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 √ √ √ √ √ √ √ √ √ √ √ √ √ Sioux City √ √ Dubuque Quincy Medical Group √ √ √ 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.