Park Nicollet Health Services. A Medicare Pioneer Accountable Care Organization

Transcription

1 Park Nicollet Health Services A Medicare Pioneer Accountable Care Organization

2 Agenda 1 Park Nicollet Health Services Background 2 Park Nicollet Pioneer ACO Overview 3 Pioneer ACO Financial and Quality Model 4 Upside and Downside to Pioneer ACO Data & Analytics 5 Questions and Discussion

3 PARK NICOLLET Accountable Care Organization ACO Team: Daniel Trajano, MD, MBA, Sr. Med Dir. of Quality, Innovation, Population Health Eva Gallagher, RN, PHD, Sr. Nursing Director of Quality, Innovation, Population Health Mark Skubic, VP Government Relations Megan Cox, Dir. Medicare Products Sam VanNorman, Dir. Business Intelligence Gregg Teeter, Dir. Business Analytics Kody Koepke, Dir. Pricing & Data Maddy Emahiser, Project Manager

4 Park Nicollet Accountable Care Organization Located in the West Metro of Minneapolis/St. Paul Serves ~500,000 Unique Patients/Year Employs 8,300 People, 1,300 are Providers 1 Hospital (~22K inpatient admissions/yr) 25+ Locations with Primary, Specialty and Surgical Specialty Care Clinics (~2.2M ambulatory visits/yr) Accountable Care Contracts with All Major Payers PNC Fun Fact: 2011 TOUR DE CLINIC CAMPAIGN David Abelson, CEO and avid cyclist, spent 3 days riding his bike 200+ miles to 21 of our PNC sites, raising more than $55K

5 THE PARK NICOLLET PIONEER ACO PROGRAM OVERVIEW

6 Pioneer ACO Program Overview: PGP Demo Sites

7 Pioneer ACO Program Overview: Pioneer ACO Sites

8 Pioneer ACO Program Overview: The Regulatory Relationship Lessons Learned from PGP Demonstration Setting the Metrics When negotiating with CMS you need to be aware of the person behind the curtain. Office of the Actuary OMB Demo consultants CBO

9 Pioneer Program Benefited from Scars of PGP Demo 10 systems 32 Systems Local Benchmark National 2+% Savings rate 1% Savings Only Share Above First Dollar Little/Late Data Monthly No risk of loss Up and down

10 Pioneer ACO Program Overview 32 players with variable structures and interests in the ACO Program. The Twin Cities players Integrated systems w/hospital Medical Group Independent Practice Associations (IPAs) Virtual Systems Low Cost Systems <$9,000 per member per year High Cost Systems >$18,000 per member per year

11 THE PIONEER ACO FINANCIAL AND QUALITY MODEL

12 Pioneer ACO Bonus Payment Overview How Do We Get Paid? Model Overview Cost Savings (must be at least 1% to qualify) Contracted Shared Risk % Quality Measure % (must meet quality performance standards to qualify) Park Nicollet Bonus Payment Hypothetical Scenarios: $6 M 75% 75% $3.4 M $10 M 75% 90% $6.8 M

13 Total Cost Pioneer ACO Expenditure Benchmark Cost Savings Trended Benchmark Shared Savings Park Nicollet Cost Year The trended benchmark will be based on trends in national, not local, expenditures To earn the shared savings bonus payments, Park Nicollet s per-capita expenditures (for assigned beneficiaries) must be less than the yearly target by at least 1% Cost Savings Contracted Shared Risk % Quality Measure % Park Nicollet Bonus Payment

14 Pioneer ACO Quality Measures 25% Patient & Caregiver Experience 1. Timely care, appointments, and information 2. How well your doctor communicates 3. Patients rating of doctor 4. Access to specialists 5. Health promotion and education 6. Shared decision making 7. Health status/functional status 25% Preventative Health 14. Influenza immunization 15. Pneumoccal vaccination 16. Adult weight screening and follow-up 17. Tobacco use assessment and tobacco cessation intervention 18. Depression screening 19. Colorectal cancer screening 20. Mammography screening 21. Proportion of adults 18+ who had blood pressure measured in preceding 2 years 25% Care Coordination & Patient Safety 8. Risk standardized, all cause readmission 9. Ambulatory Care Sensitive Admissions COPD 10. Ambulatory Care Sensitive Admissions--CHF 11. Percent of PCPs who qualify for EHR incentive 12. Medication reconciliation after discharge 13. Screening for falls risk 25% At Risk Populations 22. Diabetes Composite A1C< Diabetes Composite LDL < Diabetes Composite BP<140/ Diabetes Composite Tobacco non-use 26. Diabetes Composite ASA Use 27. Diabetes A1C poor control (>9) 28. HTN blood pressure control 29. Ischemic Vascular Disease (IVD) LDL< IVD use of ASA or other antithrombotic 31. Heart failure beta blocker for LVSD 32. Coronary artery disease composite--drug therapy for lowering LDL 33. Coronary artery disease composite--ace or ARB for CAD patient with diabetes and/or LVSD

15 THE UPSIDE AND DOWNSIDE TO PIONEER ACO DATA & ANALYTICS

16 The Upside to Data & Analytics We have 3 years (and growing monthly) of all CMS claims data for our assigned members This will allow us to track all patient expenditures and quantify the amount of services these patients are receiving outside of Park Nicollet Unlike many of the other Pioneers, we re on a single, integrated platform

17 The Downside to Data & Analytics The expenditure benchmark target is still not finalized and the details (methodology and when we will receive them) are unclear This is troubling as we are nearly halfway through 2012 and we don t have a clear understanding where we are at in reducing expenditures by 1% Several quality metrics, which we are required to report on annually, have slightly different definitions from other CMS required reporting (PGP and MU) This will require extra time & resources to modify and report on metrics Park Nicollet needs to push CMS to fully standardize detail As with PGP, the burden of Quality Reporting significant (~$100K/yr)

18 Data & Analytics : What we need to do For us to make significant improvement in lowering cost and improving quality, we need to know where we are at so we can identify opportunities There are significant analytic challenges (as we don t know our reality) Educate CMS on the realities healthcare and what it takes to support this program Park Nicollet should be the best poised to succeed in the Pioneer ACO model (given our PGP experience and organizational structure) and this is going to be very difficult Lobby CMS (ideally in partnership with Allina, Fairview, and Other Advance Pioneer ACOs) Leverage our analytics infrastructure wisely and know when to buy vs. build Understand that Epic is not built to support population health management currently. We need to decide whether we re going to stumble along with Epic until we install 2012 or buy another tool.

19 Questions and Discussion 1 Park Nicollet Health Services Background 2 Park Nicollet Pioneer ACO Overview 3 Pioneer ACO Financial and Quality Model 4 Upside and Downside to Pioneer ACO Data & Analytics 5 Questions and Discussion