Development Learning Session Case Study 3: Building an ACO on the - - PowerPoint PPT Presentation

ACO Accelerated Development Learning Session

San Francisco, CA September 15-16, 2011

• DISCLAIMER. The views expressed in this presentation are the views of the speaker and do not necessarily reflect the views or policies of the Centers for

Medicare & Medicaid Services. The materials provided are intended for educational use, and the information contained within has no bearing on participation in any CMS program.

Francis J. Crosson, MD Director, Public Policy The Permanente Medical Group Kaiser Permanente

Case Study 3: Building an ACO on the Foundation of an Integrated Delivery System

Date: September 15, 2011 Time: 10:00–10:20 a.m.

• DISCLAIMER. The views expressed in this presentation are the views of the speaker and do

not necessarily reflect the views or policies of the Centers for Medicare & Medicaid

• Services. The materials provided are intended for educational use, and the information

contained within has no bearing on participation in any CMS program.

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America’s Largest Nonprofit Health Care Organization

• Fully integrated health care

delivery system

• 8.6 million members
• 15,000+ physicians
• 166,000 employees
• 8 regions serving 9 states and DC
• 35 hospitals and medical centers
• 441 medical offices
• 450,000 surgeries
• 85,000 deliveries
• $45 billion annual revenue

(2011)

• DISCLAIMER. The views expressed in this presentation are the views of the speaker and do

not necessarily reflect the views or policies of the Centers for Medicare & Medicaid

• Services. The materials provided are intended for educational use, and the information

contained within has no bearing on participation in any CMS program.

Kaiser Foundation Health Plan Kaiser Foundation Hospitals Permanente Medical Groups

Health Plan Members

Medical Service Agreement Hospital Service Agreement Group / Individual Contracts

Operating Budgets Capitation to the Group

REVENUE EXPENSE

• Kaiser Permanente

POPULATION

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• DISCLAIMER. The views expressed in this presentation are the views of the speaker and do

not necessarily reflect the views or policies of the Centers for Medicare & Medicaid

• Services. The materials provided are intended for educational use, and the information

contained within has no bearing on participation in any CMS program.

Kaiser Permanente Experience— Six Prerequisites for Success

• A common vision and sense of purpose
• Integration
• Trusted governance
• Physician leadership
• An effective management structure
• Aligned financial incentives

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• DISCLAIMER. The views expressed in this presentation are the views of the speaker and do

not necessarily reflect the views or policies of the Centers for Medicare & Medicaid

• Services. The materials provided are intended for educational use, and the information

contained within has no bearing on participation in any CMS program.

A Common Vision and Sense of Purpose

• Should be more than financial
• Should connect to quality of care and other professional values

(the Physician Charter)

• Should contain a sense of common destiny and common

responsibility for performance

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• DISCLAIMER. The views expressed in this presentation are the views of the speaker and do

not necessarily reflect the views or policies of the Centers for Medicare & Medicaid

• Services. The materials provided are intended for educational use, and the information

contained within has no bearing on participation in any CMS program.

Delivery of Care in the United States

• Single MDs
• Small groups
• Single hospitals

– Kaiser Permanente – Group health

cooperative

 Fully integrated

systems

 Hospital/staff  Some faculty

practices

 IPAs  Single specialty

groups

 Hospital chains

LESS INTEGRATED SYSTEMS

– Henry Ford – Mayo – Geisinger – Ochsner

 Integrated delivery

systems MORE INTEGRATED SYSTEMS

 Multi-specialty group

practices with hospital affiliations

– Marshfield Clinic – Harvard Vanguard – Vanderbilt University – California groups

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• DISCLAIMER. The views expressed in this presentation are the views of the speaker and do

not necessarily reflect the views or policies of the Centers for Medicare & Medicaid

• Services. The materials provided are intended for educational use, and the information

contained within has no bearing on participation in any CMS program.

Levels of Integration

Multi-specialty group practice (MSGP)

Increasing integration

MSGP and hospital Delivery system integration MSGP, hospital, and insurance Fully integrated system

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• DISCLAIMER. The views expressed in this presentation are the views of the speaker and do

not necessarily reflect the views or policies of the Centers for Medicare & Medicaid

• Services. The materials provided are intended for educational use, and the information

contained within has no bearing on participation in any CMS program.

Types of Integration

• Clinical—shared responsibility for quality
• Financial—shared responsibility for costs
• Functional—shared capabilities
• Structural—shared governance and management

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• DISCLAIMER. The views expressed in this presentation are the views of the speaker and do

not necessarily reflect the views or policies of the Centers for Medicare & Medicaid

• Services. The materials provided are intended for educational use, and the information

contained within has no bearing on participation in any CMS program.

Trusted Governance

• Principled
• Participatory
• Perceived as equitable
• Persistently focused on strategy

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• DISCLAIMER. The views expressed in this presentation are the views of the speaker and do

not necessarily reflect the views or policies of the Centers for Medicare & Medicaid

• Services. The materials provided are intended for educational use, and the information

contained within has no bearing on participation in any CMS program.

Physician Leadership

• Multi-level
• Multi-knowledgeable
• Selected, developed, and trained
• Supported by “followership”

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• DISCLAIMER. The views expressed in this presentation are the views of the speaker and do

not necessarily reflect the views or policies of the Centers for Medicare & Medicaid

• Services. The materials provided are intended for educational use, and the information

contained within has no bearing on participation in any CMS program.

An Effective Management Structure

• Multi-level
• Matrixed (administrative and clinical)
• Supported by accurate and timely data
• Persistently focused on performance

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• DISCLAIMER. The views expressed in this presentation are the views of the speaker and do

not necessarily reflect the views or policies of the Centers for Medicare & Medicaid

• Services. The materials provided are intended for educational use, and the information

contained within has no bearing on participation in any CMS program.

Aligned Incentives

• Mission
• Quality
• Reputation
• Sustainability
• Career and professional enhancement
• Financial

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• DISCLAIMER. The views expressed in this presentation are the views of the speaker and do

not necessarily reflect the views or policies of the Centers for Medicare & Medicaid

• Services. The materials provided are intended for educational use, and the information

contained within has no bearing on participation in any CMS program.

ACA Shared Savings Model California “Delegated Model”

Full Risk Capitation Corridor Capitation FFS +/- “Bonus” FFS + “Bonus” FFS Only

Bundled Payment Medicare Group Practice Demo PCMH

Primary Care Specialty Care Admin. RK (B) Referral Costs Non Referral Costs Hospital Costs Prescr. Rx (D)

“Breadth” of Risk “Depth” of Risk

Permanente Medical Groups

A Schematic of ACO Risk Assumption

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• DISCLAIMER. The views expressed in this presentation are the views of the speaker and do

not necessarily reflect the views or policies of the Centers for Medicare & Medicaid

• Services. The materials provided are intended for educational use, and the information

contained within has no bearing on participation in any CMS program.

Tools and Resources

• Crosson, FJ, The Accountable Care Organization: Whatever Its

Growing Pains, the Concept is Too Important to Fail, Health Affairs 30:7 (2011) 1250–1255

• Partners in Health: How Physicians and Hospitals Can Be

Accountable Together (Crosson, F and Tollen, L, editors.) Jossey Bass (Wiley), San Francisco, 2010

• Kirch, DG, and Vernon, DJ, The Ethical Foundation of American

Medicine: In Search of Social Justice, JAMA (2009) 301(14): 1482–1484

• Medical Professionalism in the New Millennium: A Physician

Charter (2005), ABIMF, ACPF and EFIM

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• DISCLAIMER. The views expressed in this presentation are the views of the speaker and do not necessarily reflect the views or policies of the

Centers for Medicare & Medicaid Services. The materials provided are intended for educational use, and the information contained within has no bearing on participation in any CMS program.

Francis J. Crosson, MD Director, Public Policy The Permanente Medical Group Kaiser Permanente

Jay.Crosson@kp.org

Case Study 3: Building an ACO on the Foundation of an Integrated Delivery System