Heartland Rural Physician Alliance. Independent Physician Association Incorporated June 14, 2012

Transcription

1 Heartland Rural Physician Alliance Independent Physician Association Incorporated June 14, 2012

2 Discussion 1. Inception-CoOportunity Health 2. History 3. Care Coordination 4. Medicare ACO 5. Medicaid Health Home 6. Future

3 A health plan built for its members, by its members

4 Origin: Affordable Care Act Origin of CO-OPs embedded in the Patient Protection and Affordable Care Act (ACA) Health care CO-OPs were a late addition advocated by Sen. Kent Conrad (D-ND) and other rural state senators CO-OPs are a private sector alternative to the government option originally proposed CO-OPs predicated on the same concepts as cooperatives Member-owned and governed organizations formed for the common good of their members HHS/CMS oversight Operational no later than Jan. 1, 2014 CoOportunity Health 3/4/2013 4

5 Inception CoOportunity Health- will utilize a medical home program to fulfill its integrated care requirement for this grant application. (CoOportunity Health) will be the first private payer for medical home in Iowa, following the example of the Iowa Department of Human Services program

6 In order to provide sufficient provider interest, input, and willingness to sale the program, (CoOportunity Health) will help these providers create an Independent Providers Association(IPA).

7 This medical home-focused IPA will be the entity that works with (CoOportunty Health) to provide to providers help becoming certified, creating the reimbursement formulas for the care coordination fee and end of the year bonus, the quality and bonus parameters, and a data collection system for these parameters.

8 In addition, the IPA...work with other entities such as Medicaid and ultimately, Medicare to spread medical home-like programs throughout the state.

9 History 1. Spring, 2012-Promoted CMS to extend deadline for Shared Savings ACO 2. Summer, 2012-CMS extends Shared Savings ACO 3. Summer, 2012-Heartland Rural Providers Alliance formed to apply for Medicare Shared Savings ACO(4 clinics initial members) 4. Summer, 2012-Heartland works with South East Rural Provider Alliance(SERPA) in Nebraska 5. Fall, 2012-Both IPA s submit Medicare ACO s applications. 6. January,2013-Both IPA s applications approved.

10 Integrated Care approach to care...includes a payment process that incentivizes a system of care coordination to provide safe and clinically based quality health care in the most efficient and evidence-based manner

11 Medicare ACO Heartland part of successful Shared Savings Application of Accountable Care Associates of Massachusetts-virtual ACO-multiple states. SERPA-successful Advanced Payment Shared Savings Medicare ACO Application.

12 ACA Advantages Why you should choose Accountable Care Associates The journey from fee-for-service to managed care, global capitation, accountable care organizations, and other evolving care and payment models can be overwhelming. Trust the pioneer and leader in managed care services to enable you to adapt quickly and confidently.

13 Accountable Care Associates Our tools, services, and programs are developed for providers, by providers, and are proven to enhance efficiency while ensuring the highest quality of care.

14 Medicare ACO Responsibilities ACA-application, access to benefit of being part of bigger pool of patients, years of care coordination experience, interstate exchange of best practices, CareScreen web portal Heartland-local medical director, local case manager, organization, peer-to-peer cooperation Providers-medical home, shared savings incentive

15 Care Coordination Desired outcomes: i. Tracking of members ii. Identifying member utilization trends iii. Identifying gaps in care for prevention opportunities iv. Recommending treatment plans v. Recommending preferred specialists vi. Recommending preferred facilities

16 CareScreen provider web-portal

17 viii. Give providers quality trends, recommendations, and opportunities ix. Give providers utilization trends, recommendations, and opportunities x. Give providers pharmacy trends, recommendations, and opportunities xi. Give providers facilitate trends, recommendations, and opportunities xii. Give providers cost trends, recommendations, and opportunities xiii. Improved diagnosis coding xiv. Improve quality measures xv. Give ACO utilization and financial overview (reports and dashboards) xvi. Give PCP performance overview (reports and dashboards) xvii. Give preferred specialist lists and contact information xviii. Give preferred facilitate lists and contact information xix. Give preferred feedback opportunities

18 Data Management/Registries/ User Support:

19 i. Identify quality measures, quality outcomes, and quality trends ii. Identifying member, PCP, specialists, and facility utilization and performance trends for both modeling and incentives iii. Identifying gaps in care for prevention opportunities iv. Give population overview (reports and dashboards) v. Give individual member overview (reports and dashboards) vi. Give PCP overview (reports and dashboards) vii. Give specialist overview (reports and dashboards) viii. Give facility overview (reports and dashboards) ix. Give information to the CareScreen provider web-portal for provider behavior change and tracking x. Track and save all data for reporting to CMS

20 Medicaid Health Homes Immediate capitol Added patients for infrastructure of care coordination

21 Future Infrastructure Financing Recruitment Medical Home Transfomation Maximize Medicare ACO Maximize Medicaid Health Home Work with CoOportunity Health Work with other private payors/medicare Adv

22 IPA Partners CoOportunity Health Health Partners(Minneapolis) SERPA Accountable Care Associates State Public Policy Group