ACOS: Where Are We At?

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ACOS: Where Are We At?

  1. 1. Accountable Care Organizations: Where Are We At? HARMONY UNIVERSITY The Provider Unit ofHarmony Healthcare International, Inc. (HHI) Presented by:Kris Mastrangelo, OTR/L, LNHA, MBA President & CEO
  2. 2. “Widen Your Gaze” ~Sherlock HolmesCopyright © 2013 All Rights Harmony Healthcare International, Inc. 2Reserved
  3. 3. Objectives The learner will be able to summarize goals of ACOs The learner will be able to identify and articulate examples of the ACO process The learner will be able to identify strategies for interdisciplinary management of ACOsCopyright © 2013 All Rights Harmony Healthcare International, Inc. 3Reserved
  4. 4. Accountable Care Organizations “It is not the strongest of the species that survive, nor the most intelligent that survive. It is the one that is the most adaptable to change.” ~Charles DarwinCopyright © 2013Reserved All RightsCopyright © 2012 All Rights Harmony HealthcareInternational, Inc. Inc. Harmony Healthcare International, 4Reserved
  5. 5. Accountable Care Organizations “Voluntary groups of physicians, hospitals, and other health care providers that are willing to assume responsibility for the care of a clearly defined population of Medicare beneficiaries attributed to them on the basis of patients’ use of primary care services. If an ACO succeeds in both delivering high-quality care or improving care and reducing the cost of that care below what would otherwise have been expected, it will share in the savings it achieves for Medicare.” The New England Journal of Medicine (NEJM), October 20, 2011 Making Good on ACOs’ Promise – The Final Rule for the Medicare Shared Savings Program Donald M. Berwick MD, Administrator, CMSCopyright © 2013Reserved All RightsCopyright © 2012 All Rights Harmony HealthcareInternational, Inc. Inc. Harmony Healthcare International, 5Reserved
  6. 6. Team Medicine First building blocks of integrated team medicine: Model, data and leadership Create a care team that maximizes impact for patients Build a physician culture of multidisciplinary practiceCopyright © 2013 All Rights Harmony Healthcare International, Inc. 6Reserved
  7. 7. Team Medicine 1. An integrated, flexible physician model “Multispecialty group medical practice maximized physicians’ abilities to care for patients through doctor-to-doctor consultation, through the training and mentoring of young physicians, and through the inherent quality controls built into the group”Copyright © 2013 All Rights Harmony Healthcare International, Inc. 7Reserved
  8. 8. Team Medicine 2. Physician-Friendly Data Yields evidence-based medicineCopyright © 2013 All Rights Harmony Healthcare International, Inc. 8Reserved
  9. 9. Team Medicine 3. Rethink physician leadership “We recruit physicians with a sense that we’re a group practice. We stand for quality. We measure quality and results. We think it’s important that we tell patients we’re going to give them the kind of quality they deserve. You then orient, evaluate, and promote people based on the same set of values and expectations. Eventually you end up with a culture that is very comfortable with a focus on quality, measurement, comparison, and improvement.” Jack Cochran, MDCopyright © 2013 All Rights Harmony Healthcare International, Inc. 9Reserved
  10. 10. Healthy Bones: Tests and Prescriptions to Prevent Problem: In 2010, osteoporosis was the ninth most costly major illness among the top 5% highest cost Medicare beneficiaries In 2005, 2 million fractures cost the United States $17 billion for both acute and long-term care. By 2025, the annual fracture rate is expected to increase by 50% to about 3 million at a cost of $25 billion per year. On average, 24% of patients presenting with a osteoperosis- related fracture die within one year, and the mortality rate of men exceeds women Only 21% of women age 67 or older who have had an osteoporosis-related fracture had a bone mineral density test or a drug prescription to treat or prevent osteoporosis in the six months after the fracture * Information provided by Kaiser PermanenteCopyright © 2013 All Rights Harmony Healthcare International, Inc. 10Reserved
  11. 11. Healthy Bones Solution: Care managers, primary care physicians, and surgeons use daily reports generated from the electronic health record to identify members at risk for osteoporosis and fractures Care managers coordinate care for these patients to close care gaps Working together, the team provides patients with education, screening, treatments, and monitoring as needed. The multidisciplinary team includes: Orthopedic surgeons, endocrinologists, gerontologists, family practitioners, internists, rheumatologists, gynecologists, physical therapists, disease/care managers, radiologists and member educationCopyright © 2013 All Rights Harmony Healthcare International, Inc. 11Reserved
  12. 12. Healthy Bones Impact: Annual bone density screening rates increased by 474% from 2002 to 2009 People on anti-osteoporosis medications increased by 214% from 2002 to 2009 Over 45% reduction in rate of hip fractures (preventing >1400 hip fractures) by 2010 If the Healthy Bones approach were adopted in the United States, the country could achieve a 25% reduction in the rate of hip fractures, preventing 75,000 hip fractures per yearCopyright © 2013 All Rights Harmony Healthcare International, Inc. 12Reserved
  13. 13. Improvement Standard As the New York Times reported on its front page Tuesday, Reuters (10/24, Morgan) reports that the Obama Administration has proposed a settlement to a class-action lawsuit, promising to broaden current Medicare regulations to allow coverage to "maintain the patients current condition or ... prevent or slow further deterioration." Previously, beneficiaries had to demonstrate improvement to continue to receive coverage, the change will likely benefit thousands of Americans with degenerative conditions like multiple sclerosis, Parkinsons, and cerebral palsy. An HHS spokeswoman said the settlement merely "clarifies" current policy, and continued, "We expect no changes in access to services or costs."Copyright © 2013 All Rights Harmony Healthcare International, Inc. 13Reserved
  14. 14. Improvement Standard The case, Jimmo v. Sebelius, resulted in a focus on skilled service delivery in the context of maintenance programs Historically, patients with chronic conditions and anticipated functional deterioration were considered skilled for the establishment of a maintenance program This settlement now allows for coverage of the actual delivery of maintenance therapy by licensed nurses and therapy professionalsCopyright © 2013 All Rights Harmony Healthcare International, Inc. 14Reserved
  15. 15. Improvement Standard Current Medicare skilled guidelines state: The services must be provided with the expectation, based on the assessment made by the physician of the patient’s restoration potential, that the condition of the patient will improve materially in a reasonable and generally predictable period of time, Or the services must be necessary for the establishment of a safe and effective maintenance programCopyright © 2013 All Rights Harmony Healthcare International, Inc. 15Reserved
  16. 16. Improvement StandardThe Proposed Settlement: “Instead, providers, contactors, and adjudicators must recognize “maintenance” coverage and a beneficiary’s need for skilled care that is performed or supervised by professional nurses and therapists.” The manual revisions will clarify that, under the Skilled Nursing Facility, Home Health, and Outpatient Therapy maintenance coverage standards, skilled therapy services are covered when an individualized assessment of the patient’s clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist (“skilled care”) are necessary for the performance of a safe and effective maintenance program Such a maintenance program to maintain the patient’s current condition or to prevent or slow further deterioration is covered so long as the beneficiary requires skilled care for the safe and effective performance of the programCopyright © 2013 All Rights Harmony Healthcare International, Inc. 16Reserved
  17. 17. Improvement Standard Quality Care is our number one objective Harmony embraces the OBRA 87 regulations which require facilities to provide services to meet “the highest practicable physical, medical and psychological well- being” of every resident This practice has been our standard since its inception. This new Improvement Standard, further supports our core values as providers of specialized services to the post acute care population.Copyright © 2013 All Rights Harmony Healthcare International, Inc. 17Reserved
  18. 18. Continuum of Care Post Discharge “When the asthma attack is done, the patient goes home, and the game’s over. No one is accountable for any of the follow-up care.” George Halvorson , Chairman & CEO Kaiser PermanenteCopyright © 2013 All Rights Harmony Healthcare International, Inc. 18Reserved
  19. 19. Integrated Follow-up Call patient to make sure they are taking their meds Call patient to make sure they are avoiding any allergic triggerCopyright © 2013 All Rights Harmony Healthcare International, Inc. 19Reserved
  20. 20. Prevention Problem: One in eight women develops breast cancer, and nearly 40,000 die from it every year Regular mammograms – which can identify breast cancer early, when it is most treatable – can reduce breast cancer deaths by more than 30 percent The United States Preventive Services Task Force recommends screenings every one to two years for women aged 50-74 years. However, current screening rates fall short of these guidelines, and they have been steadily decliningCopyright © 2013 All Rights Harmony Healthcare International, Inc. 20Reserved
  21. 21. Prevention Through the Proactive Office Encounter program, the health care team identifies and targets patients with care gaps (including whether a patient is due for a mammography) or chronic medical conditions and encourages them to actively participate in own careCopyright © 2013 All Rights Harmony Healthcare International, Inc. 21Reserved
  22. 22. Proactive Office Encounter and Mammography The program engages all members of the clinical care team in a coordinated and collaborative effort to encourage and support patient health Automated creation of care checklists for all patients whose records indicate gaps in care At every point of contact with patients, clinical care teams review checklists and help patients get the care they need Based on identified gaps in care, medical assistants during office visits discuss with patients the need for preventive screenings and routine care, such as cancer screenings and tests for abnormal blood sugar or cholesterol levels, and schedule appointments on the spotCopyright © 2013 All Rights Harmony Healthcare International, Inc. 22Reserved
  23. 23. Proactive Office Encounter Also Helps Along with other concurrent improvement initiatives, the Proactive Office Encounter has contributed to: 30% increase in colon cancer screening 11% increase in breast cancer screening 5% increase in cervical cancer screening 13% improvement in cholesterol controlCopyright © 2013 All Rights Harmony Healthcare International, Inc. 23Reserved
  24. 24. Data, Data, Data “You cannot make bricks without clay.” ~Sherlock HolmesCopyright © 2013 All Rights Harmony Healthcare International, Inc. 24Reserved
  25. 25. Better Patient Management Using Evidence-Based Medicine Patient Registry and Concurrent Tracking System Identifies all members in the population Risk stratifies population for targeting interventions and resources Tracks and monitors each patient for key indicators (lab, pharmacy, encounters, clinical indicators) Easy access (web-based)Copyright © 2013 All Rights Harmony Healthcare International, Inc. 25Reserved
  26. 26. Better Patient Management Using Evidence-Based Medicine Care Management Systems Flags/alerts Supports telephone management and documentation Identifies all members in the population Supports Automated Clinical Decision Support and Practice Tools In-reach/outreach Health Education and Self-Care SupportCopyright © 2013 All Rights Harmony Healthcare International, Inc. 26Reserved
  27. 27. Evidence-based Medicine/Prevention Proactive care instead of reactive care Patients who have the largest “gaps” in recommended care do not routinely visit their primary care physicians Specialty clinics must play a role to achieve optimal results. Fewer than 40% of patients needing a mammogram or testing for diabetes visited their primary care physician. Appointments can be made on the spot or referrals generated so gaps can be readily addressedCopyright © 2013 All Rights Harmony Healthcare International, Inc. 27Reserved
  28. 28. Beyond the Patient: Widen Your Gaze Focus on primary care and prevention, and addressing chronic disease requires looking at larger communitywide issues Behavioral factors are as important as specific treatments: better diet, promoting physical activity, and reducing smoking Community education for adults and children in recognizing bad health habits and taking action to create a better health outlookCopyright © 2013 All Rights Harmony Healthcare International, Inc. 28Reserved
  29. 29. ACOs: Strategies for Interdisciplinary Management To be continued…To hear more about these introductory slides,and all that is still to come, please join me: Date: Friday, May 3rd Time: 10:15 a.m. – 11:45 a.m. Kris Mastrangelo, President & CEO Harmony Healthcare International http://www.harmony-healthcare.com/ Tweet me your questions! @KrisMastrangeloCopyright © 2013 All Rights Harmony Healthcare International, Inc. 29Reserved

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