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Bob Roth
Managing Partner, Cypress HomeCare Solutions
(602) 264-8009 bobroth@cypresshomecare.com
John Marchica
President/C...
• ACOs and Value-Based Care
Defined
• Creating a winning value
proposition: The Readmission Story
• Working with ACOs
• Ta...
ACOs and VALUE-BASED CARE
“Health information about total
populations is a prerequisite for
sound decision-making and planning
in the health care fi...
GENESIS OF ACOs
• Accountable Care Organization coined by Dr. Elliott
Fisher (Dartmouth) in 2005 at a MedPac meeting to
de...
• In general, comprised of physician groups,
health systems, hospitals, insurers—and any
combination of these providers
• ...
Patient
Experience
Lower Costs
Population
Health
Achieving all
Three
•Improve the health of
populations of people
•Improve...
ACO MODELS
• Medicare: Pioneer, Shared Savings Program,
Advance Payment, Investment, Next Generation
• Commercial
• Medica...
HospitalHospital Hospital
MONTEFIORE HEALTH
SYSTEM
Care
Management
Organization
University
Behavioral
Associates
Managed
B...
2014 Actual: $356M
Difference: $13M
Montefiore’s cut: $8.4M (63% of total savings)
SHARED SAVINGS
2014 Target: $369M
Per Be...
INTEGRATED HEALTH NETWORK OF WISCONSIN
Agnesian HealthCare
Columbia St. Mary’s
Froedtert & The Medical College of Wisconsi...
INTEGRATED HEALTH NETWORK OF WISCONSIN
• Founded on the idea that “coopetition”
would optimize patient care
• Wisconsin ma...
INTEGRATED HEALTH NETWORK OF WISCONSIN
• IHN’s platform aggregates disparate
data from 3.1 million individuals
• Includes ...
INTEGRATED HEALTH NETWORK OF WISCONSIN
• 2015 case study: 3,500 IHN members
✓Identify high-risk members for care navigatio...
INTEGRATED HEALTH NETWORK OF WISCONSIN
Forecasted 2014
& 2015 Spend
Increase
Actual %
Spend
Increase
% Savings
Actual vs.
...
VALUE-BASED CARE
• Maximizing value for patients: the best
care at the lowest cost
• Move away from supply-driven system
t...
PRICE
QUALITY
VALUE-BASED CARE
Disruptive Transformation and the Accountable Care Organization
Presentation by Bob Roth, M...
• “Single payment to a provider or health care facility
for all services to treat a given condition or provide a
given tre...
“Have you had any formal meetings or discussions with an ACO?”
PercentYesResponse
0
20
40
60
80
Home Health Hospice Privat...
“Do you currently have a preferred provider relationship with an ACO?”
PercentYesResponse
0
12.5
25
37.5
50
Home Health Ho...
“Have you ever entered into a risk sharing agreement?”
PercentYesResponse
0
12.5
25
37.5
50
Home Health Hospice Private Du...
“Financially speaking, what was the effect on your business?”
REVENUE
Home Health
Hospice
Private Duty
Percentage Response...
“Financially speaking, what was the effect on your business?”
NET PROFIT
Home Health
Hospice
Private Duty
Percentage Respo...
“Do you currently have a contractual relationship with…?”
PercentYesResponse
0
7.5
15
22.5
30
Hospital/Health System Skill...
24Hr HomeCare
• Question: Where does in-home care services fit in the new
world of bundled payments and value-based care?
...
24Hr HomeCare: LESSONS LEARNED
• Hospitals, ACOs and payers are willing to pay out of pocket for home
care services for hi...
I think we are interested because at the end of the
day, if you don't manage those patients well, you're
going to wind up ...
I'd like to see the patients that they're monitoring,
readmission rates. That's a big one I'd like to see. I'd like to
see...
Domain: Patient/Caregiver Experience
ACO-1 Getting timely care, appointments, and information
ACO-2 How well your provider...
Domain: Patient/Caregiver Experience
ACO-1 Getting timely care, appointments, and information
ACO-2 How well your provider...
Domain: Care Coordination and Patient Safety
ACO-8 Risk standardized all condition readmission
ACO-9
Ambulatory Sensitive ...
Domain: Preventive Health
ACO-14 Preventive care and screening: influenza immunization
ACO-15 Pneumonia vaccination status...
CREATING A WINNING VALUE
PROPOSITION
Master	Marketing	Plans	that	Attract	New	Clients
1. Utilizing Home Care as a part of the solution to
transitioning a patient from a hospital or post
acute setting to the h...
REDUCING HOSPITAL READMISSIONS:

Partnering for success
State of the Industry: What has changed?
20% readmission rate = $1...
CMS reports that up to 75% of re-admissions to
hospitals are potentially preventable.*

	(New England Journal of Medicine ...
Hospitals are being financially penalized 3% of each
payment for readmission for the following diagnosis:

• Congestive he...
DEVELOPING A STRATEGY TO
REDUCE READMISSIONS
“Not all of the responsibility is the hospital’s” said Arnie
Kimmel, CEO, MetroSouth Medical Center in Blue Island, IL,
re...
The Goal: Disease or condition management during
the 30 day post acute discharge and beyond
• Who will help the patient un...
Older adults are particularly vulnerable to poor
transition outcomes:
• Multiple medical conditions
• Multiple care provid...
Illinois Study* – 83% of patients had problems identified
by the social worker during the assessment at 2 days
post-discha...
Gut reaction – Medicare Home Health will take care of all of this
Reality – Medicare nurse – 30 minute visit, 2-3x/week fo...
Basics of Private Duty Homecare

• ADL’s
• Meal Prep
• Laundry/linens
• Light Housekeeping
• Transportation
Historically s...
Role of Private Duty Homecare in delivering high quality care
and reducing readmissions:

• Private Duty Homecare aides sp...
“It costs too much.”

It will cost you more if the patient gets readmitted to the hospital.
“The patient is already gettin...
“The patient is going to rehab.”

Rehab typically lasts around 20 days, leaving 10 days left when they could
still be read...
• Private duty homecare needs to share the
responsibility of preventing hospital readmissions

• Private duty homecare is ...
WORKING WITH ACOs
CHANGING YOUR SALES PARADIGM
• Multiple decision makers

• Complex problems to solve

• Frequently create buying criteria
...
MILLER HEIMAN’S 4 BUYING INFLUENCES
User Buyer

Economic Buyer

Technical Buyer

Coach
Selling complex solutions is
define...
THE RELATIONSHIP LADDER
CHAMPION

PARTNER

CLIENT

VENDOR

PROSPECT
T
R
U
S
T
“You can get what you want by giving them wh...
• The stereotypes are true: the industry is viewed with
skepticism, cynicism and distrust

• BEHAVIORS build or erode trus...
Collecting 53 data points on every client
• “Does the client have this diagnosis…”

- CAD

- COPD

- Depression/Anxiety

-...
© 2016 Darwin Advisory Partners, LLC. Darwin Health is a division of Darwin Advisory Partners, LLC.
ACOs, Philadelphia-Cam...
© 2016 Darwin Advisory Partners, LLC. Darwin Health is a division of Darwin Advisory Partners, LLC.
Top IDNs, Detroit-Warr...
Advocate Physician Partners Accountable Care (MSSP)
149,633 Medicare beneficiaries (2015); 4,000 physicians

AdvocateCare A...
Pioneer ACO Quality Scorecard—Beth Israel Deaconess Care Organization
Value-Based Initiatives
© 2016 Darwin Advisory Partn...
© 2016 Darwin Advisory Partners, LLC. Darwin Health is a division of Darwin Advisory Partners, LLC.
TABLE OF CONTENTS
OCHS...
Measure Shea Lincoln Osborne
Thompson
Peak
Deer
Valley
National
Rate
All Cause Hospital-Wide Readmission 14.50% 15.30% 15....
DRG Description
Total
Claims
Readmission
Rate
Total Days
Avg Length
of Stay
(Days)
470 MAJOR JOINT REPLACEMENT OR REATTACH...
Patient
Experience
Lower Costs
Population
Health
Achieving all
Three
• Improve the health of
populations of people
• Impro...
ALIGN YOUR MESSAGE
Preventive Health
ACO-14
Preventive care and
screening: influenza
immunization
ACO-15
Pneumonia vaccinat...
Know your ROI: What is the
Lifetime Value of a client?
Know the ACO
Market Potential:
How many covered
beneficiaries?
$/hou...
ACO Name
States where
beneficiaries reside
Number of
Beneficiaries
Readmission
%
Atlantic ACO New Jersey, Pennsylvania 73,69...
ACO Name
States where
beneficiaries reside
Number of
Beneficiaries
Atlantic ACO New Jersey, Pennsylvania 73,694
Palm Beach A...
Thank you for attending this session.
Please go the Annual Leadership Conference App
and complete the survey for this sess...
Disruptive Transformation and the Accountable Care Organization
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Disruptive Transformation and the Accountable Care Organization

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Presentation by John Marchica (Darwin Health) and Bob Roth (Cypress HomeCare Solutions) at the Home Care Association of America Leadership Conference, Sep. 30, 2016.

Published in: Healthcare
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Disruptive Transformation and the Accountable Care Organization

  1. 1. Bob Roth Managing Partner, Cypress HomeCare Solutions (602) 264-8009 bobroth@cypresshomecare.com John Marchica President/CEO, Darwin Health (480) 652-0008 jm@darwinhealth.net “Disruptive Transformation and the Accountable Care Organization”
  2. 2. • ACOs and Value-Based Care Defined • Creating a winning value proposition: The Readmission Story • Working with ACOs • Targeting and approaching the right ACO partner • Discussion, Q&A AGENDA Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  3. 3. ACOs and VALUE-BASED CARE
  4. 4. “Health information about total populations is a prerequisite for sound decision-making and planning in the health care field. Experience with a population-based health data system in Vermont reveals that there are wide variations in resource input, utilization of services, and expenditures among neighboring communities.” - John E. Wennberg Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  5. 5. GENESIS OF ACOs • Accountable Care Organization coined by Dr. Elliott Fisher (Dartmouth) in 2005 at a MedPac meeting to describe “Groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care” • Fisher and former Medicare and FDA chief Mark McClellan (Brookings), along with Jonathan Gruber (M.I.T.), were highly influential in shaping health care reform and included ACOs as a key piece of the ACA • Dartmouth-Hitchcock Medical Center and nine other IDNs part of a Medicare demonstration project testing the concept (2009-2012) Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  6. 6. • In general, comprised of physician groups, health systems, hospitals, insurers—and any combination of these providers • In most cases, they form a separate LLC • Contract states some form of baseline for quality and budget, set annually • Bonus for beating budget, penalty for exceeding budget • ACOs are NOT managed care, like an HMO • Mission-driven to achieve the Triple Aim ACOs DEFINED Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  7. 7. Patient Experience Lower Costs Population Health Achieving all Three •Improve the health of populations of people •Improve the patient experience with healthcare •Reduce per-capita healthcare costs THE TRIPLE AIM Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  8. 8. ACO MODELS • Medicare: Pioneer, Shared Savings Program, Advance Payment, Investment, Next Generation • Commercial • Medicaid • Employer • Specialty • Local Government ACO TYPES • Physician-Led • Hospital-Led • Insurer-Led Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  9. 9. HospitalHospital Hospital MONTEFIORE HEALTH SYSTEM Care Management Organization University Behavioral Associates Managed Behavioral Care IPA Montefiore IPA Department of PsychiatryMontefiore Home Care EXAMPLE: MONTEFIORE • Montefiore has largest commercial agreement with UnitedHealthcare - 1,000 affiliated facilities and 4,000 docs • Also has an ACO Agreement with Empire BCBS, started in 2012 • Pioneer ACO: 40,287 assigned beneficiaries, and 2,200 docs Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  10. 10. 2014 Actual: $356M Difference: $13M Montefiore’s cut: $8.4M (63% of total savings) SHARED SAVINGS 2014 Target: $369M Per Beneficiary: $549 HOW IT WORKS Important: Wouldn’t have earned shared savings if quality goals were not met! Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  11. 11. INTEGRATED HEALTH NETWORK OF WISCONSIN Agnesian HealthCare Columbia St. Mary’s Froedtert & The Medical College of Wisconsin Hospital Sisters Health System Ministry Health Care SSM Health Wheaton Franciscan Healthcare • 8,400 Caregivers • 1,180 Clinics • 53 hospitals • 100 associated providers, including DME, SNF & HHC FoundingHealthSystems Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  12. 12. INTEGRATED HEALTH NETWORK OF WISCONSIN • Founded on the idea that “coopetition” would optimize patient care • Wisconsin market fragmented • IHN’s formation was an alternative to mergers and acquisitions, allowing for economies of scale • Four key areas of focus: - Centralized data analytics - Patient care coordinated across member health systems - Emphasis on patient/provider relationships - Shared contracting capabilities ✓ Competition promotes innovation and lower costs ✓ Collaboration drives best practice and improved efficiency ✓ Shared data and management infrastructure ✓ Unique contracting structure Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  13. 13. INTEGRATED HEALTH NETWORK OF WISCONSIN • IHN’s platform aggregates disparate data from 3.1 million individuals • Includes clinical data from patients in all eight health systems • Comprehensive payer claims data provides a 360° view of approximately 200,000 lives managed through 12 contracts • IHN’s care model requires clinical data, claims data and financial data ✓ Clinical claims submitted to payers ✓ EMR – vitals and health maintenance ✓ Laboratory ✓ Eligibility ✓ Post-adjudicated claims ✓ Risk score ✓ Transitions of care outreach ✓ Complex conditions care coordination ✓ Frequent flier outreach ✓ Care gap closure Source: Kurt Janavitz, “Moving Beyond the ACO: Four ‘Game-Changing’ Approaches to Value-Based Contracting.” Adapted from July 17, 2016 presentation from Janavitz at the Health Forum Leadership Summit. Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  14. 14. INTEGRATED HEALTH NETWORK OF WISCONSIN • 2015 case study: 3,500 IHN members ✓Identify high-risk members for care navigation ✓Align with IHN Member system ✓Contact member ✓Schedule PCP visit ✓Correctly code visit to minimize risk adjustment variability • Results after one year: ✓Readmissions declined below national expected rate ✓Breast cancer screenings up 7% ✓Colorectal cancer screenings up 5% ✓Diabetes screenings up 4% ✓Increase in generic prescriptions (2%) Total Spend Inpatient Outpatient Physician Pharmacy Non-engaged patients 10% 2% 17% 0% 20% Engaged patients -26% -40% 4% -14% 14% Percent spending change over 1-year period, 2014-2015 Source: Kurt Janavitz, “Moving Beyond the ACO: Four ‘Game-Changing’ Approaches to Value-Based Contracting.” Adapted from July 17, 2016, presentation by Janavitz at the Health Forum Leadership Summit. Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  15. 15. INTEGRATED HEALTH NETWORK OF WISCONSIN Forecasted 2014 & 2015 Spend Increase Actual % Spend Increase % Savings Actual vs. Forecast Savings per Employee Total Savings 2014 & 2015 Health System 1 21.0% 1.3% 19.5% $3,473 $23,113,393 Health System 2 15.6% 2.1% 13.2% $2,497 $18,119,039 Conclusion: significant savings were achieved in calendar years 2014 and 2015 for two of IHN’s Member self-insured groups. The most significant factors were reduced readmissions and emergency room utilization. Source: Kurt Janavitz, “Moving Beyond the ACO: Four ‘Game-Changing’ Approaches to Value-Based Contracting.” Adapted from July 17, 2016, presentation by Janavitz at the Health Forum Leadership Summit. Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  16. 16. VALUE-BASED CARE • Maximizing value for patients: the best care at the lowest cost • Move away from supply-driven system to patient-centric system • Move away from volume and profitability of services to patient outcomes • Move away from fragmented care to coordinated care • Right person, right place, right time “It’s time for a fundamentally different strategy.” - Michael Porter VALUE = QUALITY COST Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  17. 17. PRICE QUALITY VALUE-BASED CARE Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  18. 18. • “Single payment to a provider or health care facility for all services to treat a given condition or provide a given treatment. Providers assume financial risk for the cost of services for a particular treatment or condition, as well as costs associated with preventable complications.” (Health Affairs 1/15) • Bundled payment can be triggered by a hospitalization (such as CMS BPCI) or by a diagnosis (heart failure, diabetes) • Bundles work best for procedures or conditions with measurable and somewhat predictable outcomes BUNDLED PAYMENTS Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  19. 19. “Have you had any formal meetings or discussions with an ACO?” PercentYesResponse 0 20 40 60 80 Home Health Hospice Private Duty 39 43 72 June 2016, n=63 Source: Darwin Health Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  20. 20. “Do you currently have a preferred provider relationship with an ACO?” PercentYesResponse 0 12.5 25 37.5 50 Home Health Hospice Private Duty 6 20 33 June 2016, n=63 Source: Darwin Health Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  21. 21. “Have you ever entered into a risk sharing agreement?” PercentYesResponse 0 12.5 25 37.5 50 Home Health Hospice Private Duty 9 6 28 June 2016, n=63 Source: Darwin Health Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  22. 22. “Financially speaking, what was the effect on your business?” REVENUE Home Health Hospice Private Duty Percentage Response 0 25 50 75 100 0 0 60 33 0 0 66 100 40 Increased Decreased Stayed the Same June 2016, n=63 Source: Darwin Health Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  23. 23. “Financially speaking, what was the effect on your business?” NET PROFIT Home Health Hospice Private Duty Percentage Response 0 25 50 75 100 60 0 60 15 0 10 0 100 30 Increased Decreased Stayed the Same June 2016, n=63 Source: Darwin Health Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  24. 24. “Do you currently have a contractual relationship with…?” PercentYesResponse 0 7.5 15 22.5 30 Hospital/Health System Skilled Nursing/Rehab Health Plan/MCO 2424 18 June 2016, n=33 Source: Darwin Health PRIVATE DUTY ONLY Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  25. 25. 24Hr HomeCare • Question: Where does in-home care services fit in the new world of bundled payments and value-based care? • First MHC contract in 2012 (ongoing) - High-risk patients selected by payer to receive home care for the first 24 hours following discharge - High-risk patients sent to home care if refuses SNF or don’t meet the criteria for SNF - Provided the payer a discount for services, no risk - Tracking at 7% readmission rates • Bundled payment for joint replacement with HealthSouth - 60-day period - $1000 per patient • Currently about 20 MHC and hospital relationships for “funded care” in Orange County, AZ and TX Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  26. 26. 24Hr HomeCare: LESSONS LEARNED • Hospitals, ACOs and payers are willing to pay out of pocket for home care services for high-risk patients and to prevent readmissions • Collect your data, as difficult as it may be • Build the right relationships over time to establish trust and confidence • Need a warm introduction and a capable workforce • Invest in strategic research and development! • Establish criteria with your partner: teach the case managers • Sometimes meet patient in the hospital • Always get a signed agreement for 30 day minimum • Look for clients with little support in the home: establish this up front with your partner Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  27. 27. I think we are interested because at the end of the day, if you don't manage those patients well, you're going to wind up paying fines or get denials or be in a penalty phases. There is a little bit of money that we are willing to pay to make sure this happens. Source: Darwin Health personal interview, January 29, 2016 “Would you be willing to come out-of-pocket to pay for non-medical home care?” ONE HOSPITAL CEO SAYS… Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  28. 28. I'd like to see the patients that they're monitoring, readmission rates. That's a big one I'd like to see. I'd like to see for ones that they're treating with wound, I'd like to see their would healing rates. Clinical types of how many visits they're providing on average per patient because there are metrics to see what the appropriate number of visits should be. Are there any national rankings or any national databases that they submit to or state databases? Are they on specific prohibited lists? Things like that. Source: Darwin Health personal interview, January 29, 2016 “What kind of metrics would you like to see? Would you like to see a financial argument? What do they come to the table with?” ONE HOSPITAL CEO SAYS… Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  29. 29. Domain: Patient/Caregiver Experience ACO-1 Getting timely care, appointments, and information ACO-2 How well your providers communicate ACO-3 Patients’ rating of provider ACO-4 Access to specialists ACO-5 Health promotion and education ACO-6 Shared decision making ACO-7 Health status/functional status Domain: Care Coordination and Patient Safety ACO-8 Risk standardized all condition readmission ACO-9 Ambulatory Sensitive conditions admissions: COPD or asthma in older adults ACO-10 Ambulatory sensitive conditions admissions: heart failure (HF) ACO-11 Percent of primary care physicians who successfully qualify for an EHR program incentive payment ACO-12 Medication reconciliation ACO-13 Falls: screening for future fall risk Domain: Preventive Health ACO-14 Preventive care and screening: influenza immunization ACO-15 Pneumonia vaccination status for older adults ACO-16 Body mass index screening and follow-up ACO-17 Tobacco use: screening and cessation Intervention ACO-18 Screening for clinical depression and follow-up plan ACO-19 Colorectal cancer screening ACO-20 Breast cancer screening ACO-21 Screening for high blood pressure and follow-up documented Domain: At-risk Population—Diabetes ACO-22 High blood pressure control ACO-23 Low density lipoprotein control ACO-24 Hemoglobin A1c control ACO-25 Daily aspirin or anti-platelet medication use for patients with diabetes and IVD ACO-26 Tobacco non-use ACO-27 Diabetes: hemoglobin A1c poor control Domain: At-risk Population—Hypertension ACO-28 Controlling High Blood Pressure ACO-29 Ischemic vascular disease: complete lipid panel and LDL control ACO-30 Ischemic vascular disease: use of aspirin or another antithrombotic ACO-31 Heart failure: beta-blocker therapy for left ventricular systolic dysfunction (ACO-31) ACO-32 Drug therapy to lower LDL ACO-33 ACE inhibitor or ARB therapy—diabetes or left ventricular systolic dysfunction Composite Scores Diabetes Management Composite (ACO 22-26) Coronary Artery Disease Composite (ACO 32-33) Which metrics can you improve? That leads to the Value Proposition… ACO QUALITY METRICS Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  30. 30. Domain: Patient/Caregiver Experience ACO-1 Getting timely care, appointments, and information ACO-2 How well your providers communicate ACO-3 Patients’ rating of provider ACO-4 Access to specialists ACO-5 Health promotion and education ACO-6 Shared decision making ACO-7 Health status/functional status ACO QUALITY METRICS Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  31. 31. Domain: Care Coordination and Patient Safety ACO-8 Risk standardized all condition readmission ACO-9 Ambulatory Sensitive conditions admissions: COPD or asthma in older adults ACO-10 Ambulatory sensitive conditions admissions: heart failure (HF) ACO-11 Percent of primary care physicians who successfully qualify for an EHR program incentive payment ACO-12 Medication reconciliation ACO-13 Falls: screening for future fall risk ACO QUALITY METRICS Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  32. 32. Domain: Preventive Health ACO-14 Preventive care and screening: influenza immunization ACO-15 Pneumonia vaccination status for older adults ACO-16 Body mass index screening and follow-up ACO-17 Tobacco use: screening and cessation Intervention ACO-18 Screening for clinical depression and follow-up plan ACO-19 Colorectal cancer screening ACO-20 Breast cancer screening ACO-21 Screening for high blood pressure and follow-up documented ACO QUALITY METRICS Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  33. 33. CREATING A WINNING VALUE PROPOSITION
  34. 34. Master Marketing Plans that Attract New Clients
  35. 35. 1. Utilizing Home Care as a part of the solution to transitioning a patient from a hospital or post acute setting to the home 2. Communication is paramount to the success of making this transition 3. Strategies together will keep the patient, in our case client, from re-entering your facility PREVENTING HOSPITAL READMISSIONS Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  36. 36. REDUCING HOSPITAL READMISSIONS:
 Partnering for success State of the Industry: What has changed? 20% readmission rate = $17 Billion annual cost to Medicare • CMS Mandates major cuts to Medicare Programs • First Focus is on: ✓Heart Failure (broader than CHF) ✓Pneumonia ✓AMI (heart attack) ✓Diabetes ✓Will be adding more chronic conditions in the future Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  37. 37. CMS reports that up to 75% of re-admissions to hospitals are potentially preventable.* (New England Journal of Medicine reported that half of all patients re-admitted within 30 days hadn’t visited a doctor since discharge) 3 Main Reasons most patients are re-admitted to the hospital: 1) They miss follow-up visits 2) They have difficulty complying with their medication schedule 3) They have a poor understanding of “red flag” symptoms *Medicare Payment Advisory Commission (MedPac), “Report to the Congress: Promoting Greater Efficiency in Medicare” June 2007 REDUCING HOSPITAL READMISSIONS:
 Partnering for success Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  38. 38. Hospitals are being financially penalized 3% of each payment for readmission for the following diagnosis: • Congestive heart failure • Myocardial infarction (heart attack) • Pneumonia • Chronic obstructive pulmonary disease (COPD) • Orthopedic Hip and Knee HOSPITAL READMISSIONS:
 What’s the Problem? Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  39. 39. DEVELOPING A STRATEGY TO REDUCE READMISSIONS
  40. 40. “Not all of the responsibility is the hospital’s” said Arnie Kimmel, CEO, MetroSouth Medical Center in Blue Island, IL, referring to why patients are readmitted within 30 days. “A significant part of the reason we have to attribute to (patients) lack of compliance with medical recommendations.” Hospitals are a little upset (and they deserve to be) about being penalized for something that they have very little control over: HUMAN BEHAVIOR. DON’T PLACE ALL THE BLAME ON THE HOSPITAL! Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  41. 41. The Goal: Disease or condition management during the 30 day post acute discharge and beyond • Who will help the patient understand the challenges of disease/condition management? • Who will provide solutions for a smooth transition to a lower level of care? • Who else is involved in helping patients stay at home for 30 days and beyond? DEVELOPING AN EFFECTIVE STRATEGY Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  42. 42. Older adults are particularly vulnerable to poor transition outcomes: • Multiple medical conditions • Multiple care providers • Multiple medications • Physical and cognitive limitations • Health literacy • Burdened caregivers PATIENT CONFUSION UPON DISCHARGE Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  43. 43. Illinois Study* – 83% of patients had problems identified by the social worker during the assessment at 2 days post-discharge – “surprises” • Management of post-discharge care – 25% • Obtaining community services – 24% • Understanding discharge plan – 17% • Caregiver Stress – 35% • Patient stress/coping – 35% • Social support – 10% *The Illinois Transitional Care Consortium (ITCC) presentation at the 2011 American Society on Aging Conference the Bridge Model of Transitionary Care. PATIENT CONFUSION UPON DISCHARGE Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  44. 44. Gut reaction – Medicare Home Health will take care of all of this Reality – Medicare nurse – 30 minute visit, 2-3x/week for 2-3 weeks We believe preventing readmissions is a shared responsibility – private duty homecare can take much of the burden off of the family and help pull the team together. WHO PULLS IT ALL TOGETHER? Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  45. 45. Basics of Private Duty Homecare • ADL’s • Meal Prep • Laundry/linens • Light Housekeeping • Transportation Historically seen as something a select minority of older adults could afford Increased competition in the private duty homecare industry has resulted in: • Lower cost to consumer • Greater flexibility in scheduling around the client’s needs • Higher expectations of the caregiver and agency PRIVATE DUTY HOMECARE: THE BENEFITS Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  46. 46. Role of Private Duty Homecare in delivering high quality care and reducing readmissions: • Private Duty Homecare aides spend more time in the home with patient than any other provider • Medicare home health aide – 30 to 60 minute visit, 2-3x/week for 2-3 week – personal care only • Average Cypress HomeCare Solutions client that discharges from a hospital or post acute provider receives 60 hours of care/week! Main Reasons Patients are Re-admitted to Hospital What Private Duty Homecare can do 1. Miss follow-up visits Arrange and accompany clients to follow-up physician visits 2. Difficulty complying with medication schedule Medication reminders 3. Poor understanding of “red flag” symptoms Not all private duty agencies are the same PRIVATE DUTY HOMECARE: THE BENEFITS Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  47. 47. “It costs too much.” It will cost you more if the patient gets readmitted to the hospital. “The patient is already getting Medicare home health services – we don’t need private duty home care also.” • They can go home with both – the first 48 hours is critical! 50% of the Cypress HomeCare Solutions clients discharge from the hospital discharge from the hospital with both Medicare and Private Duty home care, it should be 100%! • Patients often come home weak, debilitated and tired – have challenges because too tired to eat, take meds, get out of bed. • Home health cannot be there to ensure proper nutrition, medication compliance, help a patient get to the bathroom, etc. COMMON BARRIERS TO PRIVATE DUTY HOMECARE Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  48. 48. “The patient is going to rehab.” Rehab typically lasts around 20 days, leaving 10 days left when they could still be readmitted during the 30 day period. Who will be there to support them and what will their needs be when they leave rehab? “Some patients are in and out so quickly, we don’t have time to set up a lot of services.” Tag them early so they can get appropriate referrals. “We have transitional specialist working with the patient.” • Great! We can begin coordinating the discharge plans with him/her as soon as the patient steps into the ER. • The transitional specialist is not going to be with the patient in the home environment, that’s where our expertise comes in. COMMON BARRIERS TO PRIVATE DUTY HOMECARE Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  49. 49. • Private duty homecare needs to share the responsibility of preventing hospital readmissions • Private duty homecare is the only post-acute provider who can be in the home consistently with the patient after discharge (avg. 60 hours/wk) CONCLUSIONS Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  50. 50. WORKING WITH ACOs
  51. 51. CHANGING YOUR SALES PARADIGM • Multiple decision makers • Complex problems to solve • Frequently create buying criteria • Long time to make decisions • Contracts STRATEGIC SELLINGTRANSACTIONAL SELLING • Few decision makers • Simple problems to solve • May create buying criteria • Short time to make decisions • One-time transaction (Fee-for-service) (Value-based care) Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  52. 52. MILLER HEIMAN’S 4 BUYING INFLUENCES User Buyer Economic Buyer Technical Buyer Coach Selling complex solutions is defined as more than one buyer, more than one sales call, with a service and solution that is not cookie cutter. Selling complex solutions and services require that you have a complete understanding of how the client decides. Source: Joseph Murphy. A Short Primer on Strategic Selling. Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  53. 53. THE RELATIONSHIP LADDER CHAMPION PARTNER CLIENT VENDOR PROSPECT T R U S T “You can get what you want by giving them what they want.” Advocates for you Relies on you Trusts you Heard of you Doesn’t know you Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  54. 54. • The stereotypes are true: the industry is viewed with skepticism, cynicism and distrust • BEHAVIORS build or erode trust • At a minimum, what ACOs want: DATA • Data will get you in the door, but won’t create champions • Are you a problem solver? What problems do they face? • What is your position relative to your competition? • What is your message? • What is your strategy for engagement? PREPARING FOR PARTNERSHIPS Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  55. 55. Collecting 53 data points on every client • “Does the client have this diagnosis…” - CAD - COPD - Depression/Anxiety - Diabetes, etc. • Do you record: - DNR - Advance Directive • Has the client been hospitalized during our service? 24-Hour HomeCare Example Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  56. 56. © 2016 Darwin Advisory Partners, LLC. Darwin Health is a division of Darwin Advisory Partners, LLC. ACOs, Philadelphia-Camden-Wilmington CBSA ACO Name ACO Type City State Patient PopulationDelaware Valley ACO MSSP Radnor PA Aetna - Delaware Valley ACO Commercial ACO Radnor PA Aetna - Childrens Hospital of Philadelphia (CHOP) ACO Commercial ACO Philadelphia PA Aetna - Virtual Medical Group ACO Commercial ACO Marlton NJ Independence Blue Cross - Lumeris - Abington Health ACO Commercial ACO Abington PA Aetna - LHS Health Network ACO Commercial ACO Camden NJ LHS Health Network MSSP Camden NJ Horizon Blue Cross Blue Shied of New Jersey and LHS Health Network ACO Commercial ACO Camden NJ Horizon Blue Cross Blue Shield of New Jersey - LHS Health Network ACO Commercial ACO Camden NJ Virtua MSSP Marlton NJ Aledade Pennsylvania ACO LLC MSSP Exton PA Keystone First - Jefferson Health System ACO Medicaid ACO Radnor PA AmeriHealth - Cooper Health ACO Commercial ACO Camden NJ Christiana Care Quality Partners ACO LLC MSSP Newark DE Mercy Accountable Care Network LLC MSSP Conshohocken PA Aetna - Virtua ACO Commercial ACO Marlton NJ Advanced Comprehensive Care Organization Commercial ACO Philadelphia PA Inspira Care Connect LLC MSSP Elmer NJ Quality Health Alliance-ACO LLC MSSP Langhorne PA Camden Coalition of Healthcare Providers ACO Medicaid ACO Camden NJ Fresenius Seamless Medical Care of Philadelphia LLC ESRD Philadelphia PA Delaware Care Collaboration DCC LLC MSSP Wilmington DE Genesis Healthcare ACO LLC MSSP Kennett Square PA Delaware Valley/Humana ACO (Commercial ACO) Commercial ACO Villanova PA Philadelphia - Camden Integrated Kidney Care LLC ESRD Philadelphia PA United Medical LLC MSSP Bear DE Noble Health Alliance (To close by Dec 2016) Commercial ACO Fort Washington PA Independence Blue Cross - University Of Pennsylvania Health System ACO Commercial ACO Philadelphia PA Childrens Hospital Of Philadelphia ACO Commercial ACO Philadelphia PA Geisinger Health Plan - Christiana Care Quality Partners ACO Commercial ACO Newark DE DBA: Delaware Valley ACO (Independence Blue Cross - Jefferson Health System) Commercial ACO Philadelphia PA TABLE OF CONTENTS JEFFERSON HEALTH
  57. 57. © 2016 Darwin Advisory Partners, LLC. Darwin Health is a division of Darwin Advisory Partners, LLC. Top IDNs, Detroit-Warren-Dearborn CBSA By Number of Beds IDN Name City (headquarters) State Net Patient Revenue* Number of Beds* Member Hospitals* Beaumont Health System Royal Oak MI $3,524,660,571 2,976 8 Ascension Health St. Louis MO $2,160,479,674 2,199 10 St. John Providence Health System Warren MI $1,951,586,190 1,967 8 Henry Ford Health System Detroit MI $2,652,997,376 1,588 6 Detroit Medical Center (Tenet) Detroit MI $1,686,872,669 1,318 8 McLaren Health Care Corporation Flint MI $731,988,100 753 4 St. Joseph Mercy Health System (Trinity) Ypsilanti MI $760,697,046 676 3 Prime Healthcare Services Ontario CA $222,411,979 307 2 Vibra Healthcare Mechanicsburg PA $36,542,143 260 3 Department Of Veterans Affairs Washington DC 218 1 Universal Health Services King Of Prussia PA $44,859,678 205 1 Acadia Healthcare Franklin TN $48,846,523 191 2 Select Medical Corporation Mechanicsburg PA $83,486,683 167 5 Blue Water Health Services Port Huron MI $167,252,923 163 1 Michigan Department of Health & Human Services Lansing MI 161 2 Kindred Healthcare Louisville KY $26,365,823 77 1 Borgess Health Kalamazoo MI $20,566,993 43 1 National Surgical Hospitals Chicago IL $16,122,078 13 1 TABLE OF CONTENTS HENRY FORD * Net patient revenue, number of beds and member hospitals refers only to revenue, beds and hospitals within this CBSA.
  58. 58. Advocate Physician Partners Accountable Care (MSSP) 149,633 Medicare beneficiaries (2015); 4,000 physicians AdvocateCare ACO 375,000 Blue Cross Blue Shield of Illinois beneficiaries UnitedHealthcare - Advocate ACO 80,000 commercial and 5,500 Medicare Advantage beneficiaries BlueCare Direct (Advocate Health Care - Blue Cross Blue Shield of Illinois ACO) Commercial ACO on GetCoveredIllinois (healthcare exchange) and for small businesses; 4,000 physicians Aetna Whole Health - Advocate Health Care Commercial ACO on GetCoveredIllinois (healthcare exchange) and for small businesses; 4,000 physicians Advocate Accountable Care - Meridian Health Plan Medicaid ACO, 4,000 physicians, 90,000 Medicaid beneficiaries ACOs MSSP ACO Performance ADVOCATE PHYSICIAN PARTNERS ACO Performance Year 1 (2013) Savings: $2.9M Savings Per Beneficiary: $21 Performance Year 2 (2014) Loss: -$5.3M Loss Per Beneficiary: -$39
 Quality Score (CMS): 90.96% Performance Year 3 (2015) Savings: $72.7M
 Savings Per Beneficiary: $486
 Quality Score (CMS): 94.19% Value-Based Initiatives © 2016 Darwin Advisory Partners, LLC. Darwin Health is a division of Darwin Advisory Partners, LLC. Accountable Care Entities (ACE) Illinois was required to transition at least half of its 3 million Medicaid beneficiaries into managed care by January 1, 2015, to reduce costs, and as part of that effort has given nine Chicago-area health care groups—including Advocate Accountable Care—preliminary approval to establish accountable care entities (ACEs), which are similar to accountable care organizations. The ACE model will replace the existing fee-for-service Medicaid payment model.   The major rollout of the state’s ACE program was to be completed in July 2014 but delays occurred. Advocate’s chief medical officer, Dr. Lee Sacks, said his organization’s ACE, which could cover more than 150,000 Medicaid patients, would not happen until at least the September 1. No further updates have been available since.   According to Michael Randall, Advocate Physician Partners’ vice president for clinical innovation, one of the state’s goals for the Advocate ACE is to strengthen its ties with community clinics.  ADVOCATE TABLE OF CONTENTS Primary Contact Rick Goddard Director of Clinical Innovation wrichard.goddard@advocatehealth.com 847.375.2226 1701 W. Golf Road, Suite 2-1100 Rolling Meadows, IL 60008 http://www.advocatehealth.com/mssp
  59. 59. Pioneer ACO Quality Scorecard—Beth Israel Deaconess Care Organization Value-Based Initiatives © 2016 Darwin Advisory Partners, LLC. Darwin Health is a division of Darwin Advisory Partners, LLC. ^ Lower scores are better 10.0 percent below average or worse 5.0-9.99 percent below average 5.0 percent or more above average or better Average Darwin’s Visual Scorecard compares this ACO to the mean score for all MSSP model ACOs, by each measure. Each measure is color coded for a quick visual representation of how the ACO is performing relative to its peers. In 2015, CMS added several new measures, such as Depression Remission at 12 Months (ACO-40). CMS also stopped reporting some metrics and has changed the way the DM Composite is measured. Caution is advised when interpreting ACO-9 and ACO-10, which utilize a standardized score. Below 1.0 means the rate of discharge was better than expected, while above 1.0 means the rate of discharge was worse than expected. A detailed description of CMS’ methodology can be found here: https://www.cms.gov/Medicare/Medicare-Fee-for- Service-Payment/sharedsavingsprogram/ Downloads/2016-ACO-NarrativeMeasures- Specs.pdf BETH ISRAEL DEACONESS TABLE OF CONTENTS 2012 2013 2014 2015 Patient/Caregiver Experience Score Score Score Score ACO-1 Timely care, appointments and information 82.4 177.35%84.17 309.73%83.48 186.57%83.19 384.47% ACO-2 Provider communication 93.26 66.42%94.23 137.47%93.95 103.02%93.87 158.43% ACO-3 Patients’ rating of provider 91.88 23.45%93.36 92.45%93.17 82.73%93.86 236.58% ACO-4 Access to specialists 84.36 -35.84%82.29 -310.99%83.34 -70.12%84.43 111.93% ACO-5 Health promotion and education 59.89 494.36%65.91 1062.92%66.09 987.71%65.82 1160.53% ACO-6 Shared decision making 75.1 99.22%72.78 -163.54%76.68 274.83%75.54 98.41% ACO-7 Health status/functional status 72.53 311.30%72.89 186.66%74.65 322.25%74.65 379.95% ACO-34 Stewardship of patient resources 0.00% 0.00% 0.00%24.02 -1217.36% Care Coordination / Patient Safety ACO-8^ Risk standardized, all condition readmissions 16.11 404.88%15.32 243.92%16.12 532.85%16.05 801.73% ACO-35^ Skilled nursing facility 30-day all-cause readmission measure 0.00% 0.00% 0.00%20.30 1242.69% ACO-36^ All-cause unplanned admissions for patients with diabetes 0.00% 0.00% 0.00%55.99 259.30% ACO-37^ All-cause unplanned admissions for patients with heart failure 0.00% 0.00% 0.00%86.34 1219.00% ACO-38^ All-cause unplanned admissions for patients with multiple chronic conditions 0.00% 0.00% 0.00%67.82 778.94% ACO-9^ COPD or asthma in older adults admissions 1.12 476.47%1.24 1149.34%1.21 1398.96%1.28 1547.99% ACO-10^ Heart failure admission 1.04 66.55%1.22 560.78%1.3 1685.39%1.12 739.99% ACO-11 % physicians on EHR (Meaningful Use) 74.63 1731.91%81.54 584.77%86.14 1.16%88.76 1026.69% ACO-39 Documentation of current medications in the medical record 0.00% 0.00% 0.00%87.44 400.38% ACO-13 Falls: screening for fall risk 28.63 -1967.03%55.63 -653.49%72.33 1194.60%79.00 3959.10% Preventive Health ACO-14 Influenza immunization 57.14 706.51%72.01 431.96%76.42 831.04%76.11 2271.93% ACO-15 Pneumonia vaccination status for older adults 61.75 783.85%75.54 483.12%76.3 -90.84%80.52 2624.43% ACO-16 Body mass index screening and follow-up 60.62 1412.30%61.23 -589.88%72.19 632.05%69.09 -292.28% ACO-17 Tobacco use: screening and cessation intervention 86.85 1159.74%94.62 505.57%95.9 234.30%92.83 285.60% ACO-18 Screening for clinical depression and follow-up plan 8.82 -6265.04%30.08 -3959.26%64.08 739.96%73.88 6299.52% ACO-19 Colorectal cancer screening 68.03 1709.63%80.82 1229.41%78.44 535.08%79.37 3220.19% ACO-20 Breast cancer screening 74.27 1466.67%76.03 605.96%76.58 74.06%78.34 1933.00% ACO-21 Screening for high blood pressure & follow-up 68.44 831.15%48.31 -2182.85%44.79 -2034.86%78.15 1158.59% At-Risk Population ACO-40 Depression remission at 12 months 0.00% 0.00% 0.00%2.44 -6018.02% DM CompositeDiabetes management composite (based on ACO-27 and ACO-41) 23.56 -767.23%30.9 -710.90%31.93 -1315.82%50.00 4106.23% ACO-27^ Diabetes: hemoglobin A1c poor control 16.86 -3772.93%12.97 -1944.97%12.2 -1353.65%16.03 -2151.23% ACO-41 Diabetes: eye exam 0.00% 0.00% 0.00%56.41 3712.39% ACO-28 Percent with hypertension whose BP < 140/90 61.82 -332.08%68.64 -752.79%69.23 -766.38%69.21 -56.92% ACO-30 Percent with IVD who use of aspirin or another antithrombotic 85.61 1254.15%90.78 771.85%89.07 158.76%93.50 1155.70% ACO-31 Heart failure: beta-blocker therapy for LVSD 80.51 -187.09%83.7 -165.52%83.46 -603.41%86.08 -128.08% ACO-33 ACE inhibitor or ARB therapy for patients with diabetes or LVSD 75.13 563.79%81.9 929.31%80.84 -20.86%89.58 1522.75%
  60. 60. © 2016 Darwin Advisory Partners, LLC. Darwin Health is a division of Darwin Advisory Partners, LLC. TABLE OF CONTENTS OCHSNER HEALTH SYSTEM Leadership Team Warner Thomas President & CEO Richard Guthrie Chief Quality Officer Michael Hulefeld Executive Vice President & Chief Operating Officer Stephen Robinson CEO, Ochsner Medical Center-Kenner Tim Allen CEO, Ochsner St. Anne General Hospital and Leonard J. Chabert Medical Center Robert Hart, MD Executive Vice President & Chief Medical Officer Pete November Executive Vice President & Chief Administrative Officer Mark Muller Senior VP of Strategy and Business Development Bradley Goodson CEO, Ochsner North Shore Region Ritchie Dupre CEO, St. Charles Parish Hospital Robert Wolterman CEO, Ochsner Medical Center-Jefferson Highway Dawn Anuszkiewicz CEO, Ochsner Baptist Scott Posecai Executive Vice President & Chief Financial Officer Eric McMillen CEO, Ochsner Medical Center-Baton Rouge Tracey Moffatt Chief Nursing Officer Randy Peak System Vice President and General Counsel Michelle Dodenhoff Chief Development Officer Anthony DiGerolamo CEO, Ochsner Medical Center-West Bank Hospital CEOs Executive Management Team Bobby Brannon Executive Vice President & Treasurer David Gaines CEO – System Retail Services & System Vice President of Public Affairs William McDade, MD PhD Executive Vice President & Chief Academic Officer Patrick Quinlan, MD CEO - Ochsner Clinic Foundation Richard Milani, MD Chief Clinical Transformation Officer Kristy Nichols System Vice President, Partnerships and Innovation Alan Hodges CEO, Hancock Medical Center David Carmouche, MD SVP and President, Ochsner Health Network Senior Management Team
  61. 61. Measure Shea Lincoln Osborne Thompson Peak Deer Valley National Rate All Cause Hospital-Wide Readmission 14.50% 15.30% 15.10% 14.40% 15.50% 15.20% Rate of unplanned readmission for COPD patients 18.90% 21.00% 19.70% 21.30% 21.50% 20.20% Death rate for COPD patients 8.10% 7.80% 10.00% 6.40% 7.50% 7.70% Rate of unplanned readmission for heart attack patients 16.20% 16.40% 15.80% 16.50% 16.90% 17.00% Death rate for heart attack patients 12.20% 15.60% 14.70% 13.00% 13.20% 14.20% Rate of unplanned readmission for heart failure patients 22.70% 20.00% 20.80% 22.20% 24.00% 22.00% Death rate for heart failure patients 11.20% 11.90% 9.40% 10.70% 11.00% 11.60% Rate of unplanned readmission for pneumonia patients 17.00% 17.90% 16.00% 16.60% 16.10% 16.90% Death rate for pneumonia patients 10.50% 11.80% 11.90% 9.00% 10.00% 11.50% Rate of unplanned readmission for stroke patients 11.20% 13.10% 12.20% 12.50% 13.00% 12.70% Death rate for stroke patients 12.30% 15.40% 16.60% 12.20% 13.20% 14.80% Rate of unplanned readmission after CABG surgery 13.50% 15.90% 14.60% n/a 14.40% 14.90% Death rate following Coronary Artery Bypass Graft CABG surgery 3.70% 2.70% 2.90% n/a 3.50% 3.20% Rate of unplanned readmission after hip/knee surgery 3.80% 5.50% 5.20% 4.00% 4.50% 15.20% Rate of Complications for Hip and Knee Replacement Patients 2.40% 3.30% 2.80% 2.70% 2.80% 3.10% © 2016 Darwin Advisory Partners, LLC. Darwin Health is a division of Darwin Advisory Partners, LLC.HONOR HEALTH Comparative Statistics for HonorHealth locations 30-Day Readmission and Mortality Rates (Medicare FFS)
  62. 62. DRG Description Total Claims Readmission Rate Total Days Avg Length of Stay (Days) 470 MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC 1,579 4.40% 3,699 2.3 871 SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W MCC 681 16.80% 3,941 5.8 392 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC 496 15.80% 1,501 3 194 SIMPLE PNEUMONIA & PLEURISY W CC 320 16.50% 1,331 4.2 460 SPINAL FUSION EXCEPT CERVICAL W/O MCC 310 7.20% 827 2.7 378 G.I. HEMORRHAGE W CC 309 13.70% 1,058 3.4 872 SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W/O MCC 308 15.50% 1,255 4.1 603 CELLULITIS W/O MCC 306 10.40% 1,076 3.5 552 MEDICAL BACK PROBLEMS W/O MCC 306 15.50% 1,474 4.8 292 HEART FAILURE & SHOCK W CC 289 23.10% 1,109 3.8 690 KIDNEY & URINARY TRACT INFECTIONS W/O MCC 284 15.40% 889 3.1 65 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC 251 16.20% 1,649 6.6 310 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC 240 9.30% 517 2.2 641 MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W/O MCC 240 16.90% 727 3 291 HEART FAILURE & SHOCK W MCC 239 22.70% 1,332 5.6 481 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC 237 10.30% 993 4.2 683 RENAL FAILURE W CC 231 19.40% 876 3.8 0 UNKNOWN 226 14.50% 0 0 309 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC 214 18.80% 675 3.2 536 FRACTURES OF HIP & PELVIS W/O MCC 213 7.10% 1,776 8.3 © 2016 Darwin Advisory Partners, LLC. Darwin Health is a division of Darwin Advisory Partners, LLC.HONOR HEALTH Top 20 Readmissions by Number of Claims HonorHealth Readmissions
  63. 63. Patient Experience Lower Costs Population Health Achieving all Three • Improve the health of populations of people • Improve the patient experience with healthcare • Reduce per-capita healthcare costs What data do you have that proves: ALIGN YOUR MESSAGE ALIGN WITH ACO METRICS! Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  64. 64. ALIGN YOUR MESSAGE Preventive Health ACO-14 Preventive care and screening: influenza immunization ACO-15 Pneumonia vaccination status for older adults ACO-16 Body mass index screening and follow-up ACO-17 Tobacco use: screening and cessation Intervention ACO-18 Screening for clinical depression and follow- up plan ACO-19 Colorectal cancer screening ACO-20 Breast cancer screening ACO-21 Screening for high blood pressure and follow-up documented % Vaccina(on Check Influenza Pneumonia CLIENT Comp1 Comp2 Comp3 CLIENT Comp1 Comp2 Comp3 68.9% 70.7% 71.3% 69.6% 70.0% 71.3% 85.1% 79.2% Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  65. 65. Know your ROI: What is the Lifetime Value of a client? Know the ACO Market Potential: How many covered beneficiaries? $/hour, hours per week, average number of weeks per client Quantify the relationship. Estimate expected market share using traditional marketing. Now estimate estimated share under a preferred partnership. What’s the benefit? Are they willing to listen to your story? Some people simply won’t. What is your value proposition? And have you quantified it? Know your capacity. What’s the right ACO size? Are you willing to go at risk? Or reduce fees? Alter payment schedule? CHOOSING THE RIGHT PARTNER Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  66. 66. ACO Name States where beneficiaries reside Number of Beneficiaries Readmission % Atlantic ACO New Jersey, Pennsylvania 73,694 15.37 Meridian Accountable Care Organization, LLC New Jersey 40,133 13.73 Palm Beach Accountable Care Organization, LLC Florida 36,268 15.56 Optimus Healthcare Partners, LLC New Jersey 34,542 15.14 Memorial Hermann Accountable Care Organization Texas 34,430 14.41 Scott & White Healthcare Walgreens Well Network, LLC Texas 34,149 14.14 Accountable Care Coalition of Texas, Inc. Texas 33,739 13.89 ProHealth Physicians ACO, LLC Connecticut 32,216 14.92 Millennium Accountable Care Organization Florida 28,957 14.23 Accountable Care Clinical Services, PC Iowa, Pennsylvania, Connecticut, Massachusetts, California 19,637 15.08 Central Jersey ACO LLC New Jersey 19,340 15.43 Saint Francis HealthCare Partners ACO Inc. Connecticut 19,210 15.17 Medical Practitioners For Affordable Care, LLC Florida 17,974 16.46 BHS Accountable Care LLC Texas 17,210 14.07 Hackensack Alliance ACO New Jersey, New York 16,383 15.52 Accountable Care Coalition of Mount Kisco, LLC New York, Connecticut 16,326 14.60 Northern Maryland Collaborative Care LLC Maryland 15,470 15.58 Maryland Collaborative Care, LLC. District of Columbia, Maryland 15,465 14.78 Methodist Patient Centered ACO Texas 15,013 14.70 Largest ACOs in Client high-performing states Average readmission rate, target market: 14.97 Average readmission rate, national: 14.89 ACO TARGETING Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  67. 67. ACO Name States where beneficiaries reside Number of Beneficiaries Atlantic ACO New Jersey, Pennsylvania 73,694 Palm Beach Accountable Care Organization Florida 36,268 Optimus Healthcare Partners, LLC New Jersey 34,542 Accountable Care Clinical Services, PC Iowa, Pennsylvania, Connecticut, Massachusetts, California 19,637 Central Jersey ACO LLC New Jersey 19,340 Saint Francis HealthCare Partners ACO Inc. Connecticut 19,210 Medical Practitioners For Affordable Care, LLC Florida 17,974 Hackensack Alliance ACO New Jersey, New York 16,383 Northern Maryland Collaborative Care LLC Maryland 15,470 TOTAL ELIGIBLE BENEFICIARIES 252,518 Largest ACOs, Client high-performing states with higher-than-average readmission rates ACO TARGETING Disruptive Transformation and the Accountable Care Organization Presentation by Bob Roth, Managing Partner, Cypress HomeCare Solutions and John Marchica, President/CEO, Darwin Health
  68. 68. Thank you for attending this session. Please go the Annual Leadership Conference App and complete the survey for this session now!

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