Strategies to Elevate Your ACO Before Your 3rd Performance Year presented at the FLAACOs 2014 Fall Conference

1. STRATEGIES TO ELEVATE YOUR ACO
BEFORE YOUR 3RD PERFORMANCE YEAR
H Y M I N Z U C K E R M D , C M O &
K E L L Y A . C O N R O Y, C E O
T R I P L E A I M D E V E L O P M E N T G R O U P
S E P T E M B E R 3 0 , 2 0 1 4

2. ACTION AND STRATEGIES TO ELEVATE YOUR ACO
Conga Line
It’s a combined Team Effort!!!
Everyone pulling towards the same Goal
What are You doing differently ?
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3. ELEVATE YOUR ACO
Where are you right now?
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ProactiveReactive

4. PROACTIVE OR REACTIVE APPROACH
• Proactive approach incorporates policies, procedures, principles
and standardization of processes.
• Reactive approach analyzes what has already occurred and results
in process changes
Where are you?
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5. REACTIVE
What reports do you use?
QUER
CCLF
Assignments
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6. REACTIVE APPROACH-NEW PATIENT LIST(S)
1. Ensure all new patients have a subsequent near term PCP office visit
2. Ensure all new patients get “ACO Welcome package” including “”Opt Out”
letter
3. Ensure all new patients get an Annual Wellness Visit
Tie to ACO biggest opportunity to bend curve designated population.
4. Opportunity to discuss ACO participation
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7. REACTIVE APPROACH-LOST PATIENT LIST(S)
Utilize newly printed data sets to stratify
• Beneficiary did not receive plurality by PCP
• No physician visit with an ACO Provider
*Perform a “Root Cause” analysis on those who were lost by plurality or lack of visit
These forms do not require anything else to do.
• Beneficiary had interrupted Part A or B Coverage
• In MA plan or other part of the year
• Non- resident in USA
• In other shared savings program
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8. CMS 6 REASONS BENEFICIARY DROPPED
Reason(s) Beneficiary Not Currently Assigned1
(1) (2) (3) (4) (5) (6)
Beneficiary
did not
receive the
plurality of
his/her
primary
care
services4
from the
ACO5
Beneficiary
had at least
one month of
Part A-Only Or
Part B-Only
Coverage6
Beneficiary had
at least one
month in a group
health plan7
Beneficiary does
not reside in the
United States8
Beneficiary
included in other
Shared Savings
Initiatives9
Beneficiary did
not have a
physician visit
with an ACO
provider10
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CMS Tab 1-5

9. REACTIVE APPROACH - PATIENTS NOT SEEN IN
9 MONTHS (REGISTRY FUNCTION)
• Ensure every Beneficiary on this list is called (excluding those
who expire or knowledge exist of why they left the practice)
*You cannot control Quality and Cost if you are not seeing the
patient in 9 months.
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10. REACTIVE PROACTIVE APPROACH
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11. PROACTIVE APPROACH
Starts with a Belief!
“If you believe in something, BELIEVE in it all the way”
Walt Disney
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12. PROACTIVE – SET EXPECTATIONS
5%- 10% savings
Areas of Savings:
Part A
 Inpatient
 SNF
 HHA- Home Health
 Outpatient Institutional
 Part B
Where does this leave YOU, above MSR????
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13. BASED ON STANDARDIZED PROCESSES TO ENSURE EVERY PATIENT
ACCESS, SAFETY, INTENDED OUTCOMES AND SATISFACTION
1. Set guidelines for all patients with chronic disease: have 4
OV/year + wellness visit; all others 2 OV a year plus AWV and
Subsequent follow-up.
2. Patients are scheduled for subsequent appointments after
each OV.
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Proactive Approach:

14. PROACTIVE APPROACH CONT’D
3. Patients who leave the service area greater than 2
months are identified and scheduled for a wellness visit
prior to departure:
Ensure all prescriptions are written to cover the time away
Called 30 days after departure to confirm patient is well with attention to
providing medical records if patient intends to see physicians OOS
Remind patient to return to the office when they return to the area and
schedule an appointment
Remind patient that PCP is available to discuss issues that may arise
while they are away
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15. PROACTIVE APPROACH CONT’D
4. Patients who miss appointments are diligently rescheduled.
5. Identify all healthcare services the patient has accessed between
PCP office visits and include in the subsequent discussion and care
plan.
6. Identify all patients who are in hospital and call them after several
days to inquire on their status and discuss the Transitional Care visit
(TCM).
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16. PROACTIVE APPROACH CONT’D
7. Identify all patients who are in a SNF and call them after 7
days to inquire on their status and discuss the Transitional
visit upon discharge.
8. Ensure all patients who are seen in PCP office who are
diagnosed with acute illness be contacted for subsequent
visit to confirm health status. (resolution of illness)
9. Ensure all patients discharged from hospital or SNF to home
have a transition of care management OV within 7 days.
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17. PROACTIVE APPROACH CONT’D
10.Utilize my “Call my doc card” that request all treating physicians to
contact the patients PCP for additional pertinent medical information
(CMS now has approved ACO ID card-see the portal)
CMS Card approval language
• My doctor, <DOCTOR NAME>, is part of <ACO NAME>, a Medicare ACO. Call my
doctor at <DOCTOR PHONE NUMBER> or call <ACO NAME and NUMBER>
to get and share any needed medical information that helps coordinate my care.
<ACO LOGO>
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18. DON’T FORGET!
CREATE VALUE IN OFFICE VISIT!!
• Create an office that functions to “WOW” the patient at
every opportunity from multiple approaches
• Consider whether your office would be acceptable to you if
your mother was a patient
• Patient satisfaction is the primary driver in the reduction of
leakage/Proactive Approach
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19. HOW DO YOU DO THIS?
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A Motivated ACO
• Believes
• Is Proactive
Not a Motivated ACO
• Non Believer
• Is Reactive
• Work around “Doctor & Patient”
Relationship
• Choice- Work on “Doctor & Patient”
Relationship (Tactics & Policies)

20. TIME IS TICKING- COUNT DOWN TO ACTION!!
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92 Days
3 minutes
32 seconds
11 hours

21. C O P Y R I G H T 2 0 1 4 T R I P L E A I M D E V E L O P M E N T G R O U P 21

22. LOOK INTO THE FUTURE
CVS says its new brand complements its goals as a "new entrant" in the healthcare provider
services market. "We are taking an active and supportive role in shaping the future of
healthcare through our programs in medication adherence, delivery of care by walk-in
medical clinics, and support of patients with chronic and complex conditions."
CVS Health says it will offer:
 Programs to help manage chronic disease
 Programs to connect patients with pharmacists to help them stay on their prescribed medications
 Digital capabilities to supplement those programs
It also plans to forge strategic alliances with physicians and health plans through both
CVS/pharmacy and CVS/minuteclinic to provide clinical support, medication counseling,
chronic disease monitoring, and wellness programs.
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Behind the CVS Health Rebranding Strategy
Christopher Cheney, for HealthLeaders Media , September 8, 2014

23. CALL KELLY A. CONROY, CEO OR HYMIN ZUCKER MD, CMO
AND FOUNDING PARTNERS OF TRIPLE AIM DEVELOPMENT
GROUP AT 561.444.3000
WWW.TRIPLEAIMDG.COM
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