Starting an ACO: IT Lessons Learned
description
Transcript of Starting an ACO: IT Lessons Learned
![Page 1: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/1.jpg)
1
Starting an ACO:IT Lessons Learned
Robert Slepin, PMP, VP and CIO John C. Lincoln Health Network
Nathan Anspach, SVP and CEOJohn C. Lincoln Accountable Care Organization
John C. Lincoln Physician Network
![Page 2: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/2.jpg)
2
John C. Lincoln Health Network
Overview
![Page 3: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/3.jpg)
3
John C. Lincoln Hospitals
• North Mountain Hospital 262 Beds Trauma Center Magnet Designation
• Deer Valley Hospital 203 Beds
![Page 4: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/4.jpg)
4
Physician Network: At a Glance
• 120 primary care providers Additional planned growth
• 20 specialists• 34 locations• NCQA PCMH Accreditation In-Process• Patient Visits
2011 - 263,866 2012 - 323,144 2013 - 409,000 (projected)
![Page 5: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/5.jpg)
5
Accountable Care Organization
• Approved by CMS July 2012
• 18,000 Medicare Shared Savings Program (MSSP) and Commercial members
![Page 6: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/6.jpg)
6
JCL ACO Provider Distribution
Subspecialist70%
PCP30%
Independent65%
Employed35%
401 Providers
![Page 7: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/7.jpg)
7
Brief MSSP ACO Primer
![Page 8: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/8.jpg)
8
Organization of Health Care Providers
• Primary care and subspecialty physicians
• Hospitals Acute care Rehabilitation
• Post-acute providers
• Home health organizations
![Page 9: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/9.jpg)
9
Health Care Providers (cont.)
• Disease management
• Mental health
• Health and wellness
• Patient engagement
![Page 10: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/10.jpg)
10
Reimbursement in a Medicare ACO
• All participating providers continue to be reimbursed by Medicare on a fee-for-service basis
• Patients attributed to an ACO can continue to seek care from any Medicare participating physician, hospital or provider
• If a Medicare ACO is able to reduce the cost of caring for assigned Medicare patients and meet required quality standards, a possibility of shared savings exists
![Page 11: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/11.jpg)
11
Options for Medicare ACO Shared Savings
• Tier 1 – Limited risk
• Tier 2 – Risk-bearing
In either risk model, all providers continue to bill Medicare fee-for-service using the normal Medicare fee schedule.
![Page 12: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/12.jpg)
12
Calculate Shared SavingsStep One: Determine Base Spending Level
1. Determine the number of Medicare beneficiaries in the ACO. We will use
15,000 in our example.
2. Determine the average annual spend
per beneficiary. In Phoenix, that figure is approximately $9,000.
3. Multiply 1 times 2 and the result is a very large number - $135M.
This is the base spending level.
12
![Page 13: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/13.jpg)
13
Calculate Shared SavingsStep Two: Reducing Cost
1. Hypothetical: average cost is
reduced by 7.5% to $8,333 per beneficiary.
2. Multiply $8,333 times same number of members. Total
Spend is now $125M.
3. Subtract $125M from $135M and
savings are $10M. The ACO takes half,
or $5M, up to a maximum amount.
13
![Page 14: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/14.jpg)
14
Shared Savings Possible, Not Easy• Requires reporting performance on 33 quality
measures
• At least 50% of participating primary care physicians using an electronic health record
• Costs of care have to be reduced, but beneficiaries are not limited to ACO partners
14
![Page 15: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/15.jpg)
15
Four Domains of Quality Measures• Patient/Caregiver Experience of Care
7 measures
• Patient Safety/Care Coordination 6 measures including electronic health record
• At-Risk Population 12 measures, focused on diabetes, heart failure,
hypertension and coronary artery disease
• Preventive Health 8 measures, include a variety of screenings
15
![Page 16: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/16.jpg)
16 16
ACO Start-Up
![Page 17: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/17.jpg)
17
ACO Cycle
Process Data
Identify, Attribute
& Stratify
EngagePatients
CoordinateCare
ReportMeasures
Improve
CMS
EHRs
FAX
17
![Page 18: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/18.jpg)
18
IT Challenge #1
18
CMS transmits attribution file to ACO
ACO locates patient demographic information
ACO sends prescribed letter to attributed patients
Patients respond/don’t respond to letter
Update to CMS with patient data sharing preferences
![Page 19: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/19.jpg)
19
CMS Data Transmission
Third Party Data Analysis Tool
Disease Registries
High cost Beneficiaries
High ER Utilizers
19
IT Challenge #2
![Page 20: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/20.jpg)
20
Patient Information
PCP office visit
Create and file HCC
Disease Registry
20
IT Challenge #3
Support patient outreach, care management, and data collection workflow
![Page 21: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/21.jpg)
21
IT Challenge #4
Encounter data refreshed quarterly
Disease Registries
Q1
Q2
Q3
Q4
21
![Page 22: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/22.jpg)
22
Clinical quality measure reporting
Data Sources
Numerator/denominatorcalculation
22
IT Challenge #5
GPRO web site data entry
![Page 23: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/23.jpg)
23
Strategic IT Considerations
![Page 24: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/24.jpg)
24
Core ACO IT CapabilitiesData
• CMS files• Data acquisition• Member registry• Attribution• Stratification• Disease registries• Data warehouse• Analytics and
reporting• Predictive
modeling• Quality measures
Applications
• Beneficiary communications
• EMR• Clinical decision
support• Referrals• Formulary• ePrescribing• Care management• Disease
management• Patient portal• Physician portal• Secure
communications• Telehealth• Financial
Infrastructure
• Security• Enterprise master
patient index• HIE• Mobile/wireless
Other
• IT governance• IT leadership• IT skills• Change
management
24
![Page 25: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/25.jpg)
25
Technology Platform?• Options
Integrated ACO platform: Optum, Aetna or other Best-of-breed ACO platform: EHR, HIE and other pieces Enterprise EHR
• Our approach Leverage enterprise EHR to fullest extent Supplement with in-house development and third party
software-as-a-service where neededo Claims data processingo Population health analytics
![Page 26: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/26.jpg)
26
Single or Multiple EHRs?• Ideal: One EHR
• Reality: Many EHRs and paper
• Options Require all participants to adopt single EHR Two-three preferred EHRs Any EHR, take your pick
• Our approach Single EHR for JCL hospitals and physician practices Longer term – preferred EHRs and Health
Information Exchange
![Page 27: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/27.jpg)
27
FTE, Consultants or Outsource?
• Existing IT staff likely fully committed
• Significant IT resources needed
• Options FTE hiring/ramp-up time Consultant costly, and you lose investment in know-how Outsourcing – high risk
• Our approach Dedicated consultant project manager – rapid start Leverage central IT organization for other skills
![Page 28: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/28.jpg)
28
Patient Engagement?
• Options Personal Health Record (PHR) Patient portal Monitoring devices Mobile apps or text
• Our approach Leverage EHR patient portal Promote adoption at practices and via marketing Improve value to encourage interactions and create value
![Page 29: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/29.jpg)
29
Claims or Clinical Data?
• Claims Good picture of most but not all encounters Time delay
• Clinical Richer data not available in claims Real time
• Our approach Both sources of data are necessary for success
![Page 30: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/30.jpg)
30
CMS Measure Reporting?
• Options Leverage core EHR Third party reporting tool Custom software Manual workaround
• Our approach Extract data from core and legacy EHRs Manual compilation of measures Plan for automation for Year 2
![Page 31: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/31.jpg)
31
Health Information Exchange (HIE)?
• Options Public Private Both None
• Our approach Start without HIE Next step – private HIE Future – expand to public
![Page 32: Starting an ACO: IT Lessons Learned](https://reader036.fdocuments.us/reader036/viewer/2022081505/5681649e550346895dd68870/html5/thumbnails/32.jpg)
32
IT Organization?
CEO
CEO – ACO & PN
COO CMO
CIO
PMO EMR Data & Reporting
• Options Integrated with corporate IT Separate IT
• Our approach Fully integrated – single CIO