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The Healthcare Perspective from ACOs2015 Meals on Wheels Annual Conference
August 31, 2015
Agenda: 3 Questions…
• Question 1: Why now?• A little about us.
• Question 2: How do we move forward?• Question 3: How can you help?
Question 1: Why now?
What patient demographic and economic forces are driving change in health care? Why is it important we transform
health care now?
Question 1: Why now?
Baby Boomers entering Retirement
Growth in Life Expectancy
Federal Budget Issues
Price of Health Care
Why now?
A new form of Health Care…
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About BJC HealthCare
BJC Hospitals:
• Alton Memorial Hospital
• Barnes-Jewish Hospital
• Barnes-Jewish St. Peters Hospital
• Barnes-Jewish West County Hospital
• Boone Hospital Center
• Christian Hospital
• Missouri Baptist Medical Center
• Missouri Baptist Sullivan Hospital
• Parkland Health Center
• Progress West HealthCare Center
• St. Louis Children’s Hospital• The Rehabilitation Institute of
St. LouisBJC Health Services:• BJC Medical Group• BJC Behavioral Health• BJC Corporate Health Services• BJC Home Care Services• BJC Long Term Care Services
About BJC Accountable Care Organization
BJC ACO Composition – All BJC Acute Adult HSO’s plus…… 339 BJCMG Employed Providers207 Independent Community Providers546 BJC ACO Providers
BJC ACO Specialties (500+ Physicians)• Primary Care
• Allergy and Immunology
• Cardiology
• Dermatology
• Endocrinology
• ENT/Otolaryngology
• Gastroenerology
• General Surgery
• Geriatrics
• Gynecology, OB/GYN
• Hematology
• Infectious Diseases
• Nephrology
• Neurology
• Oncology
• Ophthalmology
• Orthopedic Surgery
• Physiatry, Rehabilitative Medicine
• Podiatry
• Pulmonology
• Rheumatology
• Urology
• Vascular Surgery
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About BJC Accountable Care Organization
• Joined Medicare Shared Savings Program in July, 2012• 1 of 2 first entrants in Missouri (1st in St. Louis)
38,988
49,600
Beneficiary Assignment(1Q 2015)
AssignedUnassigned
327
4,566 747
32,317
Assigned Beneficiary (Person Years)(1Q 2015)
ESRD*
Disabled*
Aged/Dual*
Aged/Non-Dual
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*ESRD and Aged/Dual also include Disabled beneficiaries
About BJC Accountable Care Organization
• BJC Accountable Care Organization serves over 2,000 Medicare-Medicaid Dual Eligibles.
218
137
147
98
112
319139
316
322
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Distribution of Medicare-Medicaid Dual Eligibles(2015)
AMH BHC BJH
BJSPH BJWCH CH
MBHS MBMC PHC
PWHC
* BJC ACO presently manages over 2,000 dual-eligibles.
5.0%5.1%
9.2%
2.3%
7.2%
15.6%17.2%
3.8%
12.0%
5.4%
Distribution of Medicare-Medicaid Dual EligiblesAs a % of MSSP Attributed Beneficiaries by Region
(2015)
AMH BHC BJH
BJSPH BJWCH CH
MBHS MBMC PHC
PWHC
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About BJC Accountable Care Organization
• BJC Accountable Care Organization serves urban, suburban and rural communities.
20.8% of BJC ACO attributed beneficiaries reside in rural Missouri and Illinois communities
34.3%
17.3%
6.4%
13.3%
15.0%
3.5%10.2%
Distribution of Assigned Beneficiary Residence by County(1Q 2015)
St. Louis City & County
St. Charles County
Boone County
Missouri - Mid & Rural
Illinois - STL Metro
Illinois - Rural
Outside Service Area
15.2%
44.3%
28.3%
12.3%
Age Demographics(1Q 2015)
Age < 65Age 65–74Age 75–84Age 85 +
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BJC ACO Offerings
Transitions of Care
(RNs & MSW)
ED Frequent Flyer Program
(CHAP)
Complex Care Management(RNs & MSW)
Polypharmacy Support(STLCOP)
ED/Admission Alerts
(Technology)
Remote Monitoring
(Home Health)
About BJC Accountable Care Organization
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Question 2: How do we move forward?
How do we as providers better manage and increase accountability for the full continuum of patient care? How
do we provide better health care, better heath care experience, and better value to the communities we serve?
Question 2: How do we move forward?
Providers Community Partners
Payers
Patients
Question 2: How can you help?
How can community based programs and service organizations like Meals on Wheels assist ACO’s in
population health?
Question 3: How can you help?
1. We must change the paradigm of what care is compensable by positioning Meals on Wheels and other community based partners as vital contributors in the provision of patient care.
2. To do this, we must focus on understanding the strategic niche of Meals on Wheels in population health management.
3. We must design service level agreements between Meals on Wheels and ACOs that apply this value to meet the needs of patients and providers…and at scale.
4. Through data, we must continuously evaluate the value provided by Meals on Wheels directly to the bottom line of managing population (payer) expenditures. Meals on Wheels and other community based partners ARE providers of care…and must be demonstrated as such to the payer community.
Question 3: How can you help?
• As an ACO…what are we looking for in contracts with community based partners? What provides competitive advantage?
• Seamless IT integration.• Solid process for referring patients and communicating status.• Breadth, quality and scalability of services performed.• Timeliness (from referral to patient engagement).• Patient satisfaction.• Simplicity.• Contribution to managing patient populations.
Providers Community Partners
Payers
Patients
Thank you…
My Contact Information:
Erik RasmussenProgram Manager, Accountable CareBJC HealthCare670 Mason Ridge Center Drive, Suite 300St Louis, MO [email protected]/996-7733www.bjcaco.org
