IHS ACO Strategy: Population Management Kathleen Cunningham Pam Halvorson Iowa Health System Trimark Physician Group Executive Director for VP Regional.
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IHS ACO Strategy:Population Management
Kathleen Cunningham Pam HalvorsonIowa Health System Trimark Physician GroupExecutive Director for VP Regional Clinic OperationsAccountable Care Strategies
Mike Dewerff Trinity Regional Medical
Center Chief Financial Officer
IHS Leadership SymposiumApril 17, 2012
Objectives• Review IHS Vision of our Future Healthcare
System• Describe the structured partnership between
IHS and Regional Integrated Delivery System• Review basic payor principles for Wellmark
and Medicare Contracts• Review TriHealth Pioneer ACO operational
plan• Next Steps
IHS Leadership Symposium, April 17, 2012
IHS Leadership Symposium, April 17, 2012
IHS Leadership Symposium, April 17, 2012
ACO Model
Performance Incentives for Physicians &
Hospitals
Performance Incentives for Physicians &
HospitalsTota
l cos
t of c
are
for d
efine
d po
pula
tion
$MM
Projected cost based on medical inflation
trends
Actual costs based on ACO and Medical Home
collaboration
Actual costs based on ACO and Medical Home
collaboration
2007 2008 2009 2010 2011 2012 2013 2014 2015
$ - SAVINGS FOR EMPLOYER/PAYOR$ - SAVINGS FOR
EMPLOYER/PAYOR
IHS Leadership Symposium, April 17, 2012
The Future of Our Health Care System
• Clinically integrated delivery system, regionally & system-wide, with effective population management infrastructure
• Branded as the preferred “high quality—high value” to patients, communities, businesses, and payors
• Patient-centric, physician-driven organization• National leader for healthcare reform
innovation
IHS Leadership Symposium, April 17, 2012
A New Day
• Value will be rewarded over volume• Physicians and other clinicians will be able to
serve their patients • Hospitals, physicians and other providers will
be rewarded for managing the overall health of our communities
• Patients will receive coordinated and collaborative health care…not fragmentation
IHS Leadership Symposium, April 17, 2012
ACO DefinedA clinically integrated network of
physicians, hospitals, and others providers committed to using and
advancing the latest thinking in clinical care, quality and efficiency.
Designed to achieve the triple aim: better health, better healthcare,
and better value
IHS Leadership Symposium, April 17, 2012
Population & Community Health
Facilities & ServicesProvision of inpatient, outpatient and ambulatory services required to deliver comprehensive patient care
Integrated Care Organization 1
Platform for physician engagement and collaboration to improve quality, enhance patient experience and create value
Care Management Infrastructure
Medical Home, Advanced Medical Team, Palliative Care, Coordinated Care Management/Population Management, Call Center
Analytic Support
Business and clinical analytic capabilities required to support a population focused care model
Improve the health of the people and communities we serve
Regional Integrated Delivery System
SystemSystem & Regional
Integrated Delivery System2
2 Medical homes, palliative care programming, and advanced medical team resources to be established in each affiliate region. Call Center would be an example of a system resource.
1 Organization made up of employed and independent physicians from each affiliate region; committee structure in place in each region
Population Management
IHS Leadership Symposium, April 17, 2012
System & Regional Integrated Delivery System2
IHS Leadership Symposium, April 17, 2012
Regional ACO Steering Committees
IDS Executive SponsorIHS ACO Director
Fort Dodge Pam Halvorson, VP Regional Clinic Operations April 2012
Des Moines Dr. Purtle, VPMA/CMO Marcia Stark
Cedar Rapids
John Sheehan, Executive VP/COO April 2012
Waterloo Judy Renaas, VP/CNE April 2012
Quad CitiesKatie Pearson, VP Marketing and Business Development
April 2012
Peoria Terry Waters, VP, Business Development April 2012
Sioux CityChad Markham, VP Clinic and Network Development
Late 2012
Dubuque Chad Wolbers, COO Late 2012
NewGroup Dr. Erick Laine, Executive VP/COO Marcia Stark
IHS ACO Infrastructure
Advanced Care Innovation
Population Care
ManagementACO Analytics ACO Program
Management
Integrated Care
Organization (ICO)
Functional Alignment
IHS Leadership Symposium, April 17, 2012
Other Aligned IHS Resources:* CCT : PI/Research/Education * Business Development* Communications * Information Technology/CMIO* Decision Support
Research and Development for medical care innovations; partner with business unit to create value-added programs for system-wide impact• Advanced
Medical Team• Palliative Care• Post-acute Care
Centralized analytics to include predictive risk-modeling; evidence-based care packages and disease registry to inform physician of patient gaps-in-care; monitor patient quality and provider performance.
Coordinated Care Management for IHS self-insured members expanding to all ACO members; provide care management and disease management for selected chronically ill patients.
Oversee ACO clinical strategy deployment in selected regions; use ACO Clinical Collaborative for regional engagement ; • Population risk
management• Point-of-care
management• Provider
performance
Physician-led, clinically-integrated provider organization established to be the physician arm of ACO to improve quality and create value.
IHS LeadershipIHACO Infrastructure• Kathleen Cunningham,
Executive Director• Lori Weih, System
Administrator, ACO Program Management
• Marcia Stark, ACO Director, IHDM
• Dr. Mark Barnhill, Medical Director, Pop. Care Management
• Raedean VanDenover, Director, Pop. Care Management
• Joe Walters, Interim Manager, ACO Health Informatics
• Jim Grant, Sr. Claims Analyst• Angela Rubino, Network
Development/Financial Analyst
Integrated Care Organization• Dr. Dave Williams, Medical
Director• Gina Ross, Director, Operations• Nathan Thompson, Director,
Physician ServicesIowa Health System• John Hendricks, Director, IT
Interoperability• Amber Lenhardt, Director,
Finance Services• Tim McCulley, Director, Payor
ContractingNew Group• Linda Wendt, System Director of
QualityIowa Health Home Care• Monique Reese, Chief Clinical
Officer
IHS Leadership Symposium, April 17, 2012
Pioneer ACO LeadershipHalvorson
L. Wallace. M.D.
Quality AnalyticsDr. SuriarRosfjord
NagelIHS –Walters
IHS – Jim GrantCunningham
FunctionsCMS Metrics-Claims dataUtilizationOutcomesProcess MeasuresData Analysis
FinancialDr. Wallace/TBD
DewerffHavermanSullivantHeasleyMason
IHS - DielemanIHS – Jim Grant
FunctionsAnalyticsAttributionCosts/CaseDistribution of Shared SavingsIncentives-SupportInterim Payment
ClinicalDr. MeyerAlbrechtShriverSleiterHott
IHS -ReeseIHS –VanDenover
IHS - Fazal
FunctionsPrimary Care Community Implementation TeamsCommunications to ProvidersStaff Education
Patient/Community Engagement
Dr. VottaMcquillenLeValley
Consumer - D. MichaelAlbrechtGascho
Community - PrescottIHS - Sinnard
FunctionsPatient SatisfactionMarketingLiteracyCommunicationsCommunity Relations
IT FunctionalityDr. Willerth
MartensWhaleyBaedke
Trimark-NagelIHS - Hendriks
FunctionsPortalSystem ReadinessIT Integration with Strategic PartnersContext ManagementHealth Information ExchangeDisease Registry
IHS LeadershipCunningham
Support: Weih
Pioneer ACO AdvisorsBeck – Compliance
Reiners – LegalVorpahl - SharePoint
Pioneer ACO CEOThompson
McDonald
IHS Leadership Symposium, April 17, 2012
• Health-Risk Assessment
• Iowa’s Healthiest State initiative
• Preventive screening
• Health Education and Literacy
• Wellness Program
• Care transitions – Extended Care Facilities
• ICCDM – all care settings
• Advanced Medical Team
• Telephonic-Telemonitoring
• Strategic Healthcare Partners
• Critical Access Hospitals
• Risk stratification
• Med Therapy Management
• Disease Management Coaching
• Strategic Community Partners
• Patient access to PCP
• Common screening and assessment tools
• Single, patient-centric care plan
• Med Therapy Management
• Mental Health Action Team
• Palliative Care• Inpatient• Home-based• Clinic
• Integration with PCP
• Hospice• Hospice
Home• Home-based
Primary Care Community
Home/Neighborhood - Schools - Business - Healthcare Agencies - Government -Recreation - Church/Spiritual
TriHealth Pioneer ACO: Achieving our AIM
AIM: Leverage every aspect of our “community” to achieve Best Outcome for Every Patient Every Time
Sec
onda
ry D
river
sP
rimar
y D
river
s
Supporting Choice through the Life
Span
IHS Leadership Symposium, April 17, 2012
Preparing for all Payment Arrangements
IHS Leadership Symposium, April 17, 2012
IHACO Value-based Contracts
PAYOR
TriHealth Pioneer
ACO1/1/2012
Wellmark ACO
4/1/2012
Medicare Shared Savings (MSSP)
7/1/2012
Iowa Health Self-
Insured1/1/2012
ACAMedicaidHealthHome
7/1/2012
Beneficiaries ~ 7,700 ~ 50,000 ~ 70,000 ~ 30,000IHS in review at
this time
Fort Dodge √ √ √Des Moines √ √ √Cedar Rapids √ √ √Waterloo √ √ √Quad Cities √ √Peoria √Sioux City √Dubuque √Quincy Medical Group
√IHS Leadership Symposium, April 17, 2012
ACO Program DomainsWellmark ACO Pioneer and MSSP
Patient Experience(4 measures)
Patient/Caregiver Experience (7 measures)
Chronic and Follow-Up Care(3 measures)
Care Coordination/Patient Safety(6 measures)
Primary Prevention(4 measures)
Preventative Health(8 measures)
At Risk Populations(12 measures)
Stoplight Definitions
Actively reporting measures with same definition and method
Able to report, or currently reporting with differences in definition, content, or method
Not able to report at this time, will come from payor claims data
IHS Leadership Symposium, April 17, 2012
Wellmark ACO BaselineWellmark ACO
Quality Index Score (QIS) Patient Experience (4 measures)
• Patient Confidence• Continuity of Care • Office Efficiency• Access to Care
Chronic and Follow-Up Care (3 measures)• Risk-adjusted potentially preventable readmissions• Post-acute provider visit• Provider visits for chronic disease patients
Primary Prevention (4 measures)• Breast cancer screen • colorectal cancer screening• Well-child visits (2 age categories
IHS Leadership Symposium, April 17, 2012
IHS ACO 2012 Priorities
• Clinical Priorities– Advanced Medical Team– Palliative Care
• Inpatient • Outpatient (home care)
• Regional ACO Steering Committee– Key stakeholders to
oversee ACO performance aligned with IHACO strategies
• IHS Resources Assigned– Regional ACO Director– Project Manager– Analytics (EMR and
claims)– IT liaison– Adaptive Design– Finance– Contracting– Communications
IHS Leadership Symposium, April 17, 2012
Next Steps
• Deploy 2012 ACO Priorities• Refine technology requirements and analytic
services to support ACO performance at the beneficiary level, to encompass all care settings
• Further advance additional payor and provider negotiations to increase ACO beneficiaries served.
IHS Leadership Symposium, April 17, 2012
IHS ACO Program Contacts• ACO Program Management
– Lori Weih, System Administrator, ACO Program Management– weihls@ihs.org Phone: 515-471-9791
• Population Care Management– Raedean VanDenover, IHS Director, Population Care Management– vandenRK@ihs.org Phone: 515-471-9719
• Advanced Medical Team– Monique Reese, Chief Clinical Officer, IHHC– fentonmc@ihs.org Phone: 515-557-3288
• Palliative Care– Lori Bishop, Executive Director, Statewide Palliative and Hospice, IHHC– bishoplr@ihs.org Phone: 515-727-1104
IHS Leadership Symposium, April 17, 2012
IHS Leadership Symposium, April 17, 2012
IHS Leadership Symposium, April 17, 2012
IHS Population Care Management (PCM): Patient Engagement
Examples Ab
brev
iatio
n an
d D
efini
tions
:
ACO Accountable Care Organization: A clinically integrated network of physicians, hospitals, and others providers committed to using and advancing the latest thinking in clinical care, quality and efficiency to achieve the triple aim: Better health, Better Healthcare, and Better value.
AMT Advanced Medical Team: The AMT is an interdisciplinary team comprised of a physician, nurse, pharmacist, therapist, social worker, and other experts supporting the PCP in the care of a complex patient population. Patients are identified for initial and periodic complex case review by the AMT when standardized best practice care delivery fails.
CM Case Management: management for complex, patient who requires coordination through care continuum, often episodic with a beginning and end date.
Motor-vehicle accident or specific cancer patients
DM Disease Management: Patient-specific, long-term disease management of the chronically ill patient, with condition-specific interventions to maintain health in the outpatient setting.
COPD or CHF patient long-term clinical interventions.
EHR Electronic Health Record ICCDM Integrated Chronic Care Disease Management: ICO Integrated Care Organization: IHS’ clinical integration platform for employed and
independent physicians to work together to improve quality of care, enhance the patient experience and create more value in health care
IDT Inter-disciplinary team: The care team, to include physician, nurse, social worker PCM Population Care Management: Predictive risk-modeling in a given population and overall
management, including wellness, of the entire at-risk population attributed to the ACO. Focus on population based strategies to improve the health of the at risk population while delivering high quality and high value programs.
High level overview of all ACO beneficiaries to identify clinical intervention opportunities to drive future patient engagement programming.
PCP Primary Care Physician: The primary care physician responsible for a single beneficiary care plan to advance the triple aim.
Triple Aim
better quality, better patient experience at a higher value (lower cost)
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