Medical Group and Hospital A Model for Clinical Integration

Richard Afable M.D., MPHPresident and CEO

Hoag Memorial Hospital Presbyterian

Alan PuzarneChief Operating Officer

Greater Newport Physicians / Nautilus Healthcare 

Management Group  

Outline for Today’s Discussion

• Hoag and Greater Newport Physicians• Challenges of Accountable Care:  Whose Ball 

Is It?  

• Path to an ACO:  A Long and Winding Road

• Next Step ‐

A Future in the Making

• Questions From You  

Hoag Memorial Hospital Presbyterian Not‐for‐profit, faith‐based, and ‘most preferred’

health care provider in 

Orange County, California

Hoag Memorial Hospital Presbyterian Not‐for‐profit, faith‐based, and ‘most preferred’

health care provider in 

Orange County, California

Prominent health care provider in Orange County

• 674 bed hospital on 2 campuses – Hoag Hospital Newport Beach (1952)– Hoag Hospital Irvine (2010)

• Centers of Excellence: Cancer, Heart & Vascular, Neurosciences, Orthopedics, Diabetes and Women’s Health

• 7 Community Health Centers• Over 5,000 employed staff, 2,000 volunteers,

and 1,300 medical staff• Treat nearly 30,000 inpatients and 350,000

outpatients annuallyRecognitions• Orange County’s ‘Most Preferred Hospital’ for

past 15 yrs by National Research Corporation• County’s best hospital by Orange County

residents for past 15 yrs• Magnet Hospital designation by the American

Nurses Credentialing Center

MissionOur mission as a not-for-profit, faith-based hospital is to

provide the highest quality health care services to the communities we serve.

HoagIrvine

Hoag Health

Centers

HoagHospitals

Hoag Hospital

Hoag Network

Greater Newport Physicians (GNP)Greater Newport Physicians (GNP)

Prominent IPA in Orange County• Founded in 1985• 500 affiliated physicians• Broad Ownership - 230 physician owners• Separate MSO – IPA management, EMR,

practice management, physician billing• Exclusive network of core providers• 30-45% of Hoag’s census• Only full-risk business, 100,000 lives• Primarily capitated network• Significant performance-based compensation• Emphasis on growing/building group practices• $15 million investment in EMR platform

Recognitions• IHA recognition for 5 years (P4P, Patient

Satisfaction & Technology)• CAPG 4-Star Elite Status• NCQA Certified

Vision

Greater Newport Physicians is the cornerstone of the preferred integrated healthcare delivery system in Orange County.

Accountable Care: Whose Ball?  

• Physicians and Medical Groups

• Hospitals and Health Systems

• Health Plans• Employers

• Where exactly do the patients fit in?  Or is it  the members??

THE PATH TO AN ACO A Long and Winding Road

Health Care Reform Critical Dates

3/23/10 ‐ Law passed, signed by President5/2010 GNP/Hoag joins Premier Collaborative

Shared Savings Program1/12/11 ‐ GNP/Hoag ACO Workshop3/31/11 ‐ Draft ACO Regulations released6/6/11 ‐ Deadline for commentsSept ‐ Dec 2011 ‐ Final Regulations expected7/1/12 ‐ Commence ACO Shared Savings pilots

Pioneer ACO Demonstration Project5/17/11 ‐ Released request for applications6/30/11 ‐ Letters of Intent due8/19/11 ‐ Applications due 

CAPG has provided a significant voice in the “dialogue”

on ACOs

Coordinated Care

The ACO Value Proposition: Transforming our local health care into a true coordinated system that revolves around patients and their short and long term needs. Its likely to be the entry way to health care’s new normal, and serve as a transitional business model that will enable our success in the new value-focused landscape.

Hoag/GNP Accountable Care Organization Strategic Plan

ACO Implementation Collaborative Mission & Goals

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Collaborative Mission: Assist members in building ACOs and position

them as leaders in transforming healthcare to reward value, rather than volume.

Collaborative Goals:Accelerate and lower the cost and risk of building ACOs.

Create a community of ACOs that can demonstrate significant outcomes improvements Publicize and communicate results locally and nationally.

Interact with lawmakers and regulators and help members secure ACO contracts.

Develop capabilities to help other members become ACOs.

.

Core Components:

• Patient Centered Foundation

• Health Home

• High-Value Network

• Population Health Data Mgmt

• ACO Leadership

• Payer Partnerships

• Legal Support

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The Premier ACO Model

A group of providers willing and capable of accepting accountability for the total cost and quality of care for a defined population.

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HOAG/GNP’S Readiness Dashboard (Based on the Capabilities Framework & Specific HOAG/GNP’S Needs Medicare Advantage Population)

HOAG/GNP’S Readiness Dashboard – cont’d (Based on the Capabilities Framework & Specific HOAG/GNP’S Needs Medicare Advantage Population)

1/12/2011 GNP/HOAG ACO  WORKSHOP

Definition of Success: Improving Triple Aim™

Population Outcomes

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ImprovementMetrics:•QUEST outcomes•Select HEDIS metrics•Health status•Mortality rates

Metrics:•Patient satisfaction•Patient Activation Measure scores

Metrics:•Total medical PMPM•Total Medical Trend•Total Rx PMPM•Admissions/1000•Readmission rate

Where We Go From Here?

Wait for revised regulation to be issued

Work with Health Plans on Commercial ACO

Stay focused on the Triple AIM

Improve patient experience

Improve  health  outcomes  for  the  population we serve

Reduce the per capita cost of care

ACO Capabilities Projects: STATUS UPDATECapability Project Lead(s) Status

Standard Health Risk Assessment

Tsay, Dori Current Status: Active vendor search & selection (list of Premier provided vendors)

Next Steps: physician co-development; scheme for improving response rates; integrate into Hoag for Life (pilot first)

Standardized Patient Education

Puzarne, Perazzo

Current Status: Active vendor search & selection (EMMI demo, to be scheduled: Patient Edu, HealthMedia)

Standardized Treatment of Guidelines

Measurement of Compliance to Guidelines

Evidence-Based Utilization of Guidelines

Mady, Cox Current Status: Information gathering; Drs. Mady and Brooks to collaborate on GNP and Hoag Osteoporosis programs

Next Steps: Decide on conditions for focus (GNP data to inform)

Collaborate with Physicians to Lower Costs

Laird Current Status: Scheduling meeting RE: Cardiology – cath lab following data prep/pulls

Inventory, Assess & Expand Community Resources

Emmons, Thomsen

Current Status: Focus on major ED admit pt groups, disease groups (stroke (Mesa Verde), CHF) and EBC support, Transitions of care; divide data geo; Deliverable is interactive, rated resource recommendations list and plan of how to plug in resources to where they are most relevant

Next Steps: meeting scheduled with GNP, get Community Medicine (Hoag) involved

Hospice/Palliative Care Tsay GNP Pilot Current Status: writing policy, meeting with agencies (St. Michael’s Hospice and Sonnet Home Health), looking for patients to add to program

Gary Emmons (GNP Case Manager) working closely with Mona El-Kurd (Hoag palliative care social worker)

Next Steps: to gather data regarding utilization and cost analysis; work with Hoag contracting to discuss bundled rate

ACO Capabilities Projects: STATUS UPDATE - cont’d

Accountable Care Considerations for the Future

• Collaboration versus Competition

• Commoditization of Hospitals, Others

• Effect of the Affordable Care Act• Idealized State for Your Consideration

Questions?