Accountable Care Organization

Board of Directors Report

Board Members

Subrata BeheraJim GrubelAjmal KazmanDiane Tschauner

MMI - 404 Health Enterprise Operations

Overview

• Background

• Critical Requirements for an ACO

• Further Information Needed

• Conclusion

• Rationale

• Future Direction

Assignment:

Consider becoming an Accountable Care Organization

Background

• Introduction of new or expanded medical services

• Adding information technology with new or upgraded systems

• Investing in newer digital medical equipment

• Achieving high marks from our patients through routine satisfaction surveys

Background continued

Background continued

Mission

To provide a high quality and sustainable service to our patients, physicians, and the community we serve.

CMS News Release, March 31, 2011

“If ACO’s save money by getting beneficiaries the right care at the right time, they can share in savings with Medicare.”

Background continued

Kaiser Permanente Institute for Health Policy

“Health care providers, researchers, policymakers, and the public have a growing recognition that today’s health care delivery system is not organized to take advantage of the many drivers of quality and efficiency, and that the system suffers from underuse, overuse, and misuse of care. Many experts believe that greater (and different) delivery system organizations is fundamental to improved quality and efficiency.”

Background continued

Critical Requirements for an ACO

1. ACO Member Engagement:

A successful ACO are sites that not provide high quality care but also provide effective care at best possible cost to the members. It should also take proactive steps to keep the members healthy by educating the members on leading a healthy life.

2. Cross Continuum Medical Management:

The chief criteria for becoming part of the ACO is care coordination which is managing the patient episodes of care and routine care of patients who are transferred from one facility to the other, from one provider to the other, one department to the other etc.

Critical Requirements for an ACO continued

3. Clinical Information Exchange:

Care coordination can only happen with clinical information sharing. Without clinical information sharing ACO will not meet its defined goals. Clinical sharing of information includes the following and the desired outcome that it brings around.

- Patient histories- Reduction in redundant tests- Discharge summaries- Inpatient histories- Referral order and referral Status- Test result, immunization and other data

to patients which help them monitor and engage in their own care and the care of their family members

Critical Requirements for an ACO continued 4. Quality Reporting:

In order for the ACO’s to qualify for the MedicareShare Savings Program and other ACO, initiatives,reports will have to be provided which wouldindicate meeting of quality benchmarks as defined bythe CMS/other sponsors of the program.

5. Business Intelligence, Predictive Modeling and Analytics:Formation and operation of an ACO goes beyond the traditional focus on individual patients and specific episodes of care. An ACO should be able to expand the focus to include the entire population of which the specific patient is a member.

6. ACO Risk and Revenue Cycle Management: Risk management and financial responsibilities of an ACO will require fundamental reorientation of the various revenue cycle activities. The current scope does not account for broader continuum of care. In order for an ACO to be successful it should include the broader continuum of care, a broader population and the new responsibility for managing risk and distributing payments

Further Information Needed• The information provided by Community Hospital Management

Team and Good Care Physician Group was highly informative.

• The board has thoroughly reviewed all the information provided

as part of both proposals including the references.

• In addition we conducted our own research on the matter.

Quality Improvement

• We will be interested to find out if there is more scientific data available and backed up by well designed studies in well controlled real life scenarios and supports the concept that implementing a financial reward and punishment strategy for these measures indeed is productive in terms of better patient outcomes.

Cost Reduction• On reviewing the Medicare Physician Group Practice (PGP)

Demonstration Project data, there are more questions raised than answers provided. Despite all the limitations and leniency in this study, we still do not have clear figures stating that a community organization like us after taking all the risks, will financially benefit or at least recover our experimental implementation costs.

• Even if we feel comfortable that the quality of care will be improved, do we have data to assure us that our sized organization will not risk big financial losses down the road if we follow the roadmap properly and comply with all measures.

Our Capabilities as Organization• We need more information on our organization and partner

organizations' capabilities in measuring the baseline data. We need information on the costs and practicality of recording the data, collecting the data and analyzing and reporting the data.

Our Stakeholders

• Do we have hard data on how will our internal stakeholders for example physicians, employees, management will be effected by our decision. We will be interested to see some satisfaction surveys conducted by organizations of our size on different stakeholders.

Our Community

• Do we have studies on how have ACOs effected communities in general and what do communities think about ACOs that have already been formed in areas like ours.

Recruitment and Retention

• Do we have data on how ACOs effect recruitment and retention in terms of management, physicians, clinical staff, support staff.

Autonomy

• Are there reports on small organizations who have already joined ACOs expressing these concerns.

Site Visits

• We as a board think that it might be useful to visit other organizations in similar communities as ours who have formed ACOs and listen to them on their overall experience with the transformation. These kinds of visits will give us real world experience and information on this matter.

Wait and See

• Will a wait and see approach for our organization will be more appropriate till we have more studies and more organizations like ours have reported favorable data.

Back-up plan

• Should we form an ACO with all our good faith and efforts, do we have a back-up plan if this model fails in near or distant future for some reasons like political, financial, lack of achievement of intended goals or if this model in any way collides with our mission and vision for some unforeseen reasons.

Conclusion

• Not at this time

Rationale

• Participants

• Bandwidth

Rationale, continued

• Physician Group Practice project

• Financial Risk

Rationale continued

Rationale, continued

• Unreasonable Reporting

Rationale continued

Future Direction

• Current relationships

• New relationships

• Political Presence

• IT infrastructure

Thank You

Questions?

References1. Health Management Associates, http://www.hma.com/default.aspx

2. Affordable Care Act to improve quality of care for people with Medicare. U.S. Department of Health & Human Services, News Release - March 31, 2011. http://www.hhs.gov/news/press/2011pres/03/20110331a.html

3. American Medical Association, November 14, 2010 Interim Meeting of the American Medical Association House of Delegates. http://www.cmanet.org/news/detail/?article=highlights-from-amas-2010-house-of-delegates

4. Physician Organization in Relation To Quality and Efficiency of Care: A Synthesis of Recent Literature, Laura Tollen, Kaiser Permanente Institute of Health Policy, April 2008

5. Avery Johnson (The Model of the Future? WSJ.com March 28, 2011).

6. Lindsey Dunn (Should Your Hospital Develop or Join an ACO? 5 Questions to Ask Becker’s Hospital Review November 09, 2010).

7. Health Information Requirements for Accountable Care, Computer Sciences Corporation, Enders, Battani, Zywiak, http://www.csc.com/health_services/insights/54413-health_information_requirements_for_accountable_care