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Living in the ACO Model: What’s Next

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Presentation on theme: "Living in the ACO Model: What’s Next"— 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 OSF Healthcare System Accountable Care Moving from Volume to Value
One OSF All Together Better

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 Alignment is critical Source: Truven Health Analytics

5 Institute of Medicine Analysis

6 Accountable Care

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

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 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 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 Health Alliance – 15,000 HMO members Shared Risk Quality Care Plan (OSF employees & deps.) – 30,000 members Value-Based Payment Streams Today 25% of Revenue 150,000 Covered Lives Future 60% of Revenue 400,000 Covered Lives

11 One OSF All Together Better
OSF’s Approach One OSF All Together Better

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 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 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 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 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 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 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 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 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? One OSF All Together Better

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 The journey to high value healthcare
Value-based purchasing: HACs, quality, efficiency, cuts Bundled payment Shared savings & Global payment HAC and readmission penalties Medical home Movement to integrated care, new payment models & risk High Performing Hospitals Most efficient supply chain Best outcomes in quality, safety Waste elimination Satisfied patients High Value Episodes DRG and episode targeting Care models and gainsharing Data analytics Cost management Population Management Population analytics Care management Financial modeling and management Legal Physician integration

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 Assessments drive insight
Implementation Collaborative overall assessment* Readiness Collaborative overall assessment** Blue = High Green = Average Red = Low *Data from 24 markets **Data from 51 assessments

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

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 32

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 2nd Edition published February 2013 How Reform impacts the Supply Chain 34

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


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