic care managers, a key step toward population health management.
Slide 7
ACO Growth in 2013
Slide 8
5 elements of accountable care impacting supply chain
Slide 9
1 Physician Integration
2 Alignment of Incentives
3 Clinical Integration
4 Information Management
5 Supply Chain Engagement.
1 Physician Integration
2 Alignment of Incentives
3 Clinical Integration
4 Information Management
5 Supply Chain Engagement.
Element #1
Physician Integration
Slide 10
0.0%
50.0%
100.0%
0-50 beds 51-100beds
101-250beds
251-500beds
500+beds
85.7% 80.0% 88.9% 100.0% 100.0%
Hospital Physician Employment Trend 2011-2014 © 2011-2013 MDSI
% expected to have fewer employed physicians
% expected to have more employed physicians
In 2000, 57 % of physicians were independent.
In 2013, 39 % were independent.
Element #2
Alignment of Incentives• Volume – will no longer drive physician
compensation or hospital compensation
• ACO payment models can include:
• Measurements for hospitals include:
Slide 11
Capitation (full/partial)
Bundled Payments
Shared Savings
HAIs ReadmissionsPatient Falls
Element #3
Clinical IntegrationPCMH:
•takes an integrated team consultation approach.
•assigns a care coordinator to:–avoid unnecessary testing
–perform patient education
–coordinate follow-up care
– fill/monitor prescriptions
Slide 12
Accountable care seeks to monitor and coordinate care across all stages and locations of care, often via a patient-centered medical home (PCMH).
Accountable care seeks to monitor and coordinate care across all stages and locations of care, often via a patient-centered medical home (PCMH).
Element #4
Information Management
Slide 13
Evidence
Patient Tracking
Population Health
Performance MetricsValue Based Contracting
Interconnected Information SystemsData Warehouse
EHR HIEERP
Element #4
Information Management• Serious Challenges
–Costs
–Lack of uniform standards
–Limits on data mineability
–Resistance
Slide 14
“Big data equals
big costs.” Patrick Flaherty UPMC, SMI Provider Partner
“Big data equals
big costs.” Patrick Flaherty UPMC, SMI Provider Partner
“When folks deploy EHRs, only about 30 percent of the information is really reportable, with the rest in free-form text that structured reports cannot pull out.” Mary Beth Lang, PhD, UPMC, SMI Provider Partner
“When folks deploy EHRs, only about 30 percent of the information is really reportable, with the rest in free-form text that structured reports cannot pull out.” Mary Beth Lang, PhD, UPMC, SMI Provider Partner
Element #5
Supply Chain Engagement• Emergence of the “Service Line”
organizational model presents a supply chain opportunity.
• Service line leadership monitors and manages cost, quality, and outcomes.
• Supply chain’s value analysis approach needs to integrate with service lines.
Slide 15
Hospitals4 teaching hospitals1 children's hospital1 critical access hospital5 level 1 trauma centers
Physicians6,250 medical staff members4,525 Advocate PhysicianPartners1,250 employed physicians
Post-acute
$5.0B RevenueAA Rated34,000 Associates
16
Advocate Health Care
17
Key Drivers Of Physician Engagement
18
Advocate Physician PartnersVision
To be a faith-based system providing the safest environment and best health outcomes, while building
lifelong relationships with the people we serve.
Our RoleTo drive improvement in health outcomes,
care coordination and value creation through an innovative and collaborative partnership with our
physicians and the Advocate system.
19
Pluralistic Physician Approach
Active physicians on medical staffs (6,250)
Total APP physicians (4,525)25% PCPs – 75% specialists
Employed/affiliated(1,250)
Independent APP(3,275)
Independent non-APP(1,725)
Advocate Medical Group(1,067)
DreyerAffiliated
(183)
20
More Than 100 Physicians Involved In APP Governance
APP Board of DirectorsClass A - PhysiciansClass B - Advocate
Pharmacy & Therapeutics Committee
Clinical Integration Measures Committee
PHO Boards
ContractFinance
Committee
UtilizationManagement
Committee
UtilizationManagement
Committee
Quality & CIImprovement
Committee
Quality & CIImprovement
Committee
Credentialing Committee
Audit Committee
21
Value Based AgreementsContract Lives Total Spend
Commercial 389,000 $1.8 B
Medicare Advantage 27,000 $0.3 B
Advocate Employee 23,000 $0.1 B
Medicare ACO 114,000 $1.3 B
Total 553,000 $3.5 B
1422
Advancing Evidence-Based Medicine And Care
Year 2004 Physician Reminders for Care
Chart Based Patient Management
2006 Patient Outreach
2007 Physician Office Staff Training
Pharmacy Academic Detailing Program
Generic Voucher Program
2008 Diabetes Collaborative
Patient Coaching Program
Hospitalists
2009 Diabetes Wellness Clinics
Asthma and HF/CAD Collaborative
2011 Access and COPD Collaborative
2012 Patient Experience CME and Coaching
Practice Coaching (Data Sharing)23
Our cost is 1530
Mission:To continuously improve the standard of care across the system, rooted in evidence and achieved through shared best practices
Better health outcomes (including those that matter to patients)
VALUE
Cost to achieve those health outcomes
Projects do not Advance if: Decrease in Safety and/or Quality No Value-Based Cost Benefit
Involve:PhysiciansNursesAllied Health ProvidersStaff
Principles:Data-DrivenEvidence-basedBest Practices
Tools:Education (CBTs, Rounds, Thought Leaders)Physician to Physician DetailingCommunications/PR (Multiple “Touch Points”)Metrics (Feedback, Tracking)Formulary Restrictions (Pharmacy, Supply Chain)EMR (Removal, Clinical Decision Support, Hard Stops, Order Sets)Guidelines / PoliciesCI Measures
Focus Areas:Lab utilizationImaging utilizationPharmacy utilizationPhysician preference itemsSupply chain opportunities
Clinical Effectiveness Governance• Clinical Effectiveness Advisory Committee
– Multi-disciplinary senior leadership team
• Provide advice and oversight• Remove barriers to progress • Membership
• Specialist Subcommittees
VP, Medical Management Sr. Leadership, APP
Chief Nurse Executive VP, Finance
VP, Supply Chain VP, CHIS
Medical Staff Leadership VP, Information Systems
Clinical Integration GoalCardiac Rhythm Management Devices
Supply Chain – Cardiac Rhythm Management Compliance – Practice Group
Percentage of total CRM implants using devices designated by Advocate Supply Chain
Cardiologists, Cardio Electrophysiology Cardiovascular Surgery, Interventional Cardiology
>=90% of total CRM implants
use devices designated
by Advocate
Supply Chain
0.50 Point
>=90% of total CRM implants
26
Targeted Area of Focus: Clinical Effectiveness
Governance of Product Use and Adoption
New Product Introductions
Variation of Use is widely permissive.
Advocate Physician PartnersCombined Incentive Fund Distribution History2008-2013 ($ in millions)
Note: 2008-2010 unearned applied to clinical integration incentive only
28
2013 Value Report
To download a copy of the 2013 Value Report, go to:advocatehealth.com/valuereport
29
Questions
30