ACQA THE FUTURE DEPENDS ON WHAT YOU DO TODAY

Transcription

1 ACQA THE FUTURE DEPENDS ON WHAT YOU DO TODAY

2 WHAT IS ACQA Accountable Care and Quality Agreement between St. Joseph s Health System and Excellus. Outcome: Increased quality Improve the health of patients Provide cost effective and efficient delivery of care

3 ACQA DRIVERS, THIS IS DIFFERENT Aligned Incentives or payment s based on. Quality Outcomes: As defined and measured. Patient Satisfaction Efficiency: Shared savings distributed back to Health Care System. Patient Engagement: Increased or enhanced Patient Health. Coordinated building (including investment ) of the Population Health Management infrastructure to support the health system and achieve system goals. Management of shared resources. Support and enhancement of the Clinically Integrated Network, to provide seamless care to patients throughout the care continuum.

4 STARTING POINT Identify patients that are in our panel (our responsibility). Member Attribution 24 Month Look back at PCP RVU s Most visits to PCP s with services within E and M code range. Patients assigned.

5 ACQA CORE FINANCIAL MODEL Fee for Service continues based on existing contracts Initial budget for our attributed patients is calculated based on historic cost of care. Protection from catastrophic cases is put in place (stop loss insurance). Consideration for acuity and trend is made and then CPI targets are applied. Quality measures are implemented and attainment of measures tied to cost performance (quality and cost).

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10 JUMP START As the largest commercial insurer in the market, Excellus provides us with a substantial patient panel right out of the gate. Large panel of physicians with Excellus contracts anchoring the network. Don t have to build from scratch. Providers with Excellus contracts can participate in the St. Joseph s ACQA contract for purposes of joint contracting.

11 MOVING QUICKLY We have membership established. We have historic cost, trend and acuity of our membership. We have quality measures. How do we manage this?? Requires a new skill set and expertise. Requires a new support structure.

12 CLINICAL INTEGRATION A physician alignment model that allows the health system to organize both employed and independent physicians into a single network focused on performance improvement. Quality Patient Health Affordability Governed by physicians. Allowed to Jointly contract with payers.

13 CI enables us to achieve the key objectives needed in the new payment model

14 CLINICAL INTEGRATION STRATEGY FOR PHYSICIAN ENGAGEMENT Physicians willing to take a leadership role. Physicians sign CI network participation agreement linking them to ACQA. Physicians Commit to Clinical Initiatives Physicians commit to comply with performance management process (Physician Accountability structure).

15 OTHER IMPERATIVES Care Management Model IT Enabled

16 CARE MANAGEMENT MODEL Primary Care centric. Utilizes a care team (support infrastructure) and much expanded version of the Primary Care office. Includes: Care coordinators, CDE, MNT, Nurses, Nurse Educators, administrative support. Serves as the central hub for managing coordinated, longitudinal care of patients across all settings of the care continuum. Is know for insuring the patient is in the right place at the right time and the transition from one care setting to another is seamless and coordinated.

17 IT ENABLED EMR Captures clinical data for services performed by physicians and other health care professionals at the point of service. Population Management IT Backbone Aggregates clinical and claims data from multiple sources within the clinically integrated network. Identifies patients for management: Preventive, at risk, Chronically ill. Provides predictive modeling: Patient care interventions Cost modeling and budgeting Provides data for communication to accomplish the seamless deliver of care.

18 CLINICALLY INTEGRATED PHYSICIAN MODEL INCLUDES 1. St. Joseph s Physicians: Multispecialty group that is part of St. Joseph s Health System. 2. St. Joseph s Affiliated Physicians: Community or private practice physicians with partnership relationship with the St. Joseph s Health System. 3. St. Joseph s Hospital Physicians: Hospital based physicians of St. Joseph s Health System.

19 ST. JOSEPH S AFFILIATED PHYSICIANS PARTICIPATION: PCP Participates exclusively with St. Joseph s Health System ACQA agreement. Participates in Quality Measures. EMR commitment. PCMH commitment. MU commitment. communication available. High speed internet available. Electronic Claims submission. Participation in disease registry.

20 ST. JOSEPH S AFFILIATED PHYSICIANS PARTICIPATION: SPECIALIST Participates in St. Joseph s Health System ACQA agreement. Participates in Quality Measures. Commits to utilize SJHHC for in and outpatient procedures for attributed panel. EMR commitment. MU commitment. communication available. High speed internet available. Electronic Claims submission. Participation in disease registry.

21 ST. JOSEPH AFFILIATE AND PARTNER PHYSICIANS BENEFITS Gain share eligibility in ACQA contracts. EPIC connectivity at the highest level (based on practice and EMR). Care Management infrastructure being built by St. Joseph s Health System. Patient Navigators, Care management, disease registry, EPIC interoperability. Population management. Analytics, utilize St. Joseph s network services. Goal is to provide the same opportunities as Health System partners, to our private practice partners.

22 SYSTEM GOVERNANCE Bylaws would have to be created.

23 NEXT STEPS OR IN PROGRESS Selection of IT platform (in addition to EPIC). Hire staff and build care management model. Enroll Primary Care Physicians Enroll specialists Develop governance model View attribution and identify opportunities Identify clinical initiatives for the network Much more

24 QUESTIONS