Critical Access Hospitals Network April 20, 2017 ACOs & CAHs: - - PowerPoint PPT Presentation

Critical Access Hospitals Network

April 20, 2017

ACO’s & CAH’s: Can They Co-Exist?

S t eve Barnet t , DHA, CRNA April 20, 2017

Disclosures

• I am a National Rural Accountable Care

Consortium board member.

• I am a Caravan Health board member.

Where To S tart?

• We began in 2009 by implementing a Chronic Disease
• Registry. This act began our j ourney of understanding

the population we were seeing in the Primary Care Provider (PCP) offices.

• In 2010 we began elevating our awareness of the

incentives built into the PGIP program with BCBS M and looked at other payer incentive programs.

• In 2012 we qualified one of our PCP offices for

certification as a PCMH followed by the others in 2013.

• In 2012 we began evaluating ACO partner opportunities.

PGIP & PCMH

• The Physician Group Incentive Program (PGIP) is a BCBS

M term that rewards providers that meet clearly defined metrics.

• The Patient Centered Medical Home (PCMH) model is

housed under the PGIP program and also rewards providers that meet defined PCMH metrics.

• We found that these activities, or any other payer like

programs, were good steps to take before participating in an ACO.

Accountable Care Organization

• Built into the Affordable Care Act (ACA) as a method for

delivering care to an attributed population.

• The intent is to help providers deliver care to the right

people, at the right time, for the right reason.

• To the extent that providers organized under an ACO can

better coordinate care, reduce unnecessary care and prevent medical errors, quality will improve and cost will most likely go down.

ACO Choices

• Pioneer ACOs were targeting organizations with

experience in coordinating care across care settings.

• The Medicare S

hared S avings Program (MS S P) was created to coordinate care and encourage cooperation among providers for the Medicare Fee For S ervice beneficiaries.

• The Advance Payment ACO Model is a MS

S P that provides advance funding to smaller organizations with limited financial resources, thus allowing them to participate in an ACO.

More ACO Choices

• The ACO Investment Model (AIM-ACO) builds upon

lessons learned with the Advance Payment Model.

• The Next Generation ACO Model allows providers to

accept higher levels of financial risk and reward, than experienced in previous MS S Ps.

• The Comprehensive Primary Care Plus model was

introduced by CMS in 2016. CPC+ is considered an advanced Primary Care Medical Home (PCMH) model that pays for value and quality through an innovative payment structure.

What Did We Learn?

• Y
• u must gain support for changing how you deliver care

at every level: Governance, Medical S taff, Administration, S taff, Patient.

• We decided that the best way forward was to focus on

improving the health of our local population.

• We needed to transition how we deliver care away from

sickness and volume to wellness and value.

• We needed to look for programs that would compensate

for those changes in care delivery.

Choose Y

• ur Partners Wisely
• We have considered a third party administrator (TP

A) and an insurance company, neither worked out well.

• Y
• ur partner relationships will most likely be other
• rganizations that deliver care and therefore bring lives

to the table.

• Because you will need resources to operationalize the

program, your partners need to appreciate that investment in change.

• Ultimately everyone needs to understand that if you

don’ t perform, you may be asked to leave the island.

Demands on Management Team

• Application phase was taken care of by our service

partner.

• While waiting for formal approval from CMS

, we began identifying members and roles.

• Team members represent marketing, personnel, IT

, care coordination and change management.

• The above described areas are broad and will be

expanded upon as you begin the program.

• S
• meone needs to own the program; we call that person
• ur ACO Champion.

Obstacles/ Hurdles Once Operating

• Moving data! Y
• u will need to move information from

your electronic health record to the claims data warehouse.

• Embedding a chronic care coordinator into the system

can be viewed as competitive by some of your PCPs.

• S
• me organizations struggle with their board and

medical staff adopting this change in care delivery.

• I keep reminding people that we are in a schizophrenic

payment period; we get paid for volume but we are trying to help people become well?

Important Competencies Developed

• Learning to understand claims data and impact on care delivery.
• Creating processes that identify patients who are accessing care

inappropriately and begin proactively working with them.

• Not letting annual wellness visits go by without getting the

patient in; will lose attribution if you don’ t.

• Becoming very good at coding for a more appropriate risk score of

the population.

• Becoming assertive with outside agencies delivering care; visiting

nurses, PT , DME, etc.

Risks/ Issues Unanticipated?

• We under estimated how difficult it was going to

be to move EHR data to the data warehouse.

• Our estimate of attributed lives was far less than

we were attributed (35 – 40% ).

• We expected beneficiaries to be more opposed to

the program, they were actually quite receptive.

• Revenue and volume has not gone down as we

have worked to reduce volume?

ACO Board S tructure

• We organized such that the board member is the

participating organization: sometimes referred to as “ participant” or “ community.”

• Typically the member CEO represents the member on

the board, primarily because decisions need to be made and the CEO is already authorized to act on behalf of the member.

• Physicians generally represent participants through

committee assignments related to evidence based medicine adoption and focus on the most expensive chronic disorders.

Proximity, Is It Important?

• Not really, in the National Rural ACO I had four partners in

Northern California, two in Indiana and then two of us in Michigan.

• It is important for the participants to have face to face meetings
• ccasionally, otherwise much of the business you engage in can be

done remotely.

• CMS

is more interested now in having ACOs that are state based because they would like to see multi-payer participation.

• In Michigan we have two rural ACOs, one is pretty close while the
• ther one is very broad as measured by distance.

Infrastructure & S upport Partner

• As I described earlier, those entities that wanted to

partner but had no lives were bringing infrastructure; unfortunately it was limited and expensive.

• There are a number of services you may benefit from as

you build your ACO, look for an entity that can provide all of those services.

• Marketing, Personnel, IT

, Care Coordination and maybe some assistance with change management are services you may need.

Benefits To The Organization

• I think we have positively changed our culture, more of

a team spirit than before.

• The impression among community members is changing

because they are seeing/ hearing from us when they are well, not j ust when they are sick.

• Realizing the value of data, in particular claims data,

and the impact it can have on how you improve care.

• PQRS

reporting was done under the ACO and under MACRA – MIPS is also covered; exception is Advancing Care Information that replaced MU.

Are We Happy With The Proj ect?

• Y
• es. I’ ve found that most who engage in an ACO will not

revert back to what they were doing, and this happens within the first 6 – 9 months.

• Providers seem much happier working to improve health

rather than j ust managing sickness.

• Patients are attracted to this pro-active approach to

healthcare and seem to want more.

• Most payers are interested in the changes we have made

and surprised we could make those changes in a short period of time.

S

• Are ACOs & CAHs Compatible?
• More so than most larger organizations.
• Our size is our asset, nimble and flexible.
• Population Health Management is all about Primary

Care, Primary Care is our specialty!

• I’ m certain many of you are already participating in

some payer incentive program that compensates for improving health, this will take that work to the next level.

• We have seen our volume go up, we believe it is because
• f the shift to wellness/ value; people like feeling

better.

Questions?

MHA FLEX GRANT FINANCIAL REPORT REVIEW & ANALYSIS

• Detailed hospital-specific financial and
• perational assessment to identify areas of

market, patient satisfaction, cost reduction, charge capture, revenue and service line

• pportunities.

PURPOSE

• Market service area analysis
• Inpatient and outpatient volume trend analysis
• Market services are projected population trends
• Patient satisfaction survey comparisons
• Key financial health indicator trend analysis
• Total revenue mark-up analysis
• Cost per driver analysis for selected cost centers
• Swing bed service line review
• RHC benchmarking and service line review

REPORT SUMMARY

• Most recently available public data
• Healthcare Cost Report Information System

(HCRIS)

• Hospital Compare
• U.S. Census Bureau
• Medicare inpatient and outpatient claims

DATA SOURCES

• BKD Survey
• Emergency Room
• Visits
• Regular hours
• Overtime hours
• Medical Surgical (Adults and Pediatrics &

Swingbed)

• Regular hours
• Overtime hours

DATA SOURCES

• BKD Survey
• Laboratory
• Number of tests
• Regular hours
• Overtime hours
• Radiology (including CT & MRI)
• Regular hours
• Overtime hours

DATA SOURCES

• BKD Survey
• Administrative & General
• Regular hours
• Overtime hours
• Contract Labor

DATA SOURCES

QUESTI ONS?

1201 Walnut Street, Suite 1700 Kansas City, MO 64106 Steve Parde Managing Director 816.701.0270 sparde@bkd.com Office: 816.221.6300 Fax: 816.221.6380 www.bkd.com

31

T HANK YOU GOE S A L ONG WAY.

Ho no r yo ur ho spita l he ro .  E

a c h mo nth, MHA se le c ts a “Ho spita l He ro o f the Mo nth” fro m the no mina tio ns re c e ive d o n www.mo ho spita ls.c o m.

 T

he se le c te d ho spita l he ro , a s we ll a s the individua l who no mina te d the m, e a c h will re c e ive a $100 Visa g ift c a rd.

 All o f the winne rs will b e fe a ture d in the Misso uri Ho spita l He ro Ha ll

• f F

a me a nd a ll no mine e s a re re c o g nize d with a c e rtific a te a nd a pin a nd ma y b e re c o g nize d b y the ir ho spita l o r o n so c ia l me dia .

 MHA is a lso re le a sing a se rie s o f vide o s to ho no r so me o f the

he ro e s.

32

33

Roundtable

34