Population Health Management: Advancing Your Position in the Journey to Value-Based Care

Size: px
Start display at page:

Download "Population Health Management: Advancing Your Position in the Journey to Value-Based Care"

Transcription

1 Population Health Management: Advancing Your Position in the Journey to Value-Based Care Webcast Session One: An Integrated Approach to Population Health Management 11 August 2015

2 Welcome & Introductions Gregory Maddrey Director, Accountable Care Solutions Practice Leader Mark Werner, MD National Director of Clinical Consulting Thomas Graf, MD National Director of Population Health Management Anneliese Gerland Accountable Care Solutions Practice Manager 2

3 About The Chartis Group Our mission is to materially improve the delivery of healthcare in the world. The Chartis Group is a national advisory services firm dedicated to the healthcare industry. The firm is comprised of highly experienced senior healthcare professionals and consultants who apply a deep knowledge of healthcare economics, markets, clinical models, technology and organizational dynamics to help clients achieve unequaled results. ~250 Professionals Working In: Strategic and Economic Planning Accountable Care Solutions Clinical Transformation Informatics and Technology 3

4 Today s Discussion Define Population Health Management (PHM) and share how PHM models are evolving in the market Discuss how organizations can take a proactive, integrated approach to advancing their PHM strategies and capabilities Share examples and highlight key lessons learned from providers experiences in managing the health of the populations they serve 4

5 Multiple Forces Pushing Towards Structural Change Public Purchasers Private Purchasers Providers Driving increased accountability for value to providers, to: 1. Curb cost growth and bend the cost curve 2. Improve the health of individuals and groups Consumers Illustrative 5

6 Defining Population Health Management The approaches that have emerged are diverse, but many can be grouped under the umbrella of Population Health Management, which we define as the following: Population Health Management The advancement of the health of a defined or specific population through coordinated programs and activities that address medical and/or social determinants of health and are supported by an aligned payment model that rewards improvement of the population s health and the delivery of high-value care Health Population Aligned Payment Model 6

7 The Challenge for Providers PROFITABILITY PORTION OF BUSINESS Providers do not manage a single population, but rather multiple populations under varying levels of risk. In this context, providers must resolve two fundamental issues. Managing Populations under Mixed Models Illustrative Commercial: United + - Commercial: Anthem LOW (e.g., fee-forservice) Medicare FFS Medicare Advantage Commercial: Aetna ACO DEGREE OF PERFORMANCE-BASED RISK LIMITED (e.g., one-sided shared savings) Medicaid Carve-out for Chronically Ill Children MODERATE (e.g., two-sided shared savings) Direct-to-Employer Total Joint Bundle Employee Population HIGH (e.g., capitation; employees) Medicaid Medicare Pioneer ACO Taking Increased Accountability for Performance 7

8 Participant Poll Approximately what percentage of your organization s business remains in no- or low-risk contracts, e.g. FFS, P4P (select one)? Over 90% 35% 75-89% 17% 50-74% 21% Under 50% 27% 8

9 Risks for Providers Given the complexity of these challenges, providers are faced with significant risks in this evolving and uncertain landscape. 1 Managing Populations under Mixed Models 2 Taking Increased Accountability for Performance Approaching each population separately without fully considering how populations and their respective care and payment models relate to one another Pursuing PHM from a siloed view without taking into full account the interplay between clinical, financial and operating models Succeeding under a performance-based arrangement without fully understanding the drivers of success Doing little or nothing and being unprepared when the market forces the enterprise to take more accountability for performance 9

10 Participant Poll Which of these challenges, if any, has your organization experienced in the transition to PHM? (select all that apply) Populations approached separately 36% Functional, siloed approach to PHM 47% Don't understand drivers of success 27% Doing nothing or little 15% Other 7% Participants able to select all that apply so percentages will not add to 100%. 10

11 An Integrated, Iterative Approach to Population Health Management ENTERPRISE VISION FOR POPULATION HEALTH MANAGEMENT UNDERSTAND THE MARKET EVOLUTION KNOW YOUR POPULATIONS ARTICULATE YOUR VALUE PROPOSITION ALIGN ECONOMICS THROUGH PAYOR PORTFOLIO, INCENTIVE DISTRIBUTION AND RESOURCE MANAGEMENT ADVANCE CLINCAL MANAGEMENT & CARE MODELS ENGAGE PROVIDER & COMMUNITY PARTNERS SEGMENT & STRATIFY POPULATIONS PROMOTE CONSUMER ENGAGEMENT & ACCESS CREATE AND DEPLOY POWERFUL INFORMATION THROUGH TECHNOLOGY & ANALYTICS UNIFIED LEADERSHIP AND CULTURE 11

12 Lessons Learned from Providers Experiences They are starting in different places but several key lessons emerge from early successes and failures of providers managing population health. Define an enterprise vision to guide decisions on when and how to move to increased risk Balancing an understanding of the market, the population served and the enterprise value proposition Understand populations across multiple dimensions Using different segmentation and stratification techniques for various applications Take an integrated approach to meet a population s needs Securing commercial growth through a value-based arrangement Improving access and quality for an underserved Medicaid population Mature from a narrow program to a comprehensive solution Moving to the next level in PHM 12

13 1. Define an Enterprise Vision to Guide the Transition to Risk Understand the Market Evolution: How is the market expected to evolve in the coming 3 to 5 years? e.g., Healthcare financing and implications for care delivery models, capabilities requirements and reimbursement mechanisms Purchasing behaviors of population segments Competitive positions and aspirations of other providers Potential evolution of the health plan market Know your Populations: What populations do you manage today? How may the needs of these populations change over time? What will be required to maintain or deepen existing relationships with these populations? To manage the health of additional populations? Articulate your Value Proposition: How does population health management fit within the broader enterprise vision and strategy? What is your organization uniquely positioned to offer the market to disrupt the current competitive environment and create new / lasting value? 13

14 Participant Poll Has your organization defined an enterprise vision for PHM? (select one) Yes 52% No 38% Don't know 10% 14

15 2. Understand Populations Across Multiple Dimensions At different levels Leading providers understand their populations along multiple dimensions and use different definitions to direct various activities and priorities. SEGMENT & STRATIFY POPULATIONS Disease Condition / Health Status Utilization Patterns Along different dimensions Risk Factors Geography Socio- Economic Status Social Needs Preferences and Attitudes Example Definitions The Entire Population Targeted by the System All patients the system touched in the last three years All lives in a particular geography The Population of Interest Individuals admitted more than once in the past 12 months Individuals with Heart Failure Medicare beneficiaries attributed to ACO via primary care Individuals with multiple chronic conditions The Population of Intervention Patients with Heart Failure at risk for treatment non-adherence Individuals from a specific geography with multiple chronic conditions and social needs, e.g., transportation Individuals with COPD who actively seek services and information online 15

16 2. Understand Populations Across Multiple Dimensions The Population of Interest All patients with diabetes seen 1+ in 3 years The Population of Intervention Granular Quality Reporting Officebased Systematic Team Care Embedded RN Care Management Support Disease Management Education and Support Example Interventions AP or Pharmacist DM-Focused MTM Program Community Health Agent/ Social Work Support Transportation Vouchers Advanced Personalized Education and Lifestyle Change Program A. Multi-comorbid conditions B. Newly diagnosed DM C. Poorly controlled DM despite 6 months redesigned systems of care approach D. 3+ admissions in the last 6 months E. Poor visit adherence due to transportation issues All patients with DM, plus: F. Social needs G. Preference for no use of medications 16

17 3. Take an Integrated Approach to Meet a Population s Needs Securing commercial growth through a value-based arrangement Non-profit health system with 7 hospitals, ~2,500 aligned physicians Entered into a two-sided shared savings arrangement with a commercial payor to manage a population of ~150,000 lives Enterprise Vision Leadership and Culture Desired a different payor-provider relationship, sensitive to community mission Leadership broadly discussing total cost of care (TCOC) and Pioneer ACO options Aligned Economics TCOC with commercial payor, based on beating market trend by at least 0.5%; embedded within physician compensation model as a significant bonus pool associated with TCOC/quality/service/access metrics Population Segmentation & Stratification Advanced Clinical Management and Care Models Consumer Engagement & Access Provider & Community Partner Engagement Powerful Information Focused on commercial patients in high risk and high utilization categories Use of virtual care, online patient self-management tools, clinical guidelines and PCMH based care coordination Development of a single access point for all health plan and medical care needs to support healthcare triage, appointments and benefits management through one source Engaged physicians in 72 site dissemination of PCMH, regional practice management model and medical group governance model Early TCOC and utilization profiling in partnership with payor 17

18 3. Take an Integrated Approach to Meet a Population s Needs Improving access and quality for an underserved Medicaid population Safety net ACO formed as a collaboration between public health and social service agencies, several health systems, an FQHC and a health plan serving Medicaid and Medicare enrollees Assumed full-risk for Medicaid expansion beneficiaries enrolled in the plan, starting with ~10,000 lives Enterprise Vision Mission driven organization with focus on underserved populations Leadership and Culture Aligned Economics Population Segmentation & Stratification Advanced Clinical Management and Care Models Consumer Engagement & Access Provider & Community Partner Engagement Powerful Information Senior team dedicated to PHM and has focused many operational opportunities to support transformation TCOC contracting for Medicaid and early capitation programs; implemented modest scope through a provider-sponsored Medicaid plan Geographic segmentation plus risk stratification informed by healthcare utilization, physical and behavioral health conditions PCMH, care coordination models, specialized clinics for frail and complex patients and deployed community health workers Tailored engagement plans developed for high-risk individuals through care coordination model Many community service partnerships, investing in own community-based services Real time alerts to PCMH for ED visits; patient-level dashboard customized based on type of provider 18

19 4. Mature from a Narrow Program to a Comprehensive Solution Narrow Initiative Expanding Effort Comprehensive Approach Enterprise Vision Better Elderly Chronic Disease Care Every Patient Touched Total Community Care Leadership and Culture Aligned Economics Population Segmentation & Stratification Advanced Clinical Management and Care Models Consumer Engagement & Access Provider & Community Partner Engagement Powerful Information Driven primarily by primary care and health plan leaders, select specialty leaders Medicare Advantage 20% of physician comp performance-based All patients seen 1+ times in 3 years with diabetes mellitus; expanded to other chronic diseases over time Office based systems of care, team care, EHR optimization Patient portal, patient specific report cards, proxy/family electronic access Internally, primary care highly engaged, specialty care engagement varied by service line Active registry reports; granular quality, utilization reports for population of interest + Commercial (1/3 of patients) + Addition of population payment for PCPs for non-rvu work All patients seen 1+ times in 3 years + Tiered care management support, proactive outreach, outreach ATC + Additional report cards + Expansion of population using portal + Began unidirectional data tracking of community entities + Refinement of reports and expansion of measures + Expanded population of interest Increased engagement by hospital leadership + community leaders + Managed Medicaid, grant and community support All people in a specified geography + Community health agents; community agency connectivity; program trainees integrated + Portal access to physician notes; HIE access to community records (pharmacy, community hospital, private physicians) + Engagement of hospital + Active programmatic connectivity including competing hospitals, community social agencies, university programs + Expanded population of interest, with limited data on non-patients 19

20 Participant Poll Where would you characterize your organization on the PHM journey? (select one) Narrow initiative(s) 49% Expanding effort 38% Comprehensive solution 8% Don't know 6% 20

21 An Integrated, Iterative Approach to Population Health Management ENTERPRISE VISION FOR POPULATION HEALTH MANAGEMENT UNDERSTAND THE MARKET EVOLUTION KNOW YOUR POPULATIONS ARTICULATE YOUR VALUE PROPOSITION ALIGN ECONOMICS THROUGH PAYOR PORTFOLIO, INCENTIVE DISTRIBUTION AND RESOURCE MANAGEMENT ADVANCE CLINCAL MANAGEMENT & CARE MODELS ENGAGE PROVIDER & COMMUNITY PARTNERS SEGMENT & STRATIFY POPULATIONS PROMOTE CONSUMER ENGAGEMENT & ACCESS CREATE AND DEPLOY POWERFUL INFORMATION THROUGH TECHNOLOGY & ANALYTICS UNIFIED LEADERSHIP AND CULTURE 21

22 Questions??? 22

23 Upcoming Event Access additional information at 23

Population Health Management: Advancing your Position in the Journey to Value-Based Care

Population Health Management: Advancing your Position in the Journey to Value-Based Care Population Health Management: Advancing your Position in the Journey to Value-Based Care Population Health Management as a term serves as a helpful starting point to describe the evolution of care delivery

More information

6/12/2015. Dignity Health Population Health Management and Compliance Programs. Moving Towards Accountable Care. Dignity Health Poised for Innovation

6/12/2015. Dignity Health Population Health Management and Compliance Programs. Moving Towards Accountable Care. Dignity Health Poised for Innovation Dignity Health Population Health Management and Compliance Programs Julie Bietsch, VP Population Health Management Dawnese Kindelt, Senior Compliance Director, Clinical Integration June 8, 2015 Moving

More information

Improving Quality And Bending the Cost Curve: Strategies That Work

Improving Quality And Bending the Cost Curve: Strategies That Work Improving Quality And Bending the Cost Curve: Strategies That Work Lewis G. Sandy MD SVP, Clinical Advancement, UnitedHealth Group UnitedHealth Center for Health Reform and Modernization AcademyHealth

More information

POPULATION HEALTH MANAGEMENT The Lynchpin of Emerging Healthcare Delivery Improve Patient Outcomes, Engage Physicians, and Manage Risk

POPULATION HEALTH MANAGEMENT The Lynchpin of Emerging Healthcare Delivery Improve Patient Outcomes, Engage Physicians, and Manage Risk POPULATION HEALTH MANAGEMENT The Lynchpin of Emerging Healthcare Delivery Improve Patient Outcomes, Engage Physicians, and Manage Risk Julia Andrieni, MD, FACP Vice President, Population Health and Primary

More information

Population Health Management: Leveraging Data and Analytics to Achieve Value. White Paper. A Special Report

Population Health Management: Leveraging Data and Analytics to Achieve Value. White Paper. A Special Report Authors Carol Cassell CTG Health Solutions John Kontor, MD Clinovations Lisa Shah, MD, MAPP Clinovations Contributors Marla Roberts, DrPH, RN CTG Health Solutions Katie Stevenson Clinovations : Leveraging

More information

Montefiore s Population Health Management Services. October 23, 2015

Montefiore s Population Health Management Services. October 23, 2015 Montefiore s Population Health Management Services October 23, 2015 Integrated Delivery System Our Locations 3,092 Acute Beds Across 10 Hospitals Including 132 beds at the Children s Hospital at Montefiore

More information

New York Presbyterian Innovations in Health Care Reform at Academic Medical Centers

New York Presbyterian Innovations in Health Care Reform at Academic Medical Centers New York Presbyterian Innovations in Health Care Reform at Academic Medical Centers October 28, 2011 Timothy G Ferris, MD, MPH Mass General Physicians Organization, Medical Director Associate Professor,

More information

Population Health Management Primer

Population Health Management Primer Population Health Management Primer A White Paper October 2014 Impact Advisors LLC 400 E. Diehl Road Suite 190 Naperville IL 60563 1-800- 680-7570 Impact- Advisors.com Table of Contents What Is Population

More information

ACOs: Six Things Specialty Practices Should Know

ACOs: Six Things Specialty Practices Should Know ACOs: Six Things Specialty Practices Should Know =TOS Newsletter, July/August 2014= Authors: John P. Schmitt, Ph.D. and J. Garrett Schmitt, MBA, PCMH CCE INTRODUCTION Do you remember the analogy of four

More information

CMS Innovation Center Improving Care for Complex Patients

CMS Innovation Center Improving Care for Complex Patients CMS Innovation Center Improving Care for Complex Patients ECRI Institute Dr. Patrick Conway, M.D., MSc CMS Chief Medical Officer and Deputy Administrator for Innovation and Quality Director, Center for

More information

Building an Accountable Care Organization. Jean Malouin, MD MPH University of Michigan Health System September 21, 2012

Building an Accountable Care Organization. Jean Malouin, MD MPH University of Michigan Health System September 21, 2012 Building an Accountable Care Organization Jean Malouin, MD MPH University of Michigan Health System September 21, 2012 Agenda UMHS overview PGP demo ACO precursor Current efforts underway Role of primary

More information

Guide to Population Health Management

Guide to Population Health Management Guide to Population Health Management presented by the Healthcare Intelligence Network Note: This is an authorized excerpt from the Guide to Population Health Management. To download the entire guide,

More information

Practice and Transformation Taskforce: CCIP. Design Group 3, Session 2: Technology Enablers & Monitoring Performance August 20 th, 2015

Practice and Transformation Taskforce: CCIP. Design Group 3, Session 2: Technology Enablers & Monitoring Performance August 20 th, 2015 Practice and Transformation Taskforce: CCIP Design Group 3, Session 2: Technology Enablers & Monitoring Performance August 20 th, 2015 1 Meeting Agenda Item 1. Meeting Objectives Allotted Time 5 min 2.

More information

Leading the Conversation: New Channels for Provider Contracting

Leading the Conversation: New Channels for Provider Contracting WHITE PAPER Leading the Conversation: New Channels for Provider Contracting Author: Cindy Lee On the vanguard of thought. On the front lines of ac on. Leading the Conversation: New Channels for Provider

More information

The 4 Pillars of Clinical Integration: A Flexible Model for Hospital- Physician Collaboration

The 4 Pillars of Clinical Integration: A Flexible Model for Hospital- Physician Collaboration The 4 Pillars of Clinical Integration: A Flexible Model for Hospital- Physician Collaboration Written by Daniel J. Marino, President & CEO, Health Directions November 14, 2012 Originally published by Becker

More information

CPR-PBGH Toolkit for Purchasers on Accountable Care Organizations. June 26, 2014

CPR-PBGH Toolkit for Purchasers on Accountable Care Organizations. June 26, 2014 CPR-PBGH Toolkit for Purchasers on Accountable Care Organizations June 26, 2014 Overview Introductions The Current ACO Landscape ACO Options Available to Employers Today Features of the Ideal ACO CPR-PBGH

More information

Use Facility Image if available How to Select the Right Pop Health Vendor for Your Organization

Use Facility Image if available How to Select the Right Pop Health Vendor for Your Organization Use Facility Image if available How to Select the Right Pop Health Vendor for Your Organization May 19, 2016 Agenda I. Case Study: Illinois Partnership for Heath (IPH) II. Population Health Management

More information

Program Description and FAQ s 2016 Medicare Shared Savings Program Year

Program Description and FAQ s 2016 Medicare Shared Savings Program Year and FAQ s 2016 Medicare Shared Savings Program Year Who is the National Rural Accountable Care Consortium? The National Rural Accountable Care Consortium was formed in 2013 to pool knowledge, patients,

More information

Population Health Management Systems

Population Health Management Systems Population Health Management Systems What are they and how can they help public health? August 18, 1:00 p.m. 2:30 p.m. EDT Presented by the Public Health Informatics Working Group Webinar sponsored by

More information

Response to Serving the Medi Cal SPD Population in Alameda County

Response to Serving the Medi Cal SPD Population in Alameda County Expanding Health Coverage and Increasing Access to High Quality Care Response to Serving the Medi Cal SPD Population in Alameda County As the State has acknowledged in the 1115 waiver concept paper, the

More information

Program Description and FAQ s 2016 Medicare Shared Savings Program Year

Program Description and FAQ s 2016 Medicare Shared Savings Program Year and FAQ s 2016 Medicare Shared Savings Program Year Who is the National Rural ACO? The National Rural ACO was formed in 2013 to pool knowledge, patients, and resources so that independent community health

More information

Accountable Care Communities 101. Jennifer M. Flynn, Esq. Senior Director, State Affairs Premier healthcare alliance January 30, 2014

Accountable Care Communities 101. Jennifer M. Flynn, Esq. Senior Director, State Affairs Premier healthcare alliance January 30, 2014 Accountable Care Communities 101 Jennifer M. Flynn, Esq. Senior Director, State Affairs Premier healthcare alliance January 30, 2014 Premier is the largest healthcare alliance in the U.S. Our Mission:

More information

Pushing the Boundaries of Population Health Management: How University Hospitals Launched Three ACOs July 26, 2013 American Hospital Association

Pushing the Boundaries of Population Health Management: How University Hospitals Launched Three ACOs July 26, 2013 American Hospital Association Pushing the Boundaries of Population Health Management: How University Hospitals Launched Three ACOs July 26, 2013 American Hospital Association Eric J. Bieber, M.D. Chief Medical Officer, University Hospitals

More information

Population Health Solutions for Employers MEDIA RESOURCES

Population Health Solutions for Employers MEDIA RESOURCES Population Health Solutions for Employers MEDIA RESOURCES ABOUT MISSIONPOINT MissionPoint s mission is to make healthcare more affordable, accessible and improve the quality of care for our members. MissionPoint

More information

Pushing the Envelope of Population Health

Pushing the Envelope of Population Health Pushing the Envelope of Population Health Timothy Ferris, MD, MPH Senior Vice President, Population Health Management, Partners HealthCare May 15, 2014 DISCLAIMER: The views and opinions expressed in this

More information

Clinically Integrated Networks and Accountable Care Organizations

Clinically Integrated Networks and Accountable Care Organizations Clinically Integrated Networks and Accountable Care Organizations 1 Do Nothing 2 Become Someone s Employee 3 Join a Network Provider The wake up call is for POPULATION health management managing clinical

More information

The Emergence of Innovative Payor-Provider Partnerships

The Emergence of Innovative Payor-Provider Partnerships The Emergence of Innovative Payor-Provider Partnerships Traditionally, providers and payors have had, at best, an arms-length relationship. Interactions are often Provider organizations limited to negotiations

More information

Five Myths Surrounding the Business of Population Health Management

Five Myths Surrounding the Business of Population Health Management Five Myths Surrounding the Business of Population Health Management Joan Moss, RN, MSN Robert Sehring Chief Nursing Officer and Chief Ministry Services Officer, Senior Vice President, Sg2 OSF HealthCare

More information

Helping You Achieve Better Clinical and Financial Health

Helping You Achieve Better Clinical and Financial Health McKesson Business Performance Services Accountable Care Services Helping You Achieve Better Clinical and Financial Health 1 We recognized that fee-for-service would decrease and value-based care would

More information

Future of Health Care: How Do You Fit In? Physician Leadership Institute February 28, 2015 Brian M. McCook, CPA

Future of Health Care: How Do You Fit In? Physician Leadership Institute February 28, 2015 Brian M. McCook, CPA Future of Health Care: How Do You Fit In? Physician Leadership Institute February 28, 2015 Brian M. McCook, CPA Learning Objectives Industry Transitions Challenges and Changes ACO s Look at the Future

More information

Proven Innovations in Primary Care Practice

Proven Innovations in Primary Care Practice Proven Innovations in Primary Care Practice October 14, 2014 The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA. 2014 Society for Healthcare

More information

Identifying High-Risk Medicare Beneficiaries with Predictive Analytics

Identifying High-Risk Medicare Beneficiaries with Predictive Analytics Identifying High-Risk Medicare Beneficiaries with Predictive Analytics September 2014 Until recently, with the passage of the Affordable Care Act (ACA), Medicare Fee-for-Service (FFS) providers had little

More information

Early Lessons learned from strong revenue cycle performers

Early Lessons learned from strong revenue cycle performers Healthcare Informatics June 2012 Accountable Care Organizations Early Lessons learned from strong revenue cycle performers Healthcare Informatics Accountable Care Organizations Early Lessons learned from

More information

ACCOUNTABLE CARE ANALYTICS: DEVELOPING A TRUSTED 360 DEGREE VIEW OF THE PATIENT

ACCOUNTABLE CARE ANALYTICS: DEVELOPING A TRUSTED 360 DEGREE VIEW OF THE PATIENT ACCOUNTABLE CARE ANALYTICS: DEVELOPING A TRUSTED 360 DEGREE VIEW OF THE PATIENT Accountable Care Analytics: Developing a Trusted 360 Degree View of the Patient Introduction Recent federal regulations have

More information

Ohio s strategy to enroll primary care practices in the federal Comprehensive Primary Care Plus (CPC+) Program

Ohio s strategy to enroll primary care practices in the federal Comprehensive Primary Care Plus (CPC+) Program Ohio s strategy to enroll primary care practices in the federal Comprehensive Primary Care Plus (CPC+) Program Greg Moody, Director Governor s Office of Health Transformation Webinar for Primary Care Practices

More information

Maximize the value of your COPD population health programs with advanced analytics PLAYBOOK

Maximize the value of your COPD population health programs with advanced analytics PLAYBOOK Maximize the value of your COPD population health programs with advanced analytics PLAYBOOK STEP ONE: Analyze your patient population Bend the cost curve: Learning more about your patients can lead to

More information

ACOs. ACO Definition. ACO Governance. Stuart B Black MD, FAAN Chief of Neurology Co-Director: Neurosciences Baylor University Medical Center at Dallas

ACOs. ACO Definition. ACO Governance. Stuart B Black MD, FAAN Chief of Neurology Co-Director: Neurosciences Baylor University Medical Center at Dallas Stuart B Black MD, FAAN Chief of Neurology Co-Director: Neurosciences Baylor University Medical Center at Dallas ACOs ACO Definition CMS definition of ACO Accountable Care Organizations (ACOs) are groups

More information

Enhanced Personal Health Care Program

Enhanced Personal Health Care Program Enhanced Personal Health Care Program Documents included in the Recruitment Packet: Program Summary FAQ Checklist List of Program Information Form Questions Member Medical History Plus (MMH+) access form

More information

New Business and Investment Opportunities Emerging from Population Health Management (PHM)

New Business and Investment Opportunities Emerging from Population Health Management (PHM) Stax s Perspective on Changes Driven by PHM New Business and Investment Opportunities Emerging from Population Health Management (PHM) By Natalie De Fazio, Director, Stax Inc. November 2014 New Business

More information

Population Health Management Innovation Payer and Provider Collaboration. Population Health Management Innovation Payer and Provider Collaboration

Population Health Management Innovation Payer and Provider Collaboration. Population Health Management Innovation Payer and Provider Collaboration Population Health Management Innovation Payer and Provider Collaboration Population Health Management Innovation Payer and Provider Collaboration Agenda Strategic Context Population Health Journey Key

More information

Analytics: The Key Ingredient for the Success of ACOs

Analytics: The Key Ingredient for the Success of ACOs Analytics: The Key Ingredient for the Success of ACOs Author: Senthil Raja Velusamy Business Analyst Healthcare Center of Excellence Executive Summary Accountable Care Organizations (ACOs) are structured

More information

Best Practices and Strategies to Engage ACOs, Incentive Programs and Emerging Payment Models JUSTIN T. BARNES

Best Practices and Strategies to Engage ACOs, Incentive Programs and Emerging Payment Models JUSTIN T. BARNES Best Practices and Strategies to Engage ACOs, Incentive Programs and Emerging Payment Models JUSTIN T. BARNES CHAIRMAN EMERITUS, EHR ASSOCIATION CO-CHAIR, ACCOUNTABLE CARE COMMUNITY OF PRACTICE About Justin

More information

Be Careful What You Ask For A Predictive Model That Really Works

Be Careful What You Ask For A Predictive Model That Really Works Be Careful What You Ask For A Predictive Model That Really Works Rod Christensen, MD President, Allina Health Clinics Cheryl Hermann, RN, MBA Vice President, Clinic Operations & Patient Care Services Karen

More information

ACO s as Private Label Insurance Products

ACO s as Private Label Insurance Products ACO s as Private Label Insurance Products Creating Value for Plan Sponsors Continuing Education: November 19, 2013 Clarence Williams Vice President Client Strategy Accountable Care Solutions Today s discussion

More information

Capital District Physicians Health Plan, Inc. Nonprofit Health Plan Albany, New York

Capital District Physicians Health Plan, Inc. Nonprofit Health Plan Albany, New York Capital District Physicians Health Plan, Inc. Nonprofit Health Plan Albany, New York Capital District Physicians Health Plan, Inc. (CDPHP ) is featured as a high performer in cardiovascular care, identified

More information

Introduction to the GLPTN Program. Provider Office & Physician Organization Briefing

Introduction to the GLPTN Program. Provider Office & Physician Organization Briefing Introduction to the GLPTN Program Provider Office & Physician Organization Briefing What is the GLPTN? The GLPTN is one of 29 Practice Transformation Networks (PTNs) funded under the brand new CMS Transforming

More information

How-To Guide: Accountable Care Organizations

How-To Guide: Accountable Care Organizations How-To Guide: Accountable Care Organizations How to Use this Guide The information in this guide is intended to be used primarily by self-funded purchasers of health care who are interested in understanding

More information

1115 Medicaid Waiver Programs Section1115 of the Social Security Act allows CMS the authority to approve state demonstration projects that improve care, increase efficiency, and reduce costs related to

More information

A Close Look at Care Coordination within Patient-Centered Medical Homes: West Virginia s Experience

A Close Look at Care Coordination within Patient-Centered Medical Homes: West Virginia s Experience A Close Look at Care Coordination within Patient-Centered Medical Homes: West Virginia s Experience Web Seminar May 9, 2013 Follow this event on Twitter Hashtag: #AHRQIX Using the Webcast Console and Submitting

More information

Dual RFI Response Summary

Dual RFI Response Summary Dual RFI Response Summary Improving Care through Integrated Medicare and Medi- Cal Delivery Models Stuart Levine, MD., MHA. Keith Wilson, MD Robert Margolis, MD. Stakeholder Meeting August 30, 2011 1 Organization

More information

T h e M A RY L A ND HEALTH CARE COMMISSION

T h e M A RY L A ND HEALTH CARE COMMISSION T h e MARYLAND HEALTH CARE COMMISSION Discussion Topics Overview Learning Objectives Electronic Health Records Health Information Exchange Telehealth 2 Overview - Maryland Health Care Commission Advancing

More information

The Medicare Shared Savings Program

The Medicare Shared Savings Program The Medicare Shared Savings Program Centers for Medicare & Medicaid Services Jonathan Blum, Deputy Administrator & Director, Center for Medicare May 20, 2011 Overview CMS s vision of its ACO program Summary

More information

E. Christopher Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences

E. Christopher Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences Accountable Care Organizations and You E. Christopher Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences CEO, OSU Faculty Group Practice Chair, Department of Surgery Ohio State University

More information

The Evolving Nature of Accountable Care. Results from the 2015 ACO Survey

The Evolving Nature of Accountable Care. Results from the 2015 ACO Survey The Evolving Nature of Accountable Care Results from the 2015 ACO Survey BACKGROUND Accountable care organizations (ACOs) are voluntary networks of healthcare providers that have agreed to work together

More information

Accountability and Innovation in Care Delivery Models

Accountability and Innovation in Care Delivery Models Accountability and Innovation in Care Delivery Models Lisa McDonnel Senior Vice President, Network Strategy & Innovation, United Healthcare November 6, 2015 Today s discussion topics Vision Our strategic

More information

Population health management:

Population health management: GE Healthcare Population health management: Navigating successfully from volume to value In the new world of value-based care and risk-sharing compensation, success will depend on how well provider organizations

More information

Analytic-Driven Quality Keys Success in Risk-Based Contracts. Ross Gustafson, Vice President Allina Performance Resources, Health Catalyst

Analytic-Driven Quality Keys Success in Risk-Based Contracts. Ross Gustafson, Vice President Allina Performance Resources, Health Catalyst Analytic-Driven Quality Keys Success in Risk-Based Contracts March 2 nd, 2016 Ross Gustafson, Vice President Allina Performance Resources, Health Catalyst Brian Rice, Vice President Network/ACO Integration,

More information

An Overview of Clinical Integration, ACOs and Risk Contracting

An Overview of Clinical Integration, ACOs and Risk Contracting An Overview of Clinical Integration, ACOs and Risk Contracting November 9, 2012 Todd Fitz Vice President Strategic Advisory Services Agenda Review factors driving evolution toward value-based care Outline

More information

Steven E. Ramsland, Ed.D., Senior Associate, OPEN MINDS The 2015 OPEN MINDS Performance Management Institute February 13, 2015 10:15am 11:30am

Steven E. Ramsland, Ed.D., Senior Associate, OPEN MINDS The 2015 OPEN MINDS Performance Management Institute February 13, 2015 10:15am 11:30am Steven E. Ramsland, Ed.D., Senior Associate, OPEN MINDS The 2015 OPEN MINDS Performance Management Institute February 13, 2015 10:15am 11:30am The execution or accomplishment of work, acts, or feats The

More information

Models of Value-Based Reimbursement A Valence Health Primer

Models of Value-Based Reimbursement A Valence Health Primer Models of Value-Based Reimbursement A Valence Health Primer Today s hospitals and other healthcare providers who deliver traditional, fee-for-service medicine are in the midst of navigating significant

More information

c. determine the factors that will facilitate/limit physician utilization of pharmacists for medication management services.

c. determine the factors that will facilitate/limit physician utilization of pharmacists for medication management services. Consumer, Physician, and Payer Perspectives on Primary Care Medication Management Services with a Shared Resource Pharmacists Network Marie Smith, PharmD and Michlle Breland, PhD University of Connecticut,

More information

CMS Physician Quality Reporting Programs Strategic Vision

CMS Physician Quality Reporting Programs Strategic Vision CMS Physician Quality Reporting Programs Strategic Vision FINAL DRAFT March 2015 1 EXECUTIVE SUMMARY As the largest payer of healthcare services in the United States, the Centers for Medicare & Medicaid

More information

Premier ACO Collaboratives Driving to a Patient-Centered Health System

Premier ACO Collaboratives Driving to a Patient-Centered Health System Premier ACO Collaboratives Driving to a Patient-Centered Health System As a nation we all must work to rein in spiraling U.S. healthcare costs, expand access, promote wellness and improve the consistency

More information

MODULE 11: Developing Care Management Support

MODULE 11: Developing Care Management Support MODULE 11: Developing Care Management Support In this module, we will describe the essential role local care managers play in health care delivery improvement programs and review some of the tools and

More information

I n t e r S y S t e m S W h I t e P a P e r F O R H E A L T H C A R E IT E X E C U T I V E S. In accountable care

I n t e r S y S t e m S W h I t e P a P e r F O R H E A L T H C A R E IT E X E C U T I V E S. In accountable care I n t e r S y S t e m S W h I t e P a P e r F O R H E A L T H C A R E IT E X E C U T I V E S The Role of healthcare InfoRmaTIcs In accountable care I n t e r S y S t e m S W h I t e P a P e r F OR H E

More information

ACOs are like unicorns mythical creatures. We know what they look like, but no one has seen one. *

ACOs are like unicorns mythical creatures. We know what they look like, but no one has seen one. * Understanding Accountable Care Organizations (ACOs): What s Worked and What Hasn t in California s 30 Year ACO Experience ACOs are like unicorns mythical creatures. We know what they look like, but no

More information

VALUE BASED PURCHASING

VALUE BASED PURCHASING HEALTH WEALTH CAREER VALUE BASED PURCHASING EMPLOYEE BENEFITS PLANNING ASSOCIATION MARY KAY O NEILL, MD, MBA FEBRUARY 25, 2016 WHAT ARE THE GOALS OF ACOS AND VBCS? A fundamental shift in how health care

More information

CMS Quality Measurement and Value Based Purchasing Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS

CMS Quality Measurement and Value Based Purchasing Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS CMS Quality Measurement and Value Based Purchasing Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS American Urological Association Quality Improvement Summit

More information

Performance Measurement in CMS Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS

Performance Measurement in CMS Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS Performance Measurement in CMS Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS Mind the Gap: Improving Quality Measures in Accountable Care Systems October

More information

The Changing Face of Healthcare: Challenges & Solutions. Mark Stauder, President/COO

The Changing Face of Healthcare: Challenges & Solutions. Mark Stauder, President/COO The Changing Face of Healthcare: Challenges & Solutions Mark Stauder, President/COO Disclosure of Relevant Financial Relationship with Commercial Companies/Organizations Mark Stauder has disclosed financial

More information

POPULATION HEALTH ANALYTICS

POPULATION HEALTH ANALYTICS POPULATION HEALTH ANALYTICS ANALYTICALLY-DRIVEN INSIGHTS FOR POPULATION HEALTH LAURIE ROSE, PRINCIPAL CONSULTANT HEALTH CARE GLOBAL PRACTICE DISCUSSION TOPICS Population Health: What & Why Now? Population

More information

Delivery System Innovation

Delivery System Innovation Healthcare Transformation Concepts and Definitions Our healthcare transformation process is invigorated by many stakeholders with differing backgrounds. To help them with new terms and all of us to use

More information

Population Health Management Helps Utica Park Clinic Ease the Transition to Value-Based Care

Population Health Management Helps Utica Park Clinic Ease the Transition to Value-Based Care CASE STUDY Utica Park Clinic Population Health Management Helps Utica Park Clinic Ease the Transition to Value-Based Care The transition from fee-for-service to value-based reimbursement has been a challenge

More information

Designing the Role of the Embedded Care Manager

Designing the Role of the Embedded Care Manager Designing the Role of the Embedded By Patricia Hines, Ph.D., RN and Marge Mercury, RN, MS, CMCE The Embedded The use of an Embedded ( ECM ) to coordinate within the complex delivery system is sharply increasing.

More information

ACOs: Impacting the Past, Present and Future State of Healthcare

ACOs: Impacting the Past, Present and Future State of Healthcare ACOs: Impacting the Past, Present and Future State of Healthcare Article By Alan Cudney, RN, CPHQ, PMP, FACHE, Executive Consultant October 2012 What are Accountable Care Organizations? Can they help us

More information

Pediatric Alliance: A New Solution Built on Familiar Values. Empowering physicians with an innovative pediatric Accountable Care Organization

Pediatric Alliance: A New Solution Built on Familiar Values. Empowering physicians with an innovative pediatric Accountable Care Organization Pediatric Alliance: A New Solution Built on Familiar Values Empowering physicians with an innovative pediatric Accountable Care Organization BEYOND THE TRADITIONAL MODEL OF CARE Children s Health SM Pediatric

More information

Advisory Panel for Health Care Advancing the Academic Health System for the Future: Profiles in Academic Health System Leadership.

Advisory Panel for Health Care Advancing the Academic Health System for the Future: Profiles in Academic Health System Leadership. Advisory Panel for Health Care Advancing the Academic Health System for the Future: Profiles in Academic Health System Leadership November, 2013 Project Focus and Methodology Project Focus This project

More information

Population Health Management (PHM) January 29, 2014

Population Health Management (PHM) January 29, 2014 Population Health Management (PHM) January 29, 2014 1 Agenda What is PHM? What is triggering the need for PHM? Why Now? What are 5 steps to a reasonable PHM strategy? What s a Physician s perspective of

More information

Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed?

Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed? Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed? Accountable Care Organizations: Implications for Consumers October 14, 2010 Washington, DC Sam Nussbaum, M.D. Executive Vice

More information

Federal Health Care Reform: Implications for Hospital and Physician partnerships. Walter Kopp Medical Management Services

Federal Health Care Reform: Implications for Hospital and Physician partnerships. Walter Kopp Medical Management Services Federal Health Care Reform: Implications for Hospital and Physician partnerships Walter Kopp Medical Management Services Outline Overview of federal health reform legislation Implications for Care delivery

More information

DRIVING VALUE IN HEALTHCARE: PERSPECTIVES FROM TWO ACO EXECUTIVES, PART I

DRIVING VALUE IN HEALTHCARE: PERSPECTIVES FROM TWO ACO EXECUTIVES, PART I DRIVING VALUE IN HEALTHCARE: PERSPECTIVES FROM TWO ACO EXECUTIVES, PART I A firm understanding of the key components and drivers of healthcare reform is increasingly important within the pharmaceutical,

More information

TTM Informer. Fourth Quarter 2012 - Issue 1 WELCOME TO THE TTM INFORMER

TTM Informer. Fourth Quarter 2012 - Issue 1 WELCOME TO THE TTM INFORMER TTM Informer Fourth Quarter 2012 - Issue 1 In This Issue: Provider Outreach within Accountable Care Organizations...1 What are Heathcare Leaders Saying?...2 PROVIDER OUTREACH WITHIN ACCOUNTABLE CARE ORGANIZATIONS

More information

Medicaid Payment and Delivery System Reforms: Minnesota s Experience

Medicaid Payment and Delivery System Reforms: Minnesota s Experience Medicaid Payment and Delivery System Reforms: Minnesota s Experience NATHAN MORACCO ASSISTANT COMMISSIONER MINNESOTA DEPARTMENT OF HUMAN SERVICES MARCH 2014 Overview A little Minnesota context Past Minnesota

More information

kaiser medicaid commission on and the uninsured May 2009 Community Care of North Carolina: Putting Health Reform Ideas into Practice in Medicaid

kaiser medicaid commission on and the uninsured May 2009 Community Care of North Carolina: Putting Health Reform Ideas into Practice in Medicaid P O L I C Y B R I E F kaiser commission on medicaid SUMMARY and the uninsured Community Care of North Carolina: Putting Health Reform Ideas into Practice in Medicaid May 2009 Why is Community Care of North

More information

Technology and Hawaii s Independent Physician:

Technology and Hawaii s Independent Physician: Technology and Hawaii s Independent Physician: From EMR / EHR and Meaningful Use to Transformation Presentation for the Honolulu Subarea Health Planning Council Carl Barton, Director of Business Development

More information

Sharp HealthCare ACO. Pioneer Introduction to the FSSB November 8, 2012

Sharp HealthCare ACO. Pioneer Introduction to the FSSB November 8, 2012 Sharp HealthCare ACO Pioneer Introduction to the FSSB November 8, 2012 Sharp HealthCare Not-for-profit serving 3.1 million residents of San Diego County Grew from one hospital in 1955 to an integrated

More information

Summary of the Final Medicaid Redesign Team (MRT) Report A Plan to Transform The Empire State s Medicaid Program

Summary of the Final Medicaid Redesign Team (MRT) Report A Plan to Transform The Empire State s Medicaid Program Summary of the Final Medicaid Redesign Team (MRT) Report A Plan to Transform The Empire State s Medicaid Program May 2012 This document summarizes the key points contained in the MRT final report, A Plan

More information

Ron Stock MD MA Oregon Rural Health Conference October 24, 2013

Ron Stock MD MA Oregon Rural Health Conference October 24, 2013 Ron Stock MD MA Oregon Rural Health Conference October 24, 2013 Provide a historical context for healthcare reform including the 2010 Patient Protection & Accountable Care Act Connect what is known to

More information

Pediatricians Implement Office-based Care Management Guided by Meaningful and Actionable Population Health Management

Pediatricians Implement Office-based Care Management Guided by Meaningful and Actionable Population Health Management Pediatricians Implement Office-based Care Management Guided by Meaningful and Actionable Population Health Management Changing needs of technology and data for successful coordinated care transformation

More information

The Value Quadrant of Healthcare Reform. 2008 Pharos Innovations, LLC. All Rights Reserved.

The Value Quadrant of Healthcare Reform. 2008 Pharos Innovations, LLC. All Rights Reserved. The Value Quadrant of Healthcare Reform ACOs in PPACA Provider Organizations or networked groups Accountable for quality, cost and overall care of defined population of Medicare FFS benes Key metrics to

More information

Using Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare

Using Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare December 2010 Using Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare CONTENTS Background... 2 Problems with the Shared Savings Model... 2 How

More information

Primary Care, ACOs, and Payment Reform

Primary Care, ACOs, and Payment Reform Primary Care, ACOs, and Payment Reform Mark McClellan, MD, PhD Director, Initiatives on Value and Innovation in Health Care Engelberg Center for Healthcare Reform Senior Fellow, Economic Studies The Brookings

More information

Emerging Technologies That Support Transitions of Care. 8 June 2016 Elaine Remmlinger, Senior Partner, and Robin Settle, Partner

Emerging Technologies That Support Transitions of Care. 8 June 2016 Elaine Remmlinger, Senior Partner, and Robin Settle, Partner Emerging Technologies That Support Transitions of Care 8 June 2016 Elaine Remmlinger, Senior Partner, and Robin Settle, Partner Topics of Discussion Drivers of Transitions of Care Technology Perspective:

More information

Accountable Care Organizations. Rick Shinto, MD Aveta Health Inc. July 20, 2010

Accountable Care Organizations. Rick Shinto, MD Aveta Health Inc. July 20, 2010 Accountable Care Organizations Rick Shinto, MD Aveta Health Inc. July 20, 2010 1 Health Care Reform- New Models of Care Patient Protection and Affordable care Act (PPACA 2010) controlling costs and improving

More information

Advancing Accountable Care

Advancing Accountable Care Advancing Accountable Care Sean McBride Project Manager, Engelberg Center for Health Care Reform; Project Manager, ACO Learning Network Agenda 2. 4. Overview of national ACO Implementation: growing private

More information

ViewPoint Accountable Care Organizations

ViewPoint Accountable Care Organizations ViewPoint Accountable Care Organizations Improving the Quality and Accountability of Care for ACOs with Web- Based Technology As an ACO, if you are finding it difficult to manage your patient populations

More information

DST Webinar Population Health Management

DST Webinar Population Health Management DST Webinar Population Health Management December, 2014 2014 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with

More information

The New Health Care Model. Axel Arroyo, MD MPH

The New Health Care Model. Axel Arroyo, MD MPH The New Health Care Model Axel Arroyo, MD MPH Past Learning Objectives Which are the reasons behind these changes? To review the reasons of this transformation. To review Legislative initiatives (ARRA,

More information

Automating Population Health Management to Deliver Sustainable, High-Quality Care. Michael Matthews, CEO MedVirginia / inhealth

Automating Population Health Management to Deliver Sustainable, High-Quality Care. Michael Matthews, CEO MedVirginia / inhealth Automating Population Health Management to Deliver Sustainable, High-Quality Care Michael Matthews, CEO MedVirginia / inhealth Objectives Describe how to use technology to meet the challenges of population

More information

The Next Shiny Object: Understanding Accountable Care Organizations in the PCMH and Meaningful Use Context

The Next Shiny Object: Understanding Accountable Care Organizations in the PCMH and Meaningful Use Context The Next Shiny Object: Understanding Accountable Care Organizations in the PCMH and Meaningful Use Context 1 The Next Shiny Object: Understanding Accountable Care Organizations in the PCMH and Meaningful

More information