HFMA
December 2012
Change is Upon Us
•Attacking Rising Costs
•
23% of the Medicare population has a
chronic condition with
•
5 or more co-morbid conditions that
compel them to see
•
12 (different) physicians per year, to fill
•
16 prescriptions and account for
•
68% of total Medicare spending
Source: Institute for Healthcare Improvement
Future Healthcare Model:
Strategic Imperatives
Strategy #1: Physician Integration
Mercy Health Physician Base Continues To Expand
Mercy Health employs physicians
(primary care and specialists) in
every planning area.
*
*includes MD extenders
Strategy #1: Physician Integration
4
Strategy #2: Cohesive Care Delivery Network
Strategy #3: Population Health Management
20,000
Patients
Mercy
Health
Employees
Coming
up in
2013
22,000
Patients
Medicare
Patients
Clinical
Integration
(ACO)
800
Patients
Medicare
Advantage
(MediGold)
Commercial
Payors
Strategy #4: Increasing Efficiency
LOS Index Comparison 2011 YTD
Target
approximates
top quartile
1.06
0.99
1.01
1.02
0.99
MTA
MWH
SWO
1.02
G
o
o
d
1.04
0.96
0.83
MHA
MHC
MHF
LOS Index
TJH
North
CHP
OH
Target = 1.01
Benchmark and target are
approximate
Reg
Preventable Harm Comparison 2011 YTD
Benchmark
approximates
top quartile
0.25%
0.13%
0.15%
0.14%
0.18%
0.16%
0.15%
G
o
o
d
0.17%
0.12%
MHA
MHC
MHF
Preventable harm
TJH
MTA
MWH
Target = 0.15%
SWO
North
CHP
OH
Benchmark
Reg= 0.22%
ACO Development
An Accountable Care Organization (ACO) is a group of providers willing and capable of
accepting accountability for the total cost and quality of care for a defined population.
What is an ACO?
Payer Partners
► Insurers
Core Components:
•People Centered Foundation
•Health Home
•High-Value Network
•Population Health Data Mgmt
•ACO Leadership
•Payor Partnerships
► Employers
► States
► CMS
9
Mercy Health Select / ACO Vision
 MHS is a virtual partnership between Mercy Health
hospitals, Mercy Health Physicians, community PCPs,
specialist groups contracted with MH hospitals, and
potentially other health care professionals who accept
responsibility for and are dedicated to improving the health
status of residents in the Tri-State region through improved
access, coordination of care and clinical performance
management
Mercy Health Select - Building the ACO
 Mercy Health Physicians and Affiliated Physicians
 22,000 attributed lives
 PCP determined by a plurality of visits
 Developing population health management skills
 Exploring commercial ACO opportunities
ACO Development Timeline
Medicare
Advantage
Offering
Oct 2012
Medicare
ACO
application
approved
July 2012
Physician Led
board of
managers and
committee
operational
April 2012
Oct 2011
Mercy
Health
Select LLC
was formed
Cornerstones of ACO
Clinical
Integration
Care
Coordination
ACO
Information
Technology
Financial
Management
There are two important goals the ACO must
accomplish before it can get shared savings
Create
Sufficient
Savings (>2.5%)
Shared
Savings
Meet or
exceed the
minimum
quality score
33 Quality Measures
Measure and Report
 Patient experience
 Care Coordination
 Preventive Care
 Management of Population Health for at-risk chronic
populations
Diabetes
Hypertension
IVD
CAD
Key strategies to bend
the cost curve
PCMH that is fully implemented in all of our
practices
Care Coordination to proactively manage patients
Reduce re-admits by improving
communication among PCPs/ ED/ Hospitalists
Reduce ED utilization by expanding access
CarePATH Common IT Platform
My Mercy Health Medical Home
a patient centered experience
Improving Patient Access
PCMH Care Coordination
Pilot Results
 Admission rate ↓ 51%
 Readmission rate ↓ 35%
 ER visit rate ↓ 37%
 Diabetes A1C control improved: ↑ 33%
 LDL (% Ideal) ↑ 6.45%
 Goal of not smoking: ↑ 11.8%
Pulling it All Together:
Comprehensive Population Health Management
Physician-led Governance Body and Committees
PCMH & Nurse Care Coordinator Program
Risk Stratification, Disease Mgmt., Wellness, High-Cost Claims, Data
Warehousing/Reporting
Healthier
Patients
Lower
Costs
Healthier
Population
QUESTIONS?
DISCUSSION