Living in the ACO Model: What’s Next

ModeratorJohn Pritchard, Medical Distribution Solutions, Inc.

Panelists

Scott D. Pope, PharmD, Executive Director, Healthcare Innovators Collaborative, Premier, Inc

Tara Canty, Chief Operating Officer, Accountable Care and Senior Vice President, Government Relations, OSF Healthcare System

One OSF All Together Better

OSF Healthcare SystemAccountable Care

Moving from Volume to Value

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ACO Participation at OSF

6 Acute Care Hospitals

1 Hospice Home

707 Physicians---211 Primary Care

51 Level 3 PCMH---CV Service Line---Neuro Service Line---Multi Specialty

216 NP/APN

Home Care

DME

Hospice

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Alignment is critical

Source: Truven Health Analytics

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Institute of Medicine Analysis

Less than 50% of elderly patients are up

to date on clinical

preventive services

Elderly patients with co-morbidities require

up to

19 medication doses daily

Every year the average

elderly patient sees 7 doctors across 4

practices

Specialists

Primary Care

Average surgery patient is seen by

27 different health care providers

Fewer than half of

nonsurgical patients follow up with their primary care

provider after discharge

1 out of 5 elderly patients are

readmitted within 30 days

Preventive Self-Management Outpatient Care Hospital Follow-up

Nurse

Physician

Allied Health

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Accountable Care

One OSF All Together Better

What is an Accountable Care Organization?

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Principles of Accountable Care

An ACO is a local health care organization and a related set of providers (at a minimum, primary care physicians, specialists, and hospitals) that can be held accountable for the cost and quality of care delivered to a defined population.

The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time at the right place while avoiding unnecessary duplication of services and preventing medical errors.

Accountable Care holds organizations accountable for specific levels of quality care through comprehensive, valid and reliable measurement of its performance.

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Pioneer ACO

Developed by Centers for Medicare & Medicaid Innovation in partnership with CMS

The Pioneer ACO Model is designed to encourage the cultural change necessary to achieve the Triple Aim– Improve the health of the population (wellness)– Enhance the patient experience (quality, access and reliability)– Reduce, or at least control, the per capita cost of care

Develop Accountable Relationships for care delivery with other insurers as well

Over time, deliver care at 20-30% less than the current projections

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Accountable Care Relationships at OSF

Pioneer ACO – 34,000 Medicare beneficiaries Blue Cross – 40,000 projected members -- January 1, 2014

– Capitated HMO (Ambulatory Services) and Shared Risk PPO

• Closing care gaps• Outreach to high risk patients

Humana – 8,500 Medicare Advantage members– Capitated HMO and Shared Savings PPO

• Medical Home• Closing care gaps

Health Alliance – 15,000 HMO members– Shared Risk

Quality Care Plan (OSF employees & deps.) – 30,000 members

Value-BasedPayment Streams

Today

Future

25% of Revenue 150,000 Covered Lives

60% of Revenue 400,000 Covered Lives

OSF’s Approach

One OSF All Together Better

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Areas of Focus

Reduce avoidable admissions and readmissions

Reduce length of stay

Decrease avoidable ED visits

Improve care coordination

Improved transition of care

Increase Clinical Integration

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Challenges

Limited psychiatric/substance abuse services in the community

Ability to expand access to primary care physicians and mid-level providers

Communication constraints

Establishing consistency across accountable care agreements

Non-OSF provider engagements

Maintaining timely access to data and identifying appropriate benchmarks

Balance dueling business models

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OSF’s Care Management Model

Adult - High Risk defined as: • 10% for Medicare population• 3% for Commercial population• 1% of remaining population

“Hybrid Care Management Team Model”• 3 Person teams with a 1 RN Care Manager : 2 Non RN support ratio• 450 patients managed per team

• Embedded Site RN Care Managers (PCMH)

• Centralized Care Management Support Model (MSW, LPN, MOA)

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Care Transition Projects - Implementing Best Practice Components

Patient risk assessment upon admission and throughout patient stay– Targets appropriate interventions through out stay to achieve successful discharge

– Doubled use of social work assessments and interventions

Defined discharge process/discharge checklists and after visit summaries– Patient Summary includes teaching/teach back

– More complete information for providers after discharge

Provider handoffs:– Discharge summaries

– Provider to provider verbal handoff process

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Care Transition Projects - Implementing Best Practice Components

Medication reconciliation at discharge– Includes first fill at discharge

– Considering home visit for “complete” reconciliation

Follow-up phone calls within 72 hours of discharge to ensure patient/caregiver understanding and adherence– 76% call success rate

Provider follow-up appointments within 5 days– May be home care, specialist

– Clinic for patients with no PCP

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Skilled Nursing Home Initiative

Preferred SNF network based on quality and service– CMS Star ratings: at least 4 overall and 3 quality

– 24/7 admissions

– 75% acceptance of all admissions

– 24/7 RN on site

– At least 6 days/week therapy

– Specialized sub-acute units for Cardiology and Neurology

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Skilled Nursing Home Initiative

Physician and APNs rounding on SNF patients with high frequency, managing utilization and transition to home– Multi-disciplinary team approach

– Strong clinical model• Increase discharges to home from SNF (improved patient outcome)• Decrease ALOS (from 86 days/stay to <40 days/stay)• Reduce acute readmissions (from 50% to <10%)

– All SNF patients considered high risk• All receive home care referral at discharge from SNF• All patients transitioned to Care Management/Medical Home

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Additional Initiatives

Data Analytics– Enterprise Data Warehouse

Access– Centralized Ambulatory Call Center

• Improved access to primary care• Same day appointments

– Specialty care– Transportation

Referral Management– Clinical Integration

• Leakage• Quality/outcomes

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Additional Initiatives (continued)

Telemedicine– E-ICU– Care Management– Behavioral Health, CHF, COPD, Stroke

Physician Engagement– Education, Data, reports

• Physician Dashboard

– Accountability• Quality component in compensation

One OSF All Together Better

Questions?

Scott D. Pope, PharmDExecutive Director – Healthcare Innovators Collaborative

Three take-aways

Premier is working to propel population health

You are on the ACO tracks…the train is coming

Find your strategy, your partner, or (ideally) both

24 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.

MOVEMENT TO INTEGRATED CARE, NEW PAYMENT MODELS & RISK

The journey to high value healthcare

Value-based purchasing:HACs, quality, efficiency, cuts

HAC and readmission penalties

Medical home

Shared savings & Global payment

Bundled payment

Population Management• Population analytics• Care management• Financial modeling and

management• Legal• Physician integration

High Value Episodes• DRG and episode

targeting• Care models and

gainsharing• Data analytics• Cost management

High Performing Hospitals• Most efficient supply chain• Best outcomes in quality, safety• Waste elimination• Satisfied patients

Pop Health Core Components

The Network Effect – Premier PACT

29 markets | 23 systems | 100+ hospitals | 5,000+ MDs, 1.5M accountable care covered lives

86 markets | 67 systems | 300+ hospitals | 12,000+ MDs

27 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.

Assessments drive insight

*Data from 24 markets**Data from 51 assessments

Readiness Collaborative overall assessment**

Implementation Collaborative overall assessment*

Blue = HighGreen = Average

Red = Low

28 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.

PHYSICIAN NETWORK

MANAGEMENT

POPULATION ANALYTICS & RISK

MANAGEMENT

POPULATION ENGAGEMENT

• Network development• Clinical integration

• Patient-centered medical home

• Care redesign• Practice optimization

• Community needs assessments

• Shared savings• Bundled payments

Advisory Services

Collaboratives

By leveraging our vast data assets and partnerships with leading technology providers we have developed solutions to address population health and new payment models.

Information Technology

POPULATION HEALTH COLLABORATIVE

PLATFORM

New era population health management solutions

Supplier Implications

Envisioning the future

Fee-for-service executives = More volume

ACO executives = Reduce high cost “things”

Commodity until proven otherwise

Physicians are incented on cost/outcomes

Common threads of hope

Deeply understand how ACOs really work

Provide more outcomes data, onus is on you

Bring a collaborative mindset & be willing to test

Healthcare Today

Launched in 2010

•Received by over 23,000 stakeholders

•6 issues per year

•The only publications dedicated solely to ACO development

WWW.ACOInsights.com

Triple Aim Focus of Reform

● Reducing Cost● Improving Quality● Enhancing Patient Experience

Suppliers must have a Value Proposition that aligns with the Triple Aim!

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How Reform and ACOs will impact the Supply Chain

• Physician Alignment

• Alignment of Incentives

• Clinical Integration

• Information Management

• Supply Chain Engagement

SMI/MDSI 2013 ACO Executive Briefing

HSCA 2013

Washington, D.C.

October 22, 2013John I. Pritchard

jpritchard@mdsi.org

(770) 263-5262

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