Measuring Progress
Toward Accountable Care
Aurora Health Care Readiness to Implementation
Patrick Falvey, PhD
Executive Vice President/
Chief Integration Officer
Aurora Health Care
Milwaukee, Wisconsin
The Commonwealth Fund
Webinar
March 14, 2013
Aurora at a Glance
• Private, not-for-profit integrated
health care provider
• 31 counties, 90 communities
• 15 hospitals
• 172 clinics sites
• More than 1,500 employed
physicians
• Largest homecare organization in
the state
•
•
•
•
•
More than 70 retail pharmacies
30,000 caregivers
94,000 inpatient discharges
2 million outpatient visits
4.1 million ambulatory care visits
• Revenues greater than $4.2 billion
Focused Populations
Aurora Caregivers and Beneficiaries
• 50,000 Lives
• 15 years of better-than-market
performance
• Top-tier quality performance
Shared Savings ACO
• CMS Model 1 Demonstration
• About 10,000 Beneficiaries
• Improved Quality and Efficiency
Aurora Accountable Care Network
• Commercial market ACO
• Partnership with Aetna
• Partnership with Anthem
Medicaid Program
• Medicaid OB pilot
Care Redesign Pilots
• Behavioral Health
• Orthopedics
• Nursing Home
• Kenosha ACO
3#
Transforming Towards Accountable Care
Patient-centered
continuum of care
Communication
& EHR
Operational
Efficiency
Legal
Payer
partnerships
Network
Interconnectivity
Patient
Populations
Clinical
knowledge
management
Patient/Family
engagement
Risk
Assessment
minimization
Public
policy
Measurement
Population benefits &
data management
Health
home
Factors That Differentiate Organizations with High ACO Readiness
1.
Full or partial ownership of a health plan with population
health management capabilities
2.
Existing collaboration with other health systems in the
community
3.
Existing risk-based contracts with payers including bundled
payments
4.
A sophisticated EHR and HIE implementation strategy
across the continuum of care
5.
Clinical integration across the continuum of care
6.
Patient-centered medical home with employed or
community providers
7.
Positive relationships with primary care and specialty
care providers in the market
8.
Active governance structures that include physician
leadership (e.g. PHOs)
Positive Physician Relationships
1. Accountable Care/Care Redesign Medical
Group Leadership
2. Care Redesign Around Primary Care,
Clinical Integration, Smart Chart, Clinical
Programs, and Redesign Pilots
3. Patient-Centered Medical Home
4. Physician Compensation Collaborative
Factors Likely to Become Differentiators in More Mature Models
1. Active governance structures that
include physician leadership (e.g. PHOs)
2. An EHR and HIE implementation strategy
across the continuum of care
3. Physician leadership development
programs or culture barriers
4. Payers that are initiating innovative
risk-based relationships
Organizational Relationships
1. Smart Chart Implementation to
Transformation
2. ACO Governance
3. Administrators and Physician Leadership
Development
4. Medical Group Leadership Council
5. Payer–Provider Role Definition
Population Health Analytics
1. Quality and Efficiency Metrics
2. Registries—Leverage EHR
3. Clinical and Financial Analytics
4. Patient Risk Models, ETGs
Moving Forward
1. Accountable Care Infrastructure
2. Care Redesign Tactics
3. Network Development
4. Payer Partnership
5. Analytics