TRANSFORMING DATA INTO INFORMATION (PART 1) USING CMS CLAIMS DATA TO DRIVE OUTCOMES

BPCI SHARED LEARNING WEBINAR PARTICIPANT CASE STUDY

OCTOBER 24, 2013

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Agenda

1. Welcome, Objectives & LogisticsWeslie Kary, American Institutes for Research (AIR)

2. Using CMS Data to Drive OutcomesDr. Gary Wainer, Chief Medical Officer, ExecutiveDirector, Chicago Health System

3. Discussion and Q&AAll

4. Closing, Next Steps and Post Webinar SurveyWeslie Kary, AIR

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Today’s Participant Presenters:

Gary Wainer, D.O-Chief Medical Officer, Executive Director, Chicago Health System Dr. Gary Wainer is Board Certified in Family Medicine and Addiction Medicine and was in active clinical proactive up until 2008. After serving as CMO and VP of Operations at MacNeal Hospital in Berwyn, Illinois, he is presently the CMO and Executive Director of Chicago Health System. Dr. Wainer oversees a physician network with more than 600 physicians and almost 50,000 attributed lives through the CHS ACO, Core Business and Clinical Integration programs. Kristin White, M.H.A- Director of Bundled Payments Kristin White has a Master’s Degree in Health Administration. She has been working in the Tenet Health Care Chicago Market for a year and transferred to Chicago Health Systems about 4 months ago to oversee the coordination of the Bundled Payment Program for the four Chicago hospitals. Her previous experience includes working in both process and quality improvement roles. Monika Dimitrova, RHIA-Clinical Integration Analyst Monika Dimitrova has a Bachelor of Science Degree in Health Information Management and is a Registered Health Information Administrator. She has been working for Chicago Health System for about a year and a half and has been involved with the Medicare Shared Savings Program since the beginning of the program. Her previous experience includes both pharmacy and healthcare consulting.

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Tenet Health Care (Chicago Market)

• Weiss Memorial Hospital

• West Suburban Medical Center

• Westlake Hospital

• MacNeal Hospital

• MacNeal & Weiss Physician Group

• Occupational Health & ImmediateCare

• Chicago Health System• WSHP

• Home Care

• River Forest Ambulatory Campus

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Chicago Health System

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BPCI Participation MODEL 2-90 Day Episode Length

MacNeal Hospital• 2 Orthopedic Episodes: 5 DRGs

Westlake Hospital and West Suburban Medical Center• 1 Orthopedic and 5 Medical Episodes: 28 DRGs

Weiss Memorial Hospital• 3 Orthopedic, 6 Medical, 1 General Surgery and 5 Cardiac Episodes : 62 DRGs

Selected Episodes CABG Pacemaker device replacement or revision Cardiac arrhythmia Percutaneous coronary intervention Cardiac defibrillator Revision of the hip or knee Cardiac valve Sepsis Congestive heart failure Simple pneumonia and respiratory infections COPD, bronchitis/asthma Spinal fusion (non-cervical) Hip & femur procedures except major joint Stroke Major joint replacement of the lower extremity Major bowel Pacemaker

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ACO Lessons Learned for BPCI

ACO (Shared Savings Program) BPCI (Model 2)

Defined Medicare population ( not limited to any disease categories)

Selected DRGs (limited to those patients receiving hospital services)

Pre-admission, admission, and post acute costs

Admission and post acute 90 days costs

Patient attribution focused Hospital triggered focus Approximately ~3% savings amount is achieved (50/50) Shared Savings with

CMS Keep all savings above 2%

Savings distribution based on cost and quality targets

Savings distribution only based on cost targets

Physician distribution based on CMS quality metrics

Physician distribution based on meeting quality and cost savings

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ACO Lessons Learned for BPCI Data Analysis

BPCI ACO

FREQUENCY Monthly data with a quarterly

reconciliation

Monthly and quarterly based on responses from Medicare FFS

beneficiaries who are sharing data PATIENT TRACKING

TIMEFRAME 90 Days 1 year

FORMAT - de-identified

- facility specific (trigger) - in-network/out-of-network*

- patient identified - in-network/out-of-network*

TYPE OF DATA INCLUDED

Inpatient, Outpatient*, Home Health, SNF, DME, Professional

Fees, Hospice

Inpatient, Outpatient*, Home Health, SNF, DME, Professional

Fees, Part D, Hospice

• With the similarities we used our experience with our ACO to help guide howwe used our BPCI data

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ACO Data Usage for Population Management Chicago Health System is contracted with a vendor to

receive monthly utilization reports on the ACO population.

Reports Generated for ACO• Flight Risk• Frequent Flier• Preference Sensitive Conditions Admissions• Care Retention• Attribution• Data Sharing Tracking

Created scorecard based on cost, quality, and utilization

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ACO Lessons Learned for BPCI

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Example of ACO Scorecard

*EXAMPLE FOR ILLUSTRATIVE PURPOSES ONLY*

CMS CLAIMS RAW DATA REPORTS

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BPCI Data Summary Cost Data

*EXAMPLE FOR ILLUSTRATIVE PURPOSES ONLY*

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Inpatient Data

*EXAMPLE FOR ILLUSTRATIVE PURPOSES ONLY*

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DME Data Table

*EXAMPLE FOR ILLUSTRATIVE PURPOSES ONLY*

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Outpatient Data Table

• Separate Radiology/Imaging: CT Scan MRI, ECG/EKG, EEG, X-Ray,Mammography, Ultrasound and Other

• Pathology and Laboratory: Chemistry, Immunology, Hematology, Urology, and other

*EXAMPLE FOR ILLUSTRATIVE PURPOSES ONLY*

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Professional Fees

• Separate into 58 different specialties

*EXAMPLE FOR ILLUSTRATIVE PURPOSES ONLY*

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SNF and Home Health

*EXAMPLE FOR ILLUSTRATIVE PURPOSES ONLY*

BPCI SCORECARDS

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BPCI SCORECARD

*EXAMPLE FOR ILLUSTRATIVE PURPOSES ONLY*

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BPCI SCORECARD CONTINUED

*EXAMPLE FOR ILLUSTRATIVE PURPOSES ONLY*

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SNF and HH Scorecard (Post Acute Partners)

*EXAMPLE FOR ILLUSTRATIVE PURPOSES ONLY*

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Closing Thoughts: Lessons Learned from Implementation

• What are some lessons learned that an organization lookingto replicate your program should know?

• You need IT/analytic resources to convert CMS data into a usableformat.

• Need to complete in depth cost analytics to find where savings cancome from.

• Data allows to see unforeseen insights.

• Data needs to be used to evaluate risk and reward scenarios.

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Attendee Discussion and Q&A

• Type questions in the lower right Q&A box or;

• “Raise” your hand and press *7 to unmuteyour line; *6 to re-mute your phone

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Upcoming Session

Mark your calendars!

Transforming Data into Information (Part 2) Thursday, October 31, 12:00-1:00 pm ET

NYU Langone Medical Center (M2)

Two perspectives, one goal: transforming care in orthopedics Thursday, November 7, 1:00-2:00 pm ET

Bronson Methodist Hospital (M4) Brooks Health System (M3)

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Additional Users Welcome to Join the Collaboration Site!

If you or any of your colleagues involved in the Bundled Payments for Care Improvement initiative are interested in access to the Collaboration Site please contact us via the bundledpayments@cms.hhs.gov inbox You can view prior shared learning activities, general

program information, and join or initiate a forum In the email, please include the subject line

“Collaboration Site Request”, your organization name and BPID

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Closing & Next Steps

• To suggest a topic or volunteer to present a case study, pleasecontact the Bundled Payments for Care Improvement inbox atBundledpayments@cms.hhs.gov

• To obtain a transcript of today’s session (in a few days), visit theCMS Bundled Payments for Care Improvement collaboration site(https://collaboration.cms.gov/)

• To initiate a Forum discussion log onto the CMS Bundled Paymentsfor Care Improvement collaboration site and click on the yellow“Forums” tab at the top of the program homepage

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Tell Us What You Think

Don’t forget to fill out the brief post-webinar survey!