Pioneer ACO Overview to NYSDOH ACO

Workgroup

March 6, 2014

Montefiore Overview

1,930 Beds Across 6 Hospitals

– Including 120 beds at CHAM

– 86 NICU/PICU beds

150 Skilled Nursing Beds

154 Sites Including

64 Primary Care Sites

– 21 Montefiore Medical Group Sites

21 School Health Clinics

12 Mental Health/Substance Abuse Treatment Clinics

65 Specialty Care Sites

– 2 Multi-Specialty Centers– 6 Pediatric Specialty Centers– 12 Women’s Health Centers

1 Freestanding Emergency Department

10 Dental Centers

5 Imaging Centers

Our Locations

Montefiore IPA and CMO

• Formed in 1995• MD/ Hospital Partnership• Supplies network of par

providers committed to cooperation in care improvements

• Accepts some full risk capitation from health plans

• Established in 1996• Wholly-owned subsidiary of

Montefiore Medical Center• Performs care management

delegated by health plans• CMO performs most functions

for MIPA• 900+ staff

CMOMontefiore Care

ManagementMontefiore IPA (MIPA)

The Montefiore ACO

• Bronx Accountable Healthcare Network IPA, Inc. (BAHN), does business as the Montefiore ACO

• BAHN is an IPA, separate from MIPA• BAHN contracts with CMS for Medicare Pioneer

ACO program– BAHN subcontracts with MIPA to supply most of the

network of clinical participating providers– BAHN sub-contracts with CMO to supply all care

management and all administrative services

Montefiore Pioneer ACO

Bronx Accountable HealthCare

Network IPA(BAHN)

Bronx Accountable HealthCare

Network IPA(BAHN)

Montefiore IPAMontefiore IPA

MontefioreCare

Management Org (CMO)

MontefioreCare

Management Org (CMO)

Subcontracts with:

+

Pioneer Agreement

Medicare $

Non-Montefiore Par Providers:

St. BarnabasAcacia Health

Morris HeightsHudson River HC

NS-LIJ (partial)(Most also

participate in health home governance)

Montefiore Medical Center

Community MDs (600)

Ancillary providers/labs

Montefiore Employed MDs

(1700)

Participating Network(Clinical services)

Includes BAHNHealth Home

Montefiore ACO Big Picture

•Many health plans are switching from FFS to care management arrangements with shared savings opportunities/quality metrics •Montefiore ACO has history of such arrangements with Government and non-Government Payers•Montefiore ACO encompasses other providers:

– Bronx Community-based providers– Provider groups within other entities such as NS-LIJ, St. Barnabas,

Hudson River Health Care, FQHCs– ACO will include new Montefiore affiliates (Sound Shore 750)

Care Guidance Program Supporting Innovation

7

Montefiore CMO tailors administrative requirements and care management intensity to the needs of the population being served

Our Current Portfolio

* Including Pioneer ACO members

Care Guidance Example: Behavioral Care Synergy Program

• Goal is to augment behavioral health services in patient centered medical home (PCMH) context

• Implement evidence-based models for treatment of patients with poorly controlled depression and at-risk drinking with chronic medical conditions (diabetes, CAD, CHF)

• Develop a joint care management “synergy” team approach to support and manage these complex patients

• Uses RN care manager, LCSW, psychiatrist in a “virtual” mode as standard approach

• Evaluate clinical outcomes, patient and provider satisfaction and cost

Chung et al, Gen Hospital Psych 2013

Detail: Pioneer ACO Program • Serves Medicare Part A & B beneficiaries• Care coordination program designed for organizations with

prior experience with population-based care management• Includes comprehensive patient satisfaction and quality metrics• Brings care coordination to the fee-for-service coverage

population, without restrictions such as gatekeepers or limitations on out of network benefits

• Montefiore ACO is the only Pioneer ACO in New York State• 3 Year demonstration started in 2012

– May be extended to 5 years– Just started Performance Year 3 (2014)

Quality Evaluation• 33 quality metrics in 4 domains:

– Patient/Caregiver Experience– Care Coordination/Patient Safety– Preventive Health– At-Risk Populations

• Data from patient satisfaction surveys, claims and administrative data and medical record reviews based on mix of reporting and performance relative to U.S. benchmarks

2013: Pioneer ACO Beneficiary Characteristics

• 23,250 attributed Part A & B beneficiaries• “Attributed” because majority of primary care has been

delivered to those patients by providers in the ACO• 2,500 SNF Residents• Age ranges from 5 – 112

– Average age of 72– 175 beneficiaries (0.8%) are age ≥100– 4,238 beneficiaries (18.2%) are < 65– Of those, 215 are age ≤ 30

• Approximately 1/3 of population are duals (8,000)– Interested in opportunities to more comprehensively manage Medicaid

benefit through a single care manager for each patient– Montefiore is already managing the Medicare benefit

Pioneer ACO Success

• 2012-Year One: Reduced Medicare spending by 7% against “benchmark” CMS projected it would spend in 2012 on these particular patients

• 2013-Year Two: – Created sustainable cost reduction– Added new provider partners: NSLIJ, St. Barnabas, etc.

• 2014: Just starting Year 3

2012: Inpatient Admissionsdecreased 10.4%

Source: CMMI PY1 Pioneer ACO Data Analysis

2012: 30-day All Cause Readmissions declined by 35.5%

Source: CMMI PY1 Pioneer ACO Data Analysis

2012: Inpatient Admissions for Diabetes decreased 45.7%

Source: CMMI PY1 Pioneer ACO Data Analysis

Questions?

202602114