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Pioneer ACO Overview to NYSDOH ACO Workgroup March 6, 2014.

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Presentation on theme: "Pioneer ACO Overview to NYSDOH ACO Workgroup March 6, 2014."— Presentation transcript:

1 Pioneer ACO Overview to NYSDOH ACO Workgroup March 6, 2014

2 Montefiore Overview 1,930 Beds Across 6 Hospitals – Including 120 beds at CHAM – 86 NICU/PICU beds 150 Skilled Nursing Beds 154 Sites Including 64 Primary Care Sites – 21 Montefiore Medical Group Sites 21 School Health Clinics 12 Mental Health/Substance Abuse Treatment Clinics 65 Specialty Care Sites – 2 Multi-Specialty Centers – 6 Pediatric Specialty Centers – 12 Women’s Health Centers 1 Freestanding Emergency Department 10 Dental Centers 5 Imaging Centers Our Locations

3 Montefiore IPA and CMO Formed in 1995 MD/ Hospital Partnership Supplies network of par providers committed to cooperation in care improvements Accepts some full risk capitation from health plans Established in 1996 Wholly-owned subsidiary of Montefiore Medical Center Performs care management delegated by health plans CMO performs most functions for MIPA 900+ staff CMO Montefiore Care Management Montefiore IPA (MIPA)

4 The Montefiore ACO Bronx Accountable Healthcare Network IPA, Inc. (BAHN), does business as the Montefiore ACO BAHN is an IPA, separate from MIPA BAHN contracts with CMS for Medicare Pioneer ACO program – BAHN subcontracts with MIPA to supply most of the network of clinical participating providers – BAHN sub-contracts with CMO to supply all care management and all administrative services

5 Montefiore Pioneer ACO Bronx Accountable HealthCare Network IPA (BAHN) Bronx Accountable HealthCare Network IPA (BAHN) Montefiore IPA Montefiore Care Management Org (CMO) Montefiore Care Management Org (CMO) Subcontracts with: + Pioneer Agreement Medicare $ Non-Montefiore Par Providers: St. Barnabas Acacia Health Morris Heights Hudson River HC NS-LIJ (partial) (Most also participate in health home governance) Montefiore Medical Center Community MDs (600) Ancillary providers/labs Montefiore Employed MDs (1700) Participating Network (Clinical services) Includes BAHN Health Home

6 Montefiore ACO Big Picture Many health plans are switching from FFS to care management arrangements with shared savings opportunities/quality metrics Montefiore ACO has history of such arrangements with Government and non- Government Payers Montefiore ACO encompasses other providers: – Bronx Community-based providers – Provider groups within other entities such as NS-LIJ, St. Barnabas, Hudson River Health Care, FQHCs – ACO will include new Montefiore affiliates (Sound Shore 750)

7 Care Guidance Program Supporting Innovation 6

8 Montefiore CMO tailors administrative requirements and care management intensity to the needs of the population being served Our Current Portfolio * Including Pioneer ACO members

9 Care Guidance Example: Behavioral Care Synergy Program Goal is to augment behavioral health services in patient centered medical home (PCMH) context Implement evidence-based models for treatment of patients with poorly controlled depression and at-risk drinking with chronic medical conditions (diabetes, CAD, CHF) Develop a joint care management “synergy” team approach to support and manage these complex patients Uses RN care manager, LCSW, psychiatrist in a “virtual” mode as standard approach Evaluate clinical outcomes, patient and provider satisfaction and cost Chung et al, Gen Hospital Psych 2013

10 Detail: Pioneer ACO Program Serves Medicare Part A & B beneficiaries Care coordination program designed for organizations with prior experience with population-based care management Includes comprehensive patient satisfaction and quality metrics Brings care coordination to the fee-for-service coverage population, without restrictions such as gatekeepers or limitations on out of network benefits Montefiore ACO is the only Pioneer ACO in New York State 3 Year demonstration started in 2012 – May be extended to 5 years – Just started Performance Year 3 (2014)

11 Quality Evaluation 33 quality metrics in 4 domains: –Patient/Caregiver Experience –Care Coordination/Patient Safety –Preventive Health –At-Risk Populations Data from patient satisfaction surveys, claims and administrative data and medical record reviews based on mix of reporting and performance relative to U.S. benchmarks

12 2013: Pioneer ACO Beneficiary Characteristics 23,250 attributed Part A & B beneficiaries “Attributed” because majority of primary care has been delivered to those patients by providers in the ACO 2,500 SNF Residents Age ranges from 5 – 112 – Average age of 72 – 175 beneficiaries (0.8%) are age ≥100 – 4,238 beneficiaries (18.2%) are < 65 – Of those, 215 are age ≤ 30 Approximately 1/3 of population are duals (8,000) – Interested in opportunities to more comprehensively manage Medicaid benefit through a single care manager for each patient – Montefiore is already managing the Medicare benefit

13 Pioneer ACO Success 2012-Year One: Reduced Medicare spending by 7% against “benchmark” CMS projected it would spend in 2012 on these particular patients 2013-Year Two: – Created sustainable cost reduction – Added new provider partners: NSLIJ, St. Barnabas, etc. 2014: Just starting Year 3

14 2012: Inpatient Admissions decreased 10.4% Source: CMMI PY1 Pioneer ACO Data Analysis Number of Admissions / 1000 person years

15 2012: 30-day All Cause Readmissions declined by 35.5% Source: CMMI PY1 Pioneer ACO Data Analysis Number of Readmissions / 1000 beneficiaries

16 2012: Inpatient Admissions for Diabetes decreased 45.7% Source: CMMI PY1 Pioneer ACO Data Analysis Number of Admissions / 1000 beneficiaries

17 Questions?


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