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Measuring Progress Toward Accountable Care Aurora Health Care Readiness to Implementation Patrick Falvey, PhD Executive Vice President/ Chief Integration Officer Aurora Health Care Milwaukee, Wisconsin The Commonwealth Fund Webinar March 14, 2013

Measuring Progress Toward Accountable Care

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Measuring Progress Toward Accountable Care. Aurora Health Care Readiness to Implementation. Patrick Falvey, PhD Executive Vice President/ Chief Integration Officer Aurora Health Care Milwaukee, Wisconsin. The Commonwealth Fund Webinar March 14, 2013. Aurora at a Glance. - PowerPoint PPT Presentation

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Page 1: Measuring Progress Toward Accountable Care

Measuring Progress Toward Accountable Care

Aurora Health Care Readiness to Implementation

Patrick Falvey, PhDExecutive Vice President/ Chief Integration OfficerAurora Health CareMilwaukee, Wisconsin

The Commonwealth FundWebinarMarch 14, 2013

Page 2: Measuring Progress Toward Accountable Care

Aurora at a Glance

• Private, not-for-profit integrated health care provider

• 31 counties, 90 communities

• 15 hospitals

• 172 clinics sites

• More than 1,500 employed physicians

• Largest homecare organization in the state

• More than 70 retail pharmacies

• 30,000 caregivers

• 94,000 inpatient discharges

• 2 million outpatient visits

• 4.1 million ambulatory care visits

• Revenues greater than $4.2 billion

• Private, not-for-profit integrated health care provider

• 31 counties, 90 communities

• 15 hospitals

• 172 clinics sites

• More than 1,500 employed physicians

• Largest homecare organization in the state

• More than 70 retail pharmacies

• 30,000 caregivers

• 94,000 inpatient discharges

• 2 million outpatient visits

• 4.1 million ambulatory care visits

• Revenues greater than $4.2 billion

Page 3: Measuring Progress Toward Accountable Care

3#

Focused Populations

Aurora Caregivers and Beneficiaries•50,000 Lives•15 years of better-than-market performance•Top-tier quality performance

Shared Savings ACO•CMS Model 1 Demonstration•About 10,000 Beneficiaries•Improved Quality and Efficiency

Medicaid Program•Medicaid OB pilot

Aurora Accountable Care Network•Commercial market ACO•Partnership with Aetna•Partnership with Anthem

Care Redesign Pilots•Behavioral Health•Orthopedics•Nursing Home•Kenosha ACO

Page 4: Measuring Progress Toward Accountable Care

Transforming Towards Accountable Care

Patient-centeredPatient-centeredcontinuum of carecontinuum of care

CommunicationCommunication& EHR& EHR

LegalLegal

MeasurementMeasurement

Population benefits &Population benefits &data managementdata management

PayerPayerpartnershipspartnerships

HealthHealthhomehome

PublicPublicpolicypolicy

NetworkInterconnectivity

OperationalEfficiency

Patient/Familyengagement

Clinicalknowledge

management

RiskAssessmentminimization

PatientPopulations

PatientPopulations

Page 5: Measuring Progress Toward Accountable Care

Factors That Differentiate Organizations with High ACO Readiness

1. Full or partial ownership of a health plan with population health management capabilities

2. Existing collaboration with other health systems in the community

3. Existing risk-based contracts with payers including bundled payments

4. A sophisticated EHR and HIE implementation strategy across the continuum of care

5. Clinical integration across the continuum of care

6. Patient-centered medical home with employed or community providers

7. Positive relationships with primary care and specialty care providers in the market

8. Active governance structures that include physician leadership (e.g. PHOs)

Page 6: Measuring Progress Toward Accountable Care

Positive Physician Relationships

1. Accountable Care/Care Redesign Medical Group Leadership

2. Care Redesign Around Primary Care, Clinical Integration, Smart Chart, Clinical Programs, and Redesign Pilots

3. Patient-Centered Medical Home

4. Physician Compensation Collaborative

Page 7: Measuring Progress Toward Accountable Care

Factors Likely to Become Differentiators in More Mature Models

1. Active governance structures that include physician leadership (e.g. PHOs)

2. An EHR and HIE implementation strategy across the continuum of care

3. Physician leadership development programs or culture barriers

4. Payers that are initiating innovative risk-based relationships

Page 8: Measuring Progress Toward Accountable Care

Organizational Relationships

1. Smart Chart Implementation to Transformation

2. ACO Governance

3. Administrators and Physician Leadership Development

4. Medical Group Leadership Council

5. Payer–Provider Role Definition

Page 9: Measuring Progress Toward Accountable Care

Population Health Analytics

1. Quality and Efficiency Metrics

2. Registries—Leverage EHR

3. Clinical and Financial Analytics

4. Patient Risk Models, ETGs

Page 10: Measuring Progress Toward Accountable Care

Moving Forward

1. Accountable Care Infrastructure

2. Care Redesign Tactics

3. Network Development

4. Payer Partnership

5. Analytics