This document provides an overview of Accountable Care Organizations (ACOs) from the perspective of Agnesian HealthCare. It discusses: - The origins of ACOs in the Affordable Care Act as a way to improve quality and limit unnecessary healthcare spending. - Why Agnesian HealthCare joined the Integrated Health Network of Wisconsin (IHN) ACO, including lack of expertise to start their own and need for scale and credibility. - How being in an ACO benefits Agnesian HealthCare and patients through greater care coordination, risk assessment, and use of data to improve outcomes and apply best practices. - Examples of how ACO participation has helped Agnesian HealthCare improve services

1. Know & Go!
Accountable Care
Organizations
Steve Little
President & Chief Executive Officer
Dr. Michael DeGere
Vice President, Population Health Management

2. The Birth of Accountable Care
Organizations (ACO’s)
• Patient Protection and the Affordable Care Act
(“PPACA”) – aka Obamacare
• Federal government has a budget problem
• Not really, we have a healthcare problem known as
Medicare
• Today’s workforce funds healthcare for every
United States citizen over the age of 65

3. What is an ACO?
•An ACO is a network/group of doctors and
hospitals that shares financial and medical
responsibility for providing coordinated
care to patients in hopes of improving the
quality of live and limiting unnecessary
spending.

4. Why Did Agnesian HealthCare
Join an ACO?
• Did not possess the in-house expertise to start
our own ACO
• Felt that we lacked sufficient scale
• Needed to be part of a network that covered a
larger geography
• Needed the credibility of an academic medical
center
• Lacked ownership of an insurance company

5. Why Did We Choose Integrated
Health Network of Wisconsin
(IHN)
• Prior relationship with Froedtert and the Medical
College of Wisconsin
• It was the only choice at the time!

6. Who Is IHN and Where Do
They Live?
 Initially – Froedtert & the Medical College of
Wisconsin, Columbia St. Mary’s, Bellin Health,
ThedaCare, Asprius and Agnesian HealthCare
 Today – Froedtert & the Medical College of
Wisconsin, Columbia St. Mary’s, Wheaton Franciscan,
Ministry Health Care, HSHS (Hospital Sisters Health
System) and Agnesian HealthCare
 IHN is located in Brookfield, Wisconsin and employs
82 full-time associates

7. Population Health
Communities’
Well-Being
Associates’
& Patients’
Well-Being
Managed
Populations’
Well-Being
AHC Mission,
Vision & Values

8. Profile – Integrated Health
Network of Wisconsin (IHN)
5,000 physicians
500 clinics
 42 hospitals
Agnesian HealthCare
Columbia St. Mary’s
Froedtert Health
Hospital Sisters Health System
The Medical College of Wisconsin
Ministry Health Care
Wheaton Franciscan Healthcare

9. Another Wisconsin ACO
abouthealth
Aspirus Inc.
Aurora Health Care
Bellin Health
Gundersen Health System
ProHealth Care
ThedaCare
UW Health

10. How is an ACO Important to us?
For Agnesian HealthCare
It provides a forum to share data, improve
outcomes, share best practices and network
We become part of a larger group so we can
compete against other larger healthcare
conglomerates for contracts

11. What does this mean to AHC in
the next couple of years?
We are moving from a fee-for-service to a total-risk model
IHN has worked with all systems to develop a prioritized
Care Model which will help prepare us for assuming this
risk
The Care Model aligns with most things we are already
doing or are planning to do at Agnesian HealthCare

12. IHN Work Groups
Work Group AHC Representatives
Quality Nancy Birschbach, Mike Feudner, Sue Gullickson
Pharmacy Nancy Hyland, Katie Reinke
Inpatient Dan Blaha, Barb Gorman
Readmission Dan Blaha, Barb Gorman
Care Navigation Dan Blaha
Orthopedics Zach Pitz
Depression Jim Salasek

13. Other ACO Focus Areas
End-of-Life Care Strategies
Chronic Condition Management
Clinical, Evidenced-based Guidelines
Post-acute Care Alignment
Possible House Calls Program

14. Tools for Data Support
Crimson
Valence
HealtheIntent/HealtheRegistries

15. Cerner’s HealtheIntent

16. Cerner’s HealtheRegistries
Current Registries being piloted at AHC:
Adult Wellness
Diabetes
Heart Failure
Depression

17. Cerner’s HealtheIntent

18. How is an ACO Important to us?
To our PATIENTS and PROVIDERS…
Greater coordination of care for patients
who visit ACO member systems
The structure provides a way to assess
patient risk, communicate status and
apply best practices

19. Agnesian Success Story:
Staying Ahead of Hospital Admission
An AHC 64yo lung cancer patient identified by the
Crimson data system for needing Navigator
assignment.
Follow-up found issues of deconditioning, pain
management, alteration in labs and significant
medication reconciliation issues.

20. Agnesian Success Story:
Staying Ahead of Hospital Admission
The Navigator worked with physicians to facilitate
a referral to home health and coordinate other
community services.
Through successful intervention, the patient
experienced effective and efficient management of
her symptoms and medical needs with no
additional ED or hospital visits.

21. The ACO and The Mission
Just checklists and “more work?”
Does our ACO work serve our Mission? (It better!)
Compassionate Care
Hope, Health, and Wholeness
Our Mission does not only mean treating the ill
It also means continual care of the well

22. ACOs can change our perspective,
and how we approach our work
Today, many patients come in only when health has
deteriorated between episodes of care
Moving toward “panel management,” as well as
more complete individualized care of each patient
Reaching out to those who need to come in, before
they become ill - ACO metrics can help us to keep
track

23. ACO Work Group: Depression
According to the CDC, about 9 percent of
adult Americans are living with depression
ACO member systems recognize the need to
establish a screening tool and address access
to services
AHC is leading this initiative among IHN
members

24. ACO Work Group: Pharmacy
Medication Therapy Management for Outpatients
Short-Term Goal: Identify high risk patients
for evaluation and assistance
Long-Term Goal: Spread intervention and
support to moderate and low risk population

25. Agnesian Success Story:
Mammograms
In 2014, the IHN Quality Work Group
focused efforts on closing the gaps in care
for an ACO contract population.
One of these gaps was: Mammograms

26. Agnesian Success Story:
Mammograms
 A Mammogram Call List was developed
 Due/overdue patients were called an
encouraged to come in for a mammogram

27. Agnesian Success Story:
Mammograms
Two of these patients received a
cancer diagnosis, which may have
been less timely if calls were not
made.

28. Mammograms Today at AHC

29. Walk-In Breast Clinic at AHC
Started 1/12/2015
 Visits to date
 SAH: 110 patients
 WMH: 28 patients
 RMC: 17 patients

30. Lessons We Are Learning
 Reminders can help patients
 Reminders can help providers, too (registries)
 Access and convenience make a difference

31. Getting Well, Staying Well
Focusing on preventive health efforts
Using evidence-based best practices
Managing chronic disease conditions

32. Getting Well, Staying Well
Staying ahead of acute illness
Taking care of the whole person and using
tools to assist us
Matching our Mission

33. Thank you!
Questions?
Comments?