ACO Program Management

Report
IHS ACO Strategy:
Population Management
Kathleen Cunningham
Iowa Health System
Executive Director for
Accountable Care Strategies
Pam Halvorson
Trimark Physician Group
VP Regional Clinic Operations
Mike Dewerff
Trinity Regional Medical Center
Chief Financial Officer
IHS Leadership Symposium
April 17, 2012
Objectives
• Review IHS Vision of our Future Healthcare
System
• Describe the structured partnership between
IHS and Regional Integrated Delivery System
• Review basic payor principles for Wellmark
and Medicare Contracts
• Review TriHealth Pioneer ACO operational
plan
• Next Steps
IHS Leadership Symposium, April 17, 2012
IHS Leadership Symposium, April 17, 2012
IHS Leadership Symposium, April 17, 2012
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
IHS Leadership Symposium, April 17, 2012
2014
2015
The Future of Our Health Care
System
• Clinically integrated delivery system,
regionally & system-wide, with effective
population management infrastructure
• Branded as the preferred “high quality—high
value” to patients, communities, businesses,
and payors
• Patient-centric, physician-driven organization
• National leader for healthcare reform
innovation
IHS Leadership Symposium, April 17, 2012
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
IHS Leadership Symposium, April 17, 2012
ACO Defined
A clinically integrated network of
physicians, hospitals, and others providers
committed to using and advancing the latest
thinking in clinical care, quality and
efficiency.
Designed to achieve the triple aim:
better health, better healthcare,
and better value
IHS Leadership Symposium, April 17, 2012
Improve the health of the people
and communities we serve
Population & Community Health
Facilities & Services
Provision of inpatient,
outpatient and ambulatory
services required to
deliver comprehensive
patient care
homes, palliative
care programming, and
advanced medical team
resources to be established
in each affiliate region. Call
Center would be an example
of a system resource.
Platform for physician
engagement and
collaboration to improve
quality, enhance patient
experience and create value
Regional Integrated
Delivery System
System & Regional
Integrated Delivery System2
Care Management
Infrastructure
Analytic Support
Medical Home, Advanced
Medical Team, Palliative
Care, Coordinated Care
Management/Population
Management, Call Center
2 Medical
Integrated Care
Organization 1
System & Regional
Integrated Delivery System2
Business and clinical
analytic capabilities required
to support a population
focused care model
System
IHS Leadership Symposium, April 17, 2012
1 Organization
made up of
employed and independent
physicians from each affiliate
region; committee structure
in place in each region
Regional ACO Steering Committees
IDS Executive Sponsor
IHS ACO
Director
Fort Dodge
Pam Halvorson, VP Regional Clinic Operations
April 2012
Des Moines
Dr. Purtle, VPMA/CMO
Marcia Stark
Cedar Rapids
John Sheehan, Executive VP/COO
April 2012
Waterloo
Judy Renaas, VP/CNE
April 2012
Quad Cities
Katie Pearson, VP Marketing and Business
Development
April 2012
Peoria
Terry Waters, VP, Business Development
April 2012
Sioux City
Chad Markham, VP Clinic and Network
Development
Late 2012
Dubuque
Chad Wolbers, COO
Late 2012
NewGroup
Dr. Erick Laine, Executive VP/COO
Marcia Stark
IHS Leadership Symposium, April 17, 2012
Functional
Alignment
IHS ACO Infrastructure
Advanced Care
Innovation
Population
Care
Management
Research and
Development for
medical care
innovations;
partner with
business unit to
create valueadded programs
for system-wide
impact
• Advanced
Medical Team
• Palliative Care
• Post-acute Care
Coordinated Care
Management for
IHS self-insured
members
expanding to all
ACO members;
provide care
management and
disease
management for
selected
chronically ill
patients.
ACO Analytics
Centralized
analytics to include
predictive riskmodeling;
evidence-based
care packages and
disease registry to
inform physician of
patient gaps-incare; monitor
patient quality and
provider
performance.
ACO Program
Management
Integrated
Care
Organization
(ICO)
Oversee ACO
clinical strategy
deployment in
selected regions;
use ACO Clinical
Collaborative for
regional
engagement ;
• Population risk
management
• Point-of-care
management
• Provider
performance
Physician-led,
clinicallyintegrated
provider
organization
established to
be the physician
arm of ACO to
improve quality
and create
value.
Other Aligned IHS Resources:
* CCT : PI/Research/Education
* Communications
* Decision Support
* Business Development
* Information Technology/CMIO
IHS Leadership Symposium, April 17, 2012
IHS Leadership
IHACO Infrastructure
• Kathleen Cunningham, Executive
Director
• Lori Weih, System Administrator,
ACO Program Management
• Marcia Stark, ACO Director, IHDM
• Dr. Mark Barnhill, Medical
Director, Pop. Care Management
• Raedean VanDenover, Director,
Pop. Care Management
• Joe Walters, Interim Manager,
ACO Health Informatics
• Jim Grant, Sr. Claims Analyst
• Angela Rubino, Network
Development/Financial Analyst
Integrated Care Organization
• Dr. Dave Williams, Medical
Director
• Gina Ross, Director, Operations
• Nathan Thompson, Director,
Physician Services
Iowa Health System
• John Hendricks, Director, IT
Interoperability
• Amber Lenhardt, Director,
Finance Services
• Tim McCulley, Director, Payor
Contracting
New Group
• Linda Wendt, System Director of
Quality
Iowa Health Home Care
• Monique Reese, Chief Clinical
Officer
IHS Leadership Symposium, April 17, 2012
Pioneer ACO Advisors
Pioneer ACO CEO
Beck – Compliance
Thompson
Quality Analytics
Dr. Suriar
Rosfjord
Nagel
IHS –Walters
IHS – Jim Grant
Cunningham
Functions
CMS Metrics
-Claims data
Utilization
Outcomes
Process Measures
Data Analysis
McDonald
Reiners – Legal
Pioneer ACO Leadership
IHS Leadership
Halvorson
Cunningham
L. Wallace. M.D.
Support: Weih
Financial
Clinical
Dr. Wallace/TBD
Dewerff
Haverman
Sullivant
Heasley
Mason
IHS - Dieleman
IHS – Jim Grant
Dr. Meyer
Albrecht
Shriver
Sleiter
Hott
IHS -Reese
IHS –VanDenover
IHS - Fazal
Functions
Analytics
Attribution
Costs/Case
Distribution of
Shared Savings
Incentives
-Support
Interim Payment
Functions
Primary Care Community
Implementation Teams
Communications to Providers
Staff Education
Vorpahl - SharePoint
Patient/Community
Engagement
Dr. Votta
Mcquillen
LeValley
Consumer - D. Michael
Albrecht
Gascho
Community - Prescott
IHS - Sinnard
Functions
Patient Satisfaction
Marketing
Literacy
Communications
Community Relations
IHS Leadership Symposium, April 17, 2012
IT Functionality
Dr. Willerth
Martens
Whaley
Baedke
Trimark-Nagel
IHS - Hendriks
Functions
Portal
System Readiness
IT Integration with Strategic
Partners
Context Management
Health Information Exchange
Disease Registry
TriHealth Pioneer ACO: Achieving our AIM
Secondary Drivers
Primary Drivers
AIM: Leverage every aspect of our “community” to achieve Best
Outcome for Every Patient Every Time
Primary Care Community
Supporting Choice
through the Life
Span
• Health-Risk
Assessment
• Iowa’s
Healthiest
State initiative
• Preventive
screening
• Health
Education and
Literacy
• Wellness
Program
• Patient access to
PCP
• Common
screening and
assessment tools
• Single, patientcentric care plan
• Med Therapy
Management
• Mental Health
Action Team
• Care transitions –
Extended Care
Facilities
• ICCDM – all care
settings
• Advanced Medical
Team
• TelephonicTelemonitoring
• Strategic
Healthcare
Partners
• Critical Access
Hospitals
• Risk
stratification
• Med Therapy
Management
• Disease
Management
Coaching
• Strategic
Community
Partners
• Palliative Care
• Inpatient
• Home-based
• Clinic
• Integration with
PCP
• Hospice
• Hospice
Home
• Home-based
Home/Neighborhood - Schools - Business
- Healthcare
Agencies
Government
-Recreation - Church/Spiritual
IHS Leadership
Symposium,
April -17,
2012
Preparing for all Payment Arrangements
IHS Leadership Symposium, April 17, 2012
IHACO Value-based Contracts
PAYOR
Beneficiaries
Fort Dodge
Des Moines
Cedar Rapids
Waterloo
Quad Cities
Peoria
TriHealth
Pioneer
ACO
1/1/2012
Wellmark
ACO
4/1/2012
Medicare
Shared Savings
(MSSP)
7/1/2012
Iowa
Health
SelfInsured
1/1/2012
ACA
Medicaid
Health
Home
7/1/2012
~ 7,700
~ 50,000
~ 70,000
~ 30,000
IHS in review at
this time
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Sioux City
√
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Dubuque
Quincy Medical
Group
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IHS Leadership Symposium, April 17, 2012
ACO Program Domains
Wellmark ACO
Pioneer and MSSP
 Patient Experience
(4 measures)

Patient/Caregiver Experience
(7 measures)
 Chronic and Follow-Up Care
(3 measures)

Care Coordination/Patient Safety
(6 measures)
 Primary Prevention
(4 measures)

Preventative Health
(8 measures)

At Risk Populations
(12 measures)
Stoplight Definitions

Actively reporting measures with same definition and method

Able to report, or currently reporting with differences in definition, content, or
method

Not able to report at this time, will come from payor claims data
IHS Leadership Symposium, April 17, 2012
Wellmark ACO Baseline
Wellmark ACO
Quality Index Score (QIS)

Patient Experience (4 measures)
• Patient Confidence
• Continuity of Care
• Office Efficiency
• Access to Care

Chronic and Follow-Up Care (3 measures)
• Risk-adjusted potentially preventable readmissions
• Post-acute provider visit
• Provider visits for chronic disease patients

Primary Prevention (4 measures)
• Breast cancer screen
• colorectal cancer screening
• Well-child visits (2 age categories
IHS Leadership Symposium, April 17, 2012
IHS ACO 2012 Priorities
• Clinical Priorities
• IHS Resources Assigned
– Advanced Medical Team
– Palliative Care
• Inpatient
• Outpatient (home care)
• Regional ACO Steering
Committee
– Key stakeholders to
oversee ACO performance
aligned with IHACO
strategies
– Regional ACO Director
– Project Manager
– Analytics (EMR and
claims)
– IT liaison
– Adaptive Design
– Finance
– Contracting
– Communications
IHS Leadership Symposium, April 17, 2012
Next Steps
• Deploy 2012 ACO Priorities
• Refine technology requirements and analytic
services to support ACO performance at the
beneficiary level, to encompass all care
settings
• Further advance additional payor and provider
negotiations to increase ACO beneficiaries
served.
IHS Leadership Symposium, April 17, 2012
IHS ACO Program Contacts
• ACO Program Management
– Lori Weih, System Administrator, ACO Program Management
– [email protected] Phone: 515-471-9791
• Population Care Management
– Raedean VanDenover, IHS Director, Population Care Management
– [email protected] Phone: 515-471-9719
• Advanced Medical Team
– Monique Reese, Chief Clinical Officer, IHHC
– [email protected] Phone: 515-557-3288
• Palliative Care
– Lori Bishop, Executive Director, Statewide Palliative and Hospice, IHHC
– [email protected] Phone: 515-727-1104
IHS Leadership Symposium, April 17, 2012
IHS Leadership Symposium, April 17, 2012
IHS Population Care Management (PCM): Patient Engagement
ACO
Abbreviation and Definitions:
Accountable Care Organization: A clinically integrated network of physicians, hospitals,
and others providers committed to using and advancing the latest thinking in clinical care,
quality and efficiency to achieve the triple aim: Better health, Better Healthcare, and
Better value.
AMT
Advanced Medical Team: The AMT is an interdisciplinary team comprised of a physician,
nurse, pharmacist, therapist, social worker, and other experts supporting the PCP in the
care of a complex patient population. Patients are identified for initial and periodic
complex case review by the AMT when standardized best practice care delivery fails.
CM
Case Management: management for complex, patient who requires coordination through
care continuum, often episodic with a beginning and end date.
DM
Disease Management: Patient-specific, long-term disease management of the chronically
ill patient, with condition-specific interventions to maintain health in the outpatient
setting.
EHR
Electronic Health Record
ICCDM Integrated Chronic Care Disease Management:
ICO
Integrated Care Organization: IHS’ 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
IDT
Inter-disciplinary team: The care team, to include physician, nurse, social worker
PCM
Population Care Management: Predictive risk-modeling in a given population and overall
management, including wellness, of the entire at-risk population attributed to the ACO.
Focus on population based strategies to improve the health of the at risk population while
delivering high quality and high value programs.
Examples
PCP
Triple
Aim
Primary Care Physician: The primary care physician responsible for a single beneficiary
care plan to advance the triple aim.
better quality, better patient experience at a higher value (lower cost)
IHS Leadership Symposium, April 17, 2012
Motor-vehicle accident or
specific cancer patients
COPD or CHF patient long-term
clinical interventions.
High level overview of all ACO
beneficiaries to identify clinical
intervention opportunities to
drive future patient
engagement programming.

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