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

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1 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

2 About Justin T. Barnes As a healthcare innovation executive and strategist, Justin is a corporate, board and policy advisor who also serves as an Entrepreneur-in-Residence with the Georgia Tech ATDC Innovation Incubator. In addition, Mr. Barnes is Chairman Emeritus of the HIMSS EHR Association as well as Co- Chairman of the Accountable Care Community of Practice. Barnes previously was a member of the leadership team at Greenway Health where he worked for 11 years primarily serving as Vice President of Marketing, Industry Affairs, Government Relations and International Affairs. Justin has formally addressed and/or testified before Congress as well as the last two Presidential Administrations on more than twenty occasions since 2005 with statements relating to value-based medicine, accountable care, interoperability, EHR meaningful use, consumerism and much more. Barnes is a regular public speaker on these issues and has appeared in more than 800 journals, magazines and broadcast media outlets relating to national leadership of healthcare and health IT.

3 Public Policy & Regulations

4 Policy & Regulation Healthcare Reform/Transformation Newly proposed CMS Shared Savings Program Rule focuses on more ACO flexibility, greater performancebased risk and reward as well as the use of innovative care coordination & telehealth tools In January, Medicare will start paying $42/ month to doctors to coordinate care for chronically ill Renewed chances for SGR/ FFS Reform over 3-to-5-year period. Phase in an alternative payment model that leverages outcomes & quality-based payments with a smaller fee-for-service reimbursement State of EHR Meaningful Use HIT Policy Committee released Stage 3 recommendations ~ Expect Proposed Rule in Fall 2015 Over 501,000 care providers registered for meaningful use (415,000 have achieved MU) Over $25.4 billion in incentives paid to eligible providers & hospitals

5 Assessing ICD-10 Protect your investment Continue conversion plan Education & training Reassess health IT platform Keep focus on long-term success Continue to expand clinical documentation Documenting toward quality reporting is a foundation for value-based medicine Visit CMS for ICD-10 updates:

6 Navigating Consumerism High deductible plans impact healthcare decisions Families striving to reduce the healthcare costs Engage local employers to see what plans they are offering Growing demand for care management resources Retail clinics as alternatives for consumers Many patients visit CVS or Walgreens clinics for convenience Offering lower cost and quick visits for simple treatments Consider how this impacts your patient visit volume Care providers should be proactive Create your own patient satisfaction & engagement strategy Produce analytics on patient/ consumer population Compare and contrast outcomes & quality reports

7 Sustainability & Strategy Public & private payer goals to slow growth of healthcare costs Decreasing the number of duplicate tests performed Reducing number of patient days in hospital and readmissions Increase patient compliance via engagement and satisfaction Support legislation to stabilize SGR & modify FFS National collaboration on data exchange & standards

8 Accountable Care & Care Coordination Strategies

9 The Evolution EHR Adoption Over 75% of providers have EHRs Training and usability are key Established data liquidity Meaningful Use 415,000+ providers have achieved incentives If you don t qualify, use criteria as a playbook MU Stage 2 = PCMH/ACO foundation Value-Based Medicine Quality reporting Outcomes-based payments ACO/APM/VBP These are essential building blocks for a sustainable healthcare system

10 Engage Established Incentive Models Meaningful Use Stage 2 Elements such as care coordination & patient engagement are foundations for value-based medicine Evidenced through specific core & menu items such as VDT, ToC Patient-Centered Medical Home Specialty Medicine: Patient-centered Specialty Practice (PCSP) expands PCMH from primary care Seek EHRs that offer NCQA prevalidated auto credits Accountable Care Organization Joins siloed entities: Payers, provider groups, hospitals 606+ ACOs serving 25M Americans Composition of the care delivery model is shifting For example, ACOs with hospice have increased from 19% in 2012 to 42% in 2013

11 Market Evolution Alternative Payment Models (APM) are emerging Focus of SGR repeal proposals Health plans are incentivizing patient behavior Low performers are being pushed out of APMs Rise of communities of health/ecosystems Assess peers, benchmarks, patient volume and payer transparency Provider risk-based education, analytics, RCM & Data Services MU is a foundation for ACO, PCMH, Care Coordination futures Continued positive ACO growth

12 Top ACO Reimbursement Models

13 ACO Best Practices As bonuses from shared savings flow to providers, some must be shared with frontline staff to achieve buy in with quality care and savings goals. Clearly define the criteria for creating narrow networks and selecting highperforming provider groups. At the same time, providers who are still adapting to new models must have a fair path to ACO participation. Focus on EHR interoperability with mobile platforms to get patients more involved in their own care. Gather data on patient satisfaction during the course of normal workflow, so that collecting it does not become a separate burden. ACOs will see increased use of patient activation measures, which are surveys that gauge how confident patients are in managing their own care.

14 ACO Best Practices - MSSP Lessons Learned Importance of strong clinical leadership Communication and transparency Practice redesign Innovative care coordination The value of data and dashboards Pick a few things to improve and build on success

15 ACO Best Practices Meadows Regional Medical Center 81% of self-pay is never collected Using a consolidated Patient Payment Platform: 11% increase in payments 72% of payments made in full 37.5% reduction in spend Team of pharmacists managing diabetic patients Now using mhealth tools to Improve clinic efficiency Get patients to goal faster Sustain patient engagement

16 CMS Innovations Portfolio: Testing New Models to Improve Quality

17 Community of Health Strategies

18 Position Your Practice Utilize Health IT to increase care coordination in your community Focus on the importance of EHRs and meaningful use as a foundation Standards-based interoperability Evaluate beneficiary volume in your organization and research if expansion strategies are warranted Partner with local practices and hospitals New organizational structures emerging Identify CMS, commercial, or combined care coordination/aco opportunities Research the average cost for episodes of care Medicare is sharing cost data; inquire with commercial payers as well Knowledge is power when negotiating with payers

19 Community Accountability Assess relationships in your community with peers, associations, payers, employers, and health systems Evaluate current and potential future opportunities Benchmark against regional and national peers Understand how your customers rate in outcomes, costs, etc. Ensure your organization creates a network with the best providers possible Providers will be accountable for the efficiency and level of care their peers provide Ultimately, you will care who is in your network Evaluate interoperability to effectively share patient data Do not wait; ACOs and accountable care and at risk communities are forming today around the country

20 Additional Resources The Centers for Medicare & Medicaid Services (CMS) CMS Innovation Center ( CMS Educational Events Page ( CMS Innovative Maps & Models ( U.S. Department of Health & Human Services (HHS) Understanding HIPAA ( Medicare Provider Utilization and Payment Data ( Medicare Physician Compare (

21 Questions or Comments? Justin T.

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23 Thank you To contact our speaker, Justin Barnes, him at: