Risk Evolution Task Force
• Welcome • Overview of APG • Purpose of Task Force Agenda • Leadership • Process • Next Steps • Questions
Welcome Don Crane Don Crane is the President and CEO of America's Physician Groups. During his tenure, America's Physician Groups has expanded from being a division of a regional hospital trade association consisting of 40 member groups to a national professional association consisting of over 300 physician organizations and independent practice associations. APG now has members with practices in 44 states and has become a leading voice in advocacy on both state and federal levels. With headquarters in Los Angeles, America's Physician Groups maintains advocacy offices in Sacramento, California, and Washington, DC.
Why is it needed? CMS and Congress are beginning to recognize what APG members already know – the key to providing Americans with better healthcare at lower costs is to provide physician centric groups access to risk in the form of population-based payments that enable them to effectively manage resources across an entire community of patients.
Overview of APG Over 300 members in 45 states, APG’s mission – to assist accountable APG represents and supports physician Washington, D.C., and Puerto Rico physician groups to improve the groups that assume responsibility for quality and value of healthcare clinically integrated, comprehensive, provided to patients and coordinated healthcare on behalf of our patients. Simply, we are taking responsibility for America’s health
Taking Responsibly for America’s Health is more than just a tagline for APG. It is a mission and vision for a better healthcare system where patients and physicians are at the center.
We know that asking clinicians to take on this risk and shoulder the burden of America’s health is not easy. The Risk Evolution Task Force was formed to ensure APG members and the wider physician communities have access to the education, support, and resources necessary to both be successful in current risk models (MSSP and Next Gen) and prepare for the next iteration of risk models to come.
In order to achieve the goals of the task force, we will be focused on using benchmarking to identify areas of greatest opportunities. Processes will be developed and structured as a sprint, not as a marathon, 90 day goals identified to drive improvements.
Format MONTHLY CALL PARTICIPANTS CONNECT JANUARY IN-PERSON LISTENING SESSIONS WITH COMMUNITY MEETING IN D.C. CONGRESSIONAL AND ADMINISTRATION LEADERSHIP
Leadership • Melanie Matthews – Co-Chair • Niyum Gandhi – Co- Chair • Aneesh Chopra – SME • Eric Coleman – SME • Margaret Peterson – Advocacy & Outreach • David Allen – Communications • Valinda Rutledge – Facilitator
Co- Chairs Melanie Matthews Melanie Matthews is CEO at Physicians of Southwest Washington and NW Momentum Health Partners ACO. Melanie has over 20 years of experience as a leader and innovator in various aspects of health care, including financial management, operations, human resources, system development and product marketing in health care services. Niyum Gandhi Niyum Gandhi is the Executive Vice President and Chief Population Health Officer of the Mount Sinai Health System. Prior to his position at Mount Sinai, Mr. Gandhi served as a partner in the Health and Life Sciences consulting practice of Oliver Wyman in Chicago, where he focused on value-based health care strategy and transformation for physician groups, hospitals, and health plans.
Subject Matter Experts Aneesh Chopra Aneesh Chopra is the President of CareJourney, an open data service that helps providers, payers and pharma market leaders make smarter decisions in the move to value. He previously served as the first U.S. Chief Technology Officer under President Obama (’09 - ’12). He is the author of "Innovative State: How New Technologies can Transform Government.” He joined the Board of the Health Care Cost Institute in 2017 Dr. Eric Coleman Dr. Eric A. Coleman is a leader in geriatric and chronic disease care whose work focuses on a problem in health care that has been largely ignored: the many challenges that occur as patients transition from hospitals to post- acute care and to home. Coleman has quantified the scope of the problem and devised predictive metrics and evidence- based interventions for coordinated and seamless transfers of care. His Care Transitions Intervention , led by nurses and social workers trained as Care Transitions Coaches, equips patients and caregivers with critical skills and knowledge to enable self-care.
Valinda Rutledge APG Team Prior to serving as Vice President of Federal Affairs for APG, Valinda Rutledge worked as a Senior Advisor and Group Director for the Patient Care Models Group within the Centers for Medicare & Medicaid Innovation (CMMI). David Allen David Allen serves as the Director of Communications for America’s Physician Groups, leading the organization’s local and national communications and public relations efforts. Prior to APG, he served as Senior Manager (Health) of Media Relations at AARP and Associate Director of Media Relations at the American Hospital Association. Margaret Peterson Margaret Peterson is the Director of Federal Affairs at APG. Previously, Margaret served on the health policy team for Senator Joni Ernst (R-IA), focusing on ACA reform and MACRA implementation.
Co-Chair Remarks • Experience in risk • Commitment to advancing the value movement though APG • Pearls of wisdom – measuring perforce and sharing best practices are keys to success
Process • Using Aneesh Chopra and his team at CareJourney, the task force will examine the information from CMS’ national dataset of Part A/B/C/D claims for over 65M+ Medicare and Medicare Advantage lives to identify potential key success factors that correlate to savings • The task force members will select the 5 key success factors (KSF) • Care Journey will identify the national benchmarks at both the Medicare FFS and MA level for the identified 5 key success factors (KSF) selected by the group • Each task force member will receive a report identifying where their ACO is at in relation to the national benchmark of both Medicare FFS and MA for the 5 KSF.
Process, Continued • Eric Coleman will assist task force members with identifying emerging best practices of care transitions and delivery as it relates to the 5 KSF • Members will share best practices surrounding care pathways in achieving savings with the 5 KSF • Members will collaborate to identify barriers to success in risk-based Alternative Payment Models related to program development like benchmarking methodology or impact of overlapping models (bundled payments) • The APG DC team will connect specific advocacy efforts to the barriers identified
CareJourney Embraces Participation in Industry Consortia Property of CareJourney Confidential and Proprietary
Under the Hood: Benchmarks derived from Medicare’s linked claims datasets • All CMS Medicare Part A and B claims data for the past eight years, updated quarterly through Q2 2018, Part D data from 2011 - 2016, and Medicare Advantage Part C data for Care Compliance Patient Risk Bundle/Episode Segmentation Efficiency and Opportunity 2015 • Claim-line level detail on 65M+ Medicare and Medicare Risk-Adjusted Market Share and Unnecessary Care Advantage lives Management Cost Trends Referral Retainage • Ability to develop linkages across patient care journeys for longitudinal analytics insights on cohorts, built on open data and algorithms Provider Benchmarking Designing and Performance Pricing Networks • Timely: available data 3-6 months from claims date Tools Reporting • Ability to design benchmarks on research-derived Provide insights: r X • Attributed, Assignable and Un-assignable lives • Risk-adjusted average and total cost • Specialist/Facility/PCP alignment Compare providers Substitute providers Provider Score to • Care Model care compliance and savings opportunity benchmark and analyze against peers, the and model network region, and nation statistics, performance • Part D drug opportunity and utilization • Aggregate quality of care • Avoidable and unnecessary spend Property of CareJourney Confidential and Proprietary | 18
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