Park Nicollet Health Services - AMGA ?· 1 Park Nicollet Health Services Background ... Park Nicollet…

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<ul><li><p>Park Nicollet Health Services </p><p>A Medicare Pioneer Accountable Care Organization </p></li><li><p>Agenda </p><p>1 Park Nicollet Health Services Background </p><p>2 Park Nicollet Pioneer ACO Overview </p><p>3 Pioneer ACO Financial and Quality Model </p><p>4 Upside and Downside to Pioneer ACO Data &amp; Analytics </p><p>5 Questions and Discussion </p></li><li><p>PARK NICOLLET </p><p>Accountable Care Organization </p><p>ACO Team: </p><p>Daniel Trajano, MD, MBA, Sr. Med Dir. of Quality, Innovation, Population Health </p><p>Eva Gallagher, RN, PHD, Sr. Nursing Director of Quality, Innovation, Population Health </p><p>Mark Skubic, VP Government Relations </p><p>Megan Cox, Dir. Medicare Products </p><p>Sam VanNorman, Dir. Business Intelligence </p><p>Gregg Teeter, Dir. Business Analytics </p><p>Kody Koepke, Dir. Pricing &amp; Data </p><p>Maddy Emahiser, Project Manager </p></li><li><p>Park Nicollet Accountable Care Organization </p><p> Located in the West Metro of Minneapolis/St. Paul </p><p> Serves ~500,000 Unique Patients/Year </p><p> Employs 8,300 People, 1,300 are Providers </p><p> 1 Hospital (~22K inpatient admissions/yr) </p><p> 25+ Locations with Primary, Specialty and Surgical Specialty </p><p>Care Clinics (~2.2M ambulatory visits/yr) </p><p> Accountable Care Contracts with All Major Payers </p><p> PNC Fun Fact: 2011 TOUR DE CLINIC CAMPAIGN David Abelson, CEO and avid cyclist, spent 3 days riding his bike 200+ miles to 21 of our PNC sites, raising more than $55K </p></li><li><p>THE PARK NICOLLET PIONEER ACO </p><p>PROGRAM OVERVIEW </p></li><li><p>Pioneer ACO Program Overview: PGP Demo Sites </p></li><li><p>Pioneer ACO Program Overview: Pioneer ACO Sites </p></li><li><p>Pioneer ACO Program Overview: The </p><p>Regulatory Relationship </p><p> Lessons Learned from PGP Demonstration </p><p>Setting the Metrics </p><p> When negotiating with CMS you need to be aware </p><p>of the person behind the curtain. </p><p> Office of the Actuary </p><p> OMB </p><p> Demo consultants </p><p> CBO </p></li><li><p>Pioneer Program Benefited from Scars of PGP Demo </p><p>10 systems 32 Systems </p><p>Local Benchmark National </p><p>2+% Savings rate 1% Savings </p><p>Only Share Above First Dollar </p><p>Little/Late Data Monthly </p><p>No risk of loss Up and down </p></li><li><p>Pioneer ACO Program Overview </p><p>32 players with variable structures and interests in the ACO Program. </p><p> The Twin Cities players </p><p> Integrated systems w/hospital </p><p> Medical Group </p><p> Independent Practice Associations (IPAs) </p><p> Virtual Systems </p><p> Low Cost Systems $18,000 per member per year </p></li><li><p>THE PIONEER ACO FINANCIAL AND QUALITY </p><p>MODEL </p></li><li><p>Pioneer ACO Bonus Payment Overview How Do We Get Paid? </p><p>Cost Savings </p><p>(must be at least 1% to qualify) </p><p>Contracted Shared Risk </p><p>% </p><p>Quality Measure % (must meet quality </p><p>performance standards to qualify) </p><p>Park Nicollet Bonus </p><p>Payment </p><p>$6 M 75% 75% $3.4 M </p><p>Hypothetical Scenarios: </p><p>Model Overview </p><p>$10 M 75% 90% $6.8 M </p></li><li><p>Pioneer ACO Expenditure Benchmark Cost Savings </p><p> The trended benchmark will be based on trends in national, not local, expenditures </p><p> To earn the shared savings bonus payments, Park Nicollets per-capita expenditures (for assigned beneficiaries) must be less than the yearly target by at least 1% </p><p>-3 -2 -1 0 1 2 3 </p><p>Tota</p><p>l Co</p><p>st </p><p>Year </p><p>Trended Benchmark </p><p>Park Nicollet Cost </p><p>Shared Savings </p><p>Cost Savings Contracted Shared Risk </p><p>% </p><p>Quality Measure % </p><p>Park Nicollet Bonus </p><p>Payment </p></li><li><p> 25% Patient &amp; Caregiver Experience </p><p>1. Timely care, appointments, and information </p><p>2. How well your doctor communicates </p><p>3. Patients rating of doctor </p><p>4. Access to specialists </p><p>5. Health promotion and education </p><p>6. Shared decision making </p><p>7. Health status/functional status </p><p>25% Care Coordination &amp; Patient Safety </p><p>8. Risk standardized, all cause readmission </p><p>9. Ambulatory Care Sensitive AdmissionsCOPD </p><p>10. Ambulatory Care Sensitive Admissions--CHF </p><p>11. Percent of PCPs who qualify for EHR incentive </p><p>12. Medication reconciliation after discharge </p><p>13. Screening for falls risk </p><p>25% Preventative Health </p><p>14. Influenza immunization </p><p>15. Pneumoccal vaccination </p><p>16. Adult weight screening and follow-up </p><p>17. Tobacco use assessment and tobacco cessation intervention </p><p>18. Depression screening </p><p>19. Colorectal cancer screening </p><p>20. Mammography screening </p><p>21. Proportion of adults 18+ who had blood pressure measured in preceding 2 years </p><p>25% At Risk Populations </p><p>22. Diabetes Composite A1C&lt; 8 </p><p>23. Diabetes Composite LDL &lt; 100 </p><p>24. Diabetes Composite BP9) </p><p>28. HTN blood pressure control </p><p>29. Ischemic Vascular Disease (IVD) LDL</p></li><li><p>THE UPSIDE AND DOWNSIDE TO PIONEER </p><p>ACO DATA &amp; ANALYTICS </p></li><li><p>The Upside to Data &amp; Analytics </p><p> We have 3 years (and growing monthly) of all CMS claims </p><p>data for our assigned members </p><p> This will allow us to track all patient expenditures and </p><p>quantify the amount of services these patients are </p><p>receiving outside of Park Nicollet </p><p> Unlike many of the other Pioneers, were on a single, </p><p>integrated platform </p></li><li><p>The Downside to Data &amp; Analytics </p><p> The expenditure benchmark target is still not finalized and the </p><p>details (methodology and when we will receive them) are unclear </p><p> This is troubling as we are nearly halfway through 2012 and we </p><p>dont have a clear understanding where we are at in reducing </p><p>expenditures by 1% </p><p> Several quality metrics, which we are required to report on </p><p>annually, have slightly different definitions from other CMS </p><p>required reporting (PGP and MU) </p><p> This will require extra time &amp; resources to modify and report on </p><p>metrics </p><p> Park Nicollet needs to push CMS to fully standardize detail </p><p> As with PGP, the burden of Quality Reporting significant </p><p>(~$100K/yr) </p></li><li><p>Data &amp; Analytics : What we need to do </p><p> For us to make significant improvement in lowering cost and improving </p><p>quality, we need to know where we are at so we can identify opportunities </p><p> There are significant analytic challenges (as we dont know our reality) </p><p> Educate CMS on the realities healthcare and what it takes to support this </p><p>program </p><p> Park Nicollet should be the best poised to succeed in the Pioneer ACO </p><p>model (given our PGP experience and organizational structure) and this </p><p>is going to be very difficult </p><p> Lobby CMS (ideally in partnership with Allina, Fairview, and Other </p><p>Advance Pioneer ACOs) </p><p> Leverage our analytics infrastructure wiselyand know when to buy vs. </p><p>build </p><p> Understand that Epic is not built to support population health </p><p>managementcurrently. We need to decide whether were going to stumble </p><p>along with Epic until we install 2012 or buy another tool. </p></li><li><p>Questions and Discussion </p><p>1 Park Nicollet Health Services Background </p><p>2 Park Nicollet Pioneer ACO Overview </p><p>3 Pioneer ACO Financial and Quality Model </p><p>4 Upside and Downside to Pioneer ACO Data &amp; Analytics </p><p>5 Questions and Discussion </p></li></ul>