Medical Group and Hospital A Model for Clinical Integration

Transcription

1 Medical Group and Hospital A Model for Clinical Integration Richard Afable M.D., MPH President and CEO Hoag Memorial Hospital Presbyterian Alan Puzarne Chief Operating Officer Greater Newport Physicians / Nautilus Healthcare Management Group

2 Outline for Today s Discussion Hoag and Greater Newport Physicians Challenges of Accountable Care: Whose Ball Is It? Path to an ACO: A Long and Winding Road Next Step A Future in the Making Questions From You

3 Hoag Memorial Hospital Presbyterian Not for profit, faith based, and most preferred health care provider in Orange County, California Prominent health care provider in Orange County 674 bed hospital on 2 campuses Hoag Hospital Newport Beach (1952) Hoag Hospital Irvine (2010) Centers of Excellence: Cancer, Heart & Vascular, Neurosciences, Orthopedics, Diabetes and Women s Health 7 Community Health Centers Over 5,000 employed staff, 2,000 volunteers, and 1,300 medical staff Treat nearly 30,000 inpatients and 350,000 outpatients annually Recognitions Orange County s Most Preferred Hospital for past 15 yrs by National Research Corporation County s best hospital by Orange County residents for past 15 yrs Magnet Hospital designation by the American Nurses Credentialing Center Mission Our mission as a not-for-profit, faith-based hospital is to provide the highest quality health care services to the communities we serve. Hoag Health Centers Hoag Hospitals Hoag Network Hoag Hospital Hoag Irvine

4 Greater Newport Physicians (GNP) Prominent IPA in Orange County Founded in affiliated physicians Broad Ownership physician owners Separate MSO IPA management, EMR, practice management, physician billing Exclusive network of core providers 30-45% of Hoag s census Only full-risk business, 100,000 lives Primarily capitated network Significant performance-based compensation Emphasis on growing/building group practices $15 million investment in EMR platform Vision Greater Newport Physicians is the cornerstone of the preferred integrated healthcare delivery system in Orange County. Recognitions IHA recognition for 5 years (P4P, Patient Satisfaction & Technology) CAPG 4-Star Elite Status NCQA Certified

5 Accountable Care: Whose Ball? Physicians and Medical Groups Hospitals and Health Systems Health Plans Employers Where exactly do the patients fit in? Or is it the members??

6 THE PATH TO AN ACO A Long and Winding Road

7 Health Care Reform Critical Dates 3/23/10 Law passed, signed by President 5/2010 GNP/Hoag joins Premier Collaborative Shared Savings Program 1/12/11 GNP/Hoag ACO Workshop 3/31/11 Draft ACO Regulations released 6/6/11 Deadline for comments Sept Dec 2011 Final Regulations expected 7/1/12 Commence ACO Shared Savings pilots Pioneer ACO Demonstration Project 5/17/11 Released request for applications 6/30/11 Letters of Intent due 8/19/11 Applications due CAPG has provided a significant voice in the dialogue on ACOs

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9 Coordinated Care

10 Hoag/GNP Accountable Care Organization Strategic Plan The ACO Value Proposition: Transforming our local health care into a true coordinated system that revolves around patients and their short and long term needs. Its likely to be the entry way to health care s new normal, and serve as a transitional business model that will enable our success in the new value-focused landscape.

11 ACO Implementation Collaborative Mission & Goals Collaborative Mission: Assist members in building ACOs and position them as leaders in transforming healthcare to reward value, rather than volume. Collaborative Goals: Accelerate and lower the cost and risk of building ACOs. Create a community of ACOs that can demonstrate significant outcomes improvements Publicize and communicate results locally and nationally. Interact with lawmakers and regulators and help members secure ACO contracts. Develop capabilities to help other members become ACOs.. 11

12 The Premier ACO Model A group of providers willing and capable of accepting accountability for the total cost and quality of care for a defined population. Core Components: Patient Centered Foundation Health Home High-Value Network Population Health Data Mgmt ACO Leadership Payer Partnerships Legal Support 6 12

13 HOAG/GNP S Readiness Dashboard (Based on the Capabilities Framework & Specific HOAG/GNP S Needs Medicare Advantage Population)

14 HOAG/GNP S Readiness Dashboard cont d (Based on the Capabilities Framework & Specific HOAG/GNP S Needs Medicare Advantage Population)

15 1/12/2011 GNP/HOAG ACO WORKSHOP

16 Definition of Success: Improving Triple Aim Population Outcomes ImprovementMetrics: QUEST outcomes Select HEDIS metrics Health status Mortality rates Metrics: Patient satisfaction Patient Activation Measure scores Metrics: Total medical PMPM Total Medical Trend Total Rx PMPM Admissions/1000 Readmission rate 16

17 Where We Go From Here? Wait for revised regulation to be issued Work with Health Plans on Commercial ACO Stay focused on the Triple AIM Improve patient experience Improve health outcomes for the population we serve Reduce the per capita cost of care

18 ACO Capabilities Projects: STATUS UPDATE Capability Project Lead(s) Status Standard Health Risk Assessment Standardized Patient Education Tsay, Dori Puzarne, Perazzo Current Status: Active vendor search & selection (list of Premier provided vendors) Next Steps: physician co-development; scheme for improving response rates; integrate into Hoag for Life (pilot first) Current Status: Active vendor search & selection (EMMI demo, to be scheduled: Patient Edu, HealthMedia) Standardized Treatment of Guidelines Measurement of Compliance to Guidelines Evidence-Based Utilization of Guidelines Collaborate with Physicians to Lower Costs Inventory, Assess & Expand Community Resources Mady, Cox Laird Emmons, Thomsen Current Status: Information gathering; Drs. Mady and Brooks to collaborate on GNP and Hoag Osteoporosis programs Next Steps: Decide on conditions for focus (GNP data to inform) Current Status: Scheduling meeting RE: Cardiology cath lab following data prep/pulls Current Status: Focus on major ED admit pt groups, disease groups (stroke (Mesa Verde), CHF) and EBC support, Transitions of care; divide data geo; Deliverable is interactive, rated resource recommendations list and plan of how to plug in resources to where they are most relevant Next Steps: meeting scheduled with GNP, get Community Medicine (Hoag) involved Hospice/Palliative Care Tsay GNP Pilot Current Status: writing policy, meeting with agencies (St. Michael s Hospice and Sonnet Home Health), looking for patients to add to program Gary Emmons (GNP Case Manager) working closely with Mona El-Kurd (Hoag palliative care social worker) Next Steps: to gather data regarding utilization and cost analysis; work with Hoag contracting to discuss bundled rate

19 ACO Capabilities Projects: STATUS UPDATE - cont d

20 Accountable Care Considerations for the Future Collaboration versus Competition Commoditization of Hospitals, Others Effect of the Affordable Care Act Idealized State for Your Consideration

21 Questions?