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Encouraging and Regulating Accountable Care: The New York Experience James R. Knickman May 8, 2015 Berkeley ACO Workshop

Jan 03, 2016

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  • Encouraging and Regulating Accountable Care: The New York Experience

    James R. KnickmanMay 8, 2015Berkeley ACO Workshop

  • The New York ContextExpensiveLarge and expensive Medicaid systemDownstate dominated by 5 academic health systemsUpstate has active pockets of regional planningRochesterMid-Hudson ValleyAdirondacksHistory of very active government regulation

  • The New York ContextExpensiveLarge and expensive Medicaid systemDownstate dominated by 5 academic health systemsUpstate has active pockets of regional planningRochesterMid-Hudson ValleyAdirondacksHospital-centric with weaker primary care system

  • The New York ContextExpensiveLarge and expensive Medicaid systemDownstate dominated by 5 academic health systemsUpstate has active pockets of regional planningRochesterMid-Hudson ValleyAdirondacksHospital-centric with weaker primary care system

  • Current Status of Value-Based Payments

  • Current Status of Value-Based Payments in New York StateCommercial paymentsMedicaid payments73% are fee-for-service33% are tied to value46% involve performance-based financial risk for providers13% contain shared risk

    94% are fee-for-service34% are tied to value< 15% involve performance-based financial risk for providers3% contain shared risk

  • ACOs Across New York State*

    Chart1

    0423

    4500

    1151

    MSGP

    IPA

    MD-Hospital Partnership

    System

    Sponsorship Of Medicare ACOs In NYSBy Region, January, 2015

    Pt-MDs

    Medicare ACOs Based in New York State - January, 2015

    Number of Attributed Beneficiaries and Physicians

    CohortOrganization TypePatients AttributedTotal Physicians in ACOPatients AttributedTotal Physicians in ACO

    1MontefiorenPioneer - Jan., 2012System25,0002,700NYSMSGP5Montefiore25,0002,700

    2Chinese Community ACOnApril, 2012IPA - Physician Organization12,000230IPA10Chinese Community ACO12,000230

    3Accountable Care Coalition of North CountryuApril, 2012IPA - Physician Organization5,30020MD-Hospital Partnership6Accountable Care Coalition of North Country5,30020

    4Accountable Care Coalition of Mount KiscodApril, 2012MSGP14,750290System5Accountable Care Coalition of Mount Kisco14,750290

    5Catholic Medical PartnersuApril, 2012Physician-Hospital Partnership29,000900Total26Catholic Medical Partners29,000900

    6Crystal Run Healthcare ACO, LLCdApril, 2012MSGP10,400275NYCMSGP0Crystal Run Healthcare ACO, LLC10,400275

    7Asian American Accountable Care OrganizationnJuly, 2012IPA - Physician Organization13,000334IPA4Asian American Accountable Care Organization13,000334

    8Balance Accountable Care NetworknJuly, 2012IPA - Physician Organization9,0001,000MD-Hospital Partnership1Balance Accountable Care Network9,0001,000

    9Beacon Health Partners, LLPdJuly, 2012IPA - Physician Organization16,000280System4Beacon Health Partners, LLP16,000280

    10Healthcare Provider ACO, Inc.dJuly, 2012IPA - Physician Organization28,000600Total9Healthcare Provider ACO, Inc.28,000600

    11Mount Sinai Care, LLCnJuly, 2012System32,0001,500DownstateMSGP4Mount Sinai Care, LLC32,0001,500

    12ProHEALTH Accountable Care Medical GroupdJuly, 2012MSGP25,000450IPA5ProHEALTH Accountable Care Medical Group25,000450

    13Accountable Care Coalition of Syracuse, LLCuJuly, 2012MSGP12,00065MD-Hospital Partnership0Accountable Care Coalition of Syracuse, LLC12,00065

    14Chautauqua Region Assoc. Medical PartnersuJuly, 2012Physician-Hospital Partnership7,80035System0Chautauqua Region Assoc. Medical Partners7,80035

    15WESTMED Medical Group, PCdJuly, 2012MSGP12,000281Total9WESTMED Medical Group, PC12,000281

    16NYC HHC ACO, Inc.nJan, 2013System12,5003,500UpstateMSGP1NYC HHC ACO, Inc.12,5003,500

    17Accountable Care Coalition of Greater NYnJan, 2014IPA - Physician Organization6,500100IPA1Accountable Care Coalition of Greater NY6,500100

    18Adirondacks ACOuJan, 2014Physician-Hospital Partnership26,000318MD-Hospital Partnership5Adirondacks ACO26,000318

    19FamilyHealth ACOdJan, 2014Physician Org.- FQHCs7,000200System1FamilyHealth ACO7,000200

    20New York State Elite ACOdJan, 2014IPA - Physician Organization5,60082Total8New York State Elite (NYSE) Accountable Care Organization (ACO), Inc.5,60082

    21Primary PartnerCare Associates IPA, Inc.*dJan, 2014IPA - Physician Organization7,20032Primary PartnerCare Associates IPA, Inc.7,20032

    22Rochester General Health System ACOuJan, 2014Physician-Hospital Partnership15,00095026Rochester General Health System ACO15,000950

    23Bassett Accountable Care PartnersuJan, 2015System15,794555Bassett Accountable Care Partners15,794555

    24Innovative Health Alliance of NYuJan, 2015Physician-Hospital PartnershipInnovative Health Alliance of NY00

    25New York Quality CarenJan, 2015System29,9164,000New York Quality Care29,9164,000

    26Richmond Quality, IncnJan, 2015Physician-Hospital PartnershipRichmond Quality, Inc00

    376,76018,697

    Total376,76018,697

    Medicare FFS BenniesPhysicians

    NYC139,91613,364

    Downstate125,9502,490

    Upstate110,8942,843

    Total376,76018,697

    Cohort analysis

    Medicare ACOs Based in New York State - January, 2015

    Number of Attributed Beneficiaries and Physicians

    CohortOrganization TypePatients AttributedTotal Physicians in ACOPhysician-LedHospital/System-Led

    2Chinese Community ACOnApril, 2012IPA - Physician Organization12,000230N=16201211415NYSMSGP5

    3Accountable Care Coalition of North CountryuApril, 2012IPA - Physician Organization5,30020N=12013011IPA10

    7Asian American Accountable Care OrganizationnJuly, 2012IPA - Physician Organization13,000334N=62014426MD-Hospital Partnership6

    8Balance Accountable Care NetworknJuly, 2012IPA - Physician Organization9,0001,000N=52015055System5

    9Beacon Health Partners, LLPdJuly, 2012IPA - Physician Organization16,000280Total151227Total26

    10Healthcare Provider ACO, Inc.dJuly, 2012IPA - Physician Organization28,000600NYCMSGP0

    4Accountable Care Coalition of Mount KiscodApril, 2012MSGP14,750290IPA4

    6Crystal Run Healthcare ACO, LLCdApril, 2012MSGP10,400275MSGPIPA/MD PartnershipPhysician Hosp PartnershipSystem% MD-LedMD-Hospital Partnership1

    12ProHEALTH Accountable Care Medical GroupdJuly, 2012MSGP25,000450N=152012562215201273.3%15System4

    13Accountable Care Coalition of Syracuse, LLCuJuly, 2012MSGP12,00065N=1201311201368.8%1Total9

    15WESTMED Medical Group, PCdJuly, 2012MSGP12,000281N=62014426201471.4%6DownstateMSGP4

    5Catholic Medical PartnersuApril, 2012Physician-Hospital Partnership29,000900N=52015325201553.8%5IPA5

    14Chautauqua Region Assoc. Medical PartnersuJuly, 2012Physician-Hospital Partnership7,80035MSGPIPA/MD PartnershipPhysician Hosp PartnershipSystemMD-Hospital Partnership0

    1MontefiorenPioneer - January, 2012System25,0002,700NYS Total59752627System0

    11Mount Sinai Care, LLCnJuly, 2012System32,0001,500Total9

    16NYC HHC ACO, Inc.nJan, 2013System12,5003,500UpstateMSGP1

    17Accountable Care Coalition of Greater NYnJan, 2014IPA - Physician Organization6,500100MSGPIPA/MD PartnershipPhysician Hosp PartnershipSystemIPA1

    20New York State Elite ACOdJan, 2014IPA - Physician Organization5,600822012-3562316MD-Hospital Partnership5

    21Primary PartnerCare Associates IPA, Inc.*dJan, 2014IPA - Physician Organization7,200322014-5045211System1

    19FamilyHealth ACOdJan, 2014Physician Org.- FQHCs7,000200Total8

    18Adirondacks ACOuJan, 2014Physician-Hospital Partnership26,000318Cumulative

    22Rochester General Health System ACOuJan, 2014Physician-Hospital Partnership15,000950MSGPIPA/MD PartnershipMD-Hospital PartnershipSystem% MD-Led

    23Bassett Accountable Care PartnersuJan, 2015System15,794555N=152012562273.3%

    24Innovative Health Alliance of NYuJan, 2015Physician-Hospital PartnershipN=12013562368.8%

    25New York Quality CarenJan, 2015System29,9164,000N=620145104371.4%

    26Richmond Quality, IncnJan, 2015Physician-Hospital PartnershipN=52015597553.8%

    Total376,76018,697

    Medicare FFS BenniesPhysicians

    NYC103,3668,696

    Downstate175,2005,065

    Upstate98,1944,936

    Total376,76018,697

    N=9N=9N=8

    NYCDownstateUpstate

    NYCMSGP041

    IPA451

    MD-Hospital Partnership205

    System301

    Total99826

    DownstateMSGP

    IPA

    MD-Hospital Partnership

    System

    Total

    UpstateMSGP

    IPA

    MD-Hospital Partnership

    System

    Total

    14

    2654%

    Cohort analysis

    MSGP

    IPA/MD Partnership

    Physician Hosp Partnership

    System

    Trends in Medicare ACO Sponsorship2012-2015

    Regional penetration

    2012-3

    2014-5

    Trends in Medicare ACO Sponsorship2012-2015

    Growth

    NYS Total

    Sponsorship of Medicare ACOs in NYSJanuary, 2015

    ACOs in NYS Chart

    Physician-Led

    Hospital/System-Led

    Trends in Medicare ACO Sponsorship2012-2015

    MSGP

    IPA/MD Partnership

    MD-Hospital Partnership

    System

    % MD-Led

    sPONSORSHIP of Medicare ACOs in NYSChanges, 2012-2015

    MSGP

    IPA

    MD-Hospital Partnership

    System

    Sponsorship of Medicare ACOs in NYSBy Region, January, 2015

    Medicare AdvantageACO Attributed LivesResidual FFSTotal Medicare Lives

    BeneficiariesPenetrationBeneficiariesPenetrationBeneficiariesPenetrationBeneficiariesPenetration

    NYC48997441.17%139,91611.76%560,23947.07%1,190,129100%

    Downstate190,93821.16%125,95013.96%585,61064.89%902,498100%

    Upstate516,10342.96%110,8949.23%574,32747.81%1,201,324100%

    119701536.34%376,76011.44%1,720,17652.22%3,293,951100.00%3,293,9511

    Graphic Below

    ACO AttributedFFSMedicare AdvantageTotal Medicare Lives

    NYC139,916560,239489,9741,190,1291,680,10349.50%1,190,129100%

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