Fresenius Health Partners ESCO Overview Glenda Wooten Senior ESCO - - PowerPoint PPT Presentation
Fresenius Health Partners ESCO Overview Glenda Wooten Senior ESCO Program Manager May 23, 2019 For Internal Purposes Only. 2 Disclaimer The statements contained in this document are solely those of the authors and do not necessarily reflect
For Internal Purposes Only.
May 23, 2019
Glenda Wooten Senior ESCO Program Manager
For Internal Purposes Only.
The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.
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For Internal Purposes Only.
Opportunities
The Nephrologist is the principal care provider for the ESRD patient and are involved in most major care decisions The ESRD patients are in the dialysis clinic three times a week making it the logical medical home Fragmented Care negatively impacts the patient’s quality of life and increases the risk of hospitalizations This is a resource intensive cohort of patients, with annual costs 10 times that of an average Medicare patient
Challenges
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End Stage Renal Disease Seamless Care Organization or ESCO Partnerships between CMS, nephrologists and dialysis providers Accountable for all facets of their matched beneficiaries’ care Share savings with CMS if matched beneficiaries’ expenditures decrease and quality is maintained or improved Share losses if beneficiaries’ expenditures increase
Dialysis Units Nephrology Practices Others
Medicare FFS Beneficiaries
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Enrolled in Medicare Parts A and B Medicare is primary payer Not be enrolled in a Medicare Advantage plan, cost plan, or other non-Medicare Advantage Medicare managed care plan Not be affiliated with an existing shared savings program At least 18 years of age & reside in the US Not received a kidney transplant in the last 12 months Matching through “first touch” Receive at least 50% of annual dialysis services in the ESCO’s market area
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Note: A beneficiary will be removed from the ESCO’s list of aligned beneficiaries for the entire Performance Year if the patient received more than 50 percent of his or her dialysis services from one or more Dialysis Facilities outside of the Market of the ESCO during the Performance
*Beginning in 2018 (PY3) geographic exclusions may apply.
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October 2015 – December 2016
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For Internal Purposes Only.
ESCO/Location
Seamless Care of Atlanta Seamless Care of Houston Seamless Care of Central Alabama Seamless Care of Indianapolis Seamless Care of Central Illinois Seamless Care of Las Vegas Seamless Care of Central North Carolina Seamless Care of Louisiana Seamless Care of Central Texas Seamless Care of Maryland Seamless Care of Charlotte Seamless Care of Massachusetts Seamless Care of Chicago Seamless Care of Michigan Seamless Care of Columbia Seamless Care of Minneapolis Seamless Care of Dallas Seamless Care of New York Seamless Care of Delaware Seamless Care of Philadelphia Seamless Care of Erie Valley Seamless Care of Portland Seamless Care of Gulf Shore Seamless Care of San Diego
For Internal Purposes Only.
For Internal Purposes Only.
CNU Focus: to reduce unnecessary hospital admissions
CNU is a team of nurses, social workers and service operations specialists who provide 24/7 coordination of care support
Monitors patients real time allowing for “just in time” interventions to find solutions and remove
Increasing communication between key stakeholders in a fragmented system Empowered to take extraordinary measures to safely coordinate care at the lowest level of intensity 24/7 access to all patient data contained in the dialysis center EHR Caring for >48,000* patients in various programs across North America * As of October 2018
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1% 10% 16% 16% 12% 10% 8% 6% 5% 3% 3% 11% 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% Same 2 4 6 8 10
$7,541 $9,128 $10,133 $10,568 $0 $5,000 $10,000 $15,000
Same 1 2 3
Avg Cost/day
0-3 day stays are often treatment adherence related All admits are high cost DRG w/MCC
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plan
transports during temporary disruption of permanent transportation
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Predictive Analytics and Clinical Insights: FHP teams have developed technology and predictive models to identify a list of high risk members, enabling the front line CNU to reach out in advance of clinical issues either telephonically or face to face.
Multiple hospital admissions and /
days Local CNU, Provider or Clinic Insight and Requests Clinical Indicators EOL Predictive Model Weekly No Show Predictive Model Hospitalization Risk Predictive Model
High Visibility Member List
Incident Members
F2F Visits by CNU RN
Contact the CNU at mycarenav@fmc- na.com with member needs & F2F requests 15
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Safe and Effective Care Coordination Providing care
in outpatient setting
‘emergency’ services
hospital admissions
hospital re-admissions
For Internal Purposes Only.
For Internal Purposes Only.
10 Hybrid Measures
is that shared savings strategies work in tandem with 2 of these measures.
3 Standardized Ratio Measures
methodology
Clinic Quality
7 Survey Measures
6 QIP Results
Total of 26 measures
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9 Hybrid Measures Standardized Ratio Measure
Transplant Wait List 2 Surveys ICH CAHPS & KDQOL
Based on hospital claims or CMS Clinical Data Warehouse Combination of claims data and medical records
For Internal Purposes Only.
Combination of Medicare claims data and medical record data
Hospital claims or other CMS documentation ICH-CAHPS – dialysis survey conducted for Dialysis Clinic Quality
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For Internal Purposes Only.
For Internal Purposes Only.
For Internal Purposes Only.
Glenda Wooten, RN, MN, NEA-BC Senior ESCO Program Manager glenda.wooten@fmc-na.com Cell – (704) 412-0004
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