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Living in the ACO Model: What’s Next Moderator John Pritchard, Medical Distribution Solutions, Inc. Panelists Scott D. Pope, PharmD, Executive Director,

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Presentation on theme: "Living in the ACO Model: What’s Next Moderator John Pritchard, Medical Distribution Solutions, Inc. Panelists Scott D. Pope, PharmD, Executive Director,"— Presentation transcript:

1 Living in the ACO Model: What’s Next Moderator John Pritchard, Medical Distribution Solutions, Inc. Panelists Scott D. Pope, PharmD, Executive Director, Healthcare Innovators Collaborative, Premier, Inc Tara Canty, Chief Operating Officer, Accountable Care and Senior Vice President, Government Relations, OSF Healthcare System

2 One OSF All Together Better OSF Healthcare System Accountable Care Moving from Volume to Value

3 3 ACO Participation at OSF 6 Acute Care Hospitals 1 Hospice Home 707 Physicians Primary Care 51 Level 3 PCMH ---CV Service Line ---Neuro Service Line ---Multi Specialty 216 NP/APN Home Care DME Hospice

4 4 Alignment is critical Source: Truven Health Analytics

5 5 Institute of Medicine Analysis

6 6 Accountable Care

7 One OSF All Together Better What is an Accountable Care Organization?

8 8 Principles of Accountable Care  An ACO is a local health care organization and a related set of providers (at a minimum, primary care physicians, specialists, and hospitals) that can be held accountable for the cost and quality of care delivered to a defined population.  The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time at the right place while avoiding unnecessary duplication of services and preventing medical errors.  Accountable Care holds organizations accountable for specific levels of quality care through comprehensive, valid and reliable measurement of its performance.

9 9 Pioneer ACO  Developed by Centers for Medicare & Medicaid Innovation in partnership with CMS  The Pioneer ACO Model is designed to encourage the cultural change necessary to achieve the Triple Aim – Improve the health of the population (wellness) – Enhance the patient experience (quality, access and reliability) – Reduce, or at least control, the per capita cost of care  Develop Accountable Relationships for care delivery with other insurers as well  Over time, deliver care at 20-30% less than the current projections

10 10 Accountable Care Relationships at OSF  Pioneer ACO – 34,000 Medicare beneficiaries  Blue Cross – 40,000 projected members -- January 1, 2014 – Capitated HMO (Ambulatory Services) and Shared Risk PPO Closing care gaps Outreach to high risk patients  Humana – 8,500 Medicare Advantage members – Capitated HMO and Shared Savings PPO Medical Home Closing care gaps  Health Alliance – 15,000 HMO members – Shared Risk  Quality Care Plan (OSF employees & deps.) – 30,000 members Today Future  25% of Revenue  150,000 Covered Lives  60% of Revenue  400,000 Covered Lives

11 OSF’s Approach One OSF All Together Better

12 12 Areas of Focus  Reduce avoidable admissions and readmissions  Reduce length of stay  Decrease avoidable ED visits  Improve care coordination  Improved transition of care  Increase Clinical Integration

13 13 Challenges  Limited psychiatric/substance abuse services in the community  Ability to expand access to primary care physicians and mid- level providers  Communication constraints  Establishing consistency across accountable care agreements  Non-OSF provider engagements  Maintaining timely access to data and identifying appropriate benchmarks  Balance dueling business models

14 14 OSF’s Care Management Model Adult - High Risk defined as: 10% for Medicare population 3% for Commercial population 1% of remaining population “Hybrid Care Management Team Model” 3 Person teams with a 1 RN Care Manager : 2 Non RN support ratio 450 patients managed per team Embedded Site RN Care Managers (PCMH) Centralized Care Management Support Model (MSW, LPN, MOA)

15 15 Care Transition Projects - Implementing Best Practice Components  Patient risk assessment upon admission and throughout patient stay – Targets appropriate interventions through out stay to achieve successful discharge – Doubled use of social work assessments and interventions  Defined discharge process/discharge checklists and after visit summaries – Patient Summary includes teaching/teach back – More complete information for providers after discharge  Provider handoffs: – Discharge summaries – Provider to provider verbal handoff process

16 16 Care Transition Projects - Implementing Best Practice Components  Medication reconciliation at discharge – Includes first fill at discharge – Considering home visit for “complete” reconciliation  Follow-up phone calls within 72 hours of discharge to ensure patient/caregiver understanding and adherence – 76% call success rate  Provider follow-up appointments within 5 days – May be home care, specialist – Clinic for patients with no PCP

17 17 Skilled Nursing Home Initiative  Preferred SNF network based on quality and service – CMS Star ratings: at least 4 overall and 3 quality – 24/7 admissions – 75% acceptance of all admissions – 24/7 RN on site – At least 6 days/week therapy – Specialized sub-acute units for Cardiology and Neurology

18 18 Skilled Nursing Home Initiative  Physician and APNs rounding on SNF patients with high frequency, managing utilization and transition to home – Multi-disciplinary team approach – Strong clinical model Increase discharges to home from SNF (improved patient outcome) Decrease ALOS (from 86 days/stay to <40 days/stay) Reduce acute readmissions (from 50% to <10%) – All SNF patients considered high risk All receive home care referral at discharge from SNF All patients transitioned to Care Management/Medical Home

19 19 Additional Initiatives  Data Analytics – Enterprise Data Warehouse  Access – Centralized Ambulatory Call Center Improved access to primary care Same day appointments – Specialty care – Transportation  Referral Management – Clinical Integration Leakage Quality/outcomes

20 20 Additional Initiatives (continued)  Telemedicine – E-ICU – Care Management – Behavioral Health, CHF, COPD, Stroke  Physician Engagement – Education, Data, reports Physician Dashboard – Accountability Quality component in compensation

21 One OSF All Together Better Questions?

22 Scott D. Pope, PharmD Executive Director – Healthcare Innovators Collaborative

23 Three take-aways Premier is working to propel population health You are on the ACO tracks…the train is coming Find your strategy, your partner, or (ideally) both

24 24 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC. MOVEMENT TO INTEGRATED CARE, NEW PAYMENT MODELS & RISK The journey to high value healthcare Value-based purchasing: HACs, quality, efficiency, cuts HAC and readmission penalties Medical home Shared savings & Global payment Bundled payment Population Management Population analytics Care management Financial modeling and management Legal Physician integration High Value Episodes DRG and episode targeting Care models and gainsharing Data analytics Cost management High Performing Hospitals Most efficient supply chain Best outcomes in quality, safety Waste elimination Satisfied patients

25 Pop Health Core Components

26 The Network Effect – Premier PACT 29 markets | 23 systems | 100+ hospitals | 5,000+ MDs, 1.5M accountable care covered lives 86 markets | 67 systems | 300+ hospitals | 12,000+ MDs

27 27 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC. Assessments drive insight *Data from 24 markets **Data from 51 assessments Readiness Collaborative overall assessment** Implementation Collaborative overall assessment* Blue = High Green = Average Red = Low

28 28 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC. PHYSICIAN NETWORK MANAGEMENT POPULATION ANALYTICS & RISK MANAGEMENT POPULATION ENGAGEMENT Network development Clinical integration Patient-centered medical home Care redesign Practice optimization Community needs assessments Shared savings Bundled payments Advisory Services Collaboratives By leveraging our vast data assets and partnerships with leading technology providers we have developed solutions to address population health and new payment models. Information Technology POPULATION HEALTH COLLABORATIVE PLATFORM New era population health management solutions

29 Supplier Implications

30 Envisioning the future Fee-for-service executives = More volume ACO executives = Reduce high cost “things” Commodity until proven otherwise Physicians are incented on cost/outcomes

31 Common threads of hope Deeply understand how ACOs really work Provide more outcomes data, onus is on you Bring a collaborative mindset & be willing to test

32 Healthcare Today

33 Launched in 2010 Received by over 23,000 stakeholders 6 issues per year The only publications dedicated solely to ACO development

34 Muddy Waters Published in July 2012 Updated 2 nd Edition published February 2013 How Reform impacts the Supply Chain

35 Triple Aim Focus of Reform ●Reducing Cost ●Improving Quality ●Enhancing Patient Experience Suppliers must have a Value Proposition that aligns with the Triple Aim! 35

36 How Reform and ACOs will impact the Supply Chain Physician Alignment Alignment of Incentives Clinical Integration Information Management Supply Chain Engagement SMI/MDSI 2013 ACO Executive Briefing

37 HSCA 2013 Washington, D.C. October 22, 2013 John I. Pritchard (770)


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