Living in the ACO
Model: What’s Next
Moderator
John Pritchard, Medical Distribution Solutions,
Inc.
Panelists
Scott D. Pope, PharmD, Executive Director,
Healthcare Innovators Collaborative, Premier,
Inc
Tara Canty, Chief Operating Officer, Accountable
Care and Senior Vice President, Government
Relations, OSF Healthcare System
OSF Healthcare System
Accountable Care
Moving from Volume to
Value
One OSF All Together Better
ACO Participation at OSF
6 Acute Care Hospitals
1 Hospice Home
707 Physicians
---211 Primary Care
51 Level 3 PCMH
---CV Service Line
---Neuro Service Line
---Multi Specialty
216 NP/APN
Home Care
DME
Hospice
3
Alignment is critical
Source: Truven Health Analytics
4
Institute of Medicine Analysis
1 out of 5 elderly patients are
readmitted within 30
days
Every year the average
7
doctors across 4
practices
elderly patient sees
Less than 50%
of elderly patients are up
to date on clinical
preventive services
Preventive
Elderly patients with
co-morbidities require
up to
19 medication
doses daily
Self-Management
Specialists
Primary
Care
Outpatient Care
Nurse
Physician
Allied Health
Average surgery patient is
seen by
27 different health
care providers
Hospital
Fewer than half of
follow
up with their primary care
nonsurgical patients
provider after discharge
Follow-up
5
Accountable Care
6
What is an Accountable
Care Organization?
One OSF All Together Better
Principles of Accountable Care
 An ACO is a local health care organization and a related set of
providers (at a minimum, primary care physicians, specialists, and
hospitals) that can be held accountable for the cost and quality of care
delivered to a defined population.
 The goal of coordinated care is to ensure that patients, especially the
chronically ill, get the right care at the right time at the right place
while avoiding unnecessary duplication of services and preventing
medical errors.
 Accountable Care holds organizations accountable for specific levels
of quality care through comprehensive, valid and reliable
measurement of its performance.
8
Pioneer ACO
 Developed by Centers for Medicare & Medicaid
Innovation in partnership with CMS
 The Pioneer ACO Model is designed to encourage the
cultural change necessary to achieve the Triple Aim
– Improve the health of the population (wellness)
– Enhance the patient experience (quality, access and reliability)
– Reduce, or at least control, the per capita cost of care
 Develop Accountable Relationships for care delivery with
other insurers as well
 Over time, deliver care at 20-30% less than the current
projections
9
Accountable Care Relationships at OSF
 Pioneer ACO – 34,000 Medicare beneficiaries
 Blue Cross – 40,000 projected members -- January 1, 2014
– Capitated HMO (Ambulatory Services) and
Shared Risk PPO
• Closing care gaps
• Outreach to high risk patients
 Humana – 8,500 Medicare Advantage members
– Capitated HMO and Shared Savings PPO
Value-Based
Payment Streams
Today
 25% of Revenue
 150,000 Covered Lives
• Medical Home
• Closing care gaps
 Health Alliance – 15,000 HMO members
– Shared Risk
Future
 60% of Revenue
 400,000 Covered Lives
 Quality Care Plan (OSF employees & deps.) – 30,000 members
10
OSF’s Approach
One OSF All Together Better
Areas of Focus
 Reduce avoidable admissions and readmissions
 Reduce length of stay
 Decrease avoidable ED visits
 Improve care coordination
 Improved transition of care
 Increase Clinical Integration
12
Challenges
 Limited psychiatric/substance abuse services in the community
 Ability to expand access to primary care physicians and midlevel providers
 Communication constraints
 Establishing consistency across accountable care agreements
 Non-OSF provider engagements
 Maintaining timely access to data and identifying appropriate
benchmarks
 Balance dueling business models
13
OSF’s Care Management Model
Adult - High Risk defined as:
• 10% for Medicare population
• 3% for Commercial population
• 1% of remaining population
“Hybrid Care Management Team Model”
• 3 Person teams with a 1 RN Care Manager : 2 Non RN support ratio
• 450 patients managed per team
• Embedded Site RN Care Managers (PCMH)
• Centralized Care Management Support Model (MSW, LPN, MOA)
14
Care Transition Projects - Implementing
Best Practice Components
 Patient risk assessment upon admission and throughout patient stay
– Targets appropriate interventions through out stay to achieve successful discharge
– Doubled use of social work assessments and interventions
 Defined discharge process/discharge checklists and after visit
summaries
– Patient Summary includes teaching/teach back
– More complete information for providers after discharge
 Provider handoffs:
– Discharge summaries
– Provider to provider verbal handoff process
15
Care Transition Projects - Implementing
Best Practice Components
 Medication reconciliation at discharge
– Includes first fill at discharge
– Considering home visit for “complete” reconciliation
 Follow-up phone calls within 72 hours of discharge to ensure
patient/caregiver understanding and adherence
– 76% call success rate
 Provider follow-up appointments within 5 days
– May be home care, specialist
– Clinic for patients with no PCP
16
Skilled Nursing Home Initiative
 Preferred SNF network based on quality and service
– CMS Star ratings: at least 4 overall and 3 quality
– 24/7 admissions
– 75% acceptance of all admissions
– 24/7 RN on site
– At least 6 days/week therapy
– Specialized sub-acute units for Cardiology and Neurology
17
Skilled Nursing Home Initiative
 Physician and APNs rounding on SNF patients with high
frequency, managing utilization and transition to home
– Multi-disciplinary team approach
– Strong clinical model
• Increase discharges to home from SNF (improved patient outcome)
• Decrease ALOS (from 86 days/stay to <40 days/stay)
• Reduce acute readmissions (from 50% to <10%)
– All SNF patients considered high risk
• All receive home care referral at discharge from SNF
• All patients transitioned to Care Management/Medical Home
18
Additional Initiatives
 Data Analytics
– Enterprise Data Warehouse
 Access
– Centralized Ambulatory Call Center
• Improved access to primary care
• Same day appointments
– Specialty care
– Transportation
 Referral Management
– Clinical Integration
• Leakage
• Quality/outcomes
19
Additional Initiatives (continued)
 Telemedicine
– E-ICU
– Care Management
– Behavioral Health, CHF, COPD, Stroke
 Physician Engagement
– Education, Data, reports
• Physician Dashboard
– Accountability
• Quality component in compensation
20
Questions?
One OSF All Together Better
Scott D. Pope, PharmD
Executive Director – Healthcare
Innovators Collaborative
Three take-aways
Premier is working to propel population health
You are on the ACO tracks…the train is coming
Find your strategy, your partner, or (ideally) both
The journey to high value healthcare
Value-based purchasing:
HACs, quality, efficiency, cuts
Shared savings
& Global payment
Bundled payment
HAC and readmission
penalties
Medical home
MOVEMENT TO INTEGRATED CARE, NEW PAYMENT MODELS & RISK
High Performing Hospitals
• Most efficient supply chain
• Best outcomes in quality, safety
• Waste elimination
• Satisfied patients
24
High Value Episodes
• DRG and episode
targeting
• Care models and
gainsharing
• Data analytics
• Cost management
Population Management
• Population analytics
• Care management
• Financial modeling and
management
• Legal
• Physician integration
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Pop Health Core Components
The Network Effect – Premier PACT
29 markets | 23 systems | 100+ hospitals | 5,000+ MDs,
1.5M accountable care covered lives
86 markets | 67 systems | 300+ hospitals | 12,000+ MDs
Assessments drive insight
Implementation Collaborative
overall assessment*
Readiness Collaborative
overall assessment**
Blue = High
Green = Average
Red = Low
*Data from 24 markets
**Data from 51 assessments
27
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
New era population health management solutions
By leveraging our vast data assets and partnerships with leading technology providers we have
developed solutions to address population health and new payment models.
PHYSICIAN
NETWORK
MANAGEMENT
Advisory
Services
•
•
POPULATION
ANALYTICS & RISK
MANAGEMENT
•
Network development
Clinical integration
•
•
Community needs
assessments
Shared savings
Bundled payments
POPULATION
ENGAGEMENT
•
•
•
Patient-centered
medical home
Care redesign
Practice optimization
Collaboratives
POPULATION HEALTH COLLABORATIVE
Information
Technology
PLATFORM
28
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Supplier
Implications
Envisioning the future
Fee-for-service executives = More volume
ACO executives = Reduce high cost “things”
Commodity until proven otherwise
Physicians are incented on cost/outcomes
Common threads of hope
Deeply understand how ACOs really work
Provide more outcomes data, onus is on you
Bring a collaborative mindset & be willing to test
Healthcare Today
Launched in 2010
•Received by over 23,000
stakeholders
•6 issues per year
•The only publications
dedicated solely to ACO
development
WWW.ACOInsights.com
Triple Aim Focus of Reform
● Reducing Cost
● Improving Quality
● Enhancing Patient Experience
Suppliers must have a Value Proposition that
aligns with the Triple Aim!
35
How Reform and ACOs will impact the
Supply Chain
• Physician Alignment
• Alignment of Incentives
• Clinical Integration
• Information Management
• Supply Chain Engagement
SMI/MDSI 2013 ACO Executive Briefing
HSCA 2013
Washington, D.C.
October 22, 2013
John I. Pritchard
jpritchard@mdsi.org
(770) 263-5262
37