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Published byChristina Hamilton Modified over 7 years ago
HFMA December 2012
Attacking Rising Costs 23% of the Medicare population has a chronic condition with 5 or more co-morbid conditions that compel them to see 12 (different) physicians per year, to fill 16 prescriptions and account for 68% of total Medicare spending Source: Institute for Healthcare Improvement Change is Upon Us
Future Healthcare Model: Strategic Imperatives
Strategy #1: Physician Integration Mercy Health Physician Base Continues To Expand Mercy Health employs physicians (primary care and specialists) in every planning area. * *includes MD extenders
4 Strategy #1: Physician Integration
Strategy #2: Cohesive Care Delivery Network
Clinical Integration Mercy Health Employees Commercial Payors Medicare Advantage (MediGold) Medicare Patients (ACO) 20,000 Patients 22,000 Patients 800 Patients Coming up in 2013 Strategy #3: Population Health Management
Strategy #4: Increasing Efficiency GoodGood GoodGood GoodGood GoodGood Benchmark approximates top quartile Target approximates top quartile
What is an ACO? 9 An Accountable Care Organization (ACO) is a group of providers willing and capable of accepting accountability for the total cost and quality of care for a defined population. Payer Partners ► Insurers ► Employers ► States ► CMS Core Components: People Centered Foundation Health Home High-Value Network Population Health Data Mgmt ACO Leadership Payor Partnerships
Mercy Health Select / ACO Vision MHS is a virtual partnership between Mercy Health hospitals, Mercy Health Physicians, community PCPs, specialist groups contracted with MH hospitals, and potentially other health care professionals who accept responsibility for and are dedicated to improving the health status of residents in the Tri-State region through improved access, coordination of care and clinical performance management
Mercy Health Select - Building the ACO
ACO Development Timeline Oct 2011 Mercy Health Select LLC was formed April 2012 Physician Led board of managers and committee operational July 2012 Medicare ACO application approved Oct 2012 Medicare Advantage Offering
Clinical Integration Care Coordination Information Technology Financial Management ACO Cornerstones of ACO
There are two important goals the ACO must accomplish before it can get shared savings Create Sufficient Savings (>2.5%) Meet or exceed the minimum quality score Shared Savings
33 Quality Measures Measure and Report Patient experience Care Coordination Preventive Care Management of Population Health for at-risk chronic populations Diabetes Hypertension IVD CAD
PCMH that is fully implemented in all of our practices Care Coordination to proactively manage patients Reduce re-admits by improving communication among PCPs/ ED/ Hospitalists Reduce ED utilization by expanding access CarePATH Common IT Platform Key strategies to bend the cost curve
My Mercy Health Medical Home a patient centered experience
Improving Patient Access
PCMH Care Coordination Pilot Results Admission rate ↓ 51% Readmission rate ↓ 35% ER visit rate ↓ 37% Diabetes A1C control improved: ↑ 33% LDL (% Ideal) ↑ 6.45% Goal of not smoking: ↑ 11.8%
Pulling it All Together: Comprehensive Population Health Management Physician-led Governance Body and Committees PCMH & Nurse Care Coordinator Program Risk Stratification, Disease Mgmt., Wellness, High-Cost Claims, Data Warehousing/Reporting Healthier Population Lower Costs Healthier Patients
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