How To Understand An Accountable Care Organization

Transcription

1 Accountable Care Organizations and Wound Centers No Disclosures Peter F. Lawrence, MD Professor and Chief Division of Vascular Surgery University of California Los Angeles

2 Accountable Care Organization ACO "Accountable Care Organization" was first used by Elliott Fisher, director of The Dartmouth Institute for Health Policy and Clinical Practice, in 2006 at a meeting of the Medicare Payment Advisory Commission Included in the Patient Protection and Affordable Care Act (Obamacare) Although ACO term was not coined until 2006, it bears resemblance to the definition of the Health Maintenance Organization (HMO), which rose to prominence in the 1970s

3 ACO-Definition A set of health care providers including primary care physicians, specialists, and hospitals that work together collaboratively and accept collective accountability for the cost and quality of care delivered

4 ACO vs. HMO In an ACO, providers work together across varying specialties to develop delivery of care that is coordinated and focuses on health outcomes HMOs and their provider members are not held directly responsible for the health of their patients and are not evaluated on their overall effectiveness The patient is not required to participate in the ACO, as opposed to an HMO HMOs compete for patients with insurance companies and pay providers based on their volume of services Unlike HMOs, ACOs place accountability at the provider level, enabling them to target areas for decreasing cost per patient while ensuring improvement in patient outcomes

5 Benefits of the ACO Model Shared payment system allows us to use resources in a much more efficient way We re not limited by fee-for-service model where it s much more difficult to provide unified care and significantly increases the difficult of getting patients through the process as quickly and easily as possible ACO Model opens up options that have previously been limited or not possible before Multiple tests, procedures, and treatments can be performed within the ACO system Two options for shared savings- one with financial risk on the downside (100% return), and one with only upside benefit (50% shared)- UCLA has chosen the latter

6 ACO s Current Status 360 health systems have signed on Fewer ACOs have been created than had been expected at this point One half of the 114 ACOs that began in 2012 managed to slow Medicare spending in their first year Only 29 saved enough money to qualify for bonus payments As a whole, the ACOs have been successful enough to justify future spreading of the model UCLA has several ACO s Medicare FFS, Anthem PPO, UC Care, UCLA Medical group HMO, and Cigna PPO 150,000 patients with 50K at risk for wound care

7 ACOs The good the bad & the ugly These stats apply to the Medicare ACOs Since 2012 results have been mixed Fewer than 1/5 savings that could be shared between Medicare and providers in the ACO For the majority the costs of organizing and implementing the ACOs were higher than anticipated Due to anticipated health cost increases in the coming decade, payers see these clinically integrated networks as a platform for negotiating bundled payments as a new contracting vehicle

8 ACO s in Wound Care When HHS Secretary Kathleen Sebelius introduced ACO (Accountable Care Organization) regulations in 2011, the one example she gave was how an ACO could save money was by using an outpatient wound care center and avoiding readmission! As part of an Accountable Care Organization a hospital that follows up with a patient, [for example] to make sure she gets the right wound care, can share in the savings that comes when that patient has a successful recovery with no readmission.

9 ACO s in Wound Care With an ACO model, in wound care. There is a more coordinated plan of care delivered in a rapid fashion Goal of faster healing rates by identifying and triaging patients quickly and getting them the care they need A comprehensive EHR tracks wounds effectively and tracks clinical outcomes through benchmarking

10 4 Pillars of the Wound Care ACO The four pillars create significant improvement in healing rates while providing financial incentives for providers 1. Unified Data EPIC/Care Connect have already allowed for a universal view of the patients care and reporting data 2. Integration of Specialties, for example, podiatry, vascular surgery, general surgery, and plastic surgery 3. Creating and Improving Access to Care Pathways 4. Health System with a Financial Incentive providers will have financial skin in the game

11 The Current Picture 6.5 million patients in the US are affected by non-healing wounds 35.7% Of the US Population is Obese 82,000 Amputations occur annually from diabetes alone in the US 8.3% Of the US Population has Diabetes

12 Current Wound Care Pathway Without a clear direction, patients with non healing wounds often get lost in the healthcare system TOP ISSUES 1. Out of Network Costs 2. Non-Integrated Care 3. High Hospitalization Rates 4. Multiple Unnecessary Doctor Visits

13 Financial Impact-UCLA

14 Wound Healing Percent Analysis In 2012, with the utilization of the coordination of care and multi-disciplinary wound care team, our healing rates increased from 49% to 74% with a gradual increase every year

15 Wound Analysis Our EHR provides comprehensive wound analysis for every patient. Below is a snapshot of one of our patient s wound area and volume progress graph

16 Impact of Intervention Healed Ulcers N = 84 Healing Ulcers N = 26

17 Current UCLA Outpatient Wound Operations In many ways, the UCLA Center for Wound Healing and Limb Preservation is already operating and functioning like an ACO model Utilize an EHR that tracks benchmarks, clinical outcomes, financial statistics, and quality measures Through the implementation of EPIC (Care Connect), we are able to receive and send referrals from other physicians within the UCLA system UCLA medical group HMO patients are being referred to the home health companies and the DMEs within the system

18 Barriers To Implementation of an ACO Difficult to change the compensation for providers Difficult to measure and report quality of care across the board Difficult to change the health system