Accountable Care Organizations: Roadmap for Bending the Cost Curve? Brookings-Dartmouth / Anthem / HealthCare Partners (California) Bart Wald MD HealthCare Partners Medical Group 1
California More than 500K Commercial (full capitated) 100K MAPD (full capitated) 35K Managed Medicaid (full capitated) Modest PPO business in Group Model 500 Employed MDS 2000 contracted MD HCP National Delivery System Florida 40K MAPD (full capitated) Nevada 36K MAPD (full capitated) 2
HealthCare Partners Vision HealthCare Partners will be the role model for integrated and coordinated care, leading the transformation of the national healthcare delivery system to assure quality, access, and affordable care for all. 3
HealthCare Partners Delivery System Global Capitation Predominates Physician-Led, Professionally Managed Centrally Coordinated Regionally Driven Strong Medical Management Infrastructure Robust Deployment of Technology Robust MAPD Growth: Acquisitions and Organic Growth Metrics Driven 4
The Care Team Approach MAs Interactive and collaborative teams of clinicians support HealthCare Partners clinical programs. Social Workers PCPs Disease Educators Specialists Nurses Care Managers & Disease Managers High Risk Programs HomeCare Comprehensive Care Center ESRD Disease Management Programs Diabetes CHF COPD ESRD 5
HCP selected by Dartmouth Brookings to be one of 5 national sites for Commercial ACO project D-B developed ACO concept and advises Feds and health plans on implementation Carilion Clinic Roanoke, VA Norton Healthcare Louisville, KY Tucson Medical Center Tucson, AZ HealthCare Partners Medical Group Torrance, CA Monarch HealthCare Orange County, CA
HealthCare Partners: A Brookings-Dartmouth National ACO Pilot Site Elements of this Pilot: Partnership with Commercial Insurer Attribution Model Historical Trending Multi-year Commitment Quality / Service / Transparency Financial Model 7
2011 ACO Pilot: Current Basic Assumptions Product is a Commercial PPO Anthem is the payer, Members will not prospectively select an ACO provider, PPO benefits will stay same Patients will have choice to participate 8
Evolving ACO Care Management Encounter data submission: Delegation for ambulatory referrals: Delegation for preadmissions: Full hospitalist implementation: Telephonic case management: - complex/chronically ill attributed patients Point of care reminders: 1. Anthem downloads claims 2. Identification of care gaps 3. Clinical reviewer Patient education: Disease management: - complex/chronically ill attributed patients Contracted Provider incentives, Health Risk Assessments PCP/Provider Assignments (Health Coach) 9
Where Do Future Savings Come From? Reduced Inpatient Days Preventive Care Increased Generic Rxs Appropriate Use Of Specialists Appropriate Place of Service Value Based Hospital Selection
HCP ACO Objectives Strategic positioning for Medicare ACO pilots starting in 2012 Source of future profitable commercial growth IPA PCP differentiator Contribute to positive health care outcomes and bend cost curve 11
Hospitals Aligning Incentives Modified Contracts Incremental ACO volume Hospitalist assistance with public programs Shared Savings? 12
Brookings-Dartmouth ACO Collaborative Pilot Sites In-depth consultation, technical assistance, and data analysis for participating health systems and payers. Learning Network Offers practical guidance and a forum for interested parties to learn from one another throughout the process of planning and implementation Principal Goal To engage stakeholders in piloting the ACO model and produce a successful and replicable model that can be implemented nationwide. Community Initiatives Serve as strategic support for regions interested in piloting this at the communitylevel. Washington Support Serve as a resource for legislative and executive staff on delivery system reform, specifically related to the ACO model.
THE BIGGEST CHALLENGE PULL Not A PUSH STRATEGY
So, What is an ACO? 15
LET s HOPE ITS NOT A ANY CARTEL ORGANIZATION ANY CRAPPY ORGANIZATION