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Transcript of ©2013 CliftonLarsonAllen LLP cliftonlarsonallen.com Innovation and Risk: Transitioning Through...
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Innovation and Risk:Transitioning Through Payment
Reform Activities
Indiana Rural Health Association17th Annual Rural Health Conference
June 10 – 11, 2014
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Discussion Overview
• Payment Reform: A Market in Transition
• Innovation Payment Models
• Regulatory Environment & Other Market Influences
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Payment Reform: A Market in Transition
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True Reform Will Require Disruptive Innovation*
Simplifying Technology
Low Cost Business Models
Value Network
* Source: “The Innovator’s Prescription” by Clayton M. Christensen
Regulations & Standards
That Facilitate Change
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Supreme Court Examines Constitutionality
Individual
Mandate -
ConstitutionalEntire
Affordable Care
Act- StandsMedicai
d Expansio
n-State Option
U.S. Supreme Court Ruling: June 28, 2012
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The Foundation: Value-Based Payment Value Based Payment: “a reform initiative whereby health care providers will receive payment for service based on their performance or the potential outcomes of the service”
Tying payment to performance is perhaps the most significant aspect of health care reform.The de facto definition of “value” in health care reform is the intersection of lower cost and improved quality.
Providers who can lower costs and deliver quality will be measured as “value-based providers”
Value
Lower Cost
Improved Quality
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Innovation Payment Models
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Where Payment Reform is Happening*
* Source: Americas Health Insurance Plans (AHIP) accessed via web on 9/3/13 at: http://www.ahip.org/searchResults.aspx?searchtext=payment reform activity
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Payment Reform Models Focus:Behavior-Intensive Diseases w/Deferred Consequences
Myopia
Hypothyroidism
Psoriasis
Allergies
Multiple Sclerosis
EpilepsyHIV
Depression
Infertility
Chronic Back Pain
GERD Crohn’s Disease
Celiac Disease
Ulcerative Colitis
Sickle Cell Anemia
Type I Diabetes
AsthmaCongestive HeartFailure
Type II DiabetesSchizophrenia
Alzheimer’s
Obesity
Addictions
Bipolar Disorder
Cerebrovascular Disease
Coronary Artery Disease
Parkinson
Cystic Fibrosis
Chronic Hepatitis B
Osteoporosis
HypertensionHyperlipidemia
Moti
vatio
n to
Com
ply
With
Be
st K
now
n Th
erap
y
Strong:ImmediateConsequences
Weak:DeferredConsequences
Degree to Which Behavior Change is Required
Diseases with deferred consequences
Beha
vior
dep
ende
nt d
isea
ses
Diseases with Immediate ConsequencesTe
chno
logy
Dep
ende
nt D
isea
ses
Source: “The Innovator’s Prescription” by Clayton M. Christensen
ExtensiveMinimal
Crushing costs of caring for chronically ill are in this quadrant: diabetes,
asthma, tobacco, obesity, CHF, affect tens of millions of people each.
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Beneficiaries Spending0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
14%
46%23%
28%
32%
19%32%
7%
Chronic Conditions Drive Medicare Spending
High Blood Pressu
re
High Cholestero
l
Ischemic
Heart Dise
ase
Arthriti
s
Diabetes
Heart Fa
ilure
Chronic
Kidney Dise
ase
Depressi
onCOPD
0%
10%
20%
30%
40%
50%
60%58%
45%
31% 29% 28%
16% 15% 14% 12%
Percent of Medicare Beneficiaries with Se-lect Chronic Conditions
Chronic Disease Burden on Medicare Spending*
6 or more conditions
4 to 5 conditions
2 or 3 conditions
2 or 3 conditionsZero or 1 condition
* Source: MedPAC March 2014 Report to Congress
Zero or 1 condition
4 to 5 conditions
6 or more conditions
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CMS Defined Innovation Models *• Accountable Care
– Medicare Shared Savings Program
– Medicare Advanced Payment ACO
– Pioneer ACO– Comprehensive ESRD Care
Initiative (LI/App.)
• Bundled Payment for Care Improvement– Models 1 through 4
* Arising as a result of Affordable Care Act (ACA), and excluding programs in effect prior to ACA.
• Primary Care Transformation– Comprehensive Primary Care
Initiative– FQHC Advance Primary Care
Practice Demonstration– Graduate Nurse Education
Demonstration– Independence at Home
Demonstration– Multi-Payer Advanced Primary
Care Practice
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CMS Defined Innovation Models *• Medicaid & CHIP Initiatives
– Emergency Psychiatric Demonstration
– Incentives for Prevention of Chronic Diseases Model
– Strong Start for Mothers & Newborns Initiative
◊ Reduce Early Elective Deliveries◊ Enhanced Prenatal Care Models
• Medicare-Medicaid Enrollees Initiatives– Financial Alignment Incentives– Reduce Avoidable
Hospitalizations Among Nursing Facility Residents
* Arising as a result of Affordable Care Act (ACA), and excluding programs in effect prior to ACA.
• Initiatives to Accelerate Testing & Development of New Models – Health Innovation Awards– State Innovation Models
• Initiatives to Speed Adoption of New Models– Community Based Care
Transitions Programs– Innovation Advisors Program– Million Hearts– Partnerships for Patients
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ACOs Continue to Grow
• On December 23rd CMS announced that 123 new organizations will join the Medicare ACO program effective January 1, 2014
• ACO enrollment has evolved and continued to grow since it was launched in April 2012:– April 2012 initial: 27 organizations– July 2012: 89 additional organizations– January 2013: 106 additional organizations– December 2011: 32 Pioneer ACOs, w/~ 23 remaining
• Total ACO participation – Over 360 organizations– More than 5.3 million beneficiaries– More than 50% of ACOs led by physician groups, with < 10,000
beneficiaries
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ACO Results to Date *• Pioneer ACO First Year Results:
– Cost Reduction/Shared Savings:◊ Cost growth rate for 669,000 beneficiaries .3% vs. .8%◊ 13 participants generated gross savings of $87.6 million◊ 2 participants generated losses of approximately $4 million
– Quality Metrics◊ 100% successfully reported quality measures◊ Overall performed better for all 15 clinical quality measures
• 25 of 32 generated lower risk-adjusted readmissions rates• Median rate for blood pressure control for beneficiaries with diabetes was
69% vs. 55% • Median rate for LDL cholesterol control for patients with diabetes was
57% vs. 48%
• CMS expects MSSP results later in year
* Source: CMS “Pioneer Accountable Care Organizations succeed in improving care, lowering costs” July 16, 2013
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Medicare Bundled Payments for Care:Medicare’s Largest Payment Innovation Program
More than 450 Providers Participating in BPCI1
BPCI1 Participation by State
Source: The Advisory Board
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BCPI Participants Favoring Longer Episodes
Participation by Model Type
Hospital Inpatient Services
Hospital and Physician
Inpatient and Post-Discharge
Services
Post-Discharge Services
Hospital and Physician Inpatient Services
Model 4Model 3Model 2Model 1
16%
36%
41%
7%
Source: Centers for Medicare and Medicaid Services; Health Care Advisory Board interviews and analysis.
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CMS Bundled Payments Initiatives: What is Being Bundled?
Source: The Advisory Board: “What are BPCI participants bundling?” by Rob Lazerow dated February 1, 2013
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Bundled Payments:Understanding Bundle Characteristics
Bundle Risk: Approximately 51% of total bundle costs occurred post-discharge!
Total Indexed Admissions 1,000
Total Admissions 1,327
Indexed Total Indexed Total Service Avg Cost Cost Avg Cost Cost
Hospital 12,040$ 12,040,359$ 8,662$ 8,661,981$
SNF 3,134 3,133,676 - -
HHA 2,169 2,168,509 - -
MD 3,535 3,535,248 1,975 1,975,175
All Other 654 653,696 - -
Total Costs 21,531$ 21,531,488$ 10,637$ 10,637,156$
Including Readmissions Indexed Admissions
CONFIDENTIAL: Subject to CMS Data Use Agreement #22626
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Bundled Payments:The Post Acute Care Path and Impact on Bundle
Avg Cost 30.0%
STAH $3,327SNF $12,608
20.0% HHA $1,675200 MD $1,928
All Other $843TOTAL $20,381
70.0%
Average SNF/HHA Cost per Episode $15,138
Avg Cost 21.0%
STAH $1,895SNF $839
18.0% HHA $4,150180 MD $1,531
All Other $897TOTAL $9,313
79.0%
Avg Cost 34.5%
STAH $3,826SNF $743
62.0% HHA $1,752620 MD $1,450
All Other $522TOTAL $8,293
65.5%
Community
Home Care
SNF
Readmit
NO Readmit
Readmit
NO Readmit
Readmit
NO Readmit
NO Readmit
NO ReadmitNO Readmit
Post AcuteCarePath
Acute Stay
Discharge
CONFIDENTIAL: Subject to CMS Data Use Agreement #22626
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• Payer: Walmart– Six Participating Providers:
◊ Virginia Mason Medical Center, Seattle, WA
◊ Mayo Clinic, Scottsdale, AZ , Rochester, MN & Jacksonville, FL
◊ Scott & White Memorial Hospital, Temple, TX
◊ Mercy Hospital, Springfield, MO◊ Cleveland Clinic, Cleveland, OH◊ Geisinger, Danville, PA
– Description: Beginning January 2013 1.1 million employees eligible for consultation and care for certain cardiac & Spine procedures at no additional cost. Walmart will cover cost of travel, lodging, and food for patient and one caregiver.
• Payer: PepsiCo– Participating Providers: John Hopkins,
Baltimore, MD– Description: Starting 12/11 began
waiving deductibles & co-insurance for employees who receive cardiac and complex joint replacement surgery at John Hopkins.
• Payer: Lowes– Participating Providers: Cleveland
Clinic, Cleveland, OH– Description: Contract for heart
surgery program; will waive $500 deductible, out-of-pocket costs, airfare, hotel and living expenses.
Commercial Insurance BPI Activity: Large EmployersCardiovascular & Spine Services Bundles
Source: The Advisory Board “Commercial Bundled Payment Tracker” accessed via web on 4/12/13 at:http://www.advisory.com/Research/Health-Care-Advisory-Board/Resources/2013/Commercial-Bundled-Payment-Tracker#lightbox/0/
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CMS Primary Care Transformation
• Comprehensive Primary Care Initiative– Multi-payer initiative fostering collaboration between public and private
health care payers.– 497 primary care practices covering 7 states
◊ Includes 2,347 providers serving an estimated 315,000 Medicare Beneficiaries
• Independence at Home Demonstration– Tests the effectiveness of delivering comprehensive primary care services to
Medicare beneficiaries with multiple chronic conditions at home. – Providers who succeed in reducing costs and meeting designated quality
measures will receive an incentive payment.– Participants announced in April 2012 and include 15 different practices in 12
different states
Source: The Centers for Medicare & Medicaid Innovation (CMMI)
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CMS Primary Care Transformation• Multi-Payer Advanced Primary Care Practice
– CMS participating in 8 states with multi-payer reform initiatives already being conducted in states.
– Demonstration focuses in on if advanced primary care practice will reduce unjustified utilization and expenditures, improve safety, effectiveness and timeliness and efficiency of health care services.
– Monthly care management fee is paid to cover care coordination, improved access, patient education, and other services to support chronically ill patients.
• FQHC Advanced Primary Care Practice– A three-year demonstration program designed to evaluate the effect of advanced
primary care practice model (commonly referred to PCMH) in improving care, promoting health, and reducing cost of care to Medicare beneficiaries served by FQHCs.
– 493 participating FQHCs will be paid a monthly care management fee of $6.00 (paid quarterly) per eligible beneficiary attributed to their practice.
– Fee is in addition to the usual all-inclusive payment rate currently received.
Source: The Centers for Medicare & Medicaid Innovation (CMMI)
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Patient Centered Medical Home – Demonstration Project Overview *• Project Objectives:
– Identify and eliminate “gaps” in care– Reduction of health risk factors and enhancement of quality of life
• Focused Clinical Conditions:– Asthma – Coronary Artery Disease– Hyperlipidemia– Hypertension– Adult/Adolescent/Childhood Immunizations– COPD– Diabetes– Anxiety/Depression– Breast/Cervical/Colorectal Cancer Screenings– Vital & Others
* Source: BCBSMT Presentation at MT HFMA on PCMH Demonstration Project Results Fall, 2011
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Patient Centered Medical Home: Demonstration Project Incentive Plan*• Structure Incentives Based on Outcomes
– Participation Amount– Quality Outcome Amount– Patient Satisfaction– TCOC Amount– Incentive s for Both Improving & Achieving Targets
• Additional Payment Incentives– $200 PMPY for Care Management of Chronic Conditions– $100 PMPY for Care Management of Preventive Conditions
• Potential Savings– Reduced ER visits– Preventable Admissions & Re-Admissions– Improved Health Status– Increased Productivity, Employee Morale & Reduced Absenteeism
* Source: BCBSMT Presentation at MT HFMA on PCMH Demonstration Project Results Fall, 2011
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Patient Centered Medical Home: Demonstration Project Outcomes*
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State Innovation Model InitiativesProvides up to $300 million to support the development and testing of state-based
delivery system transformation models for multi-payer payment and health care delivery system.
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Regulatory Environment &Other Market Influences
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Influencers of Medicare Reimbursement
• New formula for DSH payments.• Established requirements for
pay-for-performance initiatives
Patient Protection & Affordable Care Act (PPACA) March 2010
American Taxpayer Relief Act
January 2013• Grants CMS authority to
recoup “excess payments”in “exchange” for temporary SGR patch
CMS Annual Updates• ACA implementation• Value-Based-Payment• Readmissions• DSH Implementation
MedPAC & OIG2013 Reports
• “Payment equalization across sites of service”
• Elimination of CAH designation for 849 of 1,329 CAHs
• President Obama’s September 2011 budget
• CAH swingbed reimbursement vs. skilled nursing facilities
• Rural Health Clinic (RHC) designation and rules compliance
• Extends provisions of ATRA for 1 year
Protecting Access to Medicare Act of 2014
• Extended provisions of ATRA, including SGR, through 3/31/14
Bipartisan Budget Act of 2013
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MedPAC Pushing EqualizationPayment Pressures: “Good Ole Days” At Risk
“Last year we made a recommendation to equalize payment rates for office visits provided in hospital outpatient departments and physician offices. We will continue to analyze opportunities for applying this principle to other services and sectors, such as sectors that provide post-acute care.”
MedPAC 2013 Report to Congress
“Medicare often pays different amounts for similar services across settings. Basing the payment rate on the rate in the most efficient clinically appropriate setting would save money for Medicare… We extend that principle to specific services that meet the Commission’s criteria….”
MedPAC 2014Report to Congress
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MedPAC Payment Equalization Recommendations• Identified 5 criteria for services that are “good candidates”
– Frequently (> 50%) performed in physicians office – Minimal packaging differences across payment systems– Infrequently provided in ED– Severity no greater in HOPD then freestanding offices– Do not have a 90-day global surgical code
• Broke 450 APCs into two groups based on service category:– Group 1: 66 APCs
◊ Characteristics: No emergency standby required; no extra costs associated with complexity; no additional overhead
– Group 2: 42 APCs◊ Characteristics: Met 4 of the 5 above characteristics◊ Okay to exceed PFS rate, but only equal to cost of additional packaging
• Estimated reductions of $1.1B• LTCH Non-Chronic Critical Payment Rate
– Reduced from ~ $40,000/ case to ~ $12,000/case (similar to IP PPS)– Shift differential, ~ $2B, to IP PPS to increase outlier reimbursement for CCI patients
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Transitioning to a New Market Place *
Indiana Marketplace **
• Potential Size: 525,000
• Completed Applications: 229,815
• Enrollment: 132,423
• Estimate of Uninsured Eligible for Medicaid/CHIP: 94,495
• Assistance Eligible: 155,961
** Source: Department of HHS; “Health Insurance Marketplace: Summary of Enrollment for the Initial Annual Open Enrollment Period” 10/1/13-4/19/14.
* Source: State Reforum an online network for health reform implementation at https://www.statereforum.org/tracking-health-coverage-enrollment-by-state
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Expect Lower Provider Payment Rates, Less Patient Choice
Source: Mathews AW and Kamp J, “Another Big Step in Reshaping HealthCare,” Wall Street Journal, February 28, 2013, available at: www.online.wsj.com; Hancock J, “Aetna Cuts Predictions for Obamacare Enrollment,” Kaiser Health News, April 30, 2013, available at: www.capsules.kaiserhealthnews.org; Health Care Advisory Board interviews and analysis.
1) Pseudonym.
Anticipated Provider Reimbursement Rates for Exchange Plans
Catholic Health Initiatives Modest discounts from commercial rates
Tenet Healthcare Up to 10% below commercial rates Meriwether Hospital1
5% below commercial rates
WellPoint Inc.Between Medicare and Medicaid rates
Meyers Health1
10% above Medicare rates Case in Brief: Aetna Inc.
• Health insurer planning to sell narrow network exchange products in 14 states
• Searching for providers agreeing to lower rates in narrow network products
• Plans for rates to fall closer to Medicare than commercial reimbursement
Aetna’s Planned Reduction in Exchange Network Size
25%-50% reduction in exchange network size, compared to networks for typical commercial products
Millern Medical Center1
20% below commercial rates
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Growth in Spending Will Dictate Risk:Factors Influencing Spending Growth*
Technology
Pricing Level & Growth
Market Prominence
Health Insurance Coverage
Patient CharacteristicsDemographics
Source: MedPAC Report to Congress, March 2014
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Will Access to Coverage Kick-Start Spending Growth?
• Health care spending rose at fastest rate in 10 years in 4Q of 2013 at 5.6% **
• Hospital revenue grew by $8 billion, despite 1% decrease in IP days
• Reasons behind the increase:– Trend of shifting > out of pocket
to insured leveling off– Upward pressures on costs, such
as high-tech treatments, are remerging
– Since 2011 unemployment has dropped from 8.5% to 6.7%, adding 2.6 million jobs
Plan 2013 2014 Difference
ESI 108.7 116.9 8.2
Medicaid 12.3 18.2 5.9
Individual Market 9.4 7.8 (1.6)
Marketplace 0.0 3.9 3.9
Other 27.5 20.3 (7.2)
Subtotal (Insured) 157.9 167.2 9.3
Uninsured 40.7 31.4 (9.3)
Source: "Changes in Health Insurance Enrollment Since 2013" By Rand CorporationNumbers represent millions of people; margin of error omitted for presentation
NET CHANGES IN INSURANCE COVERAGE
FROM SEPT. 2013 TO MARCH 2014
“The Centers for Medicare and Medicaid Services expects health spending to rise 6.1% this year……as 11 million people gain health insurance.”**** Source: USA Today “Health care spending growth hits 10-year high”
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Emerging Risk in Commercial ContractingBackground• Insurer is implementing a new payment system and provided estimated impact of
conversion.• Estimated impact of the change was a reduction of net revenues of about
$831,000 (14%)• However, as claims are being processed the impact is greater than initially
estimated• Application of LCC rule further reduces net revenues by $954,000 (-16%)
Revised Estimated Impact• Baseline Conversion Impact ($831,000)• Additional Reduction Due to Application of Claim Level LCC ($954,000)
• TOTAL NET REVENUE IMPACT OF NEW CONTRACT($1,785,000)– Overall % Reduction in Payor Revenue -
30%
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Emerging Risk in Commercial Contracting (cont’d)
What it used to be under the old contract
Initial estimate based on analysis of new contract
Actual rate from paying at lower of allowable or
charges at a claim level (LCC)
Overall Payment Rate (2012 Pricing)
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Walmart Eying the Health Care Industry
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Moving Beyond Basic Retail Clinics
Source: The Advisory Board Holmes TJ, “The Diffusion of Wal-Mart and Economics of Density,” May, 2006; Zimmerman A and Hudson K, “Managing Wal-Mart: How U.S.-Store Chief Hopes to Fix Wal-Mart,” The Wall Street Journal, April 17, 2006, available at: www.wsj.com; Aboraya A, “Wal-Mart Plans to Offer Primary Care in 5-7 Years,” Orlando Business Journal, January 11, 2013, available at: www.bizjournals.com/orlando; Aboraya A, “Exclusive: Wal-Mart Exploring Private Health Insurance Exchange for Small Biz,” Orlando Business Journal, January 11, 2013, available at: www.bizjournals.com/orlando; Health Care Advisory Board interviews and analysis.
Vice PresidentHealth and Wellness Payer
Relations
”
“That’s where we’re going now: full primary care services in five to seven years.”
Potential Evolution of Health Care Products
33%Estimated portion of the US
population that visits Walmart every week
4,600+Number of Walmart stores in
the United States
Median distance between a residence
and Walmart
4.2 miles
Basic Retail Clinic
Full Primary Care
Health Insurance Exchange
Scope of Services
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Beyond Walmart
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Walgreens Aims to Become the Premier Health Destination
Source: The Advisory Board Japsen B, “How Flu Shorts Became Big Sales Booster for Walgreen, CVS,” Forbes, February 8, 2013, available at: www.forbes.com; “Take Care Clinics at Select Walgreens Expand Service Offerings,” Reuters, May 31, 2012, available at: www.reuters.com; Murphy T, “Drugstore Clinics Expand Care into Chronic Illness,” The Salt Lake Tribune, April 4, 2013, available at: www.sltrib.com, Walgreens, “Company Overview,” available at: www.walgreens.com; Health Care Advisory Board interviews and analysis.
2009: Launches flu vaccine campaign
Simple Acute Services Vaccinations and Physicals
Chronic Disease Monitoring
Chronic Disease Diagnosis and Management
2013: Launches three ACOs; begins diagnosing and managing chronic disease
Case in Brief: Walgreen Co.
• Largest drug retail chain in the United States, with 372 Take Care Clinics
• In April 2013, became first retail clinic to offer diagnosis and treatment of chronic diseases
2007: Acquires Take Care Health Systems
2012: Offers three new chronic disease tests
Not Just a Drugstore
“Our vision is to become ‘My Walgreens’ for everyone in America by transforming the traditional drugstore into a health and daily living destination...”
Walgreen Co. Overview
”
38
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2014 Market Transitions to Monitor• Transitioning commercial contracting
– More “stiff arming” especially for smaller providers
• Exchange related impacts– Glitch continuation?– Reimbursement implications– “Surprise” narrow networks ?– Increased demand for medical services– Reprieves from mandates – how long will they last?– Consumer impact – choice & out-of-pocket costs
• Escalation in ruthless competition– Formation of narrow networks impacting market share
• On-going provider operational challenges– Revenue cycle issues– Profitability continues to be squeezed– Charge capture issues
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Parting Comments• Health care payment system is being driven to “value based”
payments
• The transition in large part is market driven
• Many of the initiatives take aim at improving management, access, and quality of care provided to patients with chronic conditions
• Short-term outcomes show promise, but it will be years before we understand the true benefit of this transition
• Outside of new innovation models, some of payment reform activity is not all that innovative
• Transition market is creating unique competition challenges
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Questions/Comments
THANK YOU!Rob Schile, CPA
MP Health [email protected]
For information on health care reform, go to
CliftonLarsonAllen’s Health Care Reform Center at:
http://www.cliftonlarsonallen.com/healthreform/
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Appendix: Indiana Payment Innovation Initiatives
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4343
Advanced Payment ACO• American Health Network
of Ohio Care Organization, LLC (Indianapolis)
Pioneer ACO• Franciscan Alliance
(Indianapolis)
Indiana Innovation ActivityACO Participation
Source: The Centers for Medicare & Medicaid Innovation (CMMI)
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• Bone & Joint Specialists, P.C. (Merrillville)
• Central Indiana Orthopedics (Muncie)• Clark Memorial Hospital (Jeffersonville)• Community Hospital of Anderson and
Madison County, Inc. (Anderson)• Community Hospital South, Inc.
(Indianapolis)• Community Hospitals of Indiana, Inc.
(Indianapolis)• Community Physicians of Indiana, Inc.
(Indianapolis)• Heart Group, PC (Evansville)• Indiana Heart Hospital, LLC
(Indianapolis)
• Indiana Hospitalists PC (Richmond)• Indianapolis Osteopathic Hospital,
Inc. (Indianapolis)• Orthopaedics Indianapolis, Inc.
(Indianapolis)• Premier Healthcare, Llc
(Bloomington)• Providence Medical Group Llc (Terre
Haute)• Saint Joseph Regional Medical Center
– Mishawaka Campus (Mishawaka)• Saint Joseph Regional Medical Center
– South Bend Campus (Mishawaka)• St. Joseph Regional Medical Center –
Plymouth Campus)
Indiana Innovation ActivityBPCI Model 2 Participation
Source: The Centers for Medicare & Medicaid Innovation (CMMI)
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• Amedisys Home Health of Jeffersonville (Jeffersonville)
• Bone & Joint Specialists, P.C. (Merrillville)• Chicagoland Christian Village, Inc. (Crown
Point)• Community Physicians of Indiana, Inc.
(Indianapolis)• Covenant Care Indiana Inc. University Park
Health and Rehabilitation Center (Fort Wayne)
• Decatur Township Center (Indianapolis)• Heart Group PC (Evansville)• Home Health Care Solutions (Avon)• Hoosier Christian Village, Inc. (Indianapolis)• Indiana Hospitalists PC (Richmond)• Indianapolis Osteopathic Hospital Inc.
(Indianapolis)
• Lakeland Skilled Nursing & Rehab (Angola)
• McCormick’s Creek Rehabilitation & Skilled Nursing Facility (Spencer)
• Miller’s Merry Manor (31 locations)• New Haven Care Center (New Haven)• Norwood Health & Rehabilitation Center
(Huntington)• Oak Health Care Investors, Inc. (Butler)• Orthopaedics Indianapolis, Inc.
(Indianapolis)• Premier Healthcare Llc (Bloomington)• Providence Medical Group (Terre Haute)• Pyramid Point Post-Acute & Rehab
Center (Indianapolis)• Waldron Health & Rehab Center
(Waldron)
Indiana Innovation ActivityBPCI Model 3 Participation
Source: The Centers for Medicare & Medicaid Innovation (CMMI)
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Indiana Innovation ActivityFQHC Demonstration
Indiana Participants– Cass County Community Health Center
(Logansport, IN)
– Community Health Center of Jackson County (Seymour, IN)
– HealthLinc, Inc. (Valparaiso, IN)
– Indiana Health Centers, Inc. ◊ South Bend, IN◊ Kokomo, IN
– Vermillion-Parke Community Health Center (Clinton, IN)
3 year demonstration• Help Medicare beneficiaries manage chronic conditions and provide coordinated care• Receive $6 monthly care management fee for each eligible Medicare beneficiary• Achieve Level 3 patient-centered medical home recognition
Source: The Centers for Medicare & Medicaid Innovation (CMMI)
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CMS Centers for Medicare & Medicaid Innovation (CMMI):
Indiana Innovation Activity• Health Care Innovation Awards:
– Trustees of Indiana University: ◊ Project Title: “Dissemination of The Aging Brain Care Program” (ABC)◊ Geographic Reach: Indiana◊ Funding Amount: $7.8 Million◊ Est. 3 Year Savings: $15.7 Million◊ Project Summary:
• Reduce behavioral and psychological symptoms of dementia, improve patients’ or informal caregivers’ satisfaction and access to care, improve the quality of dementia and depression care, and reduce acute care utilization.
• Expansion of The Aging Brain Care (ABC) program which has been in effect for 2 years serving > 200 patients.
• ABC will expand to more than 2,000 Medicare & Medicaid beneficiaries with dementia and late-life depression to accomplish the stated project goals.
Source: The Centers for Medicare & Medicaid Innovation (CMMI)
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CMS Centers for Medicare & Medicaid Innovation (CMMI):
Indiana Innovation Activity• Health Care Innovation Awards:
– TransforMed◊ Geographic Reach: AL, CT, FL, GA, IN, KS, KT, MD, MA, MI, MS, NA, NC,
OK, SD, WV◊ Funding Amount: $20.7M◊ Est. 3 Year Savings: $52.8M◊ Project Summary:
• Primary care redesign project across 15 communities to support care coordination among Patient-Centered Medical Homes (PCMH), specialty practices, and hospitals, creating “medical neighborhoods”.
• Project will utilize sophisticated data analytics to identify high risk patients and coordinate care across the medical neighborhood while driving PCMH transformation in primary care practices in each community.
Source: The Centers for Medicare & Medicaid Innovation (CMMI)
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CMS Centers for Medicare & Medicaid Innovation (CMMI):
Indiana Innovation Activity• Health Care Innovation Awards:
– Nat’l Council of YMCA of USA◊ Geographic Reach: AZ, DL, FL, IN, MN, NY, OH, TX◊ Funding Amount: $11.9M◊ Est. 3 Year Savings: $4.3M◊ Project Summary:
• In partnership with other non-profit organizations, will expand YMCA’s Diabetes Prevention Program to prediabetic Medicare beneficiaries in 17 communities.
• Deliver community-based diabetes prevention through a nationally recognized diabetes prevention lifestyle change program, coordinated and taught by trained YMCA Lifestyle Coaches.
• Goal is to prevent the progression of prediabetes to diabetes, which will improve health and decrease costs associated with complications of diabetes, hypercholesterolemia and hypertension.
Source: The Centers for Medicare & Medicaid Innovation (CMMI)
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CMS Centers for Medicare & Medicaid Innovation (CMMI):
Indiana Innovation Activity• Health Care Innovation Awards:
– Feinstein Institute for Medical Research◊ Geographic Reach: FL, IN, MI, MO, NH, NM, NY, OR◊ Funding Amount: $9.4M◊ Est. 3 Year Savings: $10.1M◊ Project Summary:
• Develop a workforce capable of delivering effective treatments, using newly available technologies to at-risk, high-cost patients with schizophrenia
• Provide training and education to patients and caregivers about pharmacologic management, cognitive behavior therapy, and web-based/home-based monitoring tools for their conditions intended to improve patients quality of life and lower cost by reducing hospitalizations.
Source: The Centers for Medicare & Medicaid Innovation (CMMI)
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Community Based Care Transitions Program
• Section 3026 of ACA
• Test models for improving care transition from hospital to other settings and reducing readmissions for high risk Medicare beneficiaries
• 102 total participants
Indiana Participants:
• Aging & In-Home Services of Northeast Indiana (Fort Wayne, IN)
• LifeSpan Resources, Inc. (New Albany, IN)
Indiana Innovation ActivityCCMI Initiatives to Speed Adoption of New Models
Source: The Centers for Medicare & Medicaid Innovation (CMMI)