Accountable Care: A Value-Based Approach to Health Care - PDF document

11/23/2015 Sunday, December 6, 2015 These presenters have nothing to disclose Accountable Care: A Value-Based Approach to Health Care Transformation The 27th Annual IHI National Forum on Quality Improvement in Health Care Molly Bogan, MA Trissa Torres, MD, MSPH, FACPM Session L22: 1:00-4:30PM Orlando World Center Marriott Crystal Ballroom, Salon K-M Welcome & Introductions 2 Trissa Torres, MD, MSPH, FACPM Senior Vice President Institute for Healthcare Improvement Molly Bogan, MA Director Institute for Healthcare Improvement 1

11/23/2015 Welcome & Introductions 3 Richard Gitomer, MD President & CQO Emory Healthcare Network George Kerwin, FACHE President/CEO Bellin Health Objectives 4 Identify common challenges and solutions to running a successful ACO Recognize opportunities to accelerate their efforts to achieve cost- and quality-related improvements at scale Engage in active peer sharing and learning 2

11/23/2015 Icebreaker 5 ACO start year Region Physician-driven v. Hospital-driven Employ or Contract physicians 6 Introduction to Accelerators 3

11/23/2015 Healthcare is changing… US Affordable Care Act (ACA) HHS to tie 90% of all traditional Encouraging Improving Prohibiting Medicare Integrated Health Preventative Health Discrimination Due to President Obama payments to signs the Affordable Bring Down Health Systems &Launch of Coverage & Launch of Pre-Existing Care Act. Care Premiums ACO Pioneer SSP ACO model Conditions or Gender quality or (1/1/11) Program (1/1/12) (1/1/13) (1/1/14) (3/23/2010) value by 2018 2010 2011 2012 2013 2014 Prohibit Denying Coverage of Children Based on Pre-Existing Increase Access to Understanding and Open Enrollment in the Establishing the Conditions Services at Home and Fighting Health Health Insurance Health Insurance (9/23/2010) in the Community Disparities (3/1/12) Marketplace Begins Marketplace (2014) (10/1/1/11) (10/1/13) Provide Free Preventative Care (9/23/2010) Definition System designs that simultaneously improve three dimensions: – Improving the health of the populations; – Improving the patient experience of care (including quality and satisfaction); and – Reducing the per capita cost of health care. ​Berwick DM, Nolan TW, Whittington J. The Triple Aim: Care, health, and cost. Health Affairs. 2008 May/June;27(3):759-769 4

11/23/2015 Determinants of Health and their Contribution to Premature Death Proportional Contribution to Premature Death Social circumstances 15% Genetic predisposition Environmental 30% exposure 5% Health care 10% Behavioral patterns 40% Adapted from: McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff (Millwood) 2002;21(2): 78-93. Changing Healthcare Context Fee for Pay for Shared Global Shared Risk Service Performance Savings Payment Individuals and Individuals, Populations Focus on Individuals Populations and Communities Care Care and Cost The Triple Aim Do to Do for Do WITH 5

11/23/2015 11 Population Management DEFINITION The design, delivery, coordination, and payment of services for a defined group of people to achieve specified cost, quality and health outcomes for that group of people. http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4 a47-4ccd-4e9e-89d9-14d88ec59e8d&ID=50 12 Population Health http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a47-4ccd- 4e9e-89d9-14d88ec59e8d&ID=50 6

11/23/2015 13 Managing Services for a Population Community, Family and Individual Resources Goals Coordination Needs Delivery of Service Assessment for Services at Segment Design Scale Population Population Segmentation Outcomes Integrator Feedback Feedback Loops Loops 14 Our Framework: Five Accelerators • Building robust improvement infrastructure • Demonstrating effective leadership • Integrating data systems to support performance improvement • Engaging providers and community stakeholders in care redesign Population Management • Leveraging payment models to achieve clinical and financial targets 7

11/23/2015 15 World Café 16 Break See you back here at 2:30PM! 8

11/23/2015 Rapid Fire Case Studies 17 Richard Gitomer, MD George Kerwin, FACHE President & CQO President/CEO Emory Healthcare Network Bellin Health Rapid Fire Case Studies 18 Richard Gitomer, MD President & CQO Emory Healthcare Network 9

11/23/2015 Accountable Care: A Values Based Approach to Health Care Transformation Emory Healthcare Institute for Healthcare Richard S. Gitomer, MD, MBA, FACP Improvement National Forum President & Chief Quality Officer Learning Lab L22 Emory Healthcare Network December 6, 2015 rgitome@emory.edu Nothing to disclose Objectives • Understand why we chose to pursue value-based payment models • Understand how we engaged physicians • Our approach to value-based contracting • Emory’s population management strategy 20 10

11/23/2015 Emory Healthcare Network Geographic Footprint 21 ehn.emoryhealthcare.org Emory Healthcare Network 5 Hospital Facilities 22 11

11/23/2015 Increasing Accountability Emory Value-Based Commercial Contracts Medicare Advantage* 8,000 4 th Major Payor Medicare Advantage* 32,000 1,500 Cigna Cigna 15,000 15,000 Aetna Aetna Aetna 18,000 19,000 19,000 BCBSGA BCBSGA BCBSGA BCBSGA 32,000 32,000 32,000 38,000 2014 2015 2016 2017 (Projected) *Full Risk Capitation 23 Objectives • Understand why we chose to pursue value-based payment models • Understand how we engaged physicians • Our approach to value-based contracting • Emory’s population management strategy 24 12

11/23/2015 TH THE E CI CINDERELLA PARABLE - The pace of change to varies significantly by market and health system Preparing for a Initial Pilots and Payer Completing Change in the Basis of Demonstrations Transition to a Payment New Model Operating Margin ($ in Millions) (Midnight) Well-Timed Fee-for-service Transition World A World B Accountable Care Lagging Transition Transition Zone 3-Year to 6-Year Time Horizon 25 Commercial Insurance (Employer) Timeline • Market-specific • Employers increasingly unable to afford increasing costs • Communication challenge • Viewed as any other good or service – ↓ Cost & ↑ Value • Difficult to measure value – so low unit cost is assumed to be high value • Tension between short-term financial horizon & long-term investment for value-based provider • Impact of private and public exchanges • Commoditization vs. Differentiation • Decisions: Plan → Network → Benefits 26 13

11/23/2015 CMS’ Journey to World B Source: Medicare ACOs Provide Improved Source: Medicare ACOs Provide Improved Care Care While Slowing Cost Growth in 2014, While Slowing Cost Growth in 2014, Centers for Centers for Medicare & Medicaid Services. Medicare & Medicaid Services. August 25, 2015 August 25, 2015 27 CMS Timeline – Alternative Payment by 2019 2016 – 20 20 2017 Data a Driv rive 20 2019 MIPS Sc Scor ore Current System Medicare and CHIP Reauthorization Act (MACRA or SGR Repeal) Present to 2019 ‘19 to ’ 26 MIPS ‘19 to ’ 26 APM After ‘26 • • • Sec. Burwell – Jan ‘15 Payment updates Payment updates Payment updates • • • • ‘16 ‘15 – ‘19: 0.5% ‘15 – ‘19: 0.5% MIPS: 0.25% • • • • APM – 30% ‘20 – ‘26: 0% ‘20 – ‘26: 0% APM: 0.75% • • • • 85% value-based MIPS – Single Metric Bonus – 5% MIPS maximum • • • ‘18 Quality APM reduction – 9% • • • APM – 50% Resource use Minimum % of • • 90% value-based Improvement practice • • Current programs Meaningful use requirements • • PQRS, Max reduction (Medicare or • Meaningful use, 4% to 9% total) • Value based ‘19 score based on modifier ‘16 & ‘17 data APM = Alternative Payment Model MIPS = Merit-Based Incentive Payment System 28 14

11/23/2015 Objectives • Understand why we chose to pursue value-based payment models • Understand how we engaged physicians • Understand our approach to value-based contracting • Emory’s population management strategy 29 Recruitment & Provider Relations What is your hook? What makes your network attractive to independent providers? • Safety in numbers in times of • Preservation of referral stream • CMS penalty avoidance uncertainty • Competitive rates • Access to expensive infrastructure • IT • Population management 30 15