Measuring progress toward
accountable care: lessons from 59
pioneering hospitals
Keith J. Figlioli
SVP, Healthcare Informa...
Will vs. Preparation

Photo credit: usab.com
“The key is not the will to win. Everybody has that.
It is the will to prepar...
U.S. Healthcare Sector:
Three major transformations simultaneously

Care Model

Payment
Model

PAYMENT MODEL
End of CrossS...
And behaviors need to change

Protecting one’s
“turf”

All ideas proprietary
Closed systems

Little transparency,
no bias ...
Today’s discussion

A framework for assessing readiness
• Participants
• Methods

Important attributes for readiness
• Wha...
Framework
Growing number of ACOs nationwide

252 Medicare ACOs
in 43 states
Over 430 Medicare and
Commercial ACOs
500 providers in C...
The Network Effect – Premier PACT Collaborative

29 markets | 23 systems | 100+ hospitals | 5,000+
MDs, 1.5M accountable c...
Assessing readiness

9

PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
The Bridge from FFS to Accountable Care

What are the
underpinning
building blocks?

Current
FFS
System

Accountable
Care
...
Readiness
Overall Assessment by Component**
Patient Centered
Foundation
100%
80%

Payor Partnership

60%

Health Home

40%
20%

0%

...
Variation Among Organizations with High Component Scores

Weighted Component Scores

Organization (in
order of high to low...
Top 5 and Bottom 5 – Lessons from Comparisons
Factors That Differentiate Organizations with High ACO Readiness
1. Full or ...
Implications for future ACO development
White paper health systems
Fairview Health Services is a nonprofit healthcare
system based in Minneapolis with more than 5...
Essential lessons learned

Managing populations
requires fundamental
health delivery change

Focus of primary
transformati...
Challenges and policy implications

Challenges with physicians, local payers, infrastructure
investment, state/federal dat...
Successful implementation strategies

19

PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Crawl, Walk, Run…But Start

Target programs for top 5% utilizers - Atlanticare
Begin to change organizational construct - ...
Bench or Game

Photo credit: nbaarena.com

No one has to change. Survival is optional.
~ W. Edwards Deming
21

PROPRIETARY...
Thank you…
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CISummit 2013: Keith Figlioli, Measuring Progress Toward Accountable Care: Lessons from 50 Pioneering Hospitals

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CISummit 2013: Keith Figlioli, Measuring Progress Toward Accountable Care: Lessons from 50 Pioneering Hospitals

  1. 1. Measuring progress toward accountable care: lessons from 59 pioneering hospitals Keith J. Figlioli SVP, Healthcare Informatics Premier, Inc. October 8, 2013
  2. 2. Will vs. Preparation Photo credit: usab.com “The key is not the will to win. Everybody has that. It is the will to prepare to win that is important.” ~ Coach Bobby Knight, 1984 USA Men’s Olympic Basketball 2 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
  3. 3. U.S. Healthcare Sector: Three major transformations simultaneously Care Model Payment Model PAYMENT MODEL End of CrossSubsidization Shift to Voucher Marketplace Integrated vs. Fragmented Personal Accountability Assumption of Risk Insurance exchanges 3 Organization Model CARE MODEL Primary Care/PCMH Hospitalists / Hospitalbased Medicine Behavioral Health Chronic Disease Focus Social Science Tools Shift from sick care system to health system ORGANIZATION MODEL End of Private Practice Medicine Consolidation of Health Systems Rise of Physician & Clinical Leadership Hospital Health System PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
  4. 4. And behaviors need to change Protecting one’s “turf” All ideas proprietary Closed systems Little transparency, no bias for sharing Competition between providers, with others across healthcare Spotty collaboration efforts 4 Data hoarding Avoiding confrontation when things aren’t working Few cross continuum partnerships PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
  5. 5. Today’s discussion A framework for assessing readiness • Participants • Methods Important attributes for readiness • What mattered • What didn’t matter What we can do about it • Challenges • Successful strategies 5 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
  6. 6. Framework
  7. 7. Growing number of ACOs nationwide 252 Medicare ACOs in 43 states Over 430 Medicare and Commercial ACOs 500 providers in CMS Bundled Payment initiative 7 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
  8. 8. The Network Effect – Premier PACT Collaborative 29 markets | 23 systems | 100+ hospitals | 5,000+ MDs, 1.5M accountable care covered lives 86 markets | 67 systems | 300+ hospitals | 12,000+ MDs 8 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
  9. 9. Assessing readiness 9 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
  10. 10. The Bridge from FFS to Accountable Care What are the underpinning building blocks? Current FFS System Accountable Care Accountable Care Core Components People Centered Foundation Health Home High Value Network Population Health Data Management ACO Leadership Payor Partnerships Foundational Philosophy: Triple Aim™ Measurement 10 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
  11. 11. Readiness
  12. 12. Overall Assessment by Component** Patient Centered Foundation 100% 80% Payor Partnership 60% Health Home 40% 20% 0% High Value Network ACO Leadership Population Health Data Management Blue = Top Decile Green = Median Red = Bottom Decile **Data from 59 assessments 12 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
  13. 13. Variation Among Organizations with High Component Scores Weighted Component Scores Organization (in order of high to low overall weighted score) HH HVN PHDM ACOL PP Organization 1 0.76 0.47 0.67 0.63 0.64 0.47 0.61 Organization 2 0.59 0.64 0.52 0.60 0.46 0.39 0.53 Organization 3 0.44 0.17 0.53 0.52 0.73 0.72 0.52 Organization 4 0.51 0.42 0.36 0.56 0.58 0.58 0.51 Organization 5 0.55 0.52 0.59 0.52 0.50 0.10 0.46 Organization 6 0.41 0.38 0.44 0.47 0.45 0.55 0.45 Organization 7 0.44 0.50 0.33 0.27 0.57 0.51 0.44 Organization 8 0.52 0.27 0.47 0.46 0.47 0.36 0.43 Organization 9 0.55 0.28 0.27 0.27 0.28 0.13 0.30 Organization 10 13 PCF Overall Score 0.34 0.21 0.53 0.23 0.26 0.18 0.29 Scoring well in one component does not always translate to readiness in all components Blue indicates higher scores Red indicates lower scores PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
  14. 14. Top 5 and Bottom 5 – Lessons from Comparisons Factors That Differentiate Organizations with High ACO Readiness 1. Full or partial ownership of a health plan with pop health mgt capabilities 2. Existing collaboration with other health systems in the community 3. Existing risk-based contracts with payers including bundled payments 4. A sophisticated EHR and HIE implementation strategy across the continuum of care 5. Clinical integration across the continuum of care 6. Patient-centered medical home with employed or community providers 7. Positive relationships with primary care and specialty care providers in the market 8. Active governance structures that include physician leadership (e.g. PHOs) Factors That Do NOT Differentiate 1. Market share 2. Number of employed physicians 3. Disproportion of the market with government financed health services 4. Financial strength (strong for the entire group) 5. Medicare spending level – low cost areas are not further along 6. High proportion of commercially insured patients 7. Already in active execution of a clinical integration strategy across the system 14 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
  15. 15. Implications for future ACO development
  16. 16. White paper health systems Fairview Health Services is a nonprofit healthcare system based in Minneapolis with more than 50% of its revenue under ACO payments. AtlantiCare, in Southeastern New Jersey, is the region’s largest healthcare organization and largest non-casino employer . Presbyterian Healthcare Services serves Albuquerque and rural New Mexico with physician services at more than 30 different locations. 16 Memorial Healthcare System is a public provider of healthcare services to South Florida. It is the 5th largest public system in the nation. PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
  17. 17. Essential lessons learned Managing populations requires fundamental health delivery change Focus of primary transformation: Aligning clinical w/payment Physician leadership, engagement pivotal in ACO shift Critical success factors Care coordination Executive leadership & governance support Comprehensive & coordinated primary care services, integrated IT Pace of execution limited by payer/physician readiness for value-based participation 17 Market pressures create opportunities for mutually-beneficial partnerships PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
  18. 18. Challenges and policy implications Challenges with physicians, local payers, infrastructure investment, state/federal data regs slows execution Payers should also support ACO participation in medical home & bundled payment programs Work needed with patient engagement, specialist and post-acute care arrangements, and data exchange Ideal pacing unclear: • Slow implementation leaks savings to non-participating payers • Rapid implementation increases risk 18 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
  19. 19. Successful implementation strategies 19 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
  20. 20. Crawl, Walk, Run…But Start Target programs for top 5% utilizers - Atlanticare Begin to change organizational construct - Presbyterian Embedded care managers - Fairview Start with small populations – Memorial ED navigators – Presbyterian Culture, culture, culture – All systems 20 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
  21. 21. Bench or Game Photo credit: nbaarena.com No one has to change. Survival is optional. ~ W. Edwards Deming 21 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
  22. 22. Thank you…

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