Presented:
March 14, 2013
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About Franciscan Alliance
• Franciscan Alliance operates in
4 regions
• History of serving local
communities for over 135 years
• 14 Hospitals throughout Indiana
and Illinois, as well as several
healthcare support companies
• Employs Over 700 Providers
Franciscan Physician Network
• Will Complete Transition To Epic
during 2013
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Carmel
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Franciscan Alliance
Accountable Care Organization
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What is an Accountable Care Organization?
• An Accountable Care Organization, or ACO, is an entity that agrees
to be accountable for the quality, cost, and overall care of a defined
population
• The Goal of an ACO: Achieve the “Triple Aim”
1. Better population health
2. Higher-quality care
3. Lower costs of care
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Why Accountable Care?
• Healthcare is moving from an activity-based model to a new, value-based
model:
Current Environment
Activity-based FFS:
“More = Better”
Future Environment:
Value-Based: Rewards for
Quality & Cost Effectiveness
• Success will depend on the value of services delivered across the continuum
of care
• Need to be proactive in transitioning our care models
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Franciscan Alliance Pioneer ACO at a Glance
• Franciscan Alliance selected as 1 of only 32 Pioneer ACOs nationally
• Effective date: January 1, 2012
• Length of contract: 3-5 years with termination option
• Regions participating: CIR, NIR joined effective 01/01/13
• # ACO providers: Appx. 650
• # ACO hospitals: Franciscan St. Francis Health Indianapolis &
Mooresville, Major Hospital, Rush Memorial, Fairbanks
• # ACO beneficiaries: 28,000
• 33 Quality metrics
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Medicare ACO Initiatives
32 Pioneer ACOs
89 MSSP ACOs (2012 start)
106 MSSP ACOs (2013 start)
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Current Franciscan Alliance ACO Partnerships
• Franciscan Alliance Pioneer ACO
 Franciscan Central Region& St. Francis Health Network – 1/1/2012
• Franciscan AHN ACO (MSSP)
 American Health Network – 7/1/2012
• Franciscan Alliance Pioneer ACO Expansion
 Franciscan Northern Region – 1/1/2013
• Franciscan Union ACO (MSSP)
 Union Health System, UAP, & PMG – 1/01/2013
• Franciscan Cigna ACO (Commercial) – 1/01/2013
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ACO Critical Needs
• IT infrastructure
• Care Management across Pre/Post Acute, Ambulatory, Home
Health, and ACOs
• Education & communication with ACO providers & partners
• Administrative support
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ACO IT
• ACOs need to collect and centralize quality and cost data for
quality reporting
• Additional quality measures will be required as the industry
matures
• Population management systems that can stratify and track the
most complex patients (e.g. 20% of patients use 50% of costs)
• Move toward integrated EMR systems and advanced clinical
processes
• Data analyst critical in identifying “low hanging fruit”
opportunities
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ACO Care Management
• Creation of a robust care management program that is diverse
enough to address variety of patient needs
• Care management staff including BSN, RN, MSW, LSW, MA,
and DM
• Aggressive outreach to patients
• Population management programming efforts
• High resource utilization here
• Finding the “right fit” may be difficult
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ACO Education & Communication
• Creation of a robust education program that constantly reaches
out to beneficiaries, providers, and staff about the ACO
• Customer service is key
• Educate, then educate, then educate some more!
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Lessons Learned
• There will be bumps—and some potholes---along the way!
• Flexibility is key to survival
• There is no “right way” to do anything in this environment
• Data is central to success
• Communication among different ACO workgroups essential
• This is fun! We are making a difference on how healthcare is
delivered and our patients benefit!
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