Presentation on theme: "Robert Margolis, M.D. Chairman & CEO HealthCare Partners ACO’s – Getting from Here to There Benefits / Risks / Opportunities."— Presentation transcript:
Robert Margolis, M.D. Chairman & CEO HealthCare Partners ACO’s – Getting from Here to There Benefits / Risks / Opportunities
National Delivery System California – HealthCare Partners LLC – HealthCare Partners Medical Group – HealthCare Partners IPA Florida – JSA Nevada – Pinnacle Health Care Systems – Summit Medical Group – Fremont Medical Group – Rainbow Medical Group – In Patient Physician Network (IPN)
HealthCare Partners HealthCare Partners and its physician networks nationally serve over 1,000,000 patients including over 168,000 Medicare Advantage and over 500,000 commercially insured members primarily through global capitation. The pre-eminent physician-owned, professionally managed, patient-centered coordinated care system in the nation and an important delivery system in the many communities we serve.
Proactive Population Management The continuous ‘Virtuous Cycle’ of Improved care and outcomes is at the heart of HCP’s proactive population management. Better Care Better Quality Better Efficiency Better Patient Experience Continuous improvement to drive:
Target Patient Population Risk Stratification PMPM Costs
Stratifying Patients into the Appropriate Program Level 4 Home Care Management Level 2 Complex Care and Disease Management Level 1 Self-Management & Health Education Programs Home Care Management Provides in-home medical and palliative care management by Specialized Physicians, Nurse Care Managers and Social Workers for chronically frail seniors that have physical, mental, social and financial limitations that limits access to outpatient care, forcing unnecessary utilization of hospitals Complex Care and Disease Management Provides long-term whole person care enhancement for the population using a multidisciplinary team approach. Diabetes, COPD, CHF, CKD, Depression, Dementia Self Management, PCP Provides self-management for people with chronic disease. Level 3 High Risk Clinics High Risk Clinics and Care Management intensive one-on-one physician /nurse patient care and case management for the highest risk, most complex of the population. As the risk for hospitalization is reduced, patient is transferred to Level 2. Physicians and Care Managers are highly trained and closely Integrated into community resources and Physician offices or clinics. High PMPM Low PMPM ESRD Medical Home Hospice/Palliative Care $130 - $140 $250 - $260 $ 50 - $100 $220 - $200
The HCP Care Team Approach Interactive and collaborative teams of clinicians support HCP clinical programs. High Risk Programs: Home Care ESRD Comprehensive Care Center Post-Acute Comprehensive Care Disease Management Programs: Diabetes CAD CHF COPD Dementia
Clinical Data, Clinical Tools Disease Registries for every HCP physician to better understand the make up of his or her patient panel Web-based, Self-Serve, Disease Registries: Diabetes COPD CHF CKD Dementia CAD Asthma Depression
9 Outreach / Compliance Opportunities Custom Registries Based on Specific Interventions
Results – Medicare Patients Acute Bed Days ~ 1/3 national average @ 800 days 1K Readmission – all cause 30 days ~ ½ national average @ 12% (including elective readmissions) Terminal in hospital care ~ ½ national average @ < 20% Quality / HEDIS metrics ≥ national statistics Patient Satisfaction (“very” and “completely satisfied”) > 90%
CMMI Opportunity Embrace Medicare FFS ACO’s The Quality Improvement and Savings Opportunities are Enormous Population Based Payment Incentives Work!
Clinica Family Health Services Pete Leibig, CEO WWW.CLINICA.ORG
Underserved population Continuity If one thing… TEAM Based Way to be evidenced based Care Space Design Patient Centered Population Health Management
Group Care Space Design Alternative Visits Lower A1c Lower LBW Higher Satisfaction Advanced Access Patient Centered Population Health Management
Information Systems Partnering Community Health Record EHR Templates Evidence based Registries Outcome Reports
CMMI Help! www.clinica.org Colorado cutting Clinica’s FQHC payments as a way to reduce Medicaid expenses. DRAT!!! – Quality up – outcomes improving – Compensation down $3 million (23%) – HRSA wants more users at same cost to them – 22% of total Need demonstration of FQHC QI Investment payoff to 3 rd parties Share FQHC savings impact with Governors and Medicaid Directors in a meaningful way –they are trying to save money by cutting what we’re paid.