IHS ACO Strategy: Population Management Kathleen Cunningham Pam Halvorson Iowa Health System Trimark Physician Group Executive Director for VP Regional.

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



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


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


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


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


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


System & Regional Integrated Delivery System2


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


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


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


• 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


Preparing for all Payment Arrangements


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


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 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


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 ACO Program Contacts• ACO Program Management

– Lori Weih, System Administrator, ACO Program Management– [email protected] Phone: 515-471-9791

• Population Care Management– Raedean VanDenover, IHS Director, Population Care Management– [email protected] Phone: 515-471-9719

• Advanced Medical Team– Monique Reese, Chief Clinical Officer, IHHC– [email protected] Phone: 515-557-3288

• Palliative Care– Lori Bishop, Executive Director, Statewide Palliative and Hospice, IHHC– [email protected] Phone: 515-727-1104


mailto:[email protected]






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)

IHS ACO Strategy: Population Management Kathleen Cunningham Pam Halvorson Iowa Health System Trimark Physician Group Executive Director for VP Regional.

Documents

health care system

clinical care

comprehensive care

palliative care

care settings

steps ihs leadership

ihs aco strategy

population focused care