Table of Contents. Bellin Health Lessons from a Successful Medicare Pioneer ACO

Size: px
Start display at page:

Download "Table of Contents. Bellin Health Lessons from a Successful Medicare Pioneer ACO"

Transcription

1 Bellin Health Lessons from a Successful Medicare Pioneer ACO March 31, 2016 Table of Contents I. We Are Doing Some Good Things Rating Agency Actions II. Who We Are Bellin Health s Platform Organizational Structure Market and Scorecard Measures II. Lessons From A Top Performing Medicare Pioneer ACO 2 1

2 Strategic Initiatives We Are Doing Some Good Things Bellin Health s Ratings Actions 3 Continued Very Strong Financial Performance Operating performance measures continue to strengthen in 2014 Results are ahead of budget for first fiscal quarter of fiscal Liquidity has also improved due to positive performance and capital structure and debt service ratios are very strong. 4 2

3 Bellin Started at BBB+ 6/04 Bellin Upgraded to A 6/06 Bellin Upgraded to A 10/10 Bellin Affirmed A 4/14 Bellin Upgraded to A+ 3/15 Data as of Dec. 31, Standard & Poor s Initial Rating Assigned BBB+ Stable 9/01 Rating Affirmed 11/03 Rating Bellin Affirmed Upgraded 8/05 to A3 4/06 Rating Affirmed 10/08 Outlook Bellin Revised Upgraded to A3 to A2 Positive 12/11 6/10 Affirmed A2 Rating 3/13 Affirmed A2 Rating 6/14 Affirmed A2 Rating 3/15 Source: Moody s 6 3

4 Strategic Initiatives Who We Are Bellin Health s Platform 7 8 4

5 Our Corporate Structure Bellin Health Systems, Inc. 501(c)(3) Lake Michigan Health Care Services, Inc. 501(c)(3) Bellin College, Inc. 501(c)(3) Bellin Foundation, Inc. 501(c)(3) Bellin Psychiatric Center, Inc. 501(c)(3) Bellin Memorial Hospital, Inc. 501(c)(3) AboutHealth, LLC Taxable Bel-Regional Home Medical, Inc.. Taxable Oconto Hospital and Medical Center, Inc. 501(c)(3) Bellin-ThedaCare Healthcare Partners, Inc. Taxable D1 Sports Training of Green Bay, LLC Taxable Unity Limited Partnership 501(c)(3) Bellin Orthopedic Surgery Center, LLC Taxable Obligated Group Member NorthReach Healthcare, LLC 501(c)(3) Bellin Health Partners, Ltd. Taxable 9 Who We Are Bellin Health provides quality healthcare to the residents of a 12-county area covering northeastern Wisconsin and the Upper Peninsula of Michigan. Strong and long-standing relationships with physicians 73% of our revenue is derived from outpatient services BELLIN MEMORIAL HOSPITAL 71-bed acute care multi-specialty hospital; known as the region s heart center, it was the first hospital in the area to offer a comprehensive heart program BELLIN HEALTH OCONTO HOSPITAL 10-bed critical access hospital BELLIN PSYCHIATRIC CENTER 65-bed freestanding hospital; the Center s team of professionals treats children, adolescents, and adults with emotional and/or addictive disorders BELLIN MEDICAL GROUP Employs 151 physicians in 38 locations Continued increases in visits NORTHREACH HEALTHCARE 14 physicians and 14 midlevel providers BELLIN HEALTH FOUNDATION $5.2 million in assets as of September 30, 2015 for the benefit of the organization BELLIN COLLEGE Offers a four-year degree for students pursuing a Bachelor of Science in Nursing, Master of Science in Nursing, and a Bachelor of Science in Radiologic Technology Medical College of Wisconsin now on Bellin College Campus ABOUTHEALTH Statewide network involving six other healthcare organizations: Aspirus, Aurora Health Care, Gundersen Health System, Marshfield Clinic, ProHealth Care, ThedaCare, and University of Wisconsin Hospital & Clinics developed to build upon and advance the clinical quality, efficiency, and customer appreciation BELLIN-THEDACARE HEALTHCARE PARTNERS Pioneer Accountable Care Organization ( ACO ) Model comprised of the Hospital, ThedaCare, and approximately 700 independent and employed physicians, providing services throughout Northeastern Wisconsin and the Upper Peninsula of Michigan BELLIN HEALTH PARTNERS Locally, clinically integrated network Participating in Next Generation Medical ACO 10 5

6 Our Scorecards Follow and Measure Our Strategies Bellin has a System Scorecard that is driven by individual Brand Scorecards to define and measure progress toward achieving our Strategies. Focus of measures involves primary care growth, physician and staff engagement, improving the health of the population, including clinical quality which impacts financial performance and financial measures. The System Scorecard drills down to the department level to show clear accountability. 11 Utilization Data 12 6

7 Strategic Initiatives Lessons from a Top Performing Medicare ACO in the Country 13 Bellin-ThedaCare Healthcare Partners SYSTEM RESOURCES 715 Physicians 57 Primary Care Locations 3 Tertiary Hospitals 4 Critical Access Hospitals 1 Psychiatric Hospital with full-service Behavioral Health Clinic Hospice & Palliative Care Services Skilled Nursing Facilities (1 systemowned) POPULATION SEGMENTS Employees, Children & Families 540,000 people Medicare160,000 people Medicaid 180,000 people Uninsured 120,000 people Total Population 1,000,000 people 14 7

8 Bellin Health-ThedaCare Relationship Characteristics Contiguous markets with similar demographics and economic base Early adopters of process improvement theory Similar governance Common competitors Operated a joint venture, provider-based health plan for 10 years ( ) Share an enterprise-wide medical record based on Epic software In established a clinically integrated delivery system, know today as Bellin-ThedaCare Healthcare Partners 15 Pioneer BTHP 2 Hospital Systems 740 Physicians 1.2 Million Population 20k Pioneer Pts. 16 8

9 Pioneer Recap 17 Bellin-ThedaCare Pioneer ACO Attribution 20,000 Medicare fee-for-service beneficiaries Primarily PCP attribution Financial Accountability Medicare Parts A&B (not Part D) ALL claim files for our population Baseline expenditure vs. National Baseline expenditure Quality Accountability 33 quality metrics National comparison 18 9

10 The Math Summary Generate savings/losses CMS Quality Score BTHP 19 4 Domains of Quality Pioneer ACO must report on 33 Metrics Overall score determined the % of Shared Saving returned to the ACO Domain Source # indicators Patient/ Caregiver Experience CG-CAHPS 6 1 # pts Weighting % Care Coordination/ Patient Safety Claims EHR reporting EMR % Preventive Health At Risk Population EMR % EMR % 20 10

11 BTHP Pioneer Results 2012 $11,500 $11,000 $10,500 $10,000 $9,500 $9,000 $8,500 $8,000 $7,500 Baseline Year 1 Year 2 21 BTHP Pioneer Results 2012 $11,500 National Trend $11,000 $10,500 $10,000 $9,500 $9,000 $8,500 $8,000 $7,500 Baseline Year 1 Year

12 BTHP Pioneer Results 2012 $11,500 National Trend $11,000 $10,500 $10,000 $9,500 $9,000 BTHP $8,500 $8,000 $7,500 Baseline Year 1 Year 2 23 BTHP Pioneer Results 2012 $11,500 National Trend $11,000 $10,500 $10,000 $9,500 $9,000 BTHP $8,500 Expected Target $8,000 $7,500 Baseline Year 1 Year

13 BTHP Pioneer Results 2012 $11,500 National Trend $11,000 $10,500 $10,000 $9,500 $9,000 BTHP $8,500 Expected Target $8,000 $7,500 Baseline Year 1 Year 2 25 BTHP Pioneer Results 2012 $11,500 National Trend $11,000 $10,500 $10,000 Savings: $389 per bene $9,500 $9,000 BTHP $8,500 $8,000 Expected Target Savings $7,500 Baseline Year 1 Year

14 BTHP Pioneer Results 2012 $11,500 National Trend $11,000 $10,500 $10,000 $9,500 Savings: $389 per bene Quality: 100% Reported $9,000 BTHP $8,500 $8,000 $7,500 Expected Target Savings Baseline Year 1 Year 2 27 Pioneer $11,500 $11,000 $10,914 (PY1) National Trend $10,500 $10,731 (PY1) $10,990 (PY2) $10,819 (PY3) $10,000 $9,500 $9,000 $8,500 $8,583 (PY1) BTHP $8,419 (PY1) $8,451 (PY2) $8,521 (PY3) $8,000 $8,030 (PY1) $8,274 (PY2) $8,355 (PY3) $7,500 Baseline Year 1 Year 2 Year

15 Pioneer Summary Totals Investment Return 2012 $773,000 $5,136, $834,260 $2,268, $816,000 $2,180,463 Total $2,421,668 $9,585, Pioneer s Average Cost Per Beneficiary 16,800 15,800 14,800 13,800 12,800 11,800 10,800 9,800 8,800 Medicare Pioneer ACO's Average Annual Expenditure Per Aligned Beneficiary 7, Allina Health Banner Health Network Bellin ThedaCare Healthcare Partners Brown & Toland Physicians Fairview Health Services Heritage California ACO Monarch Healthcare Mount Auborn Cambridge Independent Practice Association Park Nicollet Health Services Steward Healthcare Network Atrius Health Beacon Health Beth Israel Deconess Care Organization Dartmouth Hitchcock ACO Franciscan Alliance Michigan Pioneer ACO Montefiore ACO OSF Healthcare System Partners HealthCare Trinity Pioneer ACO 30 15

16 Pioneer s Quality Results 96.00% 94.00% 92.00% 90.00% 88.00% 86.00% 84.00% 82.00% 80.00% 78.00% 76.00% 74.00% 72.00% 70.00% 68.00% Medicare Pioneer ACO's Overall Quality Score Allina Health Banner Health Network Bellin ThedaCare Healthcare Partners Brown & Toland Physicians Fairview Health Services Heritage California ACO Monarch Healthcare Mount Auborn Cambridge Independent Practice Association Park Nicollet Health Services Steward Healthcare Network Atrius Health Beacon Health Beth Israel Deconess Care Organization Dartmouth Hitchcock ACO Franciscan Alliance Michigan Pioneer ACO Montefiore ACO OSF Healthcare System Partners HealthCare Trinity Pioneer ACO 31 Pioneer Quality Results 32 16

17 Quality Recognition at National Headlines

18 35 Pioneer Defining Which Projects to Target by Creating a Driver Diagram 36 18

19 Pioneer Defining Which Projects to Target by Creating a Driver Diagram (closer look) 37 Pioneer Examining a Subset of the Pioneer Population Defined criteria to subdivide the Pioneer population Broke Pioneer population into 4 subsets based on spend and chronic diseases Purpose To identify how the subsets varied from one another To identify how to best manage the health and experience for each subset To identify the largest areas for opportunity to make improvements for the population 38 19

20 Pioneer Strategy Strategy #1: Primary Care Strategy 100% of our Pioneer population 1. Leverage our existing and Primary Care system 2. Medicare Annual Wellness visit 3. Pioneer metrics 4. Patients with chronic conditions are well managed and in control Strategy #2: Super User Strategy 3% who spend 30% of the costs 1. Predictive modeling 2. Identify barriers (physical, psychosocial, cultural) 3. Care coordination 39 Pioneer Success Factors 1) Continuation of trend 2) Rigorous systems of improvement 3) New initiatives spurred by financial construct 4) Leveraged primary care and common EMR 5) Spread Risk 6) Hearts and Minds 40 20

21 Lessons Learned 1) Population health big endeavor 2) Pioneer alone is not enough value-based care 3) Claims based attribution is not accurate enough 4) Financial construct devils in the details 5) Fee for service is deeply engrained 6) Quality hazards everywhere metrics, specs, measurement, reporting 41 Steps to improve 1) Move away from FFS - Total cost of care 2) Cost accounting 3) Attribution attestation, panels 4) Reward improvement and achievement 5) Better data 6) Standardize quality platform 7) Patient incentives 8) Get out of the way, let the market work 42 21

22 Manage Populations to Achieve the Triple Aim Driver Diagram 43 Future Direction 1) >50% revenue in value based contracts 2) Participating in CMMI Next Generation ACO 3) Payment to front line aligned with goals 4) Data to the point of care 5) Redesign of care systems around the patient 6) Shared responsibility patient, provider, payer 7) Partnership across community 44 22

Pioneer Accountable Care Organization Model: General Fact Sheet May 22, 2012

Pioneer Accountable Care Organization Model: General Fact Sheet May 22, 2012 Pioneer Accountable Care Organization Model: General Fact Sheet May 22, 2012 The Pioneer ACO Model is a CMS Innovation Center initiative designed to support organizations with experience operating as Accountable

More information

Managing Populations to Achieve Triple Aim Outcomes

Managing Populations to Achieve Triple Aim Outcomes Managing Populations to Achieve Triple Aim Outcomes Pete Knox, Executive Vice-President and Chief Learning & Innovation Officer March 2014 Agenda 2 1. Overview of Bellin 2. Strategically Aligning the Work

More information

Creating the New Care Design L2. George Kerwin, CEO Patient of Bellin Health Bellin Health Team. Objectives

Creating the New Care Design L2. George Kerwin, CEO Patient of Bellin Health Bellin Health Team. Objectives Creating the New Care Design L2 George Kerwin, CEO Patient of Bellin Health Bellin Health Team Objectives Identify the five views of the Production System necessary to Create a Connected Personal Experience

More information

Primary Care Transformation in the Era of Value

Primary Care Transformation in the Era of Value Primary Care Transformation in the Era of Value CMS Innovation Center & Primary Care Bruce Finke, MD Janel Jin, MSPH Gabrielle Schechter, MPH Center for Medicare & Medicaid Innovation Centers for Medicare

More information

Achieving Population Health through Team Based Care

Achieving Population Health through Team Based Care Achieving Population Health through Team Based Care Wisconsin Council on Medical Education and Workforce Conference November 12, 2015 Kathy Kerscher, Bellin Health Overview of Bellin Health 3 MISSION Bellin

More information

Rapid Fire Workshop: Pioneer ACOs After the Ink Has Dried

Rapid Fire Workshop: Pioneer ACOs After the Ink Has Dried RFB This presenter has nothing to disclose Rapid Fire Workshop: Pioneer ACOs After the Ink Has Dried Moderated by Carol Beasley, Vice President, IHI Tuesday, December 11 11:15 AM 12:30 PM Intent and Format

More information

The influx of newly insured Californians through

The influx of newly insured Californians through January 2016 Managing Cost of Care: Lessons from Successful Organizations Issue Brief The influx of newly insured Californians through the public exchange and Medicaid expansion has renewed efforts by

More information

Data-Driven Strategy for New Payment Models. Objectives. Common Acronyms

Data-Driven Strategy for New Payment Models. Objectives. Common Acronyms Data-Driven Strategy for New Payment Models Mark Sharp, CPA Partner msharp@bkd.com Objectives Understand new payment model reforms and bundling arrangements Learn how these new payment models can impact

More information

POPULATION HEALTH PLAYBOOK. Mark Wendling, MD Executive Director LVPHO/Valley Preferred 1

POPULATION HEALTH PLAYBOOK. Mark Wendling, MD Executive Director LVPHO/Valley Preferred   1 POPULATION HEALTH PLAYBOOK Mark Wendling, MD Executive Director LVPHO/Valley Preferred www.populytics.com 1 Today s Agenda Outline LVHN, LVPHO and Populytics Overview Population Health Approach Population

More information

ACOs: California Style

ACOs: California Style ACOs: California Style ACO Congress John E. Jenrette, M.D. Chief Executive Officer Sharp Community Medical Group November 2, 2011 California Style California Style A CO California Style California Style

More information

Roadmap to accountable care: The chicken or the egg technology investment or clinical process improvement?

Roadmap to accountable care: The chicken or the egg technology investment or clinical process improvement? Roadmap to accountable care: The chicken or the egg technology investment or clinical process improvement? August 29, 2012 Meet the Presenters Michael Griffis CIO Innovative Practices Tucson, AZ Beth Hartquist,

More information

Medicare / Accountable Care Organization CHS Finance Division CPE Day November 2, 2015

Medicare / Accountable Care Organization CHS Finance Division CPE Day November 2, 2015 Medicare / Accountable Care Organization CHS Finance Division CPE Day November 2, 2015 Steve Neorr Chief Administrative Officer, Triad HealthCare Network Jeff Jones Chief Financial Officer, Cone Health

More information

Examining the Differences Between Commercial and Medicare ACO Models

Examining the Differences Between Commercial and Medicare ACO Models Examining the Differences Between Commercial and Medicare ACO Models Michelle Copenhaver December 10, 2015 Agenda 1 Understanding Accountable Care Organizations 2 Moving to Accountable Care: Enhancing

More information

A Practical Approach Toward Accountable Care and Risk-Based Contracting: Design to Implementation

A Practical Approach Toward Accountable Care and Risk-Based Contracting: Design to Implementation A Practical Approach Toward Accountable Care and Risk-Based Contracting: Design to Implementation Daniel J. Marino, President/CEO, Health Directions Asad Zaman, MD June 19, 2013 Session Objectives Establish

More information

Franciscan Alliance ACO

Franciscan Alliance ACO Franciscan Alliance ACO Jennifer Westfall Regional VP Franciscan Alliance Accountable Care Organization Regional Executive Director, St. Francis Health Network 2013 Franciscan Alliance, Inc. What is an

More information

Healthcare Financial Management Association October 13 th, 2016 Introduction to Accountable Care Organizations and Clinically Integrated Networks

Healthcare Financial Management Association October 13 th, 2016 Introduction to Accountable Care Organizations and Clinically Integrated Networks Healthcare Financial Management Association October 13 th, 2016 Introduction to Accountable Care Organizations and Clinically Integrated Networks Agenda Define ACO, CIN, and Coordinated Care Review ACO/CIN

More information

Laying the Foundation for Successful Clinical Integration

Laying the Foundation for Successful Clinical Integration The Governance Institute Laying the Foundation for Successful Clinical Integration Webinar November 29, 2011, 2:00pm ET/11:00am PT Daniel M. Grauman President & CEO DGA Partners, Bala Cynwyd, PA dgrauman@dgapartners.com

More information

AccessHealth Spartanburg

AccessHealth Spartanburg TRANSFORMING COMPLEX CARE PROFILE AccessHealth Spartanburg Leveraging community partnerships to improve care for an uninsured population with complex health and social needs A ccesshealth Spartanburg (AHS)

More information

Session #6: Population Health Must Haves Care Coordination

Session #6: Population Health Must Haves Care Coordination Session #6: Population Health Must Haves Care Coordination Presenter: Robert Wieland, M.D. Arbor Lakes Saturday, Jan. 7, 2017 11:15 a.m. 12:15 p.m. Robert A. Wieland, M.D. Robert A. Wieland, M.D. (Bob)

More information

Physician Engagement

Physician Engagement Pathways for Successful Accountable Care Organizations: Physician Engagement Thomas Kloos, MD Jim Barr, MD Atlantic ACO & Optimus Healthcare Partners ACO Helping providers Care Better for their patients.

More information

From Reactive to Proactive: Creating a Population Management Platform

From Reactive to Proactive: Creating a Population Management Platform Session D9 / E9 From Reactive to Proactive: Creating a Population Management Platform Richard Gitomer, MD Director, Brigham and Women s Primary Care Center of Excellence Vice Chair, Primary Care, Dept.

More information

Next Generation Physician Compensation Design in a Schizophrenic Payer Environment

Next Generation Physician Compensation Design in a Schizophrenic Payer Environment Next Generation Physician Compensation Design in a Schizophrenic Payer Environment Presented to: 2015 Spring Managed Care Forum Friday, April 24, 2015 Today s agenda Setting the Stage Why are we Here?

More information

Forces of Change- Seeing Stepping Stones Not Potholes

Forces of Change- Seeing Stepping Stones Not Potholes May 19, 2014 Forces of Change- Seeing Stepping Stones Not Potholes 2 3 4 Overview Demographics Long Term Care Financing Challenges Broad Health System Challenges Payment Reform Delivery System Reform Where

More information

Succeeding with Accountable Care Organizations

Succeeding with Accountable Care Organizations Succeeding with Accountable Care Organizations The Point B Webinar Series October 25, 2011 Today s Discussion Key ACO trends and emerging models Critical success factors for building an ACO Developing

More information

Medical Home as a Platform for Population Health

Medical Home as a Platform for Population Health Medical Home as a Platform for Population Health Population Health Colloquium March 8, 2016 Emily Brower Vice President, Population Health Atrius Health Emily_Brower@atriushealth.org 2016 Atrius Health,

More information

Saint Francis Care and Cigna CAC Meeting the Triple Aim Together

Saint Francis Care and Cigna CAC Meeting the Triple Aim Together Saint Francis Care and Cigna CAC Meeting the Triple Aim Together Christopher M. Dadlez, President and CEO Saint Francis Care Jess Kupec, President and CEO Saint Francis HealthCare Partners 22 nd Annual

More information

The MetroHealth System

The MetroHealth System The MetroHealth System June 16, 2016 Presentation to Ohio Joint Medicaid Oversight Committee Dr. James Misak, Vice Chair of Community and Population Health, Department of Family Medicine Susan Mego, Executive

More information

Future of Patient Safety and Healthcare Quality

Future of Patient Safety and Healthcare Quality Future of Patient Safety and Healthcare Quality Patrick Conway, M.D., MSc CMS Chief Medical Officer Director, Center for Clinical Standards and Quality Acting Director, Center for Medicare and Medicaid

More information

Reforming Health Reform: After the Election, What Happens Now?

Reforming Health Reform: After the Election, What Happens Now? 2013 CliftonLarsonAllen LLP Reforming Health Reform: After the Election, What Happens Now? cliftonlarsonallen.com LeadingAge Indiana Deb Freeland May 6, 2013 Objectives Update current status of ACA Ongoing

More information

Complex Patient Care Redesign: ThedaCare Innovation. Gregory Long, MD Chief Medical Officer

Complex Patient Care Redesign: ThedaCare Innovation. Gregory Long, MD Chief Medical Officer Complex Patient Care Redesign: ThedaCare Innovation Gregory Long, MD Chief Medical Officer ThedaCare Northeastern Wisconsin An Integrated Community Health System; >7000 employees Primary service area of

More information

The State of Accountable Care: Evidence to Date and Next Steps October 20, 2014 l The Brookings Institution

The State of Accountable Care: Evidence to Date and Next Steps October 20, 2014 l The Brookings Institution The State of Accountable Care: Evidence to Date and Next Steps October 20, 2014 l The Brookings Institution #ACOFuture l @BrookingsMed www.acolearningnetwork.org l aco@brookings.edu l @aco_ln Agenda 9:00

More information

Reinventing Health Care: Health System Transformation

Reinventing Health Care: Health System Transformation Reinventing Health Care: Health System Transformation Aspen Institute Patrick Conway, M.D., MSc CMS Chief Medical Officer Director, Center for Clinical Standards and Quality Acting Director, Center for

More information

QUALITY MEASURES WHAT S ON THE HORIZON

QUALITY MEASURES WHAT S ON THE HORIZON QUALITY MEASURES WHAT S ON THE HORIZON The Hospice Quality Reporting Program (HQRP) November 2013 Plan for the Day Discuss the implementation of the Hospice Item Set (HIS) Discuss the implementation of

More information

Moving the Dial on Quality

Moving the Dial on Quality Moving the Dial on Quality Washington State Medical Oncology Society November 1, 2013 Nancy L. Fisher, MD, MPH CMO, Region X Centers for Medicare and Medicaid Serving Alaska, Idaho, Oregon, Washington

More information

Accountable Care Organizations American Osteopathic Association Health Policy Day September 23, 2011

Accountable Care Organizations American Osteopathic Association Health Policy Day September 23, 2011 Accountable Care Organizations American Osteopathic Association Health Policy Day September 23, 2011 Cary Sennett MD PhD Cary Sennett, MD, PhD Managing Director, Engelberg Center for Health Care Reform

More information

The Physician s Perspective

The Physician s Perspective The Physician s Perspective How the Changing Role of the PCP is Leading Healthcare Reform May 22, 2015 Carman A. Ciervo, DO Chief Physician Executive Our Vision To transform the healthcare To transform

More information

Red Carpet Care: Intensive Case Management Program for Super-Utilizers

Red Carpet Care: Intensive Case Management Program for Super-Utilizers Red Carpet Care: Intensive Case Management Program for Super-Utilizers Alice Stollenwerk Petrulis, MD Linda C. Stokes, PhD The MetroHealth System Picture of MH MetroHealth 750 bed facility includes Rehab,

More information

The Future Role of the Continuum of Care

The Future Role of the Continuum of Care iftonlar 2013 Cl The Future Role of the Continuum of Care on Reimbursement cliftonlarsonallen.com South Carolina HFMA May 30, 2013 A Quick Quiz: Where are we today with reform? Moving forward fast! Moving

More information

Report to the Greater Milwaukee Business Foundation on Health

Report to the Greater Milwaukee Business Foundation on Health Report to the Greater Milwaukee Business Foundation on Health Key Factors Influencing 2003 2012 Southeast Wisconsin Commercial Payer Hospital Payment Levels Presented by: Keith Kieffer, CPA, RPh Management

More information

Skating to Where the Puck is Going: Living, Thriving and Growing in the World of Value-Based Care

Skating to Where the Puck is Going: Living, Thriving and Growing in the World of Value-Based Care Skating to Where the Puck is Going: Living, Thriving and Growing in the World of Value-Based Care Craig E. Samitt, MD, MBA AMGA Institute for Quality Leadership November 13, 2014 Introduction to Dean

More information

The Importance of the Nurse Navigator in Value Based Care. Walter LeStrange, Senior Executive VP/COO ProHEALTH Medical Management, LLC May 23, 2017

The Importance of the Nurse Navigator in Value Based Care. Walter LeStrange, Senior Executive VP/COO ProHEALTH Medical Management, LLC May 23, 2017 The Importance of the Nurse Navigator in Value Based Care Walter LeStrange, Senior Executive VP/COO ProHEALTH Medical Management, LLC May 23, 2017 Today s Agenda Overview of ProHEALTH Trends in Healthcare:

More information

Reducing Hospital Admissions Through the Use of IT. Steven Milligan MD Medical Director of ACO Management Colorado Health Neighborhoods

Reducing Hospital Admissions Through the Use of IT. Steven Milligan MD Medical Director of ACO Management Colorado Health Neighborhoods Reducing Hospital Admissions Through the Use of IT Steven Milligan MD Medical Director of ACO Management Colorado Health Neighborhoods Conflict of Interest Steven Milligan, MD Has no real or apparent conflicts

More information

Succeeding in a New Era of Health Care Delivery

Succeeding in a New Era of Health Care Delivery March 14, 2012 Succeeding in a New Era of Health Care Delivery Building Value-Based Partnerships LeadingAge Pennsylvania Kathleen Griffin, PhD, National Director Post-Acute and Senior Services 1 Your Presenter

More information

Voluntary Alignment Frequently Asked Questions

Voluntary Alignment Frequently Asked Questions Voluntary Alignment Frequently Asked Questions Some Medicare beneficiaries may have recently received a letter and form in the mail asking them to confirm their main doctor or group practice. These letters

More information

Transforming Physician Practices: Evolution of ACOs in California. National Association of ACOs - Washington, DC October 2015

Transforming Physician Practices: Evolution of ACOs in California. National Association of ACOs - Washington, DC October 2015 Transforming Physician Practices: Evolution of ACOs in California National Association of ACOs - Washington, DC October 2015 Integrated Healthcare Association Statewide multi-stakeholder leadership group

More information

Physician Alignment Strategies and Options. June 1, 2011

Physician Alignment Strategies and Options. June 1, 2011 Physician Alignment Strategies and Options June 1, 2011 1 Today s Discussion Review physician-hospital alignment objectives Understand the changing paradigm Evaluate alignment strategies for a new delivery

More information

Medicare. Shared. Whitepaper. Savings:A PrActicAl Path to Accountable care SPONSORED BY. Medicare. Shared. 1 A sponsored Medical Economics whitepaper

Medicare. Shared. Whitepaper. Savings:A PrActicAl Path to Accountable care SPONSORED BY. Medicare. Shared. 1 A sponsored Medical Economics whitepaper Medicare Shared Whitepaper Savings:A PrActicAl Path to Accountable care SPONSORED BY Medicare Shared Savings:A PrActicAl Path to Accountable care 1 A sponsored Medical Economics whitepaper Medicare Ambulatory

More information

Navicent Health Physician Group Risk-Based Payments: Assessment of Readiness and Performance for Multiple Reporting Requirements

Navicent Health Physician Group Risk-Based Payments: Assessment of Readiness and Performance for Multiple Reporting Requirements Creating Clinically Integrated Health System-Based Medical Groups Collaborative Case Study Navicent Health Physician Group Risk-Based Payments: Assessment of Readiness and Performance for Multiple Reporting

More information

AMGA Webinar: MSSP Final Rule. Scott Hines, MD Chief Quality Officer Crystal Run Healthcare July 16, 2015

AMGA Webinar: MSSP Final Rule. Scott Hines, MD Chief Quality Officer Crystal Run Healthcare July 16, 2015 AMGA Webinar: MSSP Final Rule Scott Hines, MD Chief Quality Officer Crystal Run Healthcare July 16, 2015 Crystal Run Healthcare Physician owned MSG in NY State, founded 1996 >350 providers, >30 locations

More information

Accountable Care Organizations. What the Nurse Executive Needs to Know. Rebecca F. Cady, Esq., RNC, BSN, JD, CPHRM

Accountable Care Organizations. What the Nurse Executive Needs to Know. Rebecca F. Cady, Esq., RNC, BSN, JD, CPHRM JONA S Healthcare Law, Ethics, and Regulation / Volume 13, Number 2 / Copyright B 2011 Wolters Kluwer Health Lippincott Williams & Wilkins Accountable Care Organizations What the Nurse Executive Needs

More information

Should PCMH accreditation be the next step in your quest for high-quality care delivery?

Should PCMH accreditation be the next step in your quest for high-quality care delivery? This Web version may be reproduced for individual use. Should PCMH accreditation be the next step in your quest for high-quality care delivery? Lessons learned from one organization that achieved PCMH

More information

Post-Acute Care Networks: How to Succeed and Why Many Fail to Deliver JULY 18, 2016

Post-Acute Care Networks: How to Succeed and Why Many Fail to Deliver JULY 18, 2016 Post-Acute Care Networks: How to Succeed and Why Many Fail to Deliver HEALTH FORUM AND AHA LEADERSHIP SUMMIT JULY 18, 2016 SAN DIEGO, CALIFORNIA Please note that the views expressed are those of the conference

More information

What are ACOs and how are they performing?

What are ACOs and how are they performing? What are ACOs and how are they performing? What is an accountable care organisation (ACO)? ACOs involve groups of providers taking responsibility for all care for a given population within a capitated

More information

What Have we Learned from the Pioneer ACO Model?

What Have we Learned from the Pioneer ACO Model? What Have we Learned from the Pioneer ACO Model? Sherly Binu, CMMI December 7, 2016 Disclaimers 2 This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose

More information

Appendix B: Formulae Used for Calculation of Hospital Performance Measures

Appendix B: Formulae Used for Calculation of Hospital Performance Measures Appendix B: Formulae Used for Calculation of Hospital Performance Measures ADJUSTMENTS Adjustment Factor Case Mix Adjustment Wage Index Adjustment Gross Patient Revenue / Gross Inpatient Acute Care Revenue

More information

Banner Health Friday, February 20, 2015

Banner Health Friday, February 20, 2015 Banner Health Friday, February 20, 2015 Leveraging the Power of Clinical and Business Intelligence: A Primer Presented by: Dr. Maxine Rand, DNP, RN-BC, CPHIMS, Director, Clinical Education, Practice and

More information

A Values Based Approach to Accountable Care

A Values Based Approach to Accountable Care December 4, 2016 Orlando, FL A Values Based Approach to Accountable Care Evan Benjamin, MD, FACP George Kerwin, FACHE Saranya Loehrer, MD, MPH Agenda 2 Time 1:00pm-1:10pm 1:10pm-1:40pm 1:40pm-2:30pm 2:30pm-2:45pm

More information

Population Health or Single-payer The future is in our hands. Robert J. Margolis, MD

Population Health or Single-payer The future is in our hands. Robert J. Margolis, MD Population Health or Single-payer The future is in our hands Robert J. Margolis, MD Today s problems Interim steps Population health Alternatives Conclusions Outline $3,000,000,000,000 $1,000,000,000,000

More information

Thought Leadership Series White Paper The Journey to Population Health and Risk

Thought Leadership Series White Paper The Journey to Population Health and Risk AMGA Consulting Thought Leadership Series White Paper The Journey to Population Health and Risk The Journey to Population Health and Risk Howard B. Graman, M.D., FACP White Paper, January 2016 While the

More information

From Documents to Conversations: How We re Changing Our Focus

From Documents to Conversations: How We re Changing Our Focus From Documents to Conversations: How We re Changing Our Focus The name Honoring Choices Wisconsin is used under license from the Twin Cities Medical Society Foundation. Leadership Leadership Commitment

More information

Sharp HealthCare ACO. Presented by: Donald C. Balfour, M.D. President and Medical Director Sharp Rees-Stealy Medical Group

Sharp HealthCare ACO. Presented by: Donald C. Balfour, M.D. President and Medical Director Sharp Rees-Stealy Medical Group Sharp HealthCare ACO Presented by: Donald C. Balfour, M.D. President and Medical Director Sharp Rees-Stealy Medical Group Institute for Quality Leadership Annual Conference October 4, 2012 Sharp ACO Collaborations

More information

Health System Transformation. Discussion

Health System Transformation. Discussion Health System Transformation Patrick Conway, M.D., MSc CMS Chief Medical Officer Deputy Administrator for Innovation and Quality Director, Center for Medicare & Medicaid Innovation Director, Center for

More information

Prepared for North Gunther Hospital Medicare ID August 06, 2012

Prepared for North Gunther Hospital Medicare ID August 06, 2012 Prepared for North Gunther Hospital Medicare ID 000001 August 06, 2012 TABLE OF CONTENTS Introduction: Benchmarking Your Hospital 3 Section 1: Hospital Operating Costs 5 Section 2: Margins 10 Section 3:

More information

Advocate Physician Partners approach to Population Health

Advocate Physician Partners approach to Population Health Advocate Physician Partners approach to Population Health Don Calcagno President, Advocate Physician Partners March 9, 2016 Who are Advocate Health Care and Advocate Physician Partners? 1 Advocate Health

More information

Accountable Care and the Laboratory Value Proposition. Les Duncan Director of Operations Highmark Health - Home and Community Services

Accountable Care and the Laboratory Value Proposition. Les Duncan Director of Operations Highmark Health - Home and Community Services Accountable Care and the Laboratory Value Proposition Les Duncan Director of Operations Highmark Health - Home and Community Services Agenda The Goals and Status of Delivery System Reform and Alternative

More information

Post-Acute Care Networks: How to Succeed and Why Many Fail to Deliver JULY 18, 2016

Post-Acute Care Networks: How to Succeed and Why Many Fail to Deliver JULY 18, 2016 Post-Acute Care Networks: How to Succeed and Why Many Fail to Deliver HEALTH FORUM AND AHA LEADERSHIP SUMMIT JULY 18, 2016 SAN DIEGO, CALIFORNIA Please note that the views expressed are those of the conference

More information

Innovative Business Activities in Health Care with Commercial Partners

Innovative Business Activities in Health Care with Commercial Partners Innovative Business Activities in Health Care with Commercial Partners Steve Witman, CPA, MBA Vice President of Business Development / Financial and Capital Planning LifeBridge Health March 4, 2014 Business

More information

Accountable Care Organizations: The

Accountable Care Organizations: The Accountable Care Organizations: The Practical Reality BNA Webinar June 2, 2010 Douglas A. Hastings Chair, Epstein Becker & Green, P.C. Member, Board on Health Care Services, Institute of Medicine dhastings@ebglaw.com

More information

Measurement Strategy Overview

Measurement Strategy Overview Mobile Integrated Healthcare Program 911 Nurse Triage Measurement Strategy Overview Aim A clearly articulated goal statement that describes how much improvement by when and links all the specific outcome

More information

Value-Based Models: Two Successful Payer-Provider Approaches March 1, 2016

Value-Based Models: Two Successful Payer-Provider Approaches March 1, 2016 Value-Based Models: Two Successful Payer-Provider Approaches March 1, 2016 Clifford T. Fullerton, MD, MSc President, Baylor Scott & White Quality Alliance Chief Population Health Officer, Baylor Scott

More information

OVERVIEW. Helping people live healthier lives and helping make the health system work better for everyone

OVERVIEW. Helping people live healthier lives and helping make the health system work better for everyone OVERVIEW Helping people live healthier lives and helping make the health system work better for everyone About UnitedHealth Group UnitedHealth Group helps drive positive change in health care in the United

More information

kaiser medicaid and the uninsured commission on O L I C Y

kaiser medicaid and the uninsured commission on O L I C Y P O L I C Y B R I E F kaiser commission on medicaid and the uninsured 1330 G S T R E E T NW, W A S H I N G T O N, DC 20005 P H O N E: (202) 347-5270, F A X: ( 202) 347-5274 W E B S I T E: W W W. K F F.

More information

Goals & Challenges for Outpatient Quality Directors. Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE

Goals & Challenges for Outpatient Quality Directors. Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE Goals & Challenges for Outpatient Quality Directors Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE Objectives Learn a practical way for Quality Directors to align Quality Measures

More information

Accountable Care Atlas

Accountable Care Atlas Accountable Care Atlas MEDICAL PRODUCT MANUFACTURERS SERVICE CONTRACRS Accountable Care Atlas Overview Map Competency List by Phase Detailed Map Example Checklist What is the Accountable Care Atlas? The

More information

Mission Health Care Network. April 2017

Mission Health Care Network. April 2017 Mission Health Care Network April 2017 WHAT IS MISSION HEALTH CARE NETWORK? Mission Health Care Network is a Clinically Integrated Network including groups of doctors, the hospital and other health care

More information

SDRC Tip Sheet Public Use Files

SDRC Tip Sheet Public Use Files SDRC Tip Sheet Public Use Files The State Data Resource Center (SDRC) Team compiled this document highlighting free additional datasets that State Medicaid agencies can use for better understanding the

More information

NEXT GENERATION ACO PARTICIPATION WAIVER DISCLOSURES

NEXT GENERATION ACO PARTICIPATION WAIVER DISCLOSURES Laws in Connection with the Next Generation ACO Model, December 9, 2015). Pursuant to that notice, Steward Integrated Care Network, Inc. ( SICN ) seeks waiver protection for the arrangement described below:

More information

Emerging Models of Care Delivery Christy Mokrohisky Ex. Dir. of PI & Emerging Models

Emerging Models of Care Delivery Christy Mokrohisky Ex. Dir. of PI & Emerging Models Emerging Models of Care Delivery Christy Mokrohisky Ex. Dir. of PI & Emerging Models 1 Sacred Encounters Perfect Care Healthiest Communities St. Joseph Heritage Healthcare Founded in 1994 Manage 7 Medical

More information

Citigroup Non-Profit Investors Conference

Citigroup Non-Profit Investors Conference Citigroup Non-Profit Investors Conference May 24, 2017 Maine Health Care Market Hospitals are increasingly consolidated into systems - 36 hospitals in the state all not-for-profit - 84% of state s beds

More information

The Influence of Health Policy on Clinical Practice. Dr. Kim Kuebler, DNP, APRN, ANP-BC Multiple Chronic Conditions Resource Center

The Influence of Health Policy on Clinical Practice. Dr. Kim Kuebler, DNP, APRN, ANP-BC Multiple Chronic Conditions Resource Center The Influence of Health Policy on Clinical Practice Dr. Kim Kuebler, DNP, APRN, ANP-BC Multiple Chronic Conditions Resource Center Disclaimer Director: Multiple Chronic Conditions Resource Center www.multiplechronicconditions.org

More information

Medicare Physician Group Practice Demonstration

Medicare Physician Group Practice Demonstration Medicare Physician Group Practice Demonstration Disease Management Colloquium Philadelphia, Pennsylvania June 23, 2005 John Pilotte Senior Research Analyst Medicare Demonstrations Program Group Centers

More information

System Options to Achieve the Triple Aim

System Options to Achieve the Triple Aim D30/E30 This presenter has nothing to disclose System Options to Achieve the Triple Aim David M. Williams, MD, CPE Medical Director UnityPoint Health Partners December 10, 2014 Objectives Evaluate their

More information

PBGH Response to CMMI Request for Information on Advanced Primary Care Model Concepts

PBGH Response to CMMI Request for Information on Advanced Primary Care Model Concepts PBGH Response to CMMI Request for Information on Advanced Primary Care Model Concepts 575 Market St. Ste. 600 SAN FRANCISCO, CA 94105 PBGH.ORG OFFICE 415.281.8660 FACSIMILE 415.520.0927 1. Please comment

More information

eacos The Next Generation of Health Plans

eacos The Next Generation of Health Plans reprint MAGAZINE Reproduced with permission from Benefits Magazine, Volume 49, No. 12 December 2012, pages 40-47, published by the International Foundation of Employee Benefit Plans (www.ifebp.org), Brookfield,

More information

Revenue Optimization In Hospital Pharmacy Services. Presenters: Kyle Skiermont, PharmD, COO, Fairview Pharmacy Services

Revenue Optimization In Hospital Pharmacy Services. Presenters: Kyle Skiermont, PharmD, COO, Fairview Pharmacy Services Revenue Optimization In Hospital Pharmacy Services Presenters: Kyle Skiermont, PharmD, COO, Fairview Pharmacy Services FACULTY DISCLOSURE The faculty reported the following financial relationships or relationships

More information

Quality Measures and Federal Policy: Increasingly Important and A Work in Progress. American Health Quality Association Policy Forum Washington, D.C.

Quality Measures and Federal Policy: Increasingly Important and A Work in Progress. American Health Quality Association Policy Forum Washington, D.C. Quality Measures and Federal Policy: Increasingly Important and A Work in Progress American Health Quality Association Policy Forum Washington, D.C. February 9, 2016 Quality Journey NCQA Develops Health

More information

Required Public Disclosure for the Pioneer ACO Participation Waiver BRONX ACCOUNTABLE HEALTHCARE NETWORK IPA, INC. DBA MONTEFIORE ACO IPA

Required Public Disclosure for the Pioneer ACO Participation Waiver BRONX ACCOUNTABLE HEALTHCARE NETWORK IPA, INC. DBA MONTEFIORE ACO IPA Required Public Disclosure for the Pioneer ACO Participation Waiver BRONX ACCOUNTABLE HEALTHCARE NETWORK IPA, INC. DBA MONTEFIORE ACO IPA The Bronx Accountable Healthcare Network IPA (BAHN) entered into

More information

Retrospective Bundles

Retrospective Bundles Bundled Payment for Care Improvement (BPCI) Overview Shawn Matheson MBA, LNHA, FACHCA Market Manager Idaho Health Care Association Annual Convention Boise, ID July 13, 2017 Retrospective Bundles Surgeon

More information

NEXT GENERATION ACO PARTICIPATION WAIVER DISCLOSURES

NEXT GENERATION ACO PARTICIPATION WAIVER DISCLOSURES in the Next Generation ACO Model (see HHS, Notice of Waiver of Certain Fraud and Abuse Laws in Connection with the Next Generation ACO Model, December 9, 2015). Pursuant to that notice, Steward Integrated

More information

The Future of Healthcare Credit Analysis - Seven Emerging Ratios

The Future of Healthcare Credit Analysis - Seven Emerging Ratios The Future of Healthcare Credit Analysis - Seven Emerging Ratios Kevin F. Fitch Director, Strategic Financial Planning & Analysis Adam D. Lynch Vice President Robert A. Henley Director, Analytics Learning

More information

Monarch HealthCare, a Medical Group, Inc.

Monarch HealthCare, a Medical Group, Inc. Monarch HealthCare, a Medical Group, Inc. Accountable Care in the Independent Practice Model June 7, 2010 Jay J. Cohen, MD, MBA President/Chairman Monarch HealthCare Monarch HealthCare, a Medical Group,

More information

Capitalizing on Comprehensive Care: Cultivating a Medicare Advantage Mindset

Capitalizing on Comprehensive Care: Cultivating a Medicare Advantage Mindset Capitalizing on Comprehensive Care: Cultivating a Medicare Advantage Mindset AUTHORS Dave Johnson Chief Executive Officer, 4sight Health Richard Jones Chief Executive Officer of Essence Healthcare & Chief

More information

Beyond RVUs: Changing Your Primary Care Compensation Plan from Volume to Value

Beyond RVUs: Changing Your Primary Care Compensation Plan from Volume to Value Beyond RVUs: Changing Your Primary Care Compensation Plan from Volume to Value Objectives Compare different primary care compensation models Identify keys to success and best methods for transitioning

More information

ACOs the Medicare Shared Savings Program And Other Healthcare Reform Payment Methods

ACOs the Medicare Shared Savings Program And Other Healthcare Reform Payment Methods A unique vision for an ever-changing healthcare environment ACOs the Medicare Shared Savings Program And Other Healthcare Reform Payment Methods Presented by Joe Laden, President, ORVA, LLC The Environment

More information

Advanced Illness Management Leveraging Person Centered Care and Reengineering the Care Team Across the Continuum

Advanced Illness Management Leveraging Person Centered Care and Reengineering the Care Team Across the Continuum Advanced Illness Management Leveraging Person Centered Care and Reengineering the Care Team Across the Continuum Betsy Gornet, FACHE Chief Advanced Illness Management Executive Sutter Health / Sutter Care

More information

The Evolving Landscape of Healthcare Payment: Incentive Programs and ACO Model Optimization. Quality Forum August 19, 2015

The Evolving Landscape of Healthcare Payment: Incentive Programs and ACO Model Optimization. Quality Forum August 19, 2015 The Evolving Landscape of Healthcare Payment: Incentive Programs and ACO Model Optimization Quality Forum August 19, 2015 Ross Manson rmanson@eidebailly.com 701.239.8634 Barb Pritchard bpritchard@eidebailly.com

More information

Value Based Care An ACO Perspective

Value Based Care An ACO Perspective Value Based Care An ACO Perspective NCIOM Task Force on Accountable Care Communities January 24, 2018 Steve Neorr Chief Administrative Officer 2 3 4 5 Source: Banthin, Jessica. Healthcare Spending Today

More information

ACOs: Transforming Systems with New Payment Models & Community Integration

ACOs: Transforming Systems with New Payment Models & Community Integration ACOs: Transforming Systems with New Payment Models & Community Integration Sunnah Kim PNP (Moderator), American Academy of Pediatrics Herbert Druilhet, RN, DNP, FNP-BC Lafayette General Medical Doctors

More information

MACRA & Implications for Telemedicine. June 20, 2016

MACRA & Implications for Telemedicine. June 20, 2016 MACRA & Implications for Telemedicine June 20, 2016 Presentation Overview Introductions Deep Dive Into MACRA Implications for Telemedicine Questions Growth in Value-Based Care Over Next Two Years Growth

More information

Partners in the Continuum of Care: Hospitals and Post-Acute Care Providers

Partners in the Continuum of Care: Hospitals and Post-Acute Care Providers Partners in the Continuum of Care: Hospitals and Post-Acute Care Providers Presented to the Wisconsin Association for Home Health Care November 3, 2017 By: Laura Rose WHA Vice President, Policy Development

More information