Pushing the Boundaries of Accountable Care

April 13, 2015 James Walton, MD, MBA, President and CEO, Genesis Accountable Physician Network

Sandra Selzer, MSHQ, Vice President Product Management, BluePrint Healthcare IT

DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Conflict of Interest Sandra Selzer, MSHQ Has no real or apparent conflicts of interest to report.

© HIMSS 2015

Conflict of Interest James Walton, MD, MBA Consulting Fees (e.g., advisory boards): BluePrint Healthcare IT – Advisory Board Aetna – External Advisory Committee – Racial & Ethnic Disparities

© HIMSS 2015

Learning Objectives

Identify the specific challenges facing organizations in engaging, both, physicians and patients in the new accountable care world. Assess the unique needs organizations have when creating a care coordination model that addresses, both, the patient’s clinical, non-clinical and socio-economic barriers to care, as well as the physician’s need to deliver care successfully in a value-based care model. Delineate phased steps in the full deployment of the care navigation model and technologies, including mobile apps that engage clinicians, as well as patients and family caregivers. Extrapolate success criteria and barriers around deploying a care navigation model supported by care coordination technology across several care settings and with various types of care providers.

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HIMSS STEPS™ Model SATISFACTION: Implementation of key technologies allows Genesis to display the entire care team, including patients and family members, as well as offer secure messaging, journaling and one-touch calling to streamline communications. TREATMENT/CLINICAL: This initiative increases the number of care team members who directly impact patient care and health outcomes. ELECTRONIC INFORMATION/DATA: This initiative increases the value of patient data by making it available, and actionable, to care coordinators supporting a team-based model of care. PREVENTION & PATIENT EDUCATION: As part of the technologies being utilized, care coordinators can now base their activities and workflows on outcomes to assessments as well as tailor automated education to close gaps in health knowledge. SAVINGS: By creating an ACO, and providing key care coordination and engagement tools, Genesis is able to support physicians and increase their ability to care for more patients. http://www.himss.org/ValueSuite

Presenters

Sandi is a healthcare IT and quality improvement professional, who leads BluePrint’s software product strategy. Sandi previously served as the Director of the Camden Health Information Exchange and spent 15 years at the American Board of Internal Medicine in performance measurement and quality improvement.

Sandra Selzer, MSHQ Vice President Product Management BluePrint Healthcare IT

James Walton, DO, MBA President & CEO Genesis Accountable Physician Network

Dr. Walton is an internist and CEO of Genesis Physician Group and Genesis Accountable Care Network, a large IPA and ACO located in Dallas, Texas. Dr. Walton previously served as VP of Network Performance/Baylor Quality Alliance at Baylor Health Care System. Additionally, Dr. Walton was recently elected President of the Dallas County Medical Society.

Objective : Identify Challenges

Identify the specific challenges facing organizations in engaging, both, physicians and patients in the new accountable care world.

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Genesis IPA & Historical Services

Contract Management

Physician Credentialing

Supply Chain Purchasing

Office Operations Support

Pay-for-Performance Support

Genesis Physician Group is an association of independent physicians that credentials & contracts with payers, while also providing support and enabling services on behalf of its members.

No patient access

No direct patient care

No access to clinical data

No health information technology

Genesis: IPA by the Numbers

Physicians 1,400

500

900

700

400

PCPs

SCPs

Practices

Square miles in North Texas

Genesis: Challenges for Change

Pressure from integrated delivery systems and payers

Threatened and disengaged physicians

Mediocre patient quality and cost management

Excessive IT expense and inefficiency

Consolidating markets

Genesis & Clinical Integration ACO Development - Addressing the Challenge

Direct Patient Contact

Data-Driven Improvement

Population Health

Performance Measurement

Physician Collaboration

Care Coordination

ACO Creation: Genesis Accountable Physician Network (GAPN)

Physicians in ACO 320

20,000

3

120

400

Patient Lives

Contracts - 1.0 MSSP, 1.0 MA & 1.0 Commercial

PCPs

Square miles in North Texas

Joint Venture Management Services Organization

Objective : Assess & Address

Assess the unique needs organizations have when creating a care coordination model that addresses, both, the patient’s clinical, non-clinical and socio-economic barriers to care, as well as the physician’s need to deliver care successfully in a value-based care model.

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Genesis: C-MORE Strategy

Coordinate Care

Manage Utilization

Optimize Physician

Culture

Engage Patients

Engage Families

Report Improved

Performance

Setting a Course for Success Executing C-MORE

What staffing model would support care coordination across a broad set of independent providers? Human

Resources

Technology

Data

How do we connect physicians to the concept of accountable care?

What data does Genesis need to successfully identify, track and report on its ACO patient population?

GAPN’s Organizational Needs: Assessing Customer’s Needs

Physicians Patients

Limited EMR use & integration Limited MU & PQRS engagement Limited payer claims data sharing Limited organizational capacity for

data analytics, stratification and reporting

Payer attribution model limits control of “leakage”

Physician barriers limit engagement

GAPN’s Organizational Needs: Addressing Customer’s Needs

Physicians Patients

Quarterly financial rewards for EMR quality documentation

Organizational PQRS reporting Payer contracting linked to

claims sharing JV MSO for data management &

care coordination Software app. (i.e. Genesis

Ribbon) for physician engagement

Care Navigators (CHWs) & Care Coordinators (RNs) connect patients & physicians

Transitional care management for post-acute care

Software application for secure IM with patients & caregivers

Objective : Deploy Investments

Delineate phased steps in the full deployment of the care navigation model and technologies, including mobile apps that engage clinicians, as well as patients and family caregivers.

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GAPN Investment: Human Resources

Goals • Increase physician &

patient engagement • Create “headroom” for

primary care physicians • Improve quality of

patient outcomes & reduce IP costs

Quality Improvement Committee Associate Medical Directors Care Navigators

(i.e. Community Health Workers) Case Managers

(i.e. Registered Nurses) Quality & Utilization Data Analysts

Care Navigators

GAPN Investment: Health Technology

• ACO Contract Management • Physician Directory • Physician Credentialing

• Data Aggregation & Pop. Health • Disease Case Management • Performance Measurement

• Care Navigation • Patient Engagement • Physician Engagement

• Performance Measures • ACO Status Reporting

Data Aggregation Predictive Modeling Analytics & Pop. Health Mgmt. Care Gaps

GAPN Investment: Data

Quality & Utilization/Costs Performance Outcomes

ACO Statistics & Physician Incentives EMRs

HIE Claims

Care Teams & Care Plans Social & Behavioral Assessments Patient Engagement & Education

Patient Data: Well-Being 5 Survey

Objective : Success & Barriers

Extrapolate success criteria and barriers around deploying a care navigation model supported by care coordination technology across several care settings and with various types of care providers.

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Success & Barriers: Care Navigation & Transitional Care Management

Physician engagement

Patient engagement

Post-acute “capture rate” Post-acute “completion rate” Patient & physician satisfaction

Change in Total Admit Rate Change in Readmit Rate Change in Total Costs

Change in IP cost % Change in Prof. cost % Change in “OP” cost %

Process Measures

Outcome Measures

Human – Tech – Data Come Together C-MORE in Action

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Use Case

#2

Use Case

#3

Use Case

#1

Transitional Care Mgmt. (Readmission Avoidance)

Quality Management (Care Gaps)

Care Management (High Risk Cost Avoidance)

Currently hospitalized All ACO patients Complex chronic conditions (top 6%)

ADT data from hospital HIE Claims, EMR, Labs Claims

Care Navigator™ (GAPN) & Care Manager (HW)

Quality Analytics; AMDs, PCPs

Care Navigator™ (GAPN) & Care Manager (HW)

Healthways & Care Navigator™

Population Management Tool

Healthways & Care Navigator™

C-MORE in Action: “Helen Evans”

Patient: Helen Evans Age: 75 years Marital Status: Widow Smoker: Yes Geography: Texas Diagnoses: Diabetes & COPD

Lessons Learned: Human Investments Support Helen’s Care

After Before

Lesson: Physician/patient identification & referral - linked to patient acceptance

Lessons Learned: Technology Investments Support Helen’s Care

Lesson: Length & complexity of new IT deployment & adoption

After

Physician EMR

Pop. Health And Wellness Products

Care Navigator™

Mobile App

Before

?

Lessons Learned: Data Investments Support Helen’s Care

• Claims-based Utilization Data

• ADT Alerts from IP • Aggregated EMR-

documented Quality Data to Identify Care Gaps

• Non-Clinical Barriers

and Patient-Reported Data

Before After

? ?

Lesson: Lead with Phase I (i.e. non-technology dependent) solution

Benefits Realized: Collaborative Team-Based Care Powered by New Technologies

Dr. James Walton

Dr. James Walton

HIMSS STEPS™ Model SATISFACTION: Implementation of key technologies allows Genesis to display the entire care team, including patients and family members, as well as offer secure messaging, journaling and one-touch calling to streamline communications. TREATMENT/CLINICAL: This initiative increases the number of care team members who directly impact patient care and health outcomes. ELECTRONIC INFORMATION/DATA: This initiative increases the value of patient data by making it available, and actionable, to care coordinators supporting a team-based model of care. PREVENTION & PATIENT EDUCATION: As part of the technologies being utilized, care coordinators can now base their activities and workflows on outcomes to assessments as well as tailor automated education to close gaps in health knowledge. SAVINGS: By creating an ACO, and providing key care coordination and engagement tools, Genesis is able to support physicians and increase their ability to care for more patients. http://www.himss.org/ValueSuite

Questions

James Walton, MD, MBA President and CEO

Genesis Accountable Physician Network

jim.walton@genesisdocs.org Twitter: @JameswaWalton

Sandra Selzer, MSHQ Vice President, Product Management

BluePrint Healthcare IT

sandra.selzer@blueprinthit.com Twitter: @BluePrintHIT Twitter: @SandiSelzer