ACO Investment Model of

Central Minnesota

Speakers: Rachelle Schultz & Larry Schulz Wednesday, March 8, 2017

11:10 a.m. – 12:10 p.m. Sponsored by:

Rachelle Schultz

Rachelle Schultz serves as chief executive officer & president at Winona Health Services, Inc. She has more than 18 years of experience in health care management. She oversees a 99-bed acute care hospital, a 140-bed nursing home, three assisted living facilities, Winona Health clinics, home care and hospice programs, a pharmacy, a foundation and related healthcare services. In her years as an administrator, she has a proven record of accomplishments including organizational restructuring that resulted in greater efficiencies to successful completion of building projects, development and implementation of strategic plans, physician recruitment and new product line development.

Larry Schulz

Larry Schulz has been the CEO of Lake Region Healthcare in Fergus Falls since 2008. Prior to his present assignment, Schulz served as the senior vice president of operations for Catholic Health Initiatives. His 40 years in healthcare administration have also included CEO assignments in Arlington, Faribault and Little Falls.

Schulz has served on numerous healthcare organization boards including service as the chair of the Minnesota Hospital Association, the chair of the American Hospital Association Section for Small or Rural Hospitals, and the secretary of the Institute for Clinical Systems Improvement.

Schulz has been recognized for his community service and early in his career was named as one of ten outstanding young Minnesotans. He currently is co-chair of Forward Fergus Falls, a board member of Lake Region Community Partners, and a member of Kiwanis.

He is a past recipient of the MHA Spirit of Advocacy Award and in 2015 received the Stephen Rogness Distinguished Service Award from MHA.

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Rachelle Schultz

Larry Schulz

OBJECTIVES

• Describe Medicare ACO Shared Describe Medicare ACO Shared Describe Medicare ACO Shared Describe Medicare ACO Shared

Savings ProgramSavings ProgramSavings ProgramSavings Program

• Describe the Accountable Care Describe the Accountable Care Describe the Accountable Care Describe the Accountable Care

Investment Model (AIM)Investment Model (AIM)Investment Model (AIM)Investment Model (AIM)

• Share strategies of partnershipShare strategies of partnershipShare strategies of partnershipShare strategies of partnership

• Share examplesShare examplesShare examplesShare examples

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WINONA HEALTH

LAKE REGION HEALTHCARE

Lake Region Healthcare, Fergus Falls, Minn.

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MADISON HEALTHCARE SERVICES

OPPORTUNITY FOR PARTNERSHIP

• Triple AimTriple AimTriple AimTriple Aim

• FFS FFS FFS FFS ����VBPVBPVBPVBP

• IndependenceIndependenceIndependenceIndependence

• Integrated Health Partnership (IHP)Integrated Health Partnership (IHP)Integrated Health Partnership (IHP)Integrated Health Partnership (IHP)

• OtherOtherOtherOther

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MEDICARE SHARED SAVINGS PROGRAM

• What is it?What is it?What is it?What is it?

•Manage total cost of care

•Share savings with CMS

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ACO INVESTMENT MODEL (AIM)

• What is it?What is it?What is it?What is it?

• How does it work?How does it work?How does it work?How does it work?

• How do we use the AIM funds?How do we use the AIM funds?How do we use the AIM funds?How do we use the AIM funds?

“

WHAT IS AIM?

• CMS Demonstration Project to CMS Demonstration Project to CMS Demonstration Project to CMS Demonstration Project to

encourage expansion of coordinated encourage expansion of coordinated encourage expansion of coordinated encourage expansion of coordinated

accountable care in rural areaaccountable care in rural areaaccountable care in rural areaaccountable care in rural area

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AIM ELIGIBILITY

• Acceptance into Medicare Shared Savings Acceptance into Medicare Shared Savings Acceptance into Medicare Shared Savings Acceptance into Medicare Shared Savings

ACO ProgramACO ProgramACO ProgramACO Program

• Rural areaRural areaRural areaRural area

• CAH or PPS hospitals with 100 beds or fewerCAH or PPS hospitals with 100 beds or fewerCAH or PPS hospitals with 100 beds or fewerCAH or PPS hospitals with 100 beds or fewer

• Not owned by health planNot owned by health planNot owned by health planNot owned by health plan

• Did not participate in CMS Advanced Payment Did not participate in CMS Advanced Payment Did not participate in CMS Advanced Payment Did not participate in CMS Advanced Payment

ModelModelModelModel

HOW DOES AIM WORK?

• Upfront payments for improving infrastructure and Upfront payments for improving infrastructure and Upfront payments for improving infrastructure and Upfront payments for improving infrastructure and

redesigning care processesredesigning care processesredesigning care processesredesigning care processes

• Savings are projected prospectively for 2 years and Savings are projected prospectively for 2 years and Savings are projected prospectively for 2 years and Savings are projected prospectively for 2 years and

returned only if realizedreturned only if realizedreturned only if realizedreturned only if realized

• Third year ACO is on its own with upside riskThird year ACO is on its own with upside riskThird year ACO is on its own with upside riskThird year ACO is on its own with upside risk

• After 3After 3After 3After 3rdrdrdrd year providers can choose to continue, year providers can choose to continue, year providers can choose to continue, year providers can choose to continue,

disband, grow, or merge ACOdisband, grow, or merge ACOdisband, grow, or merge ACOdisband, grow, or merge ACO

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AIM FUNDING

• Upfront fixed paymentUpfront fixed paymentUpfront fixed paymentUpfront fixed payment

• Upfront variable payment based on Upfront variable payment based on Upfront variable payment based on Upfront variable payment based on

number of preliminarily prospectively number of preliminarily prospectively number of preliminarily prospectively number of preliminarily prospectively

assigned beneficiariesassigned beneficiariesassigned beneficiariesassigned beneficiaries

• Monthly variable payment based on Monthly variable payment based on Monthly variable payment based on Monthly variable payment based on

number of beneficiaries attributed to number of beneficiaries attributed to number of beneficiaries attributed to number of beneficiaries attributed to

ACOACOACOACO

AIM FUNDS USE

• Infrastructure investment Infrastructure investment Infrastructure investment Infrastructure investment

•Expansion of HIT systems

•Patient portals

•Data warehouse

•Nurse call line

•Other

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AIM FUNDS USE

• Hiring of staffHiring of staffHiring of staffHiring of staff

•Nurse case managers

•Project directors

•Data analysts

•Other

MINNESOTA RURAL ACO FUNDS USE

• Contract with Caravan HealthContract with Caravan HealthContract with Caravan HealthContract with Caravan Health

• Hiring of local staffHiring of local staffHiring of local staffHiring of local staff

• Educating providers and other staffEducating providers and other staffEducating providers and other staffEducating providers and other staff

• Redesigning care processesRedesigning care processesRedesigning care processesRedesigning care processes

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CARAVAN HEALTH CONTRACT

• ACO managementACO managementACO managementACO management

• Data analyticsData analyticsData analyticsData analytics

• EducationEducationEducationEducation

• Best practicesBest practicesBest practicesBest practices

• Other infrastructureOther infrastructureOther infrastructureOther infrastructure

MINNESOTA RURAL ACO FOCUS

• Increase number of Medicare Increase number of Medicare Increase number of Medicare Increase number of Medicare

beneficiaries in ACObeneficiaries in ACObeneficiaries in ACObeneficiaries in ACO

• Chronic care managementChronic care managementChronic care managementChronic care management

• Transitions of careTransitions of careTransitions of careTransitions of care

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INCREASE NUMBER OF ACO BENEFICIARIES

• Encourage use of annual wellness Encourage use of annual wellness Encourage use of annual wellness Encourage use of annual wellness

visitsvisitsvisitsvisits

• Add additional ACO partnersAdd additional ACO partnersAdd additional ACO partnersAdd additional ACO partners

•Riverwood Healthcare

•Olmsted Medical Center

•Mankato Clinic

CHRONIC CARE MANAGEMENT

Patient StoryPatient StoryPatient StoryPatient Story

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PATIENT OUTCOME

• Blood Pressure 140/90 � 106/64

• TRIG 370 � 246

• LDL 70 � 59

• HDL 27 � 34

• A1C 12.7 � 7.6

PATIENT OUTCOME

• Patient checks and records blood sugar level

3 times/day

• Patient increased his activity; biking daily and

attends bi-weekly exercise program

• Patient continues to live independently and

now also works part-time

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TRANSITIONS OF CARE

FacilityFacilityFacilityFacility Paid AmountPaid AmountPaid AmountPaid Amount Patient CountPatient CountPatient CountPatient Count PaidPaidPaidPaid Per PatientPer PatientPer PatientPer Patient

Nursing Home A $619,030 56 $11,054

Nursing Home B $470,256 56 $ 8,397

Nursing Home C $ 92,328 11 $ 8,393

Swing Bed D $139,114 6 $23,186

TRANSITIONS OF CARE

FacilityFacilityFacilityFacility Paid Paid Paid Paid

AmountAmountAmountAmount

Patient CountPatient CountPatient CountPatient Count PaidPaidPaidPaid Per PatientPer PatientPer PatientPer Patient

Home Health Agency A $231,625 63 $3,677

Home Health Agency B $126,573 26 $4,868

Home Health Agency C $118,731 42 $2,827

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NEXT STEPS

• Continue learning how to define risk Continue learning how to define risk Continue learning how to define risk Continue learning how to define risk factors for defined populationfactors for defined populationfactors for defined populationfactors for defined population

• Consider expansion to other payersConsider expansion to other payersConsider expansion to other payersConsider expansion to other payers

• Learn more about big data and its valueLearn more about big data and its valueLearn more about big data and its valueLearn more about big data and its value

• Continue implementation of best Continue implementation of best Continue implementation of best Continue implementation of best practices for patient centered practices for patient centered practices for patient centered practices for patient centered coordinated carecoordinated carecoordinated carecoordinated care

QUESTIONS

Contact Information:Contact Information:Contact Information:Contact Information:

Rachelle Schultz: Rachelle Schultz: Rachelle Schultz: Rachelle Schultz: Rschultz@WinonaHealth.orgRschultz@WinonaHealth.orgRschultz@WinonaHealth.orgRschultz@WinonaHealth.org

Larry Schulz: Larry Schulz: Larry Schulz: Larry Schulz: lschulz@lrhc.orglschulz@lrhc.orglschulz@lrhc.orglschulz@lrhc.org