Allina Health System. Accountable Care thoughts from an ACO Pioneer

Transcription

1 Allina Health System Accountable Care thoughts from an ACO Pioneer Care Integration and Payment Reform Workgroup Elmer Anderson Human Services Building St.Paul, MN February 6, 2012

2 Objectives for Today Key steps in transitioning to accountable care Lessons learned so far with ACO pilots Potential Pitfalls Share view on how we move more of Minnesota to accountable care models

3 Key Steps Allina ACO Development Create steering group with key leaders and content experts Develop guiding principles aligned with mission and strategic aim Determine drivers of change Encourage creativity and innovation Increase data availability, sharing and transparency Seek opportunities to learn and test care delivery models with incentives, but little or no risk Coordinate efforts with payers and patients to maximize success Pace the work as quickly as feasible

4 Map to accomplish our aim Tool Template: Driver Diagrams Aim and Outcome Primary Drivers Secondary Drivers Patient Care Model Redesign Expand Team Care model to increase capacity Expand urgent care access points Expand non visit based care options (evisit) Care Management & Coordination Implement Advance Care Team model for chronic disease/high risk patients Expand care navigators and deploy care guides Better Health, Affordable Care Clinical Excellence & Consistency Payment Reform / Contracting Identify & prioritize top areas of care variation Expand clinical service line infrastructure Increase percentage of contract revenue based on Value and evolve shared savings model Pilot bundled payment model(s) Outcomes: Deliver Optimal Care for Allina s core measures Improve patient & caregiver experience Reduce avoidable readmissions Improve affordability Network Development Measurement & Reporting Patient Engagement Build clinically integrated network with independent physician groups Establish a focused Value Analytics area and produce Pioneer patient profile & dashboard Enhance predictive modeling & risk stratification capabilities at the point of care Promote self care education in MyChart, After Visit Summary & Allina.com Expand patient advisory committees Implement shared decision making & advance care planning

5 ACO Pilots Lessons Learned Integrate population data, disseminate and track Focus on waste Use Outcome improvement approach Strengthen the patient/primary care relationship Keep the patient at the center of all decisions

6 Focus on Waste Waste Now Preventable Complications Unnecessary Treatments Inefficiency Errors Future Value Services That Add Value 100% Value All Services Add Value

7 Other Lessons Learned - Challenges Investing in resources while building the program and planning for sustainability Engaging independent physicians in care improvement initiatives without well-aligned incentives Consistent and reliable care management, patient engagement and shared decision making A difficult hiring environment for case management and analytic staff Size and complexity make it difficult to implement change quickly and we have more ideas than resources. Purposeful planning, prioritization, communication and focus is needed

8 Considerations / Potential Pitfalls Data Issues Overload, Analysis paralysis, Imperfect, Timeliness? Distribution within care system and Sharing/Consent with collaborators external to care system Benefit design unaligned Designs that have negative impact such as three day qualifying stay prior to SNF Designs that emphasize patient choice versus motivators and incentives for patient accountability Race to the bottom All care systems are improving cost so all savings should be shared

9 How to engage more in ACO work? Start with incentives tied to triple aim outcomes, to provide focus and get buy-in Help with infrastructure costs, revenue is a year behind Ensure comparative data is available to providers Help balance patient privacy with the need to share information across the care teamcurrent restrictions make this very burdensome

10 How to engage more in ACO work? Help with engaging specialists quality measures, education, incentive alignment. Build off MNCMC. Help with community engagement, educating the healthcare consumer regarding healthcare choices and the appropriate and most beneficial way to access healthcare. ACO and Health Care Home are well aligned. Keep focus on outcomes and let us continue to innovate on best ways to achieve results. Beware of adding administrative burden.