PCPCC Center for Accountable Care

Questionnaire:

Snapshot of Results and Proposed Future Plans

PCPCC Center for Accountable Care Call

December 19, 2011

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Q1: “CMS recently published the draft final ACO rule. What are your overall impressions of the final rule

verses the initial ACO rule?”

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CMS was responsive toconcerns raised from

multiple stakeholders andmade significant positivemodifications to the rule.

While CMS was veryresponsive made and many

positive changes to rule, thisis new territory for manyhealthcare organizations,several of which may have

concerns about applying forone of the programs

I have some ongoingconcerns about the rule.

I have not reviewed the finalrule.

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Q2: “At the present time, what is your organization’s intent regarding submitting an application for one of the CMS Programs?”

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Pioneer MSSP T1 MSSP T2 Bundled Payment ComprehensivePrimary Care

Not eligible Eligible but notparticipating

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Q3: “If you answered yes to MSSP T1 or T2, when would you plan on submitting your SSP application?”

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In time for 4/1/12 In time for 7/1/12 In time for 1/1/13 In time for 1/1/14 or later

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Avera

ge P

erc

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Pioneer MSSP T1 MSSP T2 Bundled Payment CPC None

Q4: “If you allocate percentages to each of the CMS programs based upon what percentage of health care organizations you predict will ultimately choose one program versus another, how would you assign those percentages (your total should add up to 100% because organizations cannot participate in more than one program)?”

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Q5: “Many are concerned about patients’ responses to ACOs. What would make ACOs attractive to patients?”

(Please check all that apply)

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Evidence aboutbetter outcomes of

care

Lower costs, bothout-of-pocket and

significantreductions in

annual premiumincreases

Evidence that careis more patient-

centered

Evidence that careis truly coordinated

between settingsand amongclinicians

Emphasis onaccess that doesn’t

require visits todoctors’ offices

Impossible-patients will neverbe attracted to an

ACO

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Q6: “Once our communities and patients are more informed and educated regarding medical homes, what would you expect the

marketplace response will be? (Please check all that apply)

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Patients will seek out MedicalHomes because they will be

viewed as “The GoldStandard” primary care

practice

Patients will shy away fromMedical Homes because

“Medical Home” will becomesynonymous with “Managed

Care”

Health Care Organizations willuse the Medical Homedesignation or NCQA

Accreditation as a means ofattracting more patients

Patients will select andchoose health care

organizations as they havehistorically- Medical Homedesignation will not have an

impact on their choice.

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Q7: “I would recommend that the PCPCC ACO Center concentrate on the following top-priority topics in the areas of Accountable Care Operations (Task Force #1 Focus)”

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Methods to reduce clinical costs

Methods to improve patient satisfaction

Strategies to meet CMS quality metric standards

Methods to re-design clinical care and staffing mix

Examples of successful EHR Optimization

Innovative and effective incentives and compensation redesign

Medical Business Intelligence

Strategies to meet Patient-Centeredness expectations

Stategies to manage Population Health and Risk

Successful Care Coordination models

Strategies to manage advanced access

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Q7: “I would recommend that the PCPCC ACO Center concentrate on the following top-priority topics in the areas of Accountable Care Operations (Task Force #1 Focus)”

• Other– How to partner with other non clinical members of the healthcare

industry (ie pharmaceutical companies)– Fiscal and IT infrastructure requirements.

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Q8: “I would recommend that the PCPCC ACO Center concentrate on the following top-priority topics in the areas of Education and Advocacy (Task Force #2 Focus)”

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Strategies to educate our community and our patients about ACOs

Strategies to educate our community and patients about theinterrelationship between ACOs and Medical Homes

Strategies to advocate to legislators about the critical role ofMedical Home in high-performing ACOs

Strategies to advocate to employers about the critical role ofMedical Home in high-performing ACOs

Strategies to influence and redesign medical and nursing educationand residency programs to prepare graduates for Medical

Home/ACO models of delivering care

Strategies to design easily comprehensible materials explainingwhat ACOs are

Strategies to design easily comprehensible materials explainingwhat Medical Homes are

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Q8: “I would recommend that the PCPCC ACO Center concentrate on the following top-priority topics in the areas of Education and Advocacy (Task Force #2 Focus)”

• Other– Strategies to educate physicians about their role as independent

physicians in the Medical Home concept. – What resources are available outside of consulting services to

help organizations achieve progress towards ACO/PCMH (ie NCQA, AMA, Big Pharma resources, etc.)

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Q9: “Now that the final ACO rule has been published and organizations will move from a regulatory focus to a more operational one, what additional areas of focus should the PCPCC ACO Center’s Regulatory Task Force concentrate on?”

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Advance additional legislationthat w ill further spur healthcareproviders to move toward more

coordinated and integrateddelivery programs

Track and provide comment onthe anticipated annual rule and

comment period for ACOs

Support work of federalagencies in implementation and

adoption of key programs

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Question 10: “As the PCPCC’s ACO Center seeks to solidify primary touch (and/or avoid duplicating work) with other PCPCC centers, what would you highlight as the top potential areas of synergy with other centers”

• MD/Hospital, MD/Insurance, and PCP/Specialist integration (3)

• Efficacious care delivery & coordination (3)

• Employer strategies (2)

• Consumer engagement-education on ACO/med. Home (2)

• ACO relationship with payers (2)

• Payment models/reform (2)

• Process re-design/optimizing use of EHRs & technology (2)

• Data sharing

• Population management

• Means to share patient information in appropriate ways

• ACO resource utilization from industry partners (biotech, pharma, etc)

• Lab results, other test results

• Medical Neighborhood

• Regulatory Advocacy

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Q11: “Would you be willing to volunteer to participate in calls with one of more of the ACO Center Task Forces? If so, which one(s)?

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Operations/Best Practices Education/Advocacy Regulatory Integration with otherCenters

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Team Volunteers

• Operations/Best Practices • David Gans- MGMA (dgans@mgma.com)

• Richard May- HuTech Resources (dmay@hutech.net)

• Scott Morgan- JH Cohn (smorgan@jhcohn.com)

• Sherri Miller- Proactive Health Strategies, Inc. (sherri.miller@proactivehealthstrategies.com)

• Education/Advocacy• Sharon West- CAP (swest@cap.org)

• Ken Bertka- Catholic Health Partners (bertka@mindspring.com)

• Regulatory • Kathryn Bradshaw- Bradshaw Healthcare Solutions (bradshawhcs@gmail.com)

• Ellen VanBuskirk- Trizetto (ellen.vanbuskirk@gmail.com)

• Integration with Other Centers • Aileen Wehren- Porter Starke Services (awehren@porterstarke.org)

• Anita Tanner- COCMHC (Tanner5001@yahoo.com)

• Amy Gibson- PCPCC (agibson@pcpcc.net)

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Co-Chair Recommended Next Steps

1. Consolidate Four Sub-Groups into Two– Operations and Best Practices Team (Co-Chairs Samitt and

Safran)– Education and Advocacy Team (Co-Chairs Epperly and Childs)

2. Modify Focus of Monthly Calls– Convert monthly member calls into Webinars to review

prioritized topics of interest (see next slide)– Coordinate quarterly calls of two sub-groups to prioritize focus

of future webinars– Co-Chairs will have separate quarterly calls to assure

coordination and alignment with PCPCC Strategic Plan

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Prioritized Topics via Questionnaire

Operations & Best Practices

1. Successful Care Coordination Models

2. Examples of successful EHR Optimization

3. Methods to re-design clinical care and staffing

4. Examples of successful MD/Hospital, MD/Insurance, PCP/Specialist Integration

5. Innovative incentive and compensation design

6. Methods to reduce clinical costs

7. Strategies to manage advanced access

8. Strategies to manage population health/risk

Education & Advocacy

1. Strategies to influence and redesign medica and nursing education and residency programs to prepare graduates for Medical Homes/ACOs

2. Strategies to educate our community and our patients about ACOs

3. Advance additional legislation that will further spur healthcare providers to move toward more coordinated and integrated delivery programs

4. Strategies to advocate to legislators about the critical role of Medical Home in high-performing ACOs

5. Strategies to design easily comprehensible materials explaining what ACOs are

6. Strategies to advocate to employers about the critical role of Medical Home in high-performing ACOs

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Discussion and Next Steps