1. WCHN PHO/ACO Annual Meeting
Rowena Bergmans
VP, Clinical Integration and Population Health
12/7/15

2. “Delivery models and payment systems are changing
“Delivery models and payment systems are changing. The episodic approach to care, characterized by one physician directly caring for each individual care “event” will be replaced by a team-based longitudinal approach across multiple facilities, sites, practitioner type including the patients home…” Kaufman Hall

3. Overview Healthcare environment Response to environmental factors
Competencies to succeed
PHO/ACO
Foundation
2015 Successes
Future

4. Healthcare Environment
Healthcare spend
3 Trillion Dollars 2014/ 17.5% of GDP
$9,146 Per Capita
Healthcare quality
Hospital errors third leading cause of death (2013)
Rank 37th in the world
Physician satisfaction
60% would retire if they had means
22% of clinician time paper work
Healthcare spend % faster than the economy/ % faster than economy
The study also highlights IM docs in their practice manage 370 unique diagnosis, 600 unique meds and 150 unique lab tests
Another study found
that in a single year in fee-for-service Medicare, the typical primary care physician had to
coordinate with 229 other physicians in 117 different practices (Pham et al., 2009).

5. National/Local Response
Downward pressures on traditional delivery volumes
Downward pressures on volume-based reimbursement rates
Growing demands for clinical integration
Expansion of non-traditional competitors
More sophisticated purchasers of care government, payers, employers and consumers

6. CMS Payment Models

7. Skills Systems Will Need for Future Success7

8. Formation of the WCHN PHO
The PHO/ACO is a vehicle for WCHN to develop a physician led clinically integrated infrastructure that will encompass both employed and aligned community providers that will result in increased quality of care, enhanced financial performance and improved patient satisfaction.

9. The WCHN PHO Board Structure
10 Physician Board Members
One Vote
5 PCP Representatives
on PHO Board
5 Specialist Representatives
5 Hospital (WCHN) Board Members
5 WCHN Representatives

10. PHYSICIAN REPRESENTATIVES
PHO/ACO Board
PHYSICIAN REPRESENTATIVES
 PCPs Specialists
James Ahern, MD Neil Culligan, MD – Neurology
Henry Allen, MD Adam Gorelick, MD – Gastroenterology
Harold Kamm, MD Jeffery Gorelick, MD – Urology (Chair)
Cornelius Ferreira, MD Sohel M. Islam, MD – Surgeon
Martin Williams, MD (Secretary) David Kramer, MD – Surgeon
HOSPITAL (WCHN) REPRESENTATIVES
Rowena Bergmans
Patrick Broderick, MD
Mike Daglio (Vice Chair) Matt Miller, MD Steve Rosenberg (Treasurer)

11. WCHN PHO Functions Develop/maintain a provider network
Contract with health plans w/ opt-ins for individual practices
Prepare our provider community for changes in the health care arena by:
Seeking ways to improve quality & efficiency of health care services provided under PHO/ACO agreements (e.g. clinical integration, collaboration, data analytics, care management.)
Offering member practices various optional administrative & technology solutions (e.g. EMR, PCMH, group purchasing, etc.)
Supporting practice managers w/ education and networking functions
Healthcare Reform Support!

12. 2015 PHO/ACO Membership 871 Providers Value Care Alliance (VCA)
282 Community
589 Employed
186 Primary Care
695 Specialists
Value Care Alliance (VCA)
St. Vincent's Hospital
Middlesex Hospital
Griffin Hospital
St. Vincent's Health Partners (PHO/ACO)
Griffin PHO

13. 2015 Contracts Current Other Future Aetna Commercial – Shared Savings
Aetna Medicare Advantage – Shared Savings
CMS MSSP – Shared Savings
Connecticare – Shared Savings
Harvard Pilgrim
Multiplan
US Family
Healthy CT
Other
Aetna Tiered Network
Future
Cigna – 2016 – Shared Savings
Anthem – PHO/ VCA
United – PHO/ VCA

14. Highlights 2015 Building the infrastructure to achieve clinical integration
Physician Leadership and Clinical Support
Dr. Bob Carr, Medical Director PHO/ACO
Care Managers (2)
PCMH Specialists
Technology and Business Intelligence
Highline data warehouse (claims)
Arcadia (EDW)
Process
CAHPS Survey Vendor (MSSP)
Finalized shared savings methodology
Trainings (ICD, CPT)

15. Where are we headed?
Utilization Review Accreditation Commission (URAC) accreditation as a clinically integrated network
Stronger partnerships with non-traditional providers
Continue to seek out shared savings relationships
Continue to move practices to PCMH level 3
Introduction of behavioral health supports
Primary care providers 79% antidepressants, 60% Treating Depression

16. Questions…