FLAACOs 2014 Conference - The Healthcare Movement - Survival on the ACO Frontier
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The Healthcare Movement - Survival on the ACO Frontier presented by John Schmitt, Ph.D. at the FLAACOs Fall 2014 Conference
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FLAACOs 2014 Conference - The Healthcare Movement - Survival on the ACO Frontier
- 1. The Healthcare Movement =Survival on the ACO Frontier= September 29, 2014 RELIANCE CONSULTING GROUP Presented by : John P. Schmitt, Ph.D. RCG Managing Director
- 2. • Introduction – The Healthcare Movement – Frontier Successes & Disasters • 5 Key ACO Success Factors • 5 Key ACO Operational Changes • Pathway to Shared Savings • ACO Tools and Resources • Q & A AGENDA 2
- 3. 3 INTRODUCTION The Westward Movement The Healthcare Movement
- 4. 4 INTRODUCTION The Homestead Act of 1862 required a three step process: 1. File an Application 2. Improve the Land 3. File for deed of title Requirements: • Must be at least 21 years old or the head of a household • Must have never taken up arms against the U.S. Government • Must reside on land for five years • Must show evidence of having made improvements MSSP ACO Process: 1. File an Application 2. Improve Population Health 3. Attribute Patient Panel
- 6. MSSP: First-Year Performance Results Successes • CMS reported 53 of 204 MSSP-ACOs (26%) achieved bonus payments of $300M+ (of those 12 in FL earned $52M) • On average, the ACOs showed overall improvement on 30 of the 33 quality measures Disasters • 4 of the ACOs forfeited $22M+ by failing quality reporting requirements • 1 ACO overspent its target by $10M and owed shared losses of $4M Source: “Fact Sheets: Medicare ACOs Continue to Succeed in Improving C are, Lowering Cost Growth”, www.CMS.gov September 16, 2014 INTRODUCTION 6
- 7. Pioneer ACO Report: Program Defections • With the withdrawal of Sharp Healthcare, 10 of the original 32 Pioneer ACOs (31%) have left the program after two years of participation. • 13 of the original 32 Pioneer ACOs (40%) generated enough savings to keep $76.1 million “The results were promising but hardly definitive. What I take from that is not that we will be successful, but that we can be” - Michael Chernew, Harvard University professor of healthcare policy Source: “Will More Pioneer ACOs Defect?”, HealthLeaders Media, September 2, 2014 INTRODUCTION 7
- 8. CMS Report: Results of MSSP ACOs (activated in 2012) • 60 of the 114 CMS ACOs (53%) reported no decrease in health spending below targets during their first 12 months. • 29 of the 114 CMS ACOs (25%) reduced spending enough during the first 12 months to keep some of the savings INTRODUCTION 8 Source: “ACOs Show Uneven Progress”, Greg Freeman, HealthLeaders Media, April 7, 2014
- 9. # 1: Practice Growth 2004: Expand market share, broaden services, exert pricing leverage, secure physicians and increase utilization 2014: Expand covered lives, establish alliances, compete on outcomes, minimize total cost, and increase access hours 5 KEY ACO SUCCESS FACTORS – 2004 vs 2014 9 2004 2014
- 10. #2: Performance Metrics 2004: Service line volume, FFS revenue, pricing growth, process efficiency, practice cost/RVS 2014: Share of covered lives, geographic reach, risk- based revenues, evidence-based outcomes, total cost of care, PCMH/PCSP measures 5 KEY ACO SUCCESS FACTORS – 2004 vs 2014 10 2004 2014
- 11. #3: Contracting Targets 2004: Government purchasers, commercial payer reps, individuals 2014: Government ACA programs (MSSP ACOs), commercial payer population health managers (Commercial ACOs), self-insured employers, narrow networks 5 KEY ACO SUCCESS FACTORS – 2004 vs 2014 11 2004 2014
- 12. #4: Critical Infrastructure 2004: Office staff, ambulatory surgery centers, ancillary services, clinical technology 2014: Physician-led care teams, care management staff & systems, health IT analytics, contracted specialists, hospitalist relationships, community resources, pharmacist collaborators 5 KEY ACO SUCCESS FACTORS – 2004 vs 2014 12 2004 2014
- 13. #5: Competitive Strategies 2004: Service line competition, referral channels, physician member loyalty 2014: Provide comprehensive care, patient satisfaction surveys, gaps-in-care reduction, total cost performance, medical home recognition 5 KEY ACO SUCCESS FACTORS – 2004 vs 2014 13 2004 2014
- 14. VALUE-BASED CONTRACTING CULTURE POSITIONING 14 ACO Operational Changes Source: “Primary Care Redesign” by Michael Zeis, HealthLeaders, April 2014
- 15. 15 5 Key ACO Operational Changes #1: Mission Commitment: Triple Aim • Medicare Shared Savings Program (MSSP) rewards participants that: – Lower their healthcare costs – Meet performance standards on quality of care – Improve population health Source: https://www.cms.gov/Medicare/Medicare-Fee-For-Service-Payment/sharedsavingsprogram/index.html
- 16. 16 # 2: Physician Culture Change (Engagement & Commitment) • Representation: Governance / Board of Directors • Membership: Medical committees • Appointments: CMOs, regional MD directors, MD department chairs • Participation: Operational meetings & conference calls • Commitment: Culture change (PCMH readiness) Detractors NegativePositive Champions # of ACO Physicians PCMHReceptivity 5 Key ACO Operational Changes
- 17. 17 SIX THINGS PAYERS WANT #3: Population Health Management (System Components & Tools) Source: Accountable Care Solutions Group (ACSG) & the American Health Data Institute (AHDI) 1.) Dashboards 2.) Patient Registries 3.) Best Practices 4.) Care Coordinators 5.) Patient Engagement Surveys 5 Key ACO Operational Changes
- 18. 18 PATIENT POPULATION GOAL OF SERVICE INTERNAL CARE TEAM INFORMATIONAL RESOURCES EXTERNAL CARE TEAM Healthy Patients Preventative Care PCP Mid-Level provider RN LPN/MA PSR Self Management Tool EMR IT Reports Quality Data Patient Feedback N/A Acute Patients Episodic Care PCP Mid-Level provider RN LPN/MA PSR Care Coordinator E-Visit Feedback Medication Management EMR IT Reports Quality Data Patient Feedback Specialists ER & Urgent Care Hospitalists Home Health Providers Social Workers Mental Health Providers Community Resources Chronic Patients Chronic Care PCP Mid-Level provider RN LPN/MA PSR Care Coordinator E-Visit Feedback Medication Management EMR IT Reports Quality Data Patient Feedback Specialists ER & Urgent Care Hospitalists Home Health Providers Social Workers Mental Health Providers Community Resources Case Managers End of Life Patients Palliative Care PCP Mid-Level provider RN LPN/MA Caregiver Care Coordinator E-Visit Feedback Medication Management EMR IT Reports Quality Data Patient Feedback Specialists Home Health Providers Social Workers Mental Health Providers Community Resources #4: Medical Home Infrastructure Copyright 2013 RCG Intellectual Property. All rights reserved 5 Key ACO Operational Changes
- 19. 19 #5: Quality & Cost Reporting Systems • EMR & MU: Input & protocol compliance • Dashboard Implementation: Tracking & reporting • Action Plans: Development & execution • Quality Metrics Reporting: ACO 33 measures • Continuous System: Results & improvement 5 Key ACO Operational Changes
- 20. Tracking & Reporting Feedback ACO INFORMATION & REPORTING 20 ACO Members practice 2 practice 3 practice 1 ACO Payers Commercials Self Insured Employers CMS State & Others IT Data Warehouse Claims Data EMR Clinical Data ACO Membership Reports Care Management Reports = PCMH Recognition == Cost & Quality Data = ACO Administration Reports
- 21. PATHWAY TO SHARED SAVINGS 21 Operational Resources Triple Aim Mission Support Operational Contribution PCMH Teams & External Team support Delivery of cost-effective & quality healthcare at practice sites Meet cost & quality performance requirements at site level IT Data: EMR, EHR, HIE, & MU Cost & quality data reporting: Dashboards, registries, & reports Medical Expense: Quality of Care: Population Health: Care Management Program: Care Coordinators & Social Workers Population Health Management: Patient-specific transitions, compliance, follow-ups, etc. Patient & Provider- specific interventions Governance & Administration: Board members, CEO, CMO, CFO, COO, etc. Policies & Procedures: Clinical standards, MSE management, patient-centric culture, physician comp. & payer contracting Operational & Financial decision making Result: SHARED SAVINGS DISTRIBUTIONS
- 22. •st “We struck shared savings!!” PATHWAY TO SHARED SAVINGS 22
- 23. 23 Shared Savings Potential There are four main reimbursement models used by accountable care organizations, according to a survey conducted by Healthcare Intelligence Network: 1. Fee for service, care coordination and shared savings: 37% 2. Shared savings: 22.2% 3. Pay for performance: 11.1% 4. Fee for service and care coordination: 11.1% 5. Bundled/episodic payment: 3.7% Survey data based on responses from 138 healthcare organizations participating in ACOs Source: Heather Punke, “Top 4 Reimbursement Models”, Beckers Hospital Review, December 31, 2013 59.2% PATHWAY TO SHARED SAVINGS
- 24. 24 Commercial Payer: Shared Savings Model PATHWAY TO SHARED SAVINGS
- 25. 25 ACO Tools & Resources Westward Movement Tools Healthcare Movement Tools 1864 2014
- 26. 26 ACO TOOLS & RESOURCES
- 28. 28 Q & A
- 29. RELIANCE CONSULTING GROUP For more information about ACO Development/Contracting, visit Reliance Consulting Group at: www.RelianceCG.com Or Contact Dr. Schmitt directly: jschmitt@reliancecg.com The Healthcare Movement =Survival on the ACO Frontier=