MaineHealth ACO in Context

W5

Who?What?

Why? When?

HoW?

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Before we Begin: Upcoming ACO Webinars

– Medicare Patient Notification: Medicare requirements for informing Medicare patients regarding your participation in our ACO

– ACO Financial Distribution Model: How will any savings – if we earn them – be distributed among providers?

– New “Value Oversight Process:” How will clinicians, practices and hospitals participate in open reviews of performance data

– PHO Transparency Policy: Sharing and benchmarking performance data among similar providers

– Quality Performance Reports: Medicare requirements for tracking and reporting key quality measures for our ACO

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Who?

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The MaineHealth ACO is all of the MaineHealth member hospitals plus

St. Mary’s Regional Medical Center and all of the physicians in Community Physicians of Maine– Maine Medical Center, Lincoln County Healthcare, Pen Bay Healthcare,

Southern Maine Medical Center, Western Maine Healthcare, Waldo County Healthcare

– Over 1,000 physicians spanning both hospital-employed and independent practices

– It is the entire MMC PHO !

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What?… is an ACO?… does it do?

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An ACO is:A group of healthcare providers who agree to work together and assume responsibility for

improving the quality and reducing the cost of care for their patients

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Providers in an ACO deliver patient-centered care:

– Put the beneficiary and family at the center– Coordinate care over time and all care settings– Attend carefully to care transitions– Manage resources carefully and respectfully– Proactively manage each patient’s care– Evaluate data to improve care and patient outcomes– Innovate and try new models of care– Invest in team-based care and workforce

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Over time, ACO providers may be paid differently:

– But, THERE IS NO CHANGE TODAY TO HOW YOU CURRENTLY BILL FOR OR RECEIVE PAYMENT

– At the end of the CMS measurement period, providers may be eligible for an additional payment at the end of the year

– The amount they receive depends on their performance on specific quality metrics and how successfully they collaborate with patients & other ACO providers to reduce the cost of care

– In later years, there may be changes to billing and payment but these will not occur today.

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Why?

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ACOs are part of a national effort toimprove healthcare

Source: May 2012. The Commonwealth Fund. Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices and Quality 10

Despite this spending, our citizens are less healthy

Japan

Switzerland

Norway

Germany

England

Canada

United States

0% 5% 10% 15% 20% 25% 30% 35% 40%

Rates of Obesity in Adult Populations of Industrialized Nations

Source: Latest Available Data. National Obesity Observatory. National Health Service. United Kingdom. 11

When?

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Our ACO just signed its first contract:

– As of July 1st, 2012 Medicare is measuring our ACO – including your practice and providers – on:

• How well we achieve specific quality targets and

• Whether we are able to reduce the overall cost of care for our Medicare patients

– The rest of this talk will address some of the specific things you need to do TODAY and in the FUTURE in order for us to be successful

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Measure Domains

Number Method Approach (subject of future webinars)

Patient Experience 7 Survey 2012-3 CMS conducts survey 2014-5 ACO conducts survey

Care Coordination / Patient Safety

3 Claims CMS reported measure based on claims data

Care Coordination / Patient Safety

1EHR Incentive Program

CMS reported measure based on claims data

Care Coordination / Patient Safety

2 GPRO Tool* CMS defines the denominator for each measure based on random sampling

ACO provides numerator information available via claims and clinical data

Practices without EHR that connects with the ACO data system will enter data into a web based portal or provide extract file

Data submitted via GPRO Tool

Preventive Health 8 GPRO Tool

At risk population 12 GPRO Tool

*GPRO is a CMS Web-Based Quality Reporting Tool

MSSP Quality Measures

What is the Timeline?

July 2012 OngoingSep-Oct

2012

Medicare Shared Savings Program Kick off

Data tools piloted

Letters sent to all assigned beneficiaries

Informational webinars conducted

• Practice visits to discuss ACO• Data review and analysis• Care Coordination activities• Patient Centered Medical Home

Implementation

Oct-Nov2012

Feb 2013

Quality Data reporting to CMS

Member Performance Review Program

How?

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Strategy for Achieving the Triple Aim:

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Primary CareOur primary care practices will operate as Patient Centered Medical Homes, and be financed to do so

Care CoordinationMaineHealth will assess, consolidate and/or reorganize system-wide care coordination resources to ensure the right focus on the right patients

TransparencyA physician-led peer review program will focus on reducing unwarranted variation in care

Information TechnologyImprove information available to clinicians at the point of care by aggregating real-time claims and select EMR information

What does it mean to you?

Beginning now….– Actively participate in the Member

Performance Review Program• Engage in quality reporting• Implement CG-CAHPS survey• Assess your practice as it relates to the Patient

Centered Medical Home (PCMH) and Neighborhood

What does it mean to you?Over time…..– PCMH and neighborhood implementation

• Implement team based care• Identify and utilize community resources• Utilize care transitions and care management resources

– Enhanced Care Coordination• Improved communications among caregivers• Utilize Guides to Care and Referrals

– Engage in data review• Identify and reduce practice variations• Identify “at risk” patients and triage to identified resources

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Upcoming Patient Notification Activities

All Medicare Shared Savings Program ACOs are required to notify patients that:

– Your provider(s) is participating in the MHACO– Your provider(s) is eligible for additional Medicare

payments or may be financially responsible to Medicare for failing to provide efficient, cost-effective care

– Medicare claims data for your patients may be shared with our ACO at the ACO’s request

– They can “Opt Out” of this data sharing by completing a form or calling 1-800-MEDICARE.

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Patient Notification….

– Attend the upcoming Webinar on how patients will be notified and how they can “opt out”

– As an intro…. • The MMC PHO/MHACO will mail your Medicare Patients a

letter with the required information• Practices have been requested to help by

• Submitting address information to the MMC PHO for Medicare patients

• Providing practice letterhead • Being prepared to answer patient questions and conduct first

visit notifications

– Please attend the webinar to learn more!

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Reminder: Attend these Future ACO Webinars

– Medicare Patient Notification: Medicare requirements for informing Medicare patients regarding your participation in our ACO

– ACO Financial Distribution Model: How will savings – if we earn them – be distributed among providers?

– New “Value Oversight Process:” How will clinicians, practices and hospitals participate in open reviews of performance data

– PHO Transparency Policy: Sharing and benchmarking performance data among similar providers

– Quality Performance Reports: Medicare requirements for tracking and reporting key quality measures for our ACO