Measuring progress toward

accountable care: lessons from 59

pioneering hospitals

Keith J. Figlioli

SVP, Healthcare Informatics

Premier, Inc.

October 8, 2013

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Will vs. Preparation

“The key is not the will to win. Everybody has that.

It is the will to prepare to win that is important.”

~ Coach Bobby Knight, 1984 USA Men’s Olympic Basketball

Photo credit: usab.com

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Care Model

Organization Model

Payment Model

U.S. Healthcare Sector:

Three major transformations simultaneously

PAYMENT MODEL

End of Cross-

Subsidization

Shift to Voucher

Marketplace

Integrated vs. Fragmented

Personal Accountability

Assumption of Risk

Insurance exchanges

ORGANIZATION MODEL

End of Private

Practice Medicine

Consolidation of

Health Systems

Rise of Physician &

Clinical Leadership

Hospital Health System

CARE MODEL

Primary Care/PCMH

Hospitalists / Hospital-

based Medicine

Behavioral Health

Chronic Disease Focus

Social Science Tools

Shift from sick care system

to health system

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And behaviors need to change

Protecting one’s “turf”

All ideas proprietary

Closed systems

Little transparency, no bias for sharing

Competition between providers, with others across healthcare

Spotty collaboration efforts

Data hoarding

Avoiding confrontation when things aren’t working

Few cross continuum partnerships

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A framework for assessing readiness

• Participants

• Methods

Important attributes for readiness

• What mattered

• What didn’t matter

What we can do about it

• Challenges

• Successful strategies

Today’s discussion

Framework

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252 Medicare ACOs

in 43 states

Over 430 Medicare and

Commercial ACOs

500 providers in CMS

Bundled Payment

initiative

Growing number of ACOs nationwide

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The Network Effect – Premier PACT Collaborative

29 markets | 23 systems | 100+ hospitals | 5,000+

MDs, 1.5M accountable care covered lives

86 markets | 67 systems | 300+ hospitals | 12,000+

MDs

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Assessing readiness

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Accountable Care Core Components

People Centered

Foundation Health Home

High Value Network

Population Health Data

Management

ACO Leadership

Payor Partnerships

Foundational Philosophy: Triple Aim™

The Bridge from FFS to Accountable Care

What are the

underpinning

building blocks?

Current

FFS

System

Accountable

Care

Measurement

Readiness

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Overall Assessment by Component**

**Data from 59 assessments

0%

20%

40%

60%

80%

100%

Patient Centered Foundation

Health Home

High Value Network

Population Health Data Management

ACO Leadership

Payor Partnership

Blue = Top Decile

Green = Median

Red = Bottom Decile

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Variation Among Organizations with High Component Scores

Organization (in

order of high to low

overall weighted

score)

Weighted Component Scores

Overall

Score PCF HH HVN PHDM ACOL PP

Organization 1

0.76

0.47

0.67 0.63 0.64

0.47 0.61

Organization 2

0.59

0.64

0.52 0.60 0.46

0.39 0.53

Organization 3

0.44

0.17

0.53 0.52 0.73

0.72 0.52

Organization 4

0.51

0.42

0.36 0.56 0.58

0.58 0.51

Organization 5

0.55

0.52

0.59 0.52 0.50

0.10 0.46

Organization 6

0.41

0.38

0.44 0.47 0.45

0.55 0.45

Organization 7

0.44

0.50

0.33 0.27 0.57

0.51 0.44

Organization 8

0.52

0.27

0.47 0.46 0.47

0.36 0.43

Organization 9

0.55

0.28

0.27 0.27 0.28

0.13 0.30

Organization 10

0.34

0.21

0.53 0.23 0.26

0.18 0.29

Scoring well in one component does not always translate to readiness in all components

Blue indicates higher scores Red indicates lower scores

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Top 5 and Bottom 5 – Lessons from Comparisons

Factors That Differentiate Organizations with High ACO Readiness

1. Full or partial ownership of a health plan with pop health mgt capabilities 2. Existing collaboration with other health systems in the community 3. Existing risk-based contracts with payers including bundled payments 4. A sophisticated EHR and HIE implementation strategy across the continuum of care 5. Clinical integration across the continuum of care 6. Patient-centered medical home with employed or community providers 7. Positive relationships with primary care and specialty care providers in the market 8. Active governance structures that include physician leadership (e.g. PHOs)

Factors That Do NOT Differentiate

1. Market share 2. Number of employed physicians 3. Disproportion of the market with government financed health services 4. Financial strength (strong for the entire group) 5. Medicare spending level – low cost areas are not further along 6. High proportion of commercially insured patients 7. Already in active execution of a clinical integration strategy across the system

Implications for future ACO development

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White paper health systems

Fairview Health Services is a nonprofit healthcare system based in Minneapolis with more than 50% of its revenue under ACO payments.

AtlantiCare, in Southeastern New Jersey, is the region’s largest healthcare organization and largest non-casino employer .

Memorial Healthcare System is a public provider of healthcare services to South Florida. It is the 5th largest public system in the nation.

Presbyterian Healthcare Services serves Albuquerque and rural New Mexico with physician services at more than 30 different locations.

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Essential lessons learned

Managing populations requires fundamental health delivery change

Focus of primary transformation: Aligning clinical

w/payment

Physician leadership, engagement pivotal in

ACO shift

Critical success factors Care coordination

Executive leadership & governance support Comprehensive & coordinated primary care

services, integrated IT

Market pressures create opportunities for

mutually-beneficial partnerships

Pace of execution limited by payer/physician

readiness for value-based participation

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Challenges with physicians, local payers, infrastructure

investment, state/federal data regs slows execution

Payers should also support ACO participation in medical

home & bundled payment programs

Work needed with patient engagement, specialist and

post-acute care arrangements, and data exchange

Ideal pacing unclear: • Slow implementation leaks savings to non-participating

payers

• Rapid implementation increases risk

Challenges and policy implications

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Successful implementation strategies

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Target programs for top 5% utilizers - Atlanticare

Begin to change organizational construct - Presbyterian

Embedded care managers - Fairview

Start with small populations – Memorial

ED navigators – Presbyterian

Culture, culture, culture – All systems

Crawl, Walk, Run…But Start

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Bench or Game

Photo credit: nbaarena.com

No one has to change. Survival is optional. ~ W. Edwards Deming

Thank you…