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IHS ACO Strategy: Population Management Kathleen Cunningham Pam Halvorson Iowa Health System Trimark Physician Group Executive Director for VP Regional.

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Presentation on theme: "IHS ACO Strategy: Population Management Kathleen Cunningham Pam Halvorson Iowa Health System Trimark Physician Group Executive Director for VP Regional."— Presentation transcript:

1 IHS ACO Strategy: Population Management Kathleen Cunningham Pam Halvorson Iowa Health System Trimark Physician Group Executive Director for VP Regional Clinic Operations Accountable Care Strategies Mike Dewerff Trinity Regional Medical Center Chief Financial Officer IHS Leadership Symposium April 17, 2012

2 Objectives Review IHS Vision of our Future Healthcare System Describe the structured partnership between IHS and Regional Integrated Delivery System Review basic payor principles for Wellmark and Medicare Contracts Review TriHealth Pioneer ACO operational plan Next Steps IHS Leadership Symposium, April 17, 2012

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5 ACO Model Performance Incentives for Physicians & Hospitals Total cost of care for defined population $MM Projected cost based on medical inflation trends Actual costs based on ACO and Medical Home collaboration $ - SAVINGS FOR EMPLOYER/PAYOR IHS Leadership Symposium, April 17, 2012

6 The Future of Our Health Care System Clinically integrated delivery system, regionally & system-wide, with effective population management infrastructure Branded as the preferred “high quality—high value” to patients, communities, businesses, and payors Patient-centric, physician-driven organization National leader for healthcare reform innovation IHS Leadership Symposium, April 17, 2012

7 A New Day Value will be rewarded over volume Physicians and other clinicians will be able to serve their patients Hospitals, physicians and other providers will be rewarded for managing the overall health of our communities Patients will receive coordinated and collaborative health care…not fragmentation IHS Leadership Symposium, April 17, 2012

8 ACO Defined A clinically integrated network of physicians, hospitals, and others providers committed to using and advancing the latest thinking in clinical care, quality and efficiency. Designed to achieve the triple aim: better health, better healthcare, and better value IHS Leadership Symposium, April 17, 2012

9 How, exactly, does IHS deliver on the Triple Aim? Align providers with a common quality agenda Use Analytics to identify at-risk patients for clinical intervention Design a care management infrastructure to follow the patient across a highly integrated provider network into all care settings Deliver comprehensive care aimed to attain and maintain health in the outpatient setting IHS Leadership Symposium, April 17, 2012

10 Population & Community HealthPopulation & Community Health Facilities & ServicesFacilities & Services Provision of inpatient, outpatient and ambulatory services required to deliver comprehensive patient care Integrated Care Organization 1 Platform for physician engagement and collaboration to improve quality, enhance patient experience and create value Care Management Infrastructure Medical Home, Advanced Medical Team, Palliative Care, Coordinated Care Management/Population Management, Call Center Analytic SupportAnalytic Support Business and clinical analytic capabilities required to support a population focused care model Improve the health of the peopleImprove the health of the people and communities we serveand communities we serve 2 Medical homes, palliative care programming, and advanced medical team resources to be established in each affiliate region. Call Center would be an example of a system resource. 1 Organization made up of employed and independent physicians from each affiliate region; committee structure in place in each region IHS Leadership Symposium, April 17, 2012

11 IHS ACO Governance Structure Iowa Health Accountable Care Board of Directors Iowa Health System Board of Directors IHACO Finance Committee IHACO Clinical Collaborative: Chief Medical Officer Regional ACO Steering Committees IHACO Quality Committee: QI Officer IHACO Quality Committee: QI Officer ICO Quality Committee Compliance Officer IHS Leadership Symposium, April 17, 2012 Iowa Health Accountable Care (Iowa Health ACO or IHACO) Board of Managers

12 Regional ACO Steering Committees IDS Executive Sponsor IHS ACO Director Fort DodgePam Halvorson, VP Regional Clinic OperationsApril 2012 Des MoinesDr. Purtle, VPMA/CMOMarcia Stark Cedar RapidsJohn Sheehan, Executive VP/COOApril 2012 WaterlooJudy Renaas, VP/CNEApril 2012 Quad Cities Katie Pearson, VP Marketing and Business Development April 2012 PeoriaTerry Waters, VP, Business DevelopmentApril 2012 Sioux City Chad Markham, VP Clinic and Network Development Late 2012 DubuqueChad Wolbers, COOLate 2012 NewGroupDr. Erick Laine, Executive VP/COOMarcia Stark IHS Leadership Symposium, April 17, 2012

13 IHS ACO Infrastructure Advanced Care Innovation Population Care Management ACO Analytics ACO Program Management Integrated Care Organization (ICO) Functional Alignment IHS Leadership Symposium, April 17, 2012 Other Aligned IHS Resources: * CCT : PI/Research/Education* Business Development * Communications * Information Technology/CMIO * Decision Support Research and Development for medical care innovations; partner with business unit to create value- added programs for system-wide impact Advanced Medical Team Palliative Care Post-acute Care Centralized analytics to include predictive risk- modeling; evidence-based care packages and disease registry to inform physician of patient gaps-in- care; monitor patient quality and provider performance. Coordinated Care Management for IHS self-insured members expanding to all ACO members; provide care management and disease management for selected chronically ill patients. Oversee ACO clinical strategy deployment in selected regions; use ACO Clinical Collaborative for regional engagement ; Population risk management Point-of-care management Provider performance Physician-led, clinically- integrated provider organization established to be the physician arm of ACO to improve quality and create value.

14 IHS Leadership IHACO Infrastructure Kathleen Cunningham, Executive Director Lori Weih, System Administrator, ACO Program Management Marcia Stark, ACO Director, IHDM Dr. Mark Barnhill, Medical Director, Pop. Care Management Raedean VanDenover, Director, Pop. Care Management Joe Walters, Interim Manager, ACO Health Informatics Jim Grant, Sr. Claims Analyst Angela Rubino, Network Development/Financial Analyst Integrated Care Organization Dr. Dave Williams, Medical Director Gina Ross, Director, Operations Nathan Thompson, Director, Physician Services Iowa Health System John Hendricks, Director, IT Interoperability Amber Lenhardt, Director, Finance Services Tim McCulley, Director, Payor Contracting New Group Linda Wendt, System Director of Quality Iowa Health Home Care Monique Reese, Chief Clinical Officer IHS Leadership Symposium, April 17, 2012

15 IHACO Leadership Functional Alignment Iowa Health Accountable Care Organization Advanced Care Innovation Population Care Management ACO Health Informatics ACO Program Management Integrated Care Organization IHS Leadership Symposium, April 17, 2012 Research and Development for medical care innovations; partner with business unit to create value- added programs for system-wide impact Primary Care Redesign Advanced Medical Team Palliative Care Post-acute Care Centralized analytics to include predictive risk- modeling; evidence-based care packages and disease registry to inform physician of patient gaps-in- care; monitor patient quality and provider performance. Coordinated Care Management for IHS self-insured members expanding to all ACO members; provide care management and disease management for selected chronically ill patients. Oversee ACO clinical strategy deployment in selected regions; use ACO Clinical Collaborative for regional engagement ; Population risk management Point-of-care management Provider performance Physician-led, clinically- integrated provider organization established to be the physician arm of ACO to improve quality and create value.

16 IHACO Leadership Functional Alignment Iowa Health Accountable Care Organization Advanced Care Innovation Population Care Management Medical Director, Dr. Mark Barnhill Director, Raedean VanDenover Manager, Care Management Programs Cathy Graham Manager, MyNurse Call Center Ann Schauer ACO Health Informatics Director Informatics (open) Health Informatics Joe Walters, Interim Manager ACO Program Management Administrator, Lori Weih Regional ACO Directors IHDM: M. Stark Cedar Rapids Waterloo Fort Dodge Quad Cities Peoria Integrated Care Organization Medical Director, Dr. Dave Williams Director Gina Ross IHS Leadership Symposium, April 17, 2012

17 Pioneer ACO Leadership Halvorson L. Wallace. M.D. Quality Analytics Dr. Suriar Rosfjord Nagel IHS –Walters IHS – Jim Grant Cunningham Functions CMS Metrics -Claims data Utilization Outcomes Process Measures Data Analysis Financial Dr. Wallace/TBD Dewerff Haverman Sullivant Heasley Mason IHS - Dieleman IHS – Jim Grant Functions Analytics Attribution Costs/Case Distribution of Shared Savings Incentives -Support Interim Payment Clinical Dr. Meyer Albrecht Shriver Sleiter Hott IHS -Reese IHS –VanDenover IHS - Fazal Functions Primary Care Community Implementation Teams Communications to Providers Staff Education Patient/Community Engagement Dr. Votta Mcquillen LeValley Consumer - D. Michael Albrecht Gascho Community - Prescott IHS - Sinnard Functions Patient Satisfaction Marketing Literacy Communications Community Relations IT Functionality Dr. Willerth Martens Whaley Baedke Trimark-Nagel IHS - Hendriks Functions Portal System Readiness IT Integration with Strategic Partners Context Management Health Information Exchange Disease Registry IHS Leadership Cunningham Support: Weih Pioneer ACO Advisors Beck – Compliance Reiners – Legal Vorpahl - SharePoint Pioneer ACO CEO Thompson McDonald IHS Leadership Symposium, April 17, 2012

18 Health-Risk Assessment Iowa’s Healthiest State initiative Preventive screening Health Education and Literacy Wellness Program Care transitions – Extended Care Facilities ICCDM – all care settings Advanced Medical Team Telephonic- Telemonitoring Strategic Healthcare Partners Critical Access Hospitals Risk stratification Med Therapy Management Disease Management Coaching Strategic Community Partners Patient access to PCP Common screening and assessment tools Single, patient- centric care plan Med Therapy Management Mental Health Action Team Palliative Care Inpatient Home-based Clinic Integration with PCP Hospice Hospice Home Home-based Primary Care Community Home/Neighborhood - Schools - Business - Healthcare Agencies - Government -Recreation - Church/Spiritual TriHealth Pioneer ACO: Achieving our AIM AIM: Leverage every aspect of our “community” to achieve Best Outcome for Every Patient Every Time Secondary Drivers Primary Drivers Supporting Choice through the Life Span IHS Leadership Symposium, April 17, 2012

19 Preparing for all Payment Arrangements IHS Leadership Symposium, April 17, 2012

20 IHACO Value-based Contracts PAYOR TriHealth Pioneer ACO 1/1/2012 Wellmark ACO 4/1/2012 Medicare Shared Savings (MSSP) 7/1/2012 Iowa Health Self- Insured 1/1/2012 ACA Medicaid Health Home 7/1/2012 Beneficiaries ~ 7,700~ 50,000~ 70,000~ 30,000 IHS in review at this time Fort Dodge √√√ Des Moines √√√ Cedar Rapids √√√ Waterloo √√√ Quad Cities √√ Peoria √ Sioux City √ Dubuque √ Quincy Medical Group √ IHS Leadership Symposium, April 17, 2012

21 ACO Program Domains Wellmark ACOPioneer and MSSP Patient Experience (4 measures) Patient/Caregiver Experience (7 measures) Chronic and Follow-Up Care (3 measures) Care Coordination/Patient Safety (6 measures) Primary Prevention (4 measures) Preventative Health (8 measures) At Risk Populations (12 measures) Stoplight Definitions Actively reporting measures with same definition and method Able to report, or currently reporting with differences in definition, content, or method Not able to report at this time, will come from payor claims data IHS Leadership Symposium, April 17, 2012

22 Wellmark ACO Baseline Wellmark ACO Quality Index Score (QIS) Patient Experience (4 measures) Patient Confidence Continuity of Care Office Efficiency Access to Care Chronic and Follow-Up Care (3 measures) Risk-adjusted potentially preventable readmissions Post-acute provider visit Provider visits for chronic disease patients Primary Prevention (4 measures) Breast cancer screen colorectal cancer screening Well-child visits (2 age categories IHS Leadership Symposium, April 17, 2012

23 IHS ACO 2012 Priorities Clinical Priorities – Advanced Medical Team – Palliative Care Inpatient Outpatient (home care) Regional ACO Steering Committee – Key stakeholders to oversee ACO performance aligned with IHACO strategies IHS Resources Assigned – Regional ACO Director – Project Manager – Analytics (EMR and claims) – IT liaison – Adaptive Design – Finance – Contracting – Communications IHS Leadership Symposium, April 17, 2012

24 Next Steps Deploy 2012 ACO Priorities Refine technology requirements and analytic services to support ACO performance at the beneficiary level, to encompass all care settings Further advance additional payor and provider negotiations to increase ACO beneficiaries served. IHS Leadership Symposium, April 17, 2012

25 IHS ACO Program Contacts ACO Program Management – Lori Weih, System Administrator, ACO Program Management – Phone: Population Care Management – Raedean VanDenover, IHS Director, Population Care Management – Phone: Advanced Medical Team – Monique Reese, Chief Clinical Officer, IHHC – Phone: Palliative Care – Lori Bishop, Executive Director, Statewide Palliative and Hospice, IHHC – Phone: IHS Leadership Symposium, April 17, 2012

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28 ACO METRICS IHS Leadership Symposium, April 17, 2012

29 ACO Program Domains Wellmark ACO Years 1-5Pioneer and MSSP Patient Experience (4 measures) Patient/Caregiver Experience (7 measures) Chronic and Follow-Up Care (3 measures) Care Coordination/Patient Safety (6 measures) Primary Prevention (4 measures) Preventative Health (8 measures) At Risk Populations (12 measures) Stoplight Definitions Actively reporting measures with same definition and method Able to report, or currently reporting with differences in definition, content, or method Not able to report at this time IHS Leadership Symposium, April 17, 2012

30 Wellmark ACO Patient Experience – How’s Your Health Survey Notes: HYH Survey Tool is uses questions that could be added to Press Ganey survey. StatusMeasure How confident are you that you can control and manage most of your health problems Do you have one person you think of as your personal doctor or nurse? When you visit your doctor’s office, how often is it well organized, efficient and does not waste your time? How easy is it to get medical care when you need it? IHS Leadership Symposium, April 17, 2012

31 Pioneer and MSSP Patient Experience – CAHPS 12 month base survey and supplemental modules Notes: CAHPS survey asks patient as a 12-month look back. CMS will survey in 2013 for 2012 performance. StatusMeasure CAHPS: Getting Timely Care, Appointments, and Information CAHPS: How Well Your Doctors Communicate CAHPS: Patients’ Rating of Doctor CAHPS: Access to Specialists CAHPS: Health Promotion and Education CAHPS: Shared Decision Making CAHPS: Health Status/Functional Status IHS Leadership Symposium, April 17, 2012

32 Wellmark ACO Chronic and Follow-Up Care Notes: Treo will be only source for risk-adjusted Wellmark claims to support these measures. Significant time delay in ability to report. EPSi may assist with second measure tracking internal discharges with follow-up in pcp office. StatusMeasure Risk-adjusted Percent Difference in Potentially Preventable Readmissions % of Attributed Members with hospital discharge with provider office visit <= 30 days post discharge % of Attributed Members with chronic disease (Clinical Risk Categories 50, 60, 70) with >= three provider visits IHS Leadership Symposium, April 17, 2012

33 Pioneer and MSSP Care Coordination/Patient Safety Measures StatusMeasure Risk-Standardized, All Condition Readmission Ambulatory Sensitive Conditions Admissions: COPD Ambulatory Sensitive Conditions Admissions: CHF % of PCPs who Successfully Qualify for an EHR Incentive Program Payment Medication Reconciliation: Reconciliation After Discharge from an Inpatient Facility Falls: Screening for Fall Risk Trident: The Delta Group Stim Set Reports No Current Reporting IHS Leadership Symposium, April 17, 2012

34 Wellmark ACO Primary Prevention Notes: Wellmark will measure using only claims with limited history. CoQ and NewGroup quality programs measure using EHR information. StatusMeasure Breast Cancer Screening Colorectal Cancer Screening % of Attributed Members 31 days to 15 months with recommended number of well-child visits (0 – 6 visits) % of Attributed Members 3 – 6 years with recommended number of well-child visits (1 or more visits last year) IHS Leadership Symposium, April 17, 2012

35 Pioneer and MSSP Preventative Health Notes: Yellow Items are Meaningful Use Measures to be addressed with workflow changes in Q1/Q StatusMeasure Influenza Immunization Pneumococcal Vaccination Adult Weight Screening and Follow-Up Tobacco Use Assessment and Tobacco Cessation Intervention Depression Screening Colorectal Cancer Screening Mammography Screening Screening for High Blood Pressure IHS Leadership Symposium, April 17, 2012

36 Pioneer and MSSP At Risk Populations Part I Notes: Composite diabetes measure is “All or None” of individual components. StatusMeasure Diabetes Composite (All or Nothing Scoring) -Hemoglobin A1c Control (<8 percent) -Low Density Lipoprotein (<100) -Blood Pressure <140/90 -Tobacco Non Use -Aspirin Use -Hemoglobin A1c Poor Control (>9 percent) Hypertension: Controlling High Blood Pressure IHS Leadership Symposium, April 17, 2012

37 Pioneer and MSSP At Risk Populations Part II Notes: All measures above except the last one** are MU measures and be reportable in Q1/Q StatusMeasure Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control (<100 mg/dL) Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction Coronary Artery Disease (CAD) Composite (All or Nothing) Scoring -Drug Therapy for Lowering LDL-Cholesterol -**Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Patients with CAD and Diabetes and/or Left Ventricular Systolic Dysfunction (LVSD) – Not MU Measure IHS Leadership Symposium, April 17, 2012


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