Fresenius Health Partners ESCO Overview Glenda Wooten Senior ESCO Program Manager May 23, 2019 For Internal Purposes Only.
2 Disclaimer The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document. For Internal Purposes Only.
3 Renal Care in a Value-Based Model Fragmented Care The Nephrologist is the negatively impacts the principal care provider for patient’s quality of life the ESRD patient and and increases the risk of are involved in most hospitalizations major care decisions Challenges Opportunities This is a resource The ESRD patients are intensive cohort of in the dialysis clinic three patients, with annual times a week making it costs 10 times that of an the logical medical home average Medicare patient For Internal Purposes Only.
4 Understanding ESCOs E nd Stage Renal Disease S eamless C are O rganization or ESCO Partnerships between CMS, nephrologists and dialysis providers Accountable for all facets of their matched beneficiaries’ care Share savings with CMS if matched beneficiaries’ expenditures decrease and quality is maintained or improved Share losses if beneficiaries’ expenditures increase CMS ESCO Nephrology Dialysis Units Others Practices Medicare FFS Beneficiaries For Internal Purposes Only.
5 Patient Eligibility Enrolled in Medicare Parts A and B Medicare is primary payer Not be enrolled in a Medicare Advantage plan, cost plan, or other non-Medicare Advantage Medicare managed care plan Not be affiliated with an existing shared savings program At least 18 years of age & reside in the US Not received a kidney transplant in the last 12 months Matching through “first touch” Receive at least 50% of annual dialysis services in the ESCO’s market area For Internal Purposes Only.
6 Patient Attribution Beneficiary matching is based on the dialysis unit Note: A beneficiary will be removed from the ESCO’s list of aligned beneficiaries for the entire Initial matching is preliminary Performance Year if the patient received more Final matching for shared than 50 percent of his or her dialysis services from one or more Dialysis Facilities outside of savings/loss is retrospective the Market of the ESCO during the Performance Beneficiaries retain all of their Year. * freedom of choice Medicare continues to pay claims *Beginning in 2018 (PY3) geographic exclusions may apply. For Internal Purposes Only.
Initial 13 ESCO Programs October 2015 – December 2016 Fresenius – 6 ESCO’s DCI – 3 ESCO’s (Nashville, Spartanburg, Newark) DaVita – 3 ESCO’s (Phoenix, Miami and Philadelphia) Non-Large Dialysis Organizations • Rogosin Kidney Care Alliance (NY) For Internal Purposes Only.
ESCO Programs 2017 to present: 36 Total Fresenius – 24 ESCO’s DCI – 5 ESCO’s (Nashville, Spartanburg, Newark, Kansas City, Pittsburgh) DaVita – 3 ESCO’s (Phoenix, Miami, Philadelphia) Non-Large Dialysis Organizations (1 ESCO each) • Rogosin Kidney Care Alliance – NY • Northeast Ohio Renal Alliance – Cleveland • The Gotham City Kidney Care ESCO – NY • Northwest Kidney Alliance – Seattle For Internal Purposes Only.
Fresenius ESCO Experience 2015 – 6 Cohort 1 ESCO’s ESCO/Location Seamless Care of Atlanta Seamless Care of Houston Seamless Care of Central Seamless Care of Indianapolis Alabama Seamless Care of Central Seamless Care of Las Vegas Illinois Seamless Care of Central North Seamless Care of Louisiana 2017 - 24 ESCO’s Carolina Seamless Care of Central Seamless Care of Maryland Texas Seamless Care of Charlotte Seamless Care of Massachusetts Seamless Care of Chicago Seamless Care of Michigan Seamless Care of Columbia Seamless Care of Minneapolis Seamless Care of Dallas Seamless Care of New York Seamless Care of Delaware Seamless Care of Philadelphia Seamless Care of Erie Valley Seamless Care of Portland Seamless Care of Gulf Shore Seamless Care of San Diego For Internal Purposes Only.
Care Navigation Unit For Internal Purposes Only.
11 Care Navigation Unit (CNU) CNU is a team of nurses, social workers and service operations specialists who provide 24/7 coordination of care support Caring for >48,000* patients in various programs across North America Increasing communication 24/7 access to all patient between key stakeholders data contained in the CNU Focus: in a fragmented system dialysis center EHR to reduce unnecessary hospital admissions Monitors patients real time Empowered to take allowing for “just in time” extraordinary measures to interventions to find safely coordinate care at solutions and remove the lowest level of intensity obstacles * As of October 2018 For Internal Purposes Only.
12 CNU Focus: Reduce Unnecessary Hospitalizations For Internal Purposes Only.
13 CNU Focus: Reduce Unnecessary Hospitalizations 0-3 day stays are often treatment adherence All admits are high cost DRG related w/MCC Admits LOS Avg Cost/day 18% 16% 16% 16% 3 $10,568 14% 12% 11% 12% 2 $10,133 10% 10% 10% 8% 8% 6% 1 $9,128 6% 5% 3% 3% 4% Same $7,541 1% 2% $0 $5,000 $10,000 $15,000 0% Same 2 4 6 8 10 For Internal Purposes Only.
14 FHP Care Navigation Unit Coordination • Scheduling medical appointments • Coordinating home health services • Obtaining DME covered by health plan • Locating community resources • Coordination of transportation • Provide short term transports during temporary disruption of permanent transportation • Locate long term solutions For Internal Purposes Only.
15 Clinical Member Surveillance Predictive Analytics and Clinical Insights : FHP teams have developed technology and predictive models to identify a list of high risk members, enabling the front line CNU to reach out in advance of clinical issues either telephonically or face to face. Contact the CNU at mycarenav@fmc- na.com with member needs & F2F requests Multiple hospital Local CNU, admissions and / Clinical Provider or or ER visits < 90 Indicators Clinic Insight days and Requests High Visibility Member List F2F Visits by CNU RN Hospitalization Incident EOL Predictive Weekly No Show Risk Predictive Members Model Predictive Model Model For Internal Purposes Only.
Safe and Effective Care Coordination ● Reduce unnecessary ‘emergency’ services ● Reduce unnecessary hospital admissions ● Reduce unnecessary hospital re-admissions Providing care opportunities in outpatient setting For Internal Purposes Only.
Quality For Internal Purposes Only.
Quality Categories - 2017 10 Hybrid Measures • Combination of claims data and chart review • All based on claims or other CMS documentation – upside 3 Standardized Ratio is that shared savings strategies work in tandem with 2 of Measures these measures. • KDQOL – This is a Health Outcome Survey (HOS) methodology 7 Survey Measures • ICH-CAHPS – uses Dialysis surveys conducted for Dialysis Clinic Quality 6 QIP Results • Patient Safety and Clinical Quality of Care Total of 26 measures For Internal Purposes Only.
19 Quality Categories -2018 9 Hybrid Measures Combination of claims data and medical records Standardized Ratio Measure Based on hospital claims or CMS Clinical Data Warehouse • 2 measures of patients on transplant waitlist • standardized ratio of First kidney transplant waitlist Transplant Wait List • percentage of Prevalent patient on a waitlist • Based on medical records and CMS Data Warehouse 2 Surveys ICH CAHPS & KDQOL Total of 19 Measures For Internal Purposes Only.
20 Quality Categories- 2019 Combination of Medicare claims data and medical record data 3 - Hybrid Measures • Influenza, Depression, Advance Care Plan 1 - Standardized Hospital claims or other CMS documentation Ratio Measure ICH-CAHPS – dialysis survey conducted for Dialysis Clinic Quality 1 - Survey • 6 Domains Total of 5 Measures For Internal Purposes Only.
PY 1 Results – All 13 ESCOs For Internal Purposes Only.
Questions?????? For Internal Purposes Only.
23 Contact Information Glenda Wooten, RN, MN, NEA-BC Senior ESCO Program Manager glenda.wooten@fmc-na.com Cell – (704) 412-0004 For Internal Purposes Only.
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