I N T E G R AT E D C A R E
O R G A N I Z AT I O N
Best Outcome for Every Patient, Every Time
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Agenda
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Today’s changing healthcare environment
Positioning IHS for success
The ICO’s role in the IHS ACO
Organizational structure of the ICO
ICO strategy
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The Catalyst
• Patient Protection and Affordable Care Act
(“health reform”)
While important, health reform has acted as a
catalyst, bringing to the forefront issues we knew
existed
With or without reform, the world as we know it
will change
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Typical Relationship Between the
Government and Physicians
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The Real Issues
• What we can all agree on
Costs for patients and employers increasing
Federal and State Budget deficits immense
Lack of affordable access to care
Increasing regulatory burdens
Decreasing reimbursement for hospitals and
physicians
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The Real Issues
• Patients are frustrated
High cost
Fragmentation
Lack of coordination and collaboration
Quality not commensurate with cost
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The Real Issues
• Physicians are frustrated
Declining reimbursement
Increasing regulatory burdens
Lack of coordination
Volume driven patient care
“Being a physician isn’t what it used to be…”
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Insanity?
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A New Day
• Value will be rewarded over volume
• Physicians and other clinicians will be able to
serve their patients
• Hospitals, physicians and other providers will
be rewarded for managing the overall health
of our communities
• Patients will receive coordinated and
collaborative health care…not fragmentation
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Integrated Care Organization
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Positioning for Success
• Physicians and hospitals are better off working
together
Collaborate on initiatives that make both clinical
and financial sense
Preparation will require a well-organized, capable
provider network with supportive infrastructure
for population management
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Potential Payment
Arrangements
Fee for Service
Value-Based Payment
Increasing Risk
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IHS Overview
• Formed in December 1994
• 15 hospitals and 800+ employed physicians practicing in more
than 76 Iowa and Illinois communities
• 2,600+ affiliated physicians
• $2.6 billion total operating revenue
• 22,200+ employees
• 4 Colleges of Nursing
• 2.5 million patient visits annually
• Mission: Improve the health of the people and communities
we serve
• Vision: Best outcome for every patient every time
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IHS Road Map
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ACO Model
Projected cost based on
medical inflation trends
$MM
Total cost of care for defined population
$ - SAVINGS FOR
EMPLOYER/PAYOR
Performance
Incentives for
Physicians &
Hospitals
Actual costs based on ACO and
Medical Home collaboration
2007
2008
2009
2010
2011
2012
2013
2014
2015
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Population Management
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ICO Vision and Identity
IHS Integrated Care Organization
About Us
The Integrated Care Organization (ICO) is our clinical integration
platform for employed and independent physicians to work
together to improve quality of care, enhance the patient
experience and create more value in health care
Vision Statement
Best Outcome for Every Patient, Every Time
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ICO Defined
• The ICO is a tax-exempt, nonprofit organization
• Designed by independent and employed
physicians with multi-specialty group leaders
from around the system
• Physicians intricately involved in governance
and operations of the ICO
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ICO Regional Overview
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ICO Leadership
Alan Kaplan, MD
Network President
Lisa Klobnak
Admin. Assistant
Kathy Cunningham
Exec. Dir. ACO Strategies
Gina Ross
ICO Director of Operations
Dave Williams, MD
ICO Medical Director
Nate Thompson
Dir. of Physician Services
Angela Rubino
Net. Dev. / Fin. Analyst
Ewa Humphrey
Clinical Integration Mgr.
Joe Walters
Analytics Manager
Amber Lenhardt
Tim McCulley
Ashley Atherton
IHS Legal Dept.
Finance
Contracting
ACO/ICO Communications
Legal Counsel
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ICO Governance Structure
Board of Directors
Operating Committee
Quality
Committee
Future ICO
Committees
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ICO Governance
• Majority of Board must be “non-insiders”
• Delegated authority to Operating Committee
Board Member
Background
Dan Allen, MD
Employed; Internal Medicine; Des Moines
Steve Herwig, DO
Independent; Otolaryngology; Des Moines
Jon Peacock, MD
Independent; Cardiology; Sioux City
Mark Baldwin*
CEO, Iowa Laser Technology; Cedar Falls
Pryce Boeye*
Real Estate Executive; Quad Cities
Rose Mitchell*
Sr. Vice President, Hy-Vee; Des Moines
John Perkins*
Attorney; Fort Dodge
*Community Board Member
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ICO Governance
• Operating Committee
16 physician & 5 non-physician members
Responsible for leading the operations of the ICO
Gregory Johnson, MD, Chair (Peoria)
• Quality Committee
9 physician & 3 non-physician members
Reports to the Operating Committee
Responsible for development of the ICO Quality
Program
Ron Iverson, MD, Chair (Dubuque)
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ICO Operating Committee
Expandable as Required
Region
PC - I
PC - E
Spec - I
Spec - E
Corporate
Des Moines
Dr. Chase
Cedar Rapids
Dr. Bell
Quad Cities
Dubuque
Dr. Kane
Dr. Wallace
Ed Brown
3
2
2
Dr. Sundaram
Dr. Adams
Dr. Stewart
Dr. Jongerius
Dr. Johnson
4
3
3
2
Dr. Remer
5
2
Mike Stoll
Fort Dodge
Total
Kaplan/Vermeer
Dr. Langager
Dr. Liaboe
Dr. Nelson
Dr. Berstler
Peoria
Total
Dr. Constantinou
Waterloo
Sioux City
Dr. Reece
Non-Phys
4
2
Shanin Harding
3
2
5
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PC-I = Primary care independent; PC-E = Primary care employed
Spec-I = Specialist Independent; Spec-E = Specialist employed
Non-Phys = Medical group leaders, IHS Chief Medical Officer & IHS Chief Financial Officer
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ICO Quality Committee
Expandable as Required
Region
PC - I
Corporate
PC - E
Spec - I
Spec - E
Dr. Williams
Des Moines
Dr. Schulte
Cedar Rapids
Non-Physician
Total
Gina Ross
2
Wendt, Sander
3
Dr. Hodge
1
Quad Cities
Dr. Raman
1
Dubuque
Dr. Iverson
1
Waterloo
Fort Dodge
Sioux City
Dr. Sampat
1
Dr. Smith
1
Dr. Brenner
1
Peoria
Total
Dr. Johnson
1
4
3
1
1
3
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PC-I = Primary care independent; PC-E = Primary care employed
Spec-I = Specialist Independent; Spec-E = Specialist employed
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ICO Strategy
• Establish a clinically integrated network across IHS
 Align independent and employed physicians on a
common quality improvement platform
 Pursue value-based contracts that reward
performance on quality metrics which are
meaningful to physicians, patients, families and our
communities (i.e. shared savings)
 Assist ICO physicians with the changing healthcare
environment where quality, patient experience and
value are recognized
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ICO Engine
• Chronic Disease Analytics
Create disease registry
Aid in the management of chronically ill patients
Enhance physician-to-physician communication
Provide outcome measures
Provide actionable information to support
management of patient populations
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ICO Engine
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ICO Initiatives
• Build system-wide primary care network
aligned on common set of metrics for 2012
• Reward achievement of quality targets with
incentive dollars
IHS Self Funded Health Plan
ACO Shared Savings agreement with Wellmark
Restructured Wellmark Pay for Performance
programs
Medicare Shared Savings Program
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Phases of Physician Engagement
• Phase One: System wide network of primary
care physicians
• Phase Two: Core specialty physicians required
for care of complex, chronically ill patients
Cardiology
Gastroenterology
Endocrinology
• Phase Three: Full spectrum of physicians
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2012 Proposed ICO Metrics
• Quality Program Measures
Chronic Care Management (Claims Data)
 Office visits within 30 days of hospital discharge
 3 or more annual office visits for chronically ill
Primary Prevention (Claims Data)
 Mammography
 Colonoscopy
 Pediatric well visits
• Thresholds based on historical
performance
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Financial Drivers for
Shared Savings
• Shared savings driven by:
Avoidable ER visits
Avoidable admissions
Reduction in pharmaceutical costs
Reduction in duplicative ancillary tests/procedures
Evidence based care guides
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• January 1, 2012
Timeline
Engage primary care physicians
• April 1, 2012
IHS Self Funded Health Plan
Wellmark ACO Shared Savings
Modified QIS Program
Engage core specialty physicians
• July 1, 2012
Engage full spectrum of physicians
Medicare Shared Savings Program
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Ideal State
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Summary
• The ICO is the physician-driven quality improvement
platform within the IHS ACO
• The ICO will create and demonstrate value through
physician collaboration around the “triple aim”:
 Improve quality outcomes
 Enhance patient experience
 Decrease overall cost of care
• ICO physicians will be positioned for long-term
stability and success, regardless of what happens
with healthcare reform
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