© 2018 PROPRIETARY & CONFIDENTIAL | 1TRANSFORMING HEALTHCARE TOGETHER®
Strategies for Success in a Medicare ACO Model
Population Health Management
Wednesday, February 7
2 – 3 pm ETVALUE-BASED CARE CONSULTING
© 2018 PROPRIETARY & CONFIDENTIAL | 2TRANSFORMING HEALTHCARE TOGETHER®
AUDIODial in to our operator assisted call, 1.800.618.4645
QUESTIONSUse the “Questions and Answers” feature
RECORDINGThis webinar is being recorded.
View it tomorrow on the event page at premierinc.com/events.
NOTESDownload today’s slides from the event post at premierinc.com/events.
Logistics
© 2018 PROPRIETARY & CONFIDENTIAL | 3TRANSFORMING HEALTHCARE TOGETHER®
Today’s discussion
• Introduction / welcome / purpose
• The movement to value-based care and population
health: The burning platform
• How Premier can help
• Case study: Ballad Health / Anewcare MSSP ACO
• Q&A
• Adjourn
© 2018 PROPRIETARY & CONFIDENTIAL | 4TRANSFORMING HEALTHCARE TOGETHER®
The burning platform
The movement to value-based care and population health
© 2018 PROPRIETARY & CONFIDENTIAL | 5TRANSFORMING HEALTHCARE TOGETHER®
Demographics + Economic Unsustainability + Chronic Disease 1. Aging Population 2. Significant Spend Increase
4. Chronic Conditions
Medicare
Medicaid
Social
Security
3. Not Fiscally Sustainable
15.0%
16.0%
17.0%
18.0%
19.0%
20.0%
21.0%
$0
$5,000
$10,000
$15,000
$20,000
200
9
201
0
201
1
201
2
201
3
201
4
201
5
201
6
201
7
201
8
201
9
202
0
202
1
202
2
202
3
202
4
202
5
National Health Expenditures, per capita
Market pressures
© 2018 PROPRIETARY & CONFIDENTIAL | 6TRANSFORMING HEALTHCARE TOGETHER®
Paths for clinicians in the Quality Payment Program
The financial impact of the chosen path can impact
payments -9 to +9% or more. Organizations must
consider the operating infrastructure required.
Impact of MIPS on
Eligible Clinicians
Impact of MIPS Track
+ Cost of Upside ACO
Impact of integrating
providers and care
TOTAL MIPS TRACKTOTAL NON-QUALIFIED
APM TRACK
TOTAL QUALIFIED
APM TRACK
MIPS Track
(+/- 4 – 9% payment adjustment)
MIPS + Non-Qualified
APM Track
(+/- 4 – 9% payment
adjustment)
Advanced
Alternative Payment
Models
(5% bonus)
© 2018 PROPRIETARY & CONFIDENTIAL | 7TRANSFORMING HEALTHCARE TOGETHER®
MACRA/QPP reporting advantages for MSSP ACOs
• As an MIPS/APM, ACOs have beneficial scoring and simpler reporting requirements. As an ACO,
you will report together as one group, reducing administrative and resource burden to report, with
the following additional benefits for each category-
Quality -
• CMS will use the GPRO measures that are already reported for the MSSP 31 quality metrics for this category (50% of composite score).
Cost -
• This category is not included in the assessment of MSSP Track 1 ACOs in MIPS, as CMS believes ACO are already being judged on efficiency through the MSSP.
Improvement Activities -
• The ACO receives full credit for this category. (20% of composite score)
Advancing Care Information -
• Each ACO Participant TIN will report this category. These scores will be aggregated, and the ACO will receive weighted average of those scores (30% of composite)
© 2018 PROPRIETARY & CONFIDENTIAL | 8TRANSFORMING HEALTHCARE TOGETHER®
Remain in MIPS12%
Select APM-MIPS56%
Become Advanced APM
32%
Results from our first round of MACRA Assessments
40% of clients
believe they have
reached a
conclusion before
the assessment
begins
Of those, 60%
change course
after seeing the
numbers
© 2018 PROPRIETARY & CONFIDENTIAL | 9TRANSFORMING HEALTHCARE TOGETHER®
Medicare ACO Models – Key Information
* Qualifies as MACRA/QPP Advanced Alternative Payment Model
Model Performance
Period
1-Sided or
2-Sided
Risk
Application
Period
Number of
ACOs (as
of January
2018)
Geographies
MSSP Track 1 3-year period 1-sided March-Oct
for Jan start
460 Nationwide
MSSP Track 1+ 3-year period 2-sided March-Oct
for Jan start
55 Nationwide
MSSP Track 2 3-year period 2-sided March-Oct
for Jan start
8 Nationwide
MSSP Track 3 3-year period 2-sided March-Oct
for Jan start
38 Nationwide
Next Generation
ACO
3-year period (w/2
optional years),
started 2016,
2017, 2018
2-sided Closed 58 Nationwide
Comprehensive
ESRD Care
5-year period,
started 2015,
2017
Both Closed 37 Nationwide
© 2018 PROPRIETARY & CONFIDENTIAL | 10TRANSFORMING HEALTHCARE TOGETHER®
76.4% 75.4% 71.7%
63.3%58.6%
54.1% 51.6%
44.2%
23.6% 24.2%27.0% 28.5% 30.4% 32.0% 32.8% 34.6%
0.0% 0.4% 1.3%
8.2% 11.0% 13.9% 15.6%21.2%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
2010 2011 2012 2013 2014 2015 2016 2017
Pe
rce
nt
of
Me
dic
are
Be
nef
icia
rie
s
Medicare Enrollment – 2017
FFS
MA
ACO
Sources:
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-01-18.html
https://www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2016-fact-sheets-items/2016-01-11.html
https://innovation.cms.gov/initiatives/Pioneer-ACO-Model/
https://data.cms.gov/Special-Programs-Initiatives-Medicare-Shared-Savin/Medicare-Shared-Savings-Program-Accountable-Care-O/x8va-z7cu
https://data.cms.gov/Special-Programs-Initiatives-Medicare-Shared-Savin/Medicare-Shared-Savings-Program-Accountable-Care-O/ucce-hhpu
https://data.cms.gov/Special-Programs-Initiatives-Medicare-Shared-Savin/Medicare-Shared-Savings-Program-Accountable-Care-O/yuq5-65xt
The share of Medicare enrollment in population
management is growing
© 2018 PROPRIETARY & CONFIDENTIAL | 11TRANSFORMING HEALTHCARE TOGETHER®
How can Premier help?
© 2018 PROPRIETARY & CONFIDENTIAL | 12TRANSFORMING HEALTHCARE TOGETHER®
Collaboratives POPULATION HEALTH
COLLABORATIVE
Advisory
Services and
Subject Matter
Expertise
Shared Savings
Measures Development
Value-based contracting
Clinical Integration
Network Development
Pop Health Strategy
PCMH
Care Management
Bundled Payments
DSRIP/Medicaid Reform Service Line Optimization Economic Analysis
Pop Health &
Health System
Strategy
External
Collaboratives
Next Generation, Pioneer,
and ESRD ACO Learning
Systems for CMS
American Society of
Anesthesia – Perioperative
Surgical Home
Greater New York Hospital
Association – DSRIP
Learning Systems
MACRAPost Acute NetworkPhysician Alignment
Population health, quality & regulatory
© 2018 PROPRIETARY & CONFIDENTIAL | 13TRANSFORMING HEALTHCARE TOGETHER®
Population Health
Management
Collaborative – Core and
Advanced
75+ members collaborating
on best practices and
performance improvement
Enabling success in population health management
Connecting People: National Population Health
Management Collaboratives
Connecting Data:Population Health Analytics
Connecting Knowledge: Operational Deployment
MO
FL
Resources to build
capabilities
Cohorts, best practices
portal, guidebooks, tools,
subject matter experts
Population Health
data management
Advanced benchmark
reports supporting
performance improvement
initiatives
© 2018 PROPRIETARY & CONFIDENTIAL | 14TRANSFORMING HEALTHCARE TOGETHER®
PHM Collaborative Offerings
Collaboration Meetings and
Events:
• National Meetings (2 per year)
• Topic Specific Meetings (3 per year)
• Oversight committee participation (4 meetings per year)
• Development workshops
Education Series and Best Practice
Sharing:
• Population Health Learning Series (monthly webinar)
• Learning and development cohorts/affinity groups:
•MSSP/Next Gen Application
•Employee Population Health
•Understanding MACRA
•Medicaid / Uninsured cohort
•Medicare ACO Advanced
•Mature Two-sided Risk Entities
•Academic Health Systems
•Clinical Leadership
•Care Management
• Performance improvement sprints
• Enriched networking opportunities
One-on-One Support:
• Onsite assessment (annual)
•Population Health Readiness
•Clinically Integrated Networks
•Board Retreats
•Bundled Payment
•Care management
•Change leadership
•MSSP Application
•PCMH
•Payor partnership
•Post Acute Care
•Insurance marketplace
•Transitions of care
•Employee Health
•MACRA
•Medicare ACO Gap assessment
•Two-sided risk
•Dedicated partners
• Access to SMEs
• ACO Intelligence Solution™ –benchmarking and analytics
Collaboration Resources:
• Newsletter (quarterly)
• Informational emails
• PremierConnect™
communities
• Innovation Catalog
• Podcasts
• Guidebooks
• Population health financial model
• Federal/state policy updates
• Tools and templates
• Access to DC office SMEs, policy updates from DC office, participation in policy development and advocacy efforts
Advanced member only offerings are highlighted in blue
© 2018 PROPRIETARY & CONFIDENTIAL | 15TRANSFORMING HEALTHCARE TOGETHER®
Goal of the PHMC ACO Intelligence Solution™ – Analytic and Benchmarking
Program:
Provide data to support performance improvement through intra-network
benchmarking, identification of best practices, prioritization of interventions
with a focus on ROI, and 1:1 support
Actionable data across the continuum for
settings of care with the most opportunities,
including inpatient, physician services, post-
acute care, end of life care, and facility
outpatient
1. Claims-based quarterly reports on cost, utilization,
and quality metrics, as well as dynamic scenario
modeling
2. Compilations of quarterly CMS expenditure and
utilization and annual financial reconciliation reports
Medicare ACO Intelligence Solution
Analytic and Benchmarking Program
Our quarterly reports provide…
• Complex analysis using claims data
• Drill down abilities to improve
performance and prioritize
interventions
• Dynamic scenario modeling
capabilities
• 1:1 support to interpret analysis,
identify and prioritize opportunities
© 2018 PROPRIETARY & CONFIDENTIAL | 16TRANSFORMING HEALTHCARE TOGETHER®
Premier’s ACO Intelligence Solution™ options
ACO Intelligence Solution
Basic
• Quarterly updates included with PHMC Advanced membership
• Detailed reports of cost and utilization
ACO Intelligence Solution
Enhanced
• Subpopulation filter
• CCHG reports
• Leakage reports
• Waste reports
ACO Intelligence Solution
Full Package
• Care Coordinator Reports
• Physician Risk and Credibility Adjusted Reports
Claims datamart to support adhoc reporting
Quarterly or Monthly Data Refresh
© 2018 PROPRIETARY & CONFIDENTIAL | 17TRANSFORMING HEALTHCARE TOGETHER®
Premier Collaborative members outperform the nation
48%
33%
23%
0%
10%
20%
30%
40%
50%
60%
$256
$213
$0
$50
$100
$150
$200
$250
$300
PHMCmembers
All MedicareACOs
$200m
11%6%
94%
% of PHMC Members who achieved
shared savings % vs. nation
PHMC members as %
of all Medicare ACOs
PHMC member savings
as % of total savings
Medicare ACO average
savings per beneficiary
Higher rate of
shared savings
Higher % of ACOs
achieving shared savings
Higher average
savings per beneficiary
* savings dollars x million
= All Medicare ACOs
= PHMC members
Premier’s Population Health Management Collaborative Advanced Member performance (PY16)
Total Savings = $1.8b
© 2018 PROPRIETARY & CONFIDENTIAL | 18TRANSFORMING HEALTHCARE TOGETHER®
Ballad Health / Anewcare Collaborative
MSSP ACO
Case study:
Mountain States Health Alliance
• Regional Integrated Health Care Delivery System (29 County, Four State Region)
• 13 Hospitals with 1,749 beds
• $1.2B Net Revenue
• Approximately 9,000 Team Members, as well as 1,220 physician medical staff, 3,500 volunteers, and 1,000 students
• AnewCare Collaborative is a subsidiary of Mountain States
Healthcare Landscape
Communities We Serve
20
Carter
Unicoi
Washington
Washington
Johnson
Letcher
Sullivan
Hawkins
Scott
Harlan
Greene
Smyth
Russell
Dickenson
Lee
Wise
Buchanan
AveryMitchell
Hamblen
Tazewell
Watauga
Madison
Yancey
Indian Path Medical
Center
Johnson City
Medical Center
North Side Hospital
Johnson City
Specialty Hospital
Johnson County
Community Hospital
Niswonger Children’s
Hospital
Sycamore Shoals
Hospital
James H. and Cecile C.
Quillen Rehabilitation
Hospital
Woodridge
Hospital
Dickenson County
Community Hospital
Norton Community
Hospital
Cocke
Ashe
Hancock
Grayson
Wythe
Russell County
Medical Center
Johnston Memorial
Hospital
Smyth County
Community
Hospital
Physician practices
Urgent Care
Imaging Center
Surgery Center
Franklin Woods
Community Hospital
Inpatient Facility
Core Service
Area
Non-Core
Service Area
AnewCare Collaborative, LLC – Accountable Care
AnewCare Collaborative is an organization of healthcare practitioners and partners that have come together to provide the
community with exceptional healthcare, greater value for every dollar spent on health & wellness services and better results as
measured by the member/patient experience
21
AnewCare
Core Functions & Initiatives
• Core Functions– Provider Network
• Provider Credentialing & Enrollment
– Care Management• Case & Disease Management
– Informatics / Analytics
• Initiatives– Medicare Shared Savings Program (MSSP)– Bundle Payment for Care Improvement (BPCI)– Oncology Care Model (OCM)– Value-Based Contracts– Team Member & Dependent Health Management Program: Diabetes– Team Member & Dependent High Cost Claimant/High Risk Care
Management Program– Accountable Health Communities (AHC)
22
Medicare Shared Saving Program
• Medicare Shared Savings Program (MSSP) Track 1 • Initial start date July 2012• Currently in year three of second agreement period
• Multi-State ACO - our membership spans between Northeast Tennessee and Southwest Virginia• Number of attributed lives: 12,800• Number of ACO participants: 13
• Employed physician groups: Mountain States Medical Group; approximately 75% of membership • Community-based independent physician practices (8 TIN’s) • Electronic Medical Record (EMR) – 9 different systems with 100% penetration rate
• Medicare sets a spending benchmark for beneficiaries attributed to AnewCare• If expenditures for the year are below the benchmark by the minimum savings
rate, AnewCare shares the savings with Medicare at 50% of our quality score• Data
– Claims: CMS sends monthly medical and pharmacy claims for all beneficiaries that had a primary care service with AnewCare’s participating physicians
– Electronic Medical Record / Quality: Captured in EMRs
23
24
AnewCare MSSP ResultsPerformance Years 1 – 4: July 2012 - 2016
100%87.5% 93.0% 95.8%
0%
25%
50%
75%
100%
Jul12 - Dec13 2014 2015 2016
Quality Score
$14.1
$8.1
$15.6
$5.7
$0
$5
$10
$15
Jul12 - Dec13 2014 2015 2016
Mill
ion
s
Generated Savings
$1
1,5
92
$9
,59
6
$1
0,1
07
$9
,54
2
$1
0,7
83
$9
,18
1
$9
,21
6
$9
,10
1
$0
$6,000
$12,000
Jul12 - Dec13 2014 2015 2016
Benchmark & Expenditures per Beneficiary per Year – Adjusted
Benchmark
Expenditures
14,408
19,579 17,518
12,877
0
5,000
10,000
15,000
20,000
Jul12 - Dec13 2014 2015 2016
Total Number of Assigned Beneficiaries –Adjusted
• Jul12 – Dec13• 18 Months• 100% Quality – Pay for Reporting
• AnewCare’s Quality Score has increased to 96% in 2016• AnewCare has generated over $43 million in savings from 2012 to 2015
100% Pay for Reporting
69.1% -Performance
7.1% 4.3% 8.8% 4.6%Savings
Rate
Strategies
Provide support and resources to the participating practices by • Deployment of outreach teams
• Provider group education & support
Focus on “ACO-wide” disease specific initiatives• Focus on targeted opportunities to be implemented at all sites
Risk stratified approach to care management• Targeted care management
• High risk/post-acute
• Home visit program
25
Outreach Team
ClinicalCare Managers & Coordinators
Practice education Manage at risk, high cost patients; close
gaps; home visits
IT/TechnicalEMR optimization, data transfer,
troubleshoot
Network Relations Practice communication, messaging
scheduling liaisons
IT/Data & AnalyticsRisk stratification
Clinical & claims analysis
Practice Outreach and Education
(Team deployed to beneficiary homes & practice sites)
26
Thank You!
27
E. Paige Younkin RN, BSN, MSPresident/CEO Integrated Solutions Health NetworkPresident/CEO AnewCare Collaborative509 Med Tech Parkway, Johnson City, TN [email protected] T | 609.350.3428 C | 423.282.1216 F |www.ishnonline.com
© 2018 PROPRIETARY & CONFIDENTIAL | 28TRANSFORMING HEALTHCARE TOGETHER®
QUESTIONS
Seth Edwards
Principal, Population Health
202.879.8006
