ACO Performance Model Increase Revenue while Building for Value Based Care

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1 Value Ahead Integrate - Measure - Improve ACO Performance Model Increase Revenue while Building for Value Based Care Frank Ross CIO, Cumberland Center for Healthcare Innovation

2 Overview of our ACO Cumberland Center for Healthcare Innovation (CCHI) Located in Cookeville and the surrounding areas of Middle Tennessee. July 2012 Start Advanced Payment MSSP ACO with approximately 12,000 attributed beneficiaries. 28 rural independent primary care practices and 39 physicians. CCHI achieved $4,732,231 in savings in 2013, and improved average quality scores from 62% to 74% between 2012 and Collaborative accountable care initiative with Cigna in January, 2014 that is benefitting more than 2,900 beneficiaries who receive care from among 37 independent CCHI physicians. Presenter Bio: Frank Ross is the Chief Information Officer for the Cumberland Center for Healthcare Innovation, and the practice manager for Ross Family Medicine, one of the CCHI primary care practices. Mr. Ross was a key leader in the development and design of the innovations discussed in this presentation.

3 Challenge Engaging Practices in ACO Compliance Reporting Disparate clinical data: multiple EMRs Provider literacy on the ACO Measures Incomplete EMR documentation workflows Can we do this in spread sheets?

4 Solution Innovating the Reporting Process Cloud-based reporting tool Pre-populate with claims & EMR data Attribution logic: match patients & providers Reporting progress is easily tracked

5 Clinigence Collection Dashboard Review collection of data by metric Collect data directly from your EMR or enter into the Clinigence system Determine when EMR data is populating to complete data set

6 Clinigence Quality Dashboard Track and Monitor CQMs Extraction of EHR Clinical Data Pre-populate CQM for Reporting

7 Clinigence Cost & Utilization Dashboard Claims Detail and Summary Cost Center View Corresponds to CMS Quarterly Reports

8 From Compliance Reporting to Care Management ACO Process Scores Population Management Use GPRO reporting scores to identify care opportunities Leverage fee for service to fill gaps in care Improve ACO process scores for the clinical quality measures

9 Challenge Resources for Care Management: Practices lack FTE s and financial resources to broaden care management ACO-wide tracking of care management activities is fragmented ACO Shared Savings is an elusive goal

10 Solution Leverage CMS Fee for Service Identify and fill gaps in care; E&M visits, screenings, labs, tests, & procedures Medicare Annual Wellness Visits (AWVs) The new Medicare Chronic Care Management (CCM) CPT code

11 What about Gaps in Care? Statistically, patients in the US only receive 55% of recommended preventive services. Why? Physicians don t have time and resources to manage them. Estimates suggest that a primary care physician would spend 21.7 hours per day to provide all recommended acute, chronic, and preventive care for a panel of 2,500 patients. If only 10 more patients per month completed: the standard preventive lab testing, a mammogram, a bone density scan; and one more patient per month had a colonoscopy, this equates to increased monthly billing of: $8,000 per month, or $96,000 per year.

12 Gaps in Care Getting Started Shift Activities to outside of the face-to-face visit Perform pre-visit planning to maximize Provider resources Utilize Nursing and Medical Assistant staff Activities count toward Chronic Care Management (CCM) Combine with Care Coordinator duties Combine with Clinical Quality Measure (CQM) activities

13 Gaps in Care Patient centric view that lists all measures for which there are gaps Can sort registry by column header Export to excel for further analysis

14 Clinical Data for Patient Stratification Color coding indicates patient ranking by gaps in care A new way to risk score a population Useful in Care Management programs for outreach

15 Patient Centric Risk Scoring Apply customized alerts to high priority gaps in care Integrate utilization history View patient through the lens of different programs (for example: MSSP ACO and Commercial ACO)

16 Medicare Annual Wellness Visit Every Medicare patient is eligible; no co-pay no deductible 2015 average reimbursement for the AWV is: Initial=$172, Subsequent=$111 Billable once every 12 months Comprehensive & personalized care plan Leverage the AWV to fill gaps in care

17 Annual Wellness Visits Reporting

18 Chronic Care Management Code $40 PMPM for 20 minutes of Chronic Care Management for patients with 2+ chronic conditions Identify patients with triggers in the EMR that indicate they have already received CCM service activity Leverage Care Plans from the AWV Ongoing Maintenance of Care Plans Use CCM to fill gaps in care

19 CCM Dashboard Registry of patients eligible for CCM Lists chronic conditions per patient Identifies documentation in the EMR that indicates that CCM activity has likely taken place.

20 Let s do the Math The average primary care practice in the US has 2,300 patients 16% of them are Medicare 69% of Medicare patients have 2 or more chronic conditions CCM: 2,300 x 0.16 x 0.69 x $40/month x 12 months = $121,881 new annual revenue per physician AWV: 2,300 x 0.16 x $111 = $40,848 annual revenue per physician

21 Adding it Up CCM = $121,881 AWV = $40,848 Gaps in Care = $96,000+ Total: $258,729 The million dollar question: does this improve health?

22 Primary Care Coordination Delivery Model Care Coordination Annual Wellness Better Quality Chronic Care Management Gaps in Care

23 Cost to Quality Comparison Y axis - Average annual Medicare cost per patient. X axis- Average quality percentile score on 22 MSSP CQMs. Each dot represents a practice in the ACO. Positive Trend line Indicates Higher Quality Lower Cost.

24 Questions?

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