Physician Engagement...• Atlantic ACO 102 • Central Jersey 114 • Meridian 119 • Atlantic Care 128 • ACO Health 130 • Barnabas Health 167 2014 MSSP Quality Results for NJ

Pathways for Successful

Accountable Care Organizations:

Physician Engagement

Thomas Kloos, MD

Jim Barr, MD

Atlantic ACO & Optimus Healthcare Partners ACO

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Helping providers Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.

Topics:

Optimus and Atlantic ACO’s

Physician Engagement Models

Performance

Specialists

Hospitals

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Helping physicians Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.

Health Care Delivery

Quality and Experience of Care • Lack of evidence-based, comprehensive, coordinated care

• Lack of emphasis on prevention and healthy behaviors

• Health insurance affordability

• Chronic disease impact will increase

Dysfunctional FFS Reimbursement System

Lack of Physician/Provider Satisfaction & Engagement

Lack of Patient Satisfaction & Activation

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The Triple Aim

Better care for individuals.

Better health for populations.

Reducing per-capita costs.

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Helping providers Care Better for their patients. Helping patients Care Better for themselves. Helping people Care Better for each other.

Atlantic & Optimus Healthcare Partners ACO’s

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ACO Relationships C

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75% 0f 353 ACO’s in PY2 did not achieve shared savings.

97 ACO’s earned bonus of $422M on $833M of shared

savings.

More experienced ACO’s tended to perform better

Overall ratio of ACO’s achieving savings similar to 2013

Pioneers:

• 11 paid bonus of 83M, 5 paid back 8M

MSSP 2014 Preliminary Results

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214 ACO’s completed outcomes reporting nationally

NJ ACO rankings in national results: • Optimus 52 • Hackensack 72 • Advocare 81 • Virtua 89 • Atlantic ACO 102 • Central Jersey 114 • Meridian 119 • Atlantic Care 128 • ACO Health 130 • Barnabas Health 167

2014 MSSP Quality Results for NJ

• AACO scored 50.8 points . 87.68% overall, a 7.4% increase from 2013 • OHP scored 52.15 points. 90.46% overall, a 7.5% increase from 2013

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2014 New Jersey ACO MSSP Participant Performance

ACO Doing Business As (DBA) or

Legal Business Name (LBN)

States Where

Beneficiaries

Reside

Agreement

Start Date

Total

Assigned

Beneficiarie

s

Expenditures

as % of Total

Benchmark

Generated

Savings

Earned Shared

Savings

Payments

Quality

Score

Optimus Healthcare Partners, LLC New Jersey 04/01/2012 23,542 3.98% $10,017,766 $4,440,296 90.46%

ACO Health Partners, LLC NJ, PA, FL 01/01/2013 12,703 4.35% $6,476,300 $2,715,442 85.57%

Hackensack Alliance ACO NJ, NY 04/01/2012 15,603 3.26% $6,464,895 $2,832,988 89.43%

Meridian AACO, LLC New Jersey 01/01/2013 41,202 1.84% - 86.45%

RWJ Partners LLC New Jersey 01/01/2014 8,456 .7% - P4R

Central Jersey ACO LLC New Jersey 01/01/2013 20,014 .63% - 86.84%

LHS Health Network, LLC NJ, PA 01/01/2014 22,375 .45% - P4R

NEPA ACO Company, LLC New Jersey 01/01/2014 6,972 .31% - P4R

Partners In Care ACO, Inc. New Jersey 01/01/2014 6,843 .26% - P4R

Barnabas Health ACO-North, LLC New Jersey 07/01/2012 12,646 -.36% - 81.29%

JFK Population Health Company New Jersey 01/01/2014 9,531 -1.2% - P4R

HNMC Hospital/Physician ACO New Jersey 01/01/2013 8,709 -1.65% - 79.49%

Atlantic ACO NJ PA 04/01/2012 70,550 -1.82% - 87.68%

NJ Physicians ACO New Jersey 01/01/2014 11,611 -2.81% - P4R

Advocare Well Network New Jersey 01/01/2013 15,121 -4.28% - 88.75%

Balance ACO NJ, NY 07/01/2012 8,165 -10.22% - 79.34%

VirtuaCare New Jersey 01/01/2013 15,837 -11.71% - 88.19%

AtlantiCare Health Solutions, Inc. New Jersey 01/01/2013 18,427 -11.9% - 85.65%

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ACO’s are in “Value Based Contracts”

The ACO’s do not negotiate fee for service rates with CMS

or commercial payers

ACO’s are paid additional dollars based on a value equation

Value = Quality/Cost

Cost is our performance against our benchmark and market

trend

Quality is how we do against national averages on quality

measures.

What is a Value Based Contract?

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Physician Engagement: The Time Problem

Based on various analysis (for 2,500 patients):

Time needed for chronic illness care = 10.6 hours per day

Time needed for preventive care = 7.4 hours per day

Time needed for acute care = 4.6 hours per day

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Structure & Process

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Population Management Workflow Support

Patient-Centered Medical Home Model

Qu

alit

y an

d s

afet

y Enh

anced

access

ACO Coordinated Care: Complex Care Coordinators, COE, Community

Personal provider

Office ACO Clinical Champions PCP & Spec: Population Management Activities

Provider-directed team

Whole-person orientation

Atlantic & Optimus ACO Services

Data Aggregation/Management (CMS, payers, labs, EMR)

Risk Stratification

o Wellness – access, patient engagement

o Rising Risk – evidence-based care, care coordination

o High Risk – complex care coordination, care transitions,

readmission prevention, COE, PAC

Quality Management – enterprise-wide Patient Registry

Cost Management – analytics, efficiency indexes, innovation

Provider Engagement & Practice Transformation

Provider Performance Management (transparency, accountability)

High Performance Network Development & Integration

Community & Patient Activation

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Population Risk Stratification

High Risk

Rising Risk

Low Risk

Top 5%

15-35% (20% will

become high risk each year)

60-80%

Whole Person: risk stratify using risk factors, not just diseases

ACO Complex Care Coordinators, COE, Plan Case Managers

ACO Population Care Managers, Practice Clinical Champions, PCMH model, Specialists

Data – Data - Data

Analytics, Reports - Performance Metrics Tools & Interventions - Barriers - Incentives

Patient Portals, PHR, Apps

Physician Engagement & Patient Engagement

Data Sources & Aggregation

Data Sources

• EMR & Paper Patient Charts

• Practice Management Systems

• Hospital (ADT’s, lab, clinical)

• Claims, Lab, Pharmacy data

• Surveys, HRA’s

Data Aggregation

• Population Manager

• Risk Manager

• Lab, Pharma, Vendor Reports

• Payer Analytics

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Team-Based Care: Staff Roles (PCC)

VIP Management

• High & Rising Risk Identification

• Proactive Patient Care Plans

Gaps in Care

ER Management

Care Transitions

• Medication Reconciliations

• Follow-up Visits

Quality Reporting

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> 50 points 50% of pmpm

ACO 2015 Incentive Program > 65 points 75% of pmpm

> 80 points 100% of pmpm

MINIMUM REQUIREMENTS: 1) Quality data reporting 2) Communication with ACO (phone, text, e-mails)

Quality IT Transformation Improvement Engagement

Identification and management of high

risk, rising risk & vulnerable patients within your practice

20 points

Use of Cortext, Relay Health/NJ Health

Connect, and McKesson

Population Manager 20 points

Population Management Office

Roles, Responsibilities &

Workflows 15 points

Office Performance Improvement

Process & Outcomes:

Plan-Do-Study-Act (PDSA)

20 points

Citizenship & Integration 25 points

PMPM Per Primary Care Physician Sample ACO Financial Proforma Practice Attribution Assumptions

**CONFIDENTIAL** Practice

Potential Actual Potential Actual # Patients 60%

Maximum Annual Paid Annual Paid Medicare 250 10%

CMS PMPM Amount Amount Amount Amount Cigna 100 4%

Performance Improvement PMPM $$ Horizon 625 25%

Shared Savings Horizon MA 25 1%

Aetna FI 100 4%

Cigna Aetna SI 200 8%

Performance Improvement PMPM $$ United 200 8%

Horizon Others 1,000 40%

Performance Improvement PMPM $$ 2,500

Horizon Medicare Advantage PMPM

Shared Savings

Aetna

Fully-Insured PIIP PMPM $$

Self-Insured PIIP PMPM $$

Shared Savings FI & SI

United

Performance Improvement PMPM $$

Shared Savings

Potential 2014 Actual 2014 Potential 2015 Actual 2015 **CONFIDENTIAL**

Total PMPM Payments= $$ $$

Total Shared Savings=

TOTAL 2014 $$ TOTAL 2015 $$

20152014

Shared Savings Distribution $$

30% ACO (operations and investment)

70% ACO Participants

• 5% Hospitals

• 95% Physicians

o 30% Specialists

– by episode volume

o 70% Primary Care Physicians

– 25% by attribution

– 25% by practice quality rating

– 50% by utilization performance & trend

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Specialists

PCMH-Neighbor Guidelines

Centers of Excellence

Clinical Integration (referral management)

Shared Savings Distributions

Bundled Payments / Episodes of Care

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Reports

Secure Access

Full Transparency

Performance Management Framework

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ACO Provider Performance – Efficiency Index

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ACO Provider Performance – KPI

Atlantic ACO PCP - Allowed PMPM

Period 4: January 1, 2014 - December 31, 2014 (4th Qtr, 2014)

Average # Members Risk Score Total Cost PMPM Total Prof PMPM Facility PMPM

Inpatient

Data Sharing Members Only Period 2 Period

3 Period

4 Period

2 Period

3 Period

4 Period

2 Period

3 Period

4 Period

2 Period

3 Period

4 Period

2 Period

3 Period

4

AACO (Weighted Averages) 30,541

35,896 41,080

0.99

0.97

1.02

$ 950

$ 953

$ 919

$ 367

$ 368

$ 356

$ 325

$ 324

$ 315

Milliman Benchmarks - Moderately Well Managed $925 $925 $925 $305 $305 $305 $315 $315 $315

Milliman Benchmarks - Well Managed $680 $680 $680 $220 $220 $220 $214 $214 $214

Practice Name Average # Members Risk Score Total Cost PMPM Total Prof PMPM

Facility PMPM Inpatient

Practice A 99

98 96

0.56

0.57

0.54

$ 1,065

$ 807

$ 761

$ 436

$ 412

$ 418

$ 446

$ 211

$ 150

Practice B 79

81 84

0.92

0.86

0.81

$ 679

$ 681

$ 753

$ 310

$ 333

$ 346

$ 149

$ 107

$ 122

… 54

52 51

0.97

0.90

1.14

$ 1,230

$ 1,088

$ 1,071

$ 363

$ 357

$ 338

$ 546

$ 419

$ 494

90

95 98

1.01

1.01

0.92

$ 1,198

$ 1,057

$ 961

$ 475

$ 419

$ 401

$ 379

$ 351

$ 299

356

402

444

0.98

1.07

1.23

$ 1,043

$ 1,029

$ 974

$ 331

$ 306

$ 272

$ 371

$ 406

$ 427

380

381

381

0.56

0.55

0.63

$ 1,207

$ 1,101

$ 996

$ 517

$ 487

$ 426

$ 357

$ 297

$ 292

206

215

222

1.13

1.10

1.21

$ 1,009

$ 1,073

$ 960

$ 277

$ 287

$ 254

$ 473

$ 485

$ 435

182

180

177

1.58

1.54

1.62

$ 944

$ 917

$ 832

$ 251

$ 248

$ 239

$ 460

$ 428

$ 375

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ACO Provider Performance – Integration

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ACO Specialist Integration Detail

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Cardiologist A B C D E F G H

Episode Efficiency

Episodes by Provider

Specialty: Cardiovascular Disease

PROVIDER # EPISODES AMT ALLOWED AMT ALLOWED/EPI

CM EI EI STAT SIGNIF

IMPACT

A 1,744 $1,020,142 $585 1.06 1.09 Y $82,714

B 1,683 $891,084 $529 1.11 0.94 N ($52,349)

C 1,678 $1,008,048 $601 1.05 1.13 Y $113,600

D 1,434 $468,957 $327 0.65 0.99 N ($3,546)

E 1,347 $750,372 $557 1.06 1.03 N $24,994

F 1,219 $563,405 $462 0.97 0.94 N ($35,648)

G 1,125 $723,941 $644 1.16 1.10 Y $66,526

H 1,102 $562,205 $510 0.92 1.09 Y $48,212

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Case Mix

Efficiency Index

Performance Management Framework

If performance level is: <50% 50-59% 60-69% 70-79% 80-84% 85-89% >90%

Improvement Needed By Next Reporting

Period = 40% 15% 10% 6% 3% 0% 0%

Examples: Base

Compliance 9 mos 12 mos 18 mos 24 mos 30 mos 36 mos

Practice "A" 50% 58% 66% 73% 77% 82% 84%

Practice "B" 25% 35% 49% 69% 75% 80% >85%

Practice "C" 80% 82% 85% 85% 85% 85% 85%

Your Practice enter value

calculate

Alignment & Collaboration

Hospitals

Payers

Employers

Unions

IT

Pharma

Labs

Medical Device / Vendors

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Barriers

Capitalization of PCMH and ACO models

FFS vs Unfamiliar Compensation Model

IT, Data and Analytics

Predictive Modeling

Management & Leadership

Culture

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“Care Better” Helping physicians “Care Better” for their patients

Helping patients “Care Better” for themselves

Helping people “Care Better” for each other

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Thank You

Q & A

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Documents

Physician Engagement...• Atlantic ACO 102 • Central Jersey 114 • Meridian 119 • Atlantic Care 128 • ACO Health 130 • Barnabas Health 167 2014 MSSP Quality Results for NJ