Joint Testimony for Senate Health and Welfare And House Health Care - PowerPoint PPT Presentation

Joint Testimony for Senate Health and Welfare And House Health Care Vicki Loner, CEO Tom Borys, Senior Director of Finance January 16, 2020 onecarevt.org

W hat is an ACO? Legal Entity, comprised and led by providers that take accountable for both quality and costs of care for a defined population onecarevt.org 2

ACO Elem ents of Success *The American Academy of Family Physicians has suggested eight essential elements of an ACO. onecarevt.org 3

Benefits of an ACO Approach: Provider led reform Supports a unified care model and investments in population health Ability to share data across providers Opportunity for payment reforms Forum to share best practices and CMS MACRA/ MIPS reward program for learnings across systems providers who participate Mechanism for sharing and Medicare benefit enhancements, such mitigating financial risk across as greater access to post-discharge multiple systems home visits, telehealth services, and skilled nursing facility services. Enable new partnerships and collaboration, without losing autonomy onecarevt.org 4

OneCare Verm ont Board of Managers OneCare Committees Federally Qualified Health Centers ( FQHC) • Population Health Strategy Committee • Finance Committee OneCare Board of I ndependent doctors Managers covers the • Patient and Family Advisory Committee entire continuum of • Clinical and Quality Advisory Committee Prospective Paym ent health care providers System ( PPS) & Critical including: Access Hospitals • Pediatrics Subcommittee • Pediatrics Subcommittee Com m unity Agencies • Laboratory Subcommittee Consum ers Accountable Communities for Health Key Facts about the Board Requires “supermajority” vote to Use committees to process Representative Board to ensure voices of all provider types are decide important key issues issues/ make recommendations present onecarevt.org 5

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OneCare Verm ont’s Com m itm ent to Transparency Next S Steps ps • Meetings of the OneCare Board of Managers are open to the public and minutes are posted on our website. Monthly financial statements are included in posted Board materials. 1. Exploring applying to the IRS and requesting • PricewaterhouseCoopers (PwC) conducted an audit of 501(c)(3) non-profit tax OneCare’s financials for 2017 and 2018 and standards exempt status for were met for both years. OneCare and will work with the Agency to • OneCare’s website has a page dedicated to sharing identify requirements of important information including shared savings, importance to quality results, and audit results. transparency. • OneCare is regulated by the Green Mountain Care 2. Developing key performance dashboards Board all certification and budget materials can be for the website. found on the Green Mountain Care Board’s website. onecarevt.org 8

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onecarevt.org pg. 10 Budget

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Value-Based Health Care Cost Health Care Reform (HCR) ~$1.36 billion Investments ~$43 million (Medicaid, Medicare, BCBSVT) (Medicaid, Medicare, BCBSVT, MVP, Hospitals) Pay Directly to Delivery System: (Fee for Service Pay OneCare Monthly for: $891 million) ($515 million) • All Providers other than Participating Hospitals including: • $472 Million Hospital Fixed Prospective Payment  FQHCs Allocation (includes all services, including hospital  Independent Primary Care & Specialists employed primary care)  Home Health & Hospice, Designated Agencies, • $43 Million Health Care Reform Investments for Skilled Nursing Facilities OneCare Population Health Management  Out of Network Providers Hospital & CPR Practices Non-Attributing Practices Non-Hospital Attributing Practices • Fixed Prospective Payments • Care Coordination Program • Population Health Management • Population Health Management Payments Payments Payments • Value Based Incentive Fund • Care Coordination Program Payments • Care Coordination Program Payments • Value Based Incentive Fund • Value Based Incentive Fund All participating providers are eligible for Innovation Funds, Blueprint funds, and specialist funds. onecarevt.org 12

Full OneCare Budget Sum m ary Budget Payer Program Investments $10.7M Break-even budget New Programs (Delivery System Reform) $6.0M Budget incorporates Existing Programs (Delivery System Reform) $1.8M no additional reserve Hospital Fixed Payment Care Coordination Allocation $5.3M development (2019 Health Information Technology (HIT) Investments $3.5M performance results Other Investments $2.3M will need to be Blueprint Funding $8.2M evaluated) Hospital Dues $24.4M Total I ncom e $ 6 2 .2 M Continued investment in the provider Population Health Payments to Providers $43.1M network Network Support $13.2M All Payer Model Regulation $1.6M continues to rely on General Admin $4.5M significant hospital Total Expense $ 6 2 .2 M investments Gain ( Loss) $ 0 onecarevt.org 13

Revenue Source Breakdow n Revenue Source Budget ACO Contracts with Payers (includes $18,999,749 Blueprint Funding) Federal w/ State Match * $11,300,000 ACO Contracts Federal Share $6,770,000 w ith Payers State Match Share $4,530,000 Hospitals $31,779,307 Hospitals Dues $24,467,227 Hospital Fixed Payment Care $5,300,000 Coordination Allocation Federal w / Deferred Hospital Dues $2,012,080 State Match * Other $313,759 Total $ 6 2 ,3 9 2 ,8 1 5 Other * Federal funds dependent on state match onecarevt.org 14

All figures subject to CMS review and onecarevt.org 15 approval, and ongoing negotiations

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Better Health and Wellness for Vermonters Investments to Advance the All-Payer Model Care Goals Payer and Attribution Growth in the All-Payer Model Hospital Payment Reform Primary Care and Community-Based Services Support Continuity of Medicare Blueprint and SASH Funds onecarevt.org 18