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Living in the ACO Model: What’s Next. Moderator John Pritchard, Medical Distribution Solutions, Inc. Panelists Scott D. Pope, PharmD , Executive Director, Healthcare Innovators Collaborative, Premier, Inc - PowerPoint PPT Presentation
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Living in the ACO Model: What’s Next
ModeratorJohn Pritchard, Medical Distribution Solutions, Inc.
Panelists
Scott D. Pope, PharmD, Executive Director, Healthcare Innovators Collaborative, Premier, Inc
Tara Canty, Chief Operating Officer, Accountable Care and Senior Vice President, Government Relations, OSF Healthcare System
One OSF All Together Better
OSF Healthcare SystemAccountable Care
Moving from Volume to Value
3
ACO Participation at OSF
6 Acute Care Hospitals
1 Hospice Home
707 Physicians---211 Primary Care
51 Level 3 PCMH---CV Service Line---Neuro Service Line---Multi Specialty
216 NP/APN
Home Care
DME
Hospice
4
Alignment is critical
Source: Truven Health Analytics
5
Institute of Medicine Analysis
Less than 50% of elderly patients are up
to date on clinical
preventive services
Elderly patients with co-morbidities require
up to
19 medication doses daily
Every year the average
elderly patient sees 7 doctors across 4
practices
Specialists
Primary Care
Average surgery patient is seen by
27 different health care providers
Fewer than half of
nonsurgical patients follow up with their primary care
provider after discharge
1 out of 5 elderly patients are
readmitted within 30 days
Preventive Self-Management Outpatient Care Hospital Follow-up
Nurse
Physician
Allied Health
6
Accountable Care
One OSF All Together Better
What is an Accountable Care Organization?
8
Principles of Accountable Care
An ACO is a local health care organization and a related set of providers (at a minimum, primary care physicians, specialists, and hospitals) that can be held accountable for the cost and quality of care delivered to a defined population.
The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time at the right place while avoiding unnecessary duplication of services and preventing medical errors.
Accountable Care holds organizations accountable for specific levels of quality care through comprehensive, valid and reliable measurement of its performance.
9
Pioneer ACO
Developed by Centers for Medicare & Medicaid Innovation in partnership with CMS
The Pioneer ACO Model is designed to encourage the cultural change necessary to achieve the Triple Aim– Improve the health of the population (wellness)– Enhance the patient experience (quality, access and reliability)– Reduce, or at least control, the per capita cost of care
Develop Accountable Relationships for care delivery with other insurers as well
Over time, deliver care at 20-30% less than the current projections
10
Accountable Care Relationships at OSF
Pioneer ACO – 34,000 Medicare beneficiaries Blue Cross – 40,000 projected members -- January 1, 2014
– Capitated HMO (Ambulatory Services) and Shared Risk PPO
• Closing care gaps• Outreach to high risk patients
Humana – 8,500 Medicare Advantage members– Capitated HMO and Shared Savings PPO
• Medical Home• Closing care gaps
Health Alliance – 15,000 HMO members– Shared Risk
Quality Care Plan (OSF employees & deps.) – 30,000 members
Value-BasedPayment Streams
Today
Future
25% of Revenue 150,000 Covered Lives
60% of Revenue 400,000 Covered Lives
OSF’s Approach
One OSF All Together Better
12
Areas of Focus
Reduce avoidable admissions and readmissions
Reduce length of stay
Decrease avoidable ED visits
Improve care coordination
Improved transition of care
Increase Clinical Integration
13
Challenges
Limited psychiatric/substance abuse services in the community
Ability to expand access to primary care physicians and mid-level providers
Communication constraints
Establishing consistency across accountable care agreements
Non-OSF provider engagements
Maintaining timely access to data and identifying appropriate benchmarks
Balance dueling business models
14
OSF’s Care Management Model
Adult - High Risk defined as: • 10% for Medicare population• 3% for Commercial population• 1% of remaining population
“Hybrid Care Management Team Model”• 3 Person teams with a 1 RN Care Manager : 2 Non RN support ratio• 450 patients managed per team
• Embedded Site RN Care Managers (PCMH)
• Centralized Care Management Support Model (MSW, LPN, MOA)
15
Care Transition Projects - Implementing Best Practice Components
Patient risk assessment upon admission and throughout patient stay– Targets appropriate interventions through out stay to achieve successful discharge
– Doubled use of social work assessments and interventions
Defined discharge process/discharge checklists and after visit summaries– Patient Summary includes teaching/teach back
– More complete information for providers after discharge
Provider handoffs:– Discharge summaries
– Provider to provider verbal handoff process
16
Care Transition Projects - Implementing Best Practice Components
Medication reconciliation at discharge– Includes first fill at discharge
– Considering home visit for “complete” reconciliation
Follow-up phone calls within 72 hours of discharge to ensure patient/caregiver understanding and adherence– 76% call success rate
Provider follow-up appointments within 5 days– May be home care, specialist
– Clinic for patients with no PCP
17
Skilled Nursing Home Initiative
Preferred SNF network based on quality and service– CMS Star ratings: at least 4 overall and 3 quality
– 24/7 admissions
– 75% acceptance of all admissions
– 24/7 RN on site
– At least 6 days/week therapy
– Specialized sub-acute units for Cardiology and Neurology
18
Skilled Nursing Home Initiative
Physician and APNs rounding on SNF patients with high frequency, managing utilization and transition to home– Multi-disciplinary team approach
– Strong clinical model• Increase discharges to home from SNF (improved patient outcome)• Decrease ALOS (from 86 days/stay to <40 days/stay)• Reduce acute readmissions (from 50% to <10%)
– All SNF patients considered high risk• All receive home care referral at discharge from SNF• All patients transitioned to Care Management/Medical Home
19
Additional Initiatives
Data Analytics– Enterprise Data Warehouse
Access– Centralized Ambulatory Call Center
• Improved access to primary care• Same day appointments
– Specialty care– Transportation
Referral Management– Clinical Integration
• Leakage• Quality/outcomes
20
Additional Initiatives (continued)
Telemedicine– E-ICU– Care Management– Behavioral Health, CHF, COPD, Stroke
Physician Engagement– Education, Data, reports
• Physician Dashboard
– Accountability• Quality component in compensation
One OSF All Together Better
Questions?
Scott D. Pope, PharmDExecutive Director – Healthcare Innovators Collaborative
Three take-aways
Premier is working to propel population health
You are on the ACO tracks…the train is coming
Find your strategy, your partner, or (ideally) both
24 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
MOVEMENT TO INTEGRATED CARE, NEW PAYMENT MODELS & RISK
The journey to high value healthcare
Value-based purchasing:HACs, quality, efficiency, cuts
HAC and readmission penalties
Medical home
Shared savings & Global payment
Bundled payment
Population Management• Population analytics• Care management• Financial modeling and
management• Legal• Physician integration
High Value Episodes• DRG and episode
targeting• Care models and
gainsharing• Data analytics• Cost management
High Performing Hospitals• Most efficient supply chain• Best outcomes in quality, safety• Waste elimination• Satisfied patients
Pop Health Core Components
The Network Effect – Premier PACT
29 markets | 23 systems | 100+ hospitals | 5,000+ MDs, 1.5M accountable care covered lives
86 markets | 67 systems | 300+ hospitals | 12,000+ MDs
27 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Assessments drive insight
*Data from 24 markets**Data from 51 assessments
Readiness Collaborative overall assessment**
Implementation Collaborative overall assessment*
Blue = HighGreen = Average
Red = Low
28 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
PHYSICIAN NETWORK
MANAGEMENT
POPULATION ANALYTICS & RISK
MANAGEMENT
POPULATION ENGAGEMENT
• Network development• Clinical integration
• Patient-centered medical home
• Care redesign• Practice optimization
• Community needs assessments
• Shared savings• Bundled payments
Advisory Services
Collaboratives
By leveraging our vast data assets and partnerships with leading technology providers we have developed solutions to address population health and new payment models.
Information Technology
POPULATION HEALTH COLLABORATIVE
PLATFORM
New era population health management solutions
Supplier Implications
Envisioning the future
Fee-for-service executives = More volume
ACO executives = Reduce high cost “things”
Commodity until proven otherwise
Physicians are incented on cost/outcomes
Common threads of hope
Deeply understand how ACOs really work
Provide more outcomes data, onus is on you
Bring a collaborative mindset & be willing to test
Healthcare Today
Launched in 2010
•Received by over 23,000 stakeholders
•6 issues per year
•The only publications dedicated solely to ACO development
WWW.ACOInsights.com
Triple Aim Focus of Reform
● Reducing Cost● Improving Quality● Enhancing Patient Experience
Suppliers must have a Value Proposition that aligns with the Triple Aim!
35
How Reform and ACOs will impact the Supply Chain
• Physician Alignment
• Alignment of Incentives
• Clinical Integration
• Information Management
• Supply Chain Engagement
SMI/MDSI 2013 ACO Executive Briefing
HSCA 2013
Washington, D.C.
October 22, 2013John I. Pritchard
(770) 263-5262
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