Pioneer ACO Overview to NYSDOH ACO
Workgroup
March 6, 2014
Montefiore Overview
1,930 Beds Across 6 Hospitals
– Including 120 beds at CHAM
– 86 NICU/PICU beds
150 Skilled Nursing Beds
154 Sites Including
64 Primary Care Sites
– 21 Montefiore Medical Group Sites
21 School Health Clinics
12 Mental Health/Substance Abuse Treatment Clinics
65 Specialty Care Sites
– 2 Multi-Specialty Centers– 6 Pediatric Specialty Centers– 12 Women’s Health Centers
1 Freestanding Emergency Department
10 Dental Centers
5 Imaging Centers
Our Locations
Montefiore IPA and CMO
• Formed in 1995• MD/ Hospital Partnership• Supplies network of par
providers committed to cooperation in care improvements
• Accepts some full risk capitation from health plans
• Established in 1996• Wholly-owned subsidiary of
Montefiore Medical Center• Performs care management
delegated by health plans• CMO performs most functions
for MIPA• 900+ staff
CMOMontefiore Care
ManagementMontefiore IPA (MIPA)
The Montefiore ACO
• Bronx Accountable Healthcare Network IPA, Inc. (BAHN), does business as the Montefiore ACO
• BAHN is an IPA, separate from MIPA• BAHN contracts with CMS for Medicare Pioneer
ACO program– BAHN subcontracts with MIPA to supply most of the
network of clinical participating providers– BAHN sub-contracts with CMO to supply all care
management and all administrative services
Montefiore Pioneer ACO
Bronx Accountable HealthCare
Network IPA(BAHN)
Bronx Accountable HealthCare
Network IPA(BAHN)
Montefiore IPAMontefiore IPA
MontefioreCare
Management Org (CMO)
MontefioreCare
Management Org (CMO)
Subcontracts with:
+
Pioneer Agreement
Medicare $
Non-Montefiore Par Providers:
St. BarnabasAcacia Health
Morris HeightsHudson River HC
NS-LIJ (partial)(Most also
participate in health home governance)
Montefiore Medical Center
Community MDs (600)
Ancillary providers/labs
Montefiore Employed MDs
(1700)
Participating Network(Clinical services)
Includes BAHNHealth Home
Montefiore ACO Big Picture
•Many health plans are switching from FFS to care management arrangements with shared savings opportunities/quality metrics •Montefiore ACO has history of such arrangements with Government and non-Government Payers•Montefiore ACO encompasses other providers:
– Bronx Community-based providers– Provider groups within other entities such as NS-LIJ, St. Barnabas,
Hudson River Health Care, FQHCs– ACO will include new Montefiore affiliates (Sound Shore 750)
Care Guidance Program Supporting Innovation
7
Montefiore CMO tailors administrative requirements and care management intensity to the needs of the population being served
Our Current Portfolio
* Including Pioneer ACO members
Care Guidance Example: Behavioral Care Synergy Program
• Goal is to augment behavioral health services in patient centered medical home (PCMH) context
• Implement evidence-based models for treatment of patients with poorly controlled depression and at-risk drinking with chronic medical conditions (diabetes, CAD, CHF)
• Develop a joint care management “synergy” team approach to support and manage these complex patients
• Uses RN care manager, LCSW, psychiatrist in a “virtual” mode as standard approach
• Evaluate clinical outcomes, patient and provider satisfaction and cost
Chung et al, Gen Hospital Psych 2013
Detail: Pioneer ACO Program • Serves Medicare Part A & B beneficiaries• Care coordination program designed for organizations with
prior experience with population-based care management• Includes comprehensive patient satisfaction and quality metrics• Brings care coordination to the fee-for-service coverage
population, without restrictions such as gatekeepers or limitations on out of network benefits
• Montefiore ACO is the only Pioneer ACO in New York State• 3 Year demonstration started in 2012
– May be extended to 5 years– Just started Performance Year 3 (2014)
Quality Evaluation• 33 quality metrics in 4 domains:
– Patient/Caregiver Experience– Care Coordination/Patient Safety– Preventive Health– At-Risk Populations
• Data from patient satisfaction surveys, claims and administrative data and medical record reviews based on mix of reporting and performance relative to U.S. benchmarks
2013: Pioneer ACO Beneficiary Characteristics
• 23,250 attributed Part A & B beneficiaries• “Attributed” because majority of primary care has been
delivered to those patients by providers in the ACO• 2,500 SNF Residents• Age ranges from 5 – 112
– Average age of 72– 175 beneficiaries (0.8%) are age ≥100– 4,238 beneficiaries (18.2%) are < 65– Of those, 215 are age ≤ 30
• Approximately 1/3 of population are duals (8,000)– Interested in opportunities to more comprehensively manage Medicaid
benefit through a single care manager for each patient– Montefiore is already managing the Medicare benefit
Pioneer ACO Success
• 2012-Year One: Reduced Medicare spending by 7% against “benchmark” CMS projected it would spend in 2012 on these particular patients
• 2013-Year Two: – Created sustainable cost reduction– Added new provider partners: NSLIJ, St. Barnabas, etc.
• 2014: Just starting Year 3
2012: Inpatient Admissionsdecreased 10.4%
Source: CMMI PY1 Pioneer ACO Data Analysis
2012: 30-day All Cause Readmissions declined by 35.5%
Source: CMMI PY1 Pioneer ACO Data Analysis
2012: Inpatient Admissions for Diabetes decreased 45.7%
Source: CMMI PY1 Pioneer ACO Data Analysis
Questions?
202602114
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