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Jan 23, 2023 380 likes •549 views

Ac c e le r ating He alth Syste m T r ansfor mation Wha t ro le fo r ACOs? Ho w mig ht we do b e tte r? Ove r vie w Conc e ptua l fra me work: wha t a re we trying to a c hie ve ? Whe re a re we now? Na tio na l po lic y c o nte

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SLIDE 1

Ac c e le r ating He alth Syste m T r ansfor mation

Wha t ro le fo r ACOs? Ho w mig ht we do b e tte r?

Ove r vie w Conc e ptua l fra me work: wha t a re we trying to a c hie ve ? Whe re a re we now?

  • Na tio na l po lic y c o nte xt
  • Wha t do we kno w a b o ut ACO c a pa b ilitie s?
  • Wha t do ACOs think is impo rta nt?

Wha t role for c e rtific a tion? Wha t e lse mig ht we do? Moving forwa rd

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SLIDE 2

Conc e ptual F r ame wor k

Wha t a re we trying to a c hie ve ?

Purpose : improve c a re , improve he a lth, lowe r c osts

  • F
  • r pa tie nts se rve d b y he a lth syste ms
  • F
  • r a ll re side nts o f c o mmunitie s the y se rve

Sourc e s of le ve ra g e

  • F

ina nc ia l inc e ntive s

  • Re g ula tio n
  • Pe rfo rma nc e me a sure me nt / pub lic re po rting
  • L

e a rning / fe e db a c k / te c hnic a l suppo rt

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SLIDE 3

Whe r e ar e we now?

Na tio na l Po lic y Co nte xt

ACO pa yme nt mode l c ontinue s to e xpa nd

  • 749 ACOs (F

e b rua ry)

  • Physic ia n Gro up: 295

Go ve rnme nt 404

  • Ho spita l le d:

314 Co mme rc ia l 220

  • I

nsure r 54 Bo th: 104

Number of Enrollees (Millions) Sources: Kaiser Family Foundation; Leavitt Partners

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SLIDE 4

Whe r e ar e we now?

Na tio na l Po lic y Co nte xt

E a rly e vide nc e : g la ss ha lf full

  • Qua lity
  • ACO syste ms pe rfo rming b e tte r tha n F

F S (se le c tio n)

  • ACOs impro ving o n a lmo st a ll me a sure s (se le c tio n le ss like ly)
  • Co st: mo de st sa ving s (MSSP, Pio ne e r, AQC)
  • Co ntrib uting to slo wing o f Me dic a re spe nding g ro wth?
  • Me dic a id ACOs a ppe a r pro mising

E a rly e vide nc e : g la ss ha lf e mpty

  • Me dic a re : ha lf a c hie ve d sa ving s; o ne q ua rte r g o t b o nus
  • Ma jo r c o nc e rns a b o ut MSSP a nd Pio ne e r
  • F

ina nc ia l mo de l to o unpre dic ta b le ; to o little e a rly re turn

  • Diffic ult fo r ACOs to e ng a g e pa tie nts (Me dPAC: 1/ 69)
  • Ma ny still o n side line s; ma ny pla ying vo lume / pric e g a me
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SLIDE 5

Whe r e ar e we now?

Na tio na l Po lic y Co nte xt

F e de ra l c ommitme nt to moving forwa rd a ppe a rs strong

  • Se c re ta ry Burwe ll’ s a nno unc e me nt
  • ACOs: 30% b y 2016; 50% b y 2018:
  • CMS mo ving fo rwa rd
  • Re visio n o f MSSP rule unde rwa y
  • Additio na l CMMI

pro g ra ms like ly (“Va ng ua rd”? )

Priva te se c tor? He a lth Ca re T ra nsforma tion T a skforc e

  • Purc ha se rs, Pa ye rs, Pro vide rs a nd Pa tie nts -- to g e the r
  • Co mmitme nt to 75% T

riple -a im b a se d c o ntra c ts b y 2020

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SLIDE 6

Whe r e ar e we now?

ACO Ca pa b ilitie s

46% 47% 25% 62% 36% 27% 0% 10% 20% 30% 40% 50% 60% 70% F ully de ve lo pe d p ro g ra m to a sse ss a nd re d uc e ho sp ita l re a dmissio ns Ro utine ly a sse sse s ina ppro pria te use o f the E D a nd use s this da ta to re d uc e use Syste ms in pa lc e to a ssure smo o th tra nsitio ns a c ro ss c a re se tting s Ac tive ly e ng a g e s in p ro g ra ms to re d uc e ho spita l a d missio ns fo r a mb ula to ry c a re se nsitive c o nd itio ns Co mpre he nsive c hro nic c a re ma na g e me nt in pla c e Co mpre he nsive pre -visit pla nning , me dic a tio n ma na g e me nt, & pre ve nta tive c a re re mind e rs

Proportion of ACOs

ACO Char ac te r istic s

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SLIDE 7

Whe r e ar e we now?

ACO Ca pa b ilitie s

8% 77% 50% 59% 40% 23% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% No ne I ndividua l Qua lity Me a sure s I ndividua l Co st Me a sure s One -o n-o ne re vie w a nd fe e d b a c k I ndividua l fina nc ia l inc e ntive s I ndividua l no n- fina nc ia l re wa rds o r re c o g nitio n

Pe rc e nt Pa rtic ipa tion

Use of Physic ian Pe r for manc e Manage me nt Str ate gie s

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SLIDE 8

Whe r e ar e we now?

Wha t do we kno w a b o ut wha t ACOs think is impo rta nt?

ACO Re a dine ss T

  • ol – Orig ins
  • De ve lo pe d with he a lth syste m e xe c utive s
  • He lp the m a nswe r q ue stio n: “Wha t sho uld I

do ? ”

  • Co nte nt: NSACO, AMGA, e xe c utive s unde r APMs
  • Prio ritie s: “Ho w impo rta nt is this to suc c e ss? ”
  • Co mpe te nc y: “Ho w a re yo u do ing o n this? ”
  • Ga ps a re info rma tive :
  • Be twe e n prio ritie s a nd se lf-a sse sse d c o mpe te nc y
  • Be twe e n e xe c utive s a nd fro nt-line pro vide rs

Da ta now inc lude s

  • 14 syste ms
  • T

wo Pio ne e rs

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SLIDE 9

Whe r e ar e we now?

Wha t do we kno w a b o ut c urre nt pe rc e ptio ns o f prio rity fo r va lue -o rie nte d Do ma ins?

Pione e r A

106 T

  • tal Re sponde nts

Pione e r B

56 T

  • tal Re sponde nts
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SLIDE 10

Whe r e ar e we now?

Wha t do we kno w a b o ut c urre nt pe rc e ptio ns o f pro fic ie nc y fo r va lue -o rie nte d Co mpe te nc ie s?

Bubble size indicates level of agreement across respondents – a bigger bubble indicates a wide variation in responses

Ave ra g e profic ie nc y sc ore s (1- 9) for two Me dic a re Pione e r ACOs.

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SLIDE 11

Whe r e ar e we now?

Wha t do we kno w a b o ut c urre nt pe rc e ptio ns o f prio rity fo r va lue -o rie nte d Do ma ins?

Bubble size indicates level of agreement across respondents – a bigger bubble indicates a wide variation in responses

Ave ra g e priority sc ore s (1- 5) for two Me dic a re Pione e r ACOs.

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SLIDE 12

Ac c e le r ating He alth Syste m T r ansfor mation

Ce rtific a tio n: Ge ne ra l tho ug hts

Cha lle ng e s:

  • Curre nt e vide nc e o n link b e twe e n c a pa b ilitie s a nd

pe rfo rma nc e is thin

  • E

xc e ptio ns:

  • L

e a de rship: e sse ntia l (b ut ha rd to re g ula te )

  • I

nsura nc e o ve rsig ht if risk b e a ring

  • Pe rfo rma nc e re po rting (so we kno w ho w the y a re do ing )
  • Co nte xt matte rs – o rg a niza tio na l a nd ma rke t le ve l
  • Re ma rka b le dive rsity in c urre nt mo de ls

Ove r- spe c ific a tion like ly ha rmful

  • Re duc e s like liho o d o f inno va tive mo de ls e me rg ing
  • Pre c lude s le a rning fro m va ria tio n
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SLIDE 13

Ac c e le r ating He alth Syste m T r ansfor mation

Ce rtific a tio n: Minimum sta nda rds, ACO L e ve l 1

Wha t I would hope for:

  • Alig n with MSSP to e xte nt po ssib le
  • E

nc o ura g e syste ms to mo ve to a ll-pa ye r ACO c o ntra c ts

  • Minimize b urde n o f sta rting do wn APM pa thwa y
  • Allo w fle xib ility, inno va tio n, le a rning

L e g isla tive la ng ua g e se e ms c le a r

  • ACO must re po rt ho w the y a re me e ting re q uire me nts
  • Avo id spe c ifying e xa c tly ho w (wo uld a llo w fle xib ility)

Conside r:

  • Sta nda rdize d re po rting o n struc ture , c o ntra c ts, c a pa b ilitie s
  • (Ag a in – to suppo rt le a rning )
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SLIDE 14

Ac c e le r ating He alth Syste m T r ansfor mation

Ce rtific a tio n: Pro g re ssio n to hig he r le ve ls

Wha t is the purpose of L e ve ls 2 a nd 3?

  • Hig he r le ve ls o f risk b e a ring ? I

nsura nc e re g ula tio n wise

  • Hig he r re wa rds? (re a so na b le ide a )
  • Mo tiva tio n? (g o ld sta r? Suppo rt ma rke ting ? )

A fe w thoug hts:

  • L

ink le ve ls to :

  • Pro po rtio n o f prima ry c a re pa tie nts unde r ACO mo de l
  • De g re e o f risk b e a ring
  • Ab ility to re po rt o n a dva nc e d me a sure s (PROMs, he a lth risk)
  • Pric e re duc tio ns fo r re ma ining F

F S c o ntra c ts

  • Wha t mig ht a lte rna tive b e ?
  • T

ranspare nc y o n pe rfo rmanc e

  • Graduate d share d saving s
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SLIDE 15

Ac c e le r ating He alth Syste m T r ansfor mation

Spe c ific issue s

Cross- c ontinuum ne twork

  • Go a l: c o o rdina tio n, e ffe c tive tra nsitio ns, info rma tio n flo w
  • Co nc e rn: wha t if b e st c a re is o utside ACO?

Clinic a l inte g ra tion, pra c tic e g uide line s, E BM, pe rforma nc e improve me nt, popula tion he a lth ma na g e me nt

  • I

nfo rma tio n syste ms; risk stra tific a tio n, g a p a na lysis; te a ms

  • Pro c e ss impro ve me nt (te a m); pro vide r fe e db a c k (individua l)

Alig ne d inc e ntive s within ACO

  • Pro po rtio n o f pa tie nts unde r APMs impo rta nt
  • L

ike ly va rie s b y site / pro vide r (PCPs vs Ho spita l vs po st-a c ute )

  • Ho w to e nc o ura g e re fe rra l o utside whe n b e tte r/ c he a pe r c a re
  • Mig ht tra nspa re nc y he lp? (unit pric e )
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SLIDE 16

What e lse might we do?

L e ve ra g ing c e rtific a tio n pro c e ss to a c c e le ra te le a rning

Sourc e s of le ve ra g e

  • Re g ula tio n; fina nc ia l c e rtific a tio n
  • Pa yme nt mo de l c o nc o rda nc e (push o the r pa ye rs)
  • Pe rfo rma nc e me a sure me nt / pub lic re po rting
  • L

e a rning / fe e db a c k / te c hnic a l suppo rt

How c e rtific a tion c ould he lp:

  • De sig n the c e rtific a tio n pro c e ss to a c c e le ra te le a rning
  • Sta nda rdize d da ta c o lle c tio n; link to pe rfo rma nc e tra c king
  • Use a sse ssme nts to ide ntify pe e r-c o a c hing o ppo rtunitie s

And:

  • T

e c hnic a l suppo rt (NAACOs); Ac c e ss to e vide nc e

  • Da ta suppo rt;