Force Welcome Overview of APG Purpose of Task Force Agenda - - PowerPoint PPT Presentation

Risk Evolution Task Force

Agenda

• Welcome
• Overview of APG
• Purpose of Task Force
• Leadership
• Process
• Next Steps
• Questions

Welcome Don Crane

Don Crane is the President and CEO of America's Physician

• Groups. During his tenure, America's Physician Groups has

expanded from being a division of a regional hospital trade association consisting of 40 member groups to a national professional association consisting of over 300 physician

• rganizations and independent practice associations. APG

now has members with practices in 44 states and has become a leading voice in advocacy on both state and federal

• levels. With headquarters in Los Angeles, America's Physician

Groups maintains advocacy offices in Sacramento, California, and Washington, DC.

Why is it needed?

CMS and Congress are beginning to recognize what APG members already know – the key to providing Americans with better healthcare at lower costs is to provide physician centric groups access to risk in the form of population-based payments that enable them to effectively manage resources across an entire community of patients.

Overview of APG

Over 300 members in 45 states, Washington, D.C., and Puerto Rico APG’s mission – to assist accountable physician groups to improve the quality and value of healthcare provided to patients APG represents and supports physician groups that assume responsibility for clinically integrated, comprehensive, and coordinated healthcare on behalf

• f our patients. Simply, we are taking

responsibility for America’s health

Taking Responsibly for America’s Health is more than just a tagline for APG. It is a mission and vision for a better healthcare system where patients and physicians are at the center.

We know that asking clinicians to take on this risk and shoulder the burden of America’s health is not easy. The Risk Evolution Task Force was formed to ensure APG members and the wider physician communities have access to the education, support, and resources necessary to both be successful in current risk models (MSSP and Next Gen) and prepare for the next iteration

• f risk models to come.

In order to achieve the goals of the task force, we will be focused on using benchmarking to identify areas of greatest opportunities. Processes will be developed and structured as a sprint, not as a marathon, 90 day goals identified to drive improvements.

Format

MONTHLY CALL PARTICIPANTS CONNECT COMMUNITY JANUARY IN-PERSON MEETING IN D.C. LISTENING SESSIONS WITH CONGRESSIONAL AND ADMINISTRATION LEADERSHIP

Leadership

• Melanie Matthews – Co-Chair
• Niyum Gandhi – Co- Chair
• Aneesh Chopra – SME
• Eric Coleman – SME
• Margaret Peterson – Advocacy & Outreach
• David Allen – Communications
• Valinda Rutledge – Facilitator

Melanie Matthews Niyum Gandhi

Melanie Matthews is CEO at Physicians of Southwest Washington and NW Momentum Health Partners

• ACO. Melanie has over 20 years of

experience as a leader and innovator in various aspects of health care, including financial management,

• perations, human resources, system

development and product marketing in health care services. Niyum Gandhi is the Executive Vice President and Chief Population Health Officer of the Mount Sinai Health System. Prior to his position at Mount Sinai, Mr. Gandhi served as a partner in the Health and Life Sciences consulting practice of Oliver Wyman in Chicago, where he focused on value-based health care strategy and transformation for physician groups, hospitals, and health plans.

Co- Chairs

Aneesh Chopra

• Dr. Eric Coleman

Aneesh Chopra is the President of CareJourney, an open data service that helps providers, payers and pharma market leaders make smarter decisions in the move to value. He previously served as the first U.S. Chief Technology Officer under President Obama (’09-’12). He is the author of "Innovative State: How New Technologies can Transform Government.” He joined the Board of the Health Care Cost Institute in 2017

• Dr. Eric A. Coleman is a leader in geriatric and

chronic disease care whose work focuses on a problem in health care that has been largely ignored: the many challenges that occur as patients transition from hospitals to post- acute care and to home. Coleman has quantified the scope of the problem and devised predictive metrics and evidence- based interventions for coordinated and seamless transfers of care. His Care Transitions Intervention , led by nurses and social workers trained as Care Transitions Coaches, equips patients and caregivers with critical skills and knowledge to enable self-care.

Subject Matter Experts

Valinda Rutledge Margaret Peterson

Prior to serving as Vice President of Federal Affairs for APG, Valinda Rutledge worked as a Senior Advisor and Group Director for the Patient Care Models Group within the Centers for Medicare & Medicaid Innovation (CMMI). Margaret Peterson is the Director of Federal Affairs at APG. Previously, Margaret served on the health policy team for Senator Joni Ernst (R-IA), focusing on ACA reform and MACRA implementation.

APG Team

David Allen

David Allen serves as the Director of Communications for America’s Physician Groups, leading the organization’s local and national communications and public relations efforts. Prior to APG, he served as Senior Manager (Health) of Media Relations at AARP and Associate Director of Media Relations at the American Hospital Association.

Co-Chair Remarks

• Experience in risk
• Commitment to advancing the value

movement though APG

• Pearls of wisdom –measuring perforce and

sharing best practices are keys to success

Process

• Using Aneesh Chopra and his team at CareJourney, the task force will

examine the information from CMS’ national dataset of Part A/B/C/D claims for over 65M+ Medicare and Medicare Advantage lives to identify potential key success factors that correlate to savings

• The task force members will select the 5 key success factors (KSF)
• Care Journey will identify the national benchmarks at both the Medicare

FFS and MA level for the identified 5 key success factors (KSF) selected by the group

• Each task force member will receive a report identifying where their ACO

is at in relation to the national benchmark of both Medicare FFS and MA for the 5 KSF.

Process, Continued

• Eric Coleman will assist task force members with identifying emerging best

practices of care transitions and delivery as it relates to the 5 KSF

• Members will share best practices surrounding care pathways in achieving

savings with the 5 KSF

• Members will collaborate to identify barriers to success in risk-based

Alternative Payment Models related to program development like benchmarking methodology or impact of overlapping models (bundled payments)

• The APG DC team will connect specific advocacy efforts to the barriers

identified

Property of CareJourney Confidential and Proprietary

CareJourney Embraces Participation in Industry Consortia

Property of CareJourney Confidential and Proprietary | 18

Under the Hood: Benchmarks derived from Medicare’s linked claims datasets

Benchmarking Tools Provide r X Compare providers against peers, the region, and nation Care Compliance and Opportunity Risk-Adjusted Cost Trends Patient Risk Segmentation Unnecessary Care Management Market Share and Referral Retainage Bundle/Episode Efficiency Designing and Pricing Networks Substitute providers and model network statistics, performance Provider Performance Reporting Provider Score to benchmark and analyze

• All CMS Medicare Part A and B claims data for the past

eight years, updated quarterly through Q2 2018, Part D data from 2011 - 2016, and Medicare Advantage Part C data for 2015

• Claim-line level detail on 65M+ Medicare and Medicare

Advantage lives

• Ability to develop linkages across patient care journeys for

longitudinal analytics insights on cohorts, built on open data and algorithms

• Timely: available data 3-6 months from claims date
• Ability to design benchmarks on research-derived

insights:

• Attributed, Assignable and Un-assignable lives
• Risk-adjusted average and total cost
• Specialist/Facility/PCP alignment
• Care Model care compliance and savings opportunity
• Part D drug opportunity and utilization
• Aggregate quality of care
• Avoidable and unnecessary spend

Property of CareJourney Confidential and Proprietary | 19

A Journal of the American Medical Association (JAMA) paper analyzed over 18 million TCM-eligible discharges over a three-year period to quantify the impact of compliant TCM services on post-discharge spend, mortality rate, and readmission rates.

“Drill-Down” on TCM Services: Scorecard derived from open science

$3,358 $3,033 $2,000 $2,500 $3,000 $3,500

Post-Discharge Spend, 31-60 Days After Eligible Discharge

No TCM

Adjusted Medicare Spend ($), Per Discharge

1.6% 1.0% 0.0% 0.5% 1.0% 1.5% 2.0%

Post-Discharge Mortality Rate, 31-60 Days After Eligible Discharge

No TCM

Adjusted Mortality Rate (%)

Summary: Furnishing TCM services has proven to significantly lower post-discharge spend, mortality rates, and re-admission rates. Using CareJourney’s suite of products, our members are able to track TCM compliance at different organizational levels, filter on high-need high-cost patient segments for targeted interventions, and benchmark their compliance against regional and national ACOs.

The Impact of Transitional Care Management (TCM) Services

Source: Bindman AB, Cox DF. Changes in Health Care Costs and Mortality Associated With Transitional Care Management Services After a Discharge Among Medicare Beneficiaries. JAMA Intern Med. 2018;178(9):1165–1171. doi:10.1001/jamainternmed.2018.2572

N = 18,756,707 P < .001 N = 18,756,707 P < .001

TCM Services Scorecard

TIN #1 TIN #2 TIN #3 TIN #4

9.7% decrease in spend 0.6% decrease in mortality

Property of CareJourney Confidential and Proprietary | 20

Sample Output: TCM Rates on risk-bearing MSSP ACOs

Task Force Communications

APG and Task Force members will communicate through three primary channels:

• APG Website
• APG Emails
• APG RETF LinkedIn Group

APG Website: We will create a RETF “subpage” on our website which will contain events, resources and other information. This subpage will be accessible by members only. APG Emails: We will use our customer relationship management (CRM) software to email contacts on the Task Force roster to alert them to events, and to share resources and other information. APG RETF LinkedIn Group: The recommended method of communicating online with Task Force members is via a dedicated LinkedIn group. This allows us to control group members, share documents and other resources, foster discussions, and keep all Task Force members up-to-date—all under a secure platform that a vast majority of people have already joined.

Advocacy

Once the 5 KSF have been identified and mapped, Margaret will work with members to identify advocacy priorities (e.g. increased data sharing and transparency from CMS) and create and proliferate advocacy and educational materials to Congressional and Administrative staff. In-person meetings to follow as necessary. Task force members to present at Congressional staff briefing on the role they play in delivery system reform and successes and challenges. Margaret and Valinda will represent task force interests at CMS, HHS, and CMMI meetings, and work to

• vercome barriers to increased participation in risk bearing population health models.

How to Join?

BE A MEMBER OR PLANNING ON BECOMING A MEMBER OF APG WITHIN 6 MONTHS EMAIL MARGARET PETERSON, MPETERSON@APG.ORG, TO INDICATE INTEREST

Questions?

Valinda Rutledge vrutledge@apg.org Margaret Peterson mpeterson@apg.org