CMS IACO 4-29-15
23
Medicare Shared Savings Program ACO Learning System Strategies of SSP ACOs Achieving Shared Savings— Session 2 Wednesday, April 29, 2015 2:30 – 4:00 PM ET Audio for this session can be streamed through your computer, or accessed by phone by dialing 1-857-232-0156; access code: 271840
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Transcript of CMS IACO 4-29-15
Medicare Shared Savings Program ACO Learning System
Strategies of SSP ACOs Achieving Shared Savings—Session 2
Wednesday, April 29, 20152:30 – 4:00 PM ET
Audio for this session can be streamed through your computer, or accessed by phone by dialing 1-857-232-0156; access code: 271840
Disclaimer
The comments made on this call are offered only for general informational and educational purposes. As always, the agency’s positions on matters may be subject to change. CMS’s comments are not offered as and do not constitute legal advice or legal opinions, and no statement made on this call will preclude the agency and/or its law enforcement partners from enforcing any and all applicable laws, rules and regulations. ACOs are responsible for ensuring that their actions fully comply with applicable laws, rules and regulations, and we encourage you to consult with your own legal counsel to ensure such compliance.
Furthermore, to the extent that we may seek to gather facts and information from you during this call, we intend to gather your individual input. CMS is not seeking group advice.
Webinar Agenda
• Housekeeping items• IntegratedACO• Integral Healthcare• Q&A• Wrap-up
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Rivka Weiser
per discussion, I removed Group Chat since we will not plan to use during our topic focused webinars. need to replace photo at top hereIdeally should also replace same image later on when mentions survey, but fine if dont
IntegratedACO
Vipul Mankad, MDFounder & Senior Medical Adviser
Eric Weaver, MHAPresident & CEO
Charles Bunnell, MPAExecutive Director &
Chief Operating Officer
©
ACO LEARNING SYSTEMS PRESENTATION for CMS
April 29, 2015
© 7
Introductions
Vipul Mankad, M.D. Founder and Senior Medical
Adviser, IACO (2013-present); Senior Medical
Adviser-CMS (2005-2006); RWJ Health Policy
Fellow-US Senate (2003-2004);
Eric Weaver, MHA, President, IACO, Focus on
Leadership, Physician Practice and Information
Management
Charlie Bunnell, MPA, Executive Director (COO),
IACO
© 8
Provider Location Map
Weatherford
Austin
San Antonio
Alpine
Midland/Odessa
Provider locations:Midland/Odessa 10
San Antonio 14
Austin 13
Weatherford 1
Alpine 1
Bastrop 1
Port Lavaca 8
Port Lavaca
Bastrop
© 9
Integrated ACO LLC
Track 1, Advance Payment Model, January 1, 2013
Independent Practices initially in medically underserved
region of West Texas with high numbers of Hispanics Vast Geographic Area (Distances of 500 miles between
sites)
Physicians: 28 in 2013 > 48 in 2015
Beneficiaries: 7,177 in 2013 > 13,025 in 2015
EHR penetration: 90%, 9 Platforms (8 MU Certified, 7 HL7
Compatible)
© 10
ACO Formation, Culture and Background
Initial Skepticism and Resistance Will Affordable Care Act be repealed after 2012
elections? Will Supreme Court find it unconstitutional? We are busy enough; why change?
Education by a highly respected local physician and a
physician with national policy experience Inevitability due to macroeconomic factors Tangible benefits to physicians and their patients
Openness to Information Management Loop 360 Healthcare Solutions
© 11
Our Strengths
Physician Ownership, Incentives and Governance No Conflict of Interest for focusing on reduction of
unnecessary hospitalizations for Ambulatory Care Sensitive Admissions (ACSA)
Executive leadership
Medical Leadership in each region (West Texas,
Austin; San Antonio) and Overall
Well-defined Care Coordination protocols CHF and Diabetes
Clinical and Predictive analytics
© 12
Performance Year 1 Results
One of only 6 Advance Payment ACOs to pay back the
advance in the first year of operation and create a surplus
Per capita expenditure benchmark: $12,203
Actual Per Capita expenditure: $11,668
Reduction from $81.4 MM to $77.8 MM Approximately 4.5% cost reduction in PY1
Successfully reported on 100% of quality measures
Returned $1.54 MM and created a surplus of
$208,000 50% performance bonus and 50% reinvestment
© 13
Key strategies
Integrated Data Warehouse and EHR Penetration
Versatility in EHR interfacing methodologies
Utilizes powerful algorithm for prediction of preventable
admissions for CHF patients (C-statistic: AUC 0.9 with a Lift of 17.6 at 1%)
Psychographic segmentation of patient population based
on personality type so we can personalize care
coordination intervention
© 14
Loop360 Population Management System
1.Integrated
Data Warehouse
Public Database
s HIE
Other Insurers
HospitalEHRHIS
Laboratory
Pharmacy
PhysicianEMRPM
Medical Personas - Different Cost
Of Care & Different
Interventions Required
Cu
sto
miz
ed
Pop
ula
tion
Man
ag
em
en
t S
yste
m
2. Quality3. Descriptive 4. Advanced
Clinical 5.Predictive
Analytics
Alerts
Patient Portal
Patient Outreach
Point of Care
Care Management
CMS
© 15
Prediction of CHF PQI
© 16
Cost Effective Use of Care Coordinators
8,000 Medicare Beneficiaries 40 Care Coordinators to achieve 1:200 ratio for
all ACO patients 26 Care Coordinators for patients with multiple
chronic conditions 2 Care Coordinators if 5% of population (most
likely to generate future costs) is selected
Challenge: Identify 5% of patients most prone to
ACSA admissions in the near future (e.g., within
next 6 months) 1 CHF admission = $18,000
© 17
Pearls of Wisdom
Build momentum by earning shared savings in the first
year Solidify physician buy-in
Align incentives and engage physicians
Address economic self-interest of physicians
Standardize processes and data (P4P)
Employ Strong Information Technology Service
© 18
Pearls of Wisdom
Understand population dynamics based on risk
modeling
Promote timely physician feedback via data-
driven report cards (use transparency among
peers to drive performance)
Focus on the “low hanging” fruit
Create a shared purpose (common organizational
goals)
Promote patient engagement
© 19
Future Directions
By Dec. 2015, serve at least 10,000 Medicare lives/year
Expand geographic reach within rural areas of Texas
Implement patient engagement technology platform for
customized prevention and disease management
Build on lessons learned from the Medicare Shared
Savings Program and
Serve commercially insured, Medicare Advantage, and
Medicaid populations.
© 20
Contact Information
Vipul Mankad, M.D., Senior Medical Advisor
Eric Weaver, CEO
Charles Bunnell, Executive Director
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