modern healthcare: acos for real- does it make sense for your organization?

Download Modern Healthcare: ACOs for Real- Does it make sense for your organization?

Post on 09-May-2015



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Listen to the playback of the Modern Healthcare webinar led byDell's Betsy Block (Director of Accountable Care Solution Strategies) and Dave Marchand (CTO):


  • 1.ACOs for Real: Does itmake sense for yourorganization?Betsy BlockDave MarchandDirector of Accountable Care CTOSolution StrategiesHealthcare & Life Sciences Services

2. CMS timeline for reform20102011 20122013 20142015 HIPAA 5010ICD 10 Penalty for nonPQRIPQRI (eRx) PQRS submission of PQRIPenalty forARRAMeaningful Use noncompliance Reduced No MatchingHospital Acquired ConditionsPayment forPayment HAC Accountable Care Organizations Penalties for High Rates of ReadmissionsInpatient Value Based Purchasing Program Bundled Payment Pilot Source: Kaiser Family Foundation Health Reform Source 11.10.20102 Services 3. Accountable Care Organizations:What are theyUnder section 3022 of theAffordable Care Act, Medicareproviders and suppliersparticipating in AccountableCare Organizations (ACOs)can continue to receivetraditional FFS payments andare eligible for additionalpayments based on meetingspecified quality and savingsrequirements.3 3Services 4. What Constitutes an ACO?Who belongs to an ACO?An ACO consists of a collection of providers in a given geographythat can include primary care physicians, hospitals, specialists,home care, etc.What are they Responsible for?100% of the healthcare and costs for a defined group of patientsWhat Functions do they Perform? Coordination of all care activities between the providers in anACO Measurement and improvement of outcomes and costs Financial management and distribution of cost savings acrossACOServices 5. Early Success in Clinical Integration Advocate Physician Partners, Chicago 3400 physicians, 8 hospitals, 280,000 Capitated lives, 137performance measuresIncentive FundsPerformance YearDistributed2005$12.4 million2006$16.7 million2007$25.0 million2008$28.2 million2009$32 million* * Estimated from 2010 Value Report, Advocate Physician Partners5 Services 6. PGP DemonstrationOrganizational Characteristics of PGP ParticipantsPart of Owns or Organizational Number of Includes Not For Participants RegionIntegrated DeliveryOwned an StructurePhysiciansAMC? Profit? System? HMO?Faculty/Dartmouth-Hitchcock NortheastComm. Group907 ClinicPracticeBillings ClinicWestGroup Practice232Geisinger Clinic Northeast Group Practice833 Middlesex Health Northeast Network Model 293 SystemMarshfield Clinic MidwestGroup Practice 1,039 Forsyth Medical GroupSouth Group Practice250 Park Nicollet ClinicMidwestGroup Practice648 St. Johns Clinic MidwestGroup Practice522 The Everett Clinic WestGroup Practice250University Of Michigan FacultyMidwest1,291 Faculty Group Practice Practice Source: CMS; Commonwealth Fund; WSJ, Healthcare Overhaul Increases Rewards for Efficiency, 11/2010 6 Services 7. The secret sauce of ACOs Clinical Integration is a physician andprovider led effort Internally motivated to monitor themselvesand deliver better quality and higher value not something that is forced on them fromthe outside The secret sauce is the empowerment ofthe physicians Financial incentives are important but notthe only motivating factor in a successfulACO Need to foster an entrepreneurial attitudeand a desire to seek out novel solutions andaccept the challenge to explore and learnhow to make this work7 Services 8. CMS ACO Development Timeline DataGovernanceInfrastructureProfilingAnalyzing7/1/2011 1/1/2012 Legal organization Claims Data Recruit members Pull Reports Measures Quality Data Establish connectivity Verify Data Incentives Reporting Train on use of Care management: Participants and TINs Population ID reporting toolsmechanism for care Application Ancillary Data Benchmarks coordination Beneficiary Disease Registries Risk Management: IDrepresentativehigh risk individuals Pt Satisfactionand develop care Senior medical (CAHPS)plansdirector Summary of care Executive underdocumentsgoverning body Beneficiary access to Marketing materialsmed recordmust be authorized Available to public PSA determination of using CMS formatACO8 Services 9. Proposed CMS ACO guidelinesACOs can choose between 2 options: Track 1 Shared savings for Year 1 and 2, Year 3 is shared savings and shared losses (if any) over certain threshold Savings and Losses are capped Bonus for including a FQHC or RHC 50% shared savings up to 7.5% of benchmark Track 2 Shared savings and shared loss (if any) all 3 years Savings and losses are capped Bonus for including a FQHC or RHC 60% shared savings up to 10% of benchmark 9 Services 10. CMS Math: Estimates per ACO, based on100 ACOsYear 1Year 2Year 3Total 3 yearsBonus$8,000,000PayoutCost $1,755,251$1,265,897$1,265,897 $4,287,075Bonus left$3,712,925 Source: CMS -1345-P Proposed Rule Medicare Shared Savings Program: Accountable Care 3. 31.2011 p.35010 Services 11. Infrastructure Cost Estimates For ACO Prototype(ACO includes 200 beds, 80 PCPS, 150 SPC)* Categories of CostsStart UpOngoingNetwork Development and Management $2,275,000 $2,900,000Care Coordination, Quality Improvement and UtilizationManagement $405,000 $1,515,000 Clinical Information Systems$2,350,000 $1,500,000 Data Analytics$285,000 $385,000 Total $5,315,000 $6,300,000 11Services* White Paper - THE WORK AHEAD: Activities and Costs to Develop an Accountable Care Organization, AHA 12. Do we really need to do this? As a small community hospital, you may wonder if you have to form an ACO or CI program There are a number of reasons you should: Commercial payers moving to ACO model too Competition for community primary care physicians is on the rise Integrated delivery networks are forming Clinical integration principles are very successful in smaller hospitals12 12Services 13. TechnologyInfrastructureneeded by ACOs Healthcare 14. Healthcare Information Landscape is rapidlychanging ARRA/HITECHICD-10/5010 CONSOLIDATIONHC REFORM CONSUMERISM14Healthcare 15. More Information is becoming DIGITAL Diet & Medical Exercise Images MedicationsGenomicsResultsProteomics Histories & EncountersDigital Procedures PathologySmart Medical Devices15Healthcare 16. Data must be Shared, Aggregated, andAnalyzed Health Information needsPhysicians to be EXCHANGED withinCommunities HospitalsHealth Plans PublicLong HealthTermAgencies Care Standardized Analytics &Informatics solutions drive improvements in QUALITY & Pharmacies ConsumersEFFICIENCYLaboratories Other Medical Intermediaries16Healthcare 17. Proposed Initial Quality Measures byDomainAt Risk Populations Heart Failure 7At Risk Populations COPD 3Patient / CareCareGiver7 7 ExperienceCoordinationAt Risk Populations Frail Elderly 3 CareCoordination /Patient Safety Information2 5 SystemsAt Risk Populations 10 DiabetesPreventative Care Coordination /At Risk Populations 48 Health Transitions Coronary Artery 6 DiseaseAt Risk PopulationsHypertension 2Healthcare 18. Data + Analytics will drive Quality andEfficiencyIndividual/Patient Care Gap Management Preventative Health Outreach/EducationCommunity Identified Data Analysis Care Coordination Financial AnalysisPopulation Disease Management Care Improvement18Healthcare 19. Where does the Data come From? Quality Targets for quality and careMeasuresmanagement standards Medical records Manual or Automated EMR/PM/HIS Clinical outcomes Patient billing/Charge Master Labs, RxHIE Encounters Histories Historical patient dataPayers outside treatment information Reimbursement rules Surveillance data Other Adverse drug events Genomics/Imaging19 Healthcare 20. Dells Health Strategy In the CloudSimplifies use with interoperability that creates a true healthcare system HospitalsPhysicians Payers Life Science Other Healthcare Cloud PlatformData Management InteroperabilityMobility SecurityHealthcare SolutionsElectronic RevenueImage PayersReporting Analytics MedicalCycle Portals Archiving Solutions& Alerting Records Services20Healthcare 21. Patient Outreach Future PossibilitiesMedication Reminder Exampled JaneDoh Reminder to take 2 -100mg SOMA tablets(sent at 8pm local time)Alerting Example Generic Alert #AllergyAlert #HighPollenCount Plano, TX 5-12-2011 Patient Specific Alerts d JaneDoh #HighPollenCount 5/12/11 take Pollen or Patient List d JohnDoh #HighPollenCount 5/12/11 wear mask outsidePollution 21Healthcare 22. Wrap Up Whether the current rules for an ACO survive as is or are modified, the concept of clinical integration and shared cost savings will survive The infrastructure needed for an ACO consisting of separate provider entities in a community is the same infrastructure needed for a single provider entity, such as a health system, to improve quality and efficiency The key to improving quality and efficiency is consistent ways to gather the data, compare the results, and look for patterns of improvement A cloud based infrastructure enables a standard set of interoperability and analytics tools to be utilized across ACOs resulting in further efficiencies and sharing of best practices and innovation Change is Inevitable22 Healthcare 23. Thank YouBetsy BlockDave Marchand(317) 225-6244 (972) Dave_Marchand@dell.com23