CMS IACO 4-29-15

Medicare Shared Savings Program ACO Learning System

Strategies of SSP ACOs Achieving Shared Savings—Session 2

Wednesday, April 29, 20152:30 – 4:00 PM ET

Audio for this session can be streamed through your computer, or accessed by phone by dialing 1-857-232-0156; access code: 271840

Disclaimer

The comments made on this call are offered only for general informational and educational purposes. As always, the agency’s positions on matters may be subject to change. CMS’s comments are not offered as and do not constitute legal advice or legal opinions, and no statement made on this call will preclude the agency and/or its law enforcement partners from enforcing any and all applicable laws, rules and regulations. ACOs are responsible for ensuring that their actions fully comply with applicable laws, rules and regulations, and we encourage you to consult with your own legal counsel to ensure such compliance.

Furthermore, to the extent that we may seek to gather facts and information from you during this call, we intend to gather your individual input.  CMS is not seeking group advice. 

Webinar Agenda

• Housekeeping items• IntegratedACO• Integral Healthcare• Q&A• Wrap-up

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IntegratedACO

Vipul Mankad, MDFounder & Senior Medical Adviser

Eric Weaver, MHAPresident & CEO

Charles Bunnell, MPAExecutive Director &

Chief Operating Officer

©

ACO LEARNING SYSTEMS PRESENTATION for CMS

April 29, 2015

© 7

Introductions

Vipul Mankad, M.D. Founder and Senior Medical

Adviser, IACO (2013-present); Senior Medical

Adviser-CMS (2005-2006); RWJ Health Policy

Fellow-US Senate (2003-2004);

Eric Weaver, MHA, President, IACO, Focus on

Leadership, Physician Practice and Information

Management

Charlie Bunnell, MPA, Executive Director (COO),

IACO

© 8

Provider Location Map

Weatherford

Austin

San Antonio

Alpine

Midland/Odessa

Provider locations:Midland/Odessa 10

San Antonio 14

Austin 13

Weatherford 1

Alpine 1

Bastrop 1

Port Lavaca 8

Port Lavaca

Bastrop

© 9

Integrated ACO LLC

Track 1, Advance Payment Model, January 1, 2013

Independent Practices initially in medically underserved

region of West Texas with high numbers of Hispanics Vast Geographic Area (Distances of 500 miles between

sites)

Physicians: 28 in 2013 > 48 in 2015

Beneficiaries: 7,177 in 2013 > 13,025 in 2015

EHR penetration: 90%, 9 Platforms (8 MU Certified, 7 HL7

Compatible)

© 10

ACO Formation, Culture and Background

Initial Skepticism and Resistance Will Affordable Care Act be repealed after 2012

elections? Will Supreme Court find it unconstitutional? We are busy enough; why change?

Education by a highly respected local physician and a

physician with national policy experience Inevitability due to macroeconomic factors Tangible benefits to physicians and their patients

Openness to Information Management Loop 360 Healthcare Solutions

© 11

Our Strengths

Physician Ownership, Incentives and Governance No Conflict of Interest for focusing on reduction of

unnecessary hospitalizations for Ambulatory Care Sensitive Admissions (ACSA)

Executive leadership

Medical Leadership in each region (West Texas,

Austin; San Antonio) and Overall

Well-defined Care Coordination protocols CHF and Diabetes

Clinical and Predictive analytics

© 12

Performance Year 1 Results

One of only 6 Advance Payment ACOs to pay back the

advance in the first year of operation and create a surplus

Per capita expenditure benchmark: $12,203

Actual Per Capita expenditure: $11,668

Reduction from $81.4 MM to $77.8 MM Approximately 4.5% cost reduction in PY1

Successfully reported on 100% of quality measures

Returned $1.54 MM and created a surplus of

$208,000 50% performance bonus and 50% reinvestment

© 13

Key strategies

Integrated Data Warehouse and EHR Penetration

Versatility in EHR interfacing methodologies

Utilizes powerful algorithm for prediction of preventable

admissions for CHF patients (C-statistic: AUC 0.9 with a Lift of 17.6 at 1%)

Psychographic segmentation of patient population based

on personality type so we can personalize care

coordination intervention

© 14

Loop360 Population Management System

1.Integrated

Data Warehouse

Public Database

s HIE

Other Insurers

HospitalEHRHIS

Laboratory

Pharmacy

PhysicianEMRPM

Medical Personas - Different Cost

Of Care & Different

Interventions Required

Cu

sto

miz

ed

Pop

ula

tion

Man

ag

em

en

t S

yste

m

2. Quality3. Descriptive 4. Advanced

Clinical 5.Predictive

Analytics

Alerts

Patient Portal

Patient Outreach

Point of Care

Care Management

CMS

© 15

Prediction of CHF PQI

© 16

Cost Effective Use of Care Coordinators

8,000 Medicare Beneficiaries 40 Care Coordinators to achieve 1:200 ratio for

all ACO patients 26 Care Coordinators for patients with multiple

chronic conditions 2 Care Coordinators if 5% of population (most

likely to generate future costs) is selected

Challenge: Identify 5% of patients most prone to

ACSA admissions in the near future (e.g., within

next 6 months) 1 CHF admission = $18,000

© 17

Pearls of Wisdom

Build momentum by earning shared savings in the first

year Solidify physician buy-in

Align incentives and engage physicians

Address economic self-interest of physicians

Standardize processes and data (P4P)

Employ Strong Information Technology Service

© 18

Pearls of Wisdom

Understand population dynamics based on risk

modeling

Promote timely physician feedback via data-

driven report cards (use transparency among

peers to drive performance)

Focus on the “low hanging” fruit

Create a shared purpose (common organizational

goals)

Promote patient engagement

© 19

Future Directions

By Dec. 2015, serve at least 10,000 Medicare lives/year

Expand geographic reach within rural areas of Texas

Implement patient engagement technology platform for

customized prevention and disease management

Build on lessons learned from the Medicare Shared

Savings Program and

Serve commercially insured, Medicare Advantage, and

Medicaid populations.

© 20

Contact Information

Vipul Mankad, M.D., Senior Medical Advisor

[email protected]

Eric Weaver, CEO

[email protected]

Charles Bunnell, Executive Director

[email protected]

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