The Future of Cardiovascular Medicine in the Accountable Care Community. Nancy Steiger, RN, FACHE CEO & Chief Mission Officer

Transcription

1 The Future of Cardiovascular Medicine in the Accountable Care Community Nancy Steiger, RN, FACHE CEO & Chief Mission Officer

2 Our Mission, Our Values, and Accountable Care We carry on the healing mission of Jesus Christ by promoting personal and community health, relieving pain and suffering, and treating each person in a loving and caring way Values: Respect Collaboration Stewardship Social Justice Doing the right thing for the right person the right way in the right place at the right time for the right price

3 Take Home Message: Your Charge Create and participate in a clinically integrated community of providers accountable for equitable access to high-value health care services

4 Accountable Care 1. Accountable Care Organizations a. As part of a bigger plan b. Their role c. Some technicalities 2. Practical applications 3. Applications to Cardiology 4. Moving to the Accountable Care Community

5 Accountable Care Organizations A BIGGER PLAN

6 Not delivering value Same quality, twice the cost World Health Organization Commonwealth Fund Making Errors IOM: To ERR is Human up to 98,000 avoidable deaths in hospitals annually Rand Corp (Beth McGlynn): The Quality of Health Care Delivered to Adults in the United States care known to be beneficial delivered 54.9% of the time Low value IOM: Crossing the Quality Chasm CMS data: Dartmouth Atlas

7 Value Defined IOM: Crossing the Quality Chasm 6 Aims for high value health care Safe Timely Patient-Centered Equitable Effective Efficient IHI: Triple Aim Improved patient experience Improved population health Decreased per capita cost

8 Examples of Value Managed Care of the 90s: costs down Medicare demonstration program: quality up cost down PCMH pilot programs: care coordination improves value Higher-Value health systems/organizations: proven clinical outcomes and economic efficiency Intermountain Health Advocate Health Billings Clinic Geisinger Grand Junction

9 Common Characteristics Physician led Most successful health care organizations are Lean principles: People who do the work lead the work People who do the work can change the work Coordinated care Significant primary care component Common clinical quality and economic efficiency efforts Communication using common shared health information technology

10 Common Characteristics, cont, Integrated Size Aligned purpose Interdependent provider accountability Aligned incentives Measurement metrics Data collection and reporting Aggregated physicians and hospitals Provides more capital and other resources Data aggregation

11 Common Infrastructure Organization Integration Leadership: physicians Governance: shared Operations: efficient, value add for members

12 Common Infrastructure Systems Integration Electronic health record Integrated practice management system Out/In-patient systems integrated or interfaced Common data collection, storage, analysis, and reporting Actuarial data Patient portal/communication

13 Common Infrastructure Clinical Integration Overt clinical quality and economic efficiency improvement programs Overt provider performance/accountability program Demonstrable investment of time, talent, and treasure by all members Interdependent accountability Demonstrable value to consumer Value greater than that achieved by disaggregated physicians and hospitals

14 Consumers Tired of Waiting - Legislation American Recovery and Reinvestment Act HITECH/Meaningful Use: HIT implementation and use Patient Centered Medical Homes: Care coordination Patient Protection and Affordable Care Act Accountable Care Organizations Provider accountability Organization integration Finance Provider reimbursement Value-Based Purchasing Health insurance exchanges Individual mandate

15 Accountable Care Organizations SOME TECHNICALITIES

16 An ACO is: Legal entity, with TIN, under State law (multiple options) Composed of eligible group of ACO participants Work to manage and coordinate care for M Care FFS Mechanism for shared governance with proportional control 75%+ control to ACO participants; At least 1 beneficiary representative

17 Who May Form an ACO Group practice or networks of ACO professionals Partnership/JV among hospitals, ACO professionals Hospital employing ACO professionals Other providers/suppliers: Insurance companies buying provider organizations

18 ACO Leadership/Management Demonstrate leadership and management structure, including clinical and administrative systems that align with and support SSP and triple aim. Managed by executive under board control, with leadership team Full-time Medical director oversees clinical management Participants and providers, suppliers have meaningful commitment to clinical integration (financial, human capital investment)

19 ACO Leadership/Management Physician-directed QA and process improvement committee Implement evidence-based medicine or clinical guidelines and processes consistent with triple aim Participants and suppliers/providers agree to comply Infrastructure, such as IT, to collect data, provide feedback, including information at point of care

20 Focus on Patient-Centeredness Must have processes or systems for: Experience of care survey; Patient involvement in governance Evaluating needs, including diversity, and addressing needs Identifying high risk individuals and plans to address individual needs (promote improved outcomes, tailored to needs, preferences and values, coordinate with community resources) Coordination of care (including transition to other providers)

21 Focus on Patient-Centeredness Must have processes or systems for: Communication of clinical information to patient Beneficiary engagement, shared decision making Beneficiary access and communication, including access to medical record Measuring clinical/service performance of physicians and using results to improve care

22 Accountable Care Organizations THEIR ROLE

23 The Role of Accountable Care Organizations Provide the governance, management, and operational framework for accountable care efforts Implement common characteristics of higher-value health care systems/organizations Make operational 6 Aims Triple aim Decrease overuse, underuse, misuse, and variability Hold providers accountable through different reimbursement models Redistribute health care dollar from low performing to high performing/value providers Collect and report clinical and economic performance data

24 Accountable Care Organizations PRACTICAL APPLICATIONS

25 Practical Applications No more siloed practices Providers will participate in some type of provider organization Physician leadership and governance Interdependent accountability Accountable for things you don t manage: medication changes Manage things for which others are accountable: readmission

26 Practical Applications New payment methods (will look like old methods) Risk/capitation v FFS Withholds Incentive/bonus payments for performance New models of care Service lines v departments Cross continuum v siloed venues

27 Work in the Whatcom Community Guided under the auspices of Whatcom Alliance for Healthcare Access (WAHA) Gathering of various and multiple stake holders Committees: Steering, Delivery System, IT/HIE, and Finance Two public educational seminars Developing business case Initial ask for investment funding about to take place 3026 grant effort for transitions of care the first project

28 Simple SWOT for Whatcom ACC Strengths Engaged, broad participation Previous experience, if failed High degree of connectivity Desire to do better and innovate Weaknesses Loss of governance authority Lack of defined structure Too inclusive Years to achieve Opportunities Clinically integrate the community Improve the value of healthcare svcs Public accountability for hc svcs Draw providers and hospital closer Gain shared savings Create shared payor contracts Threats Governance by hc neophytes Usurpation of revenue stream PH/PHMG unpreparedness Capitated/risk payment We could get cut out

29 Accountable Care Organizations APPLICATIONS TO CARDIOLOGY

30 No Different Than for Other Specialties Specificity for accountability will come in the form of specialty specific measures Patient experience Economic efficiency Population health Overuse Underuse Misuse Variability Value Based Purchasing

31 Measure Examples Patient experience: willingness to recommend Economic efficiency: pmpm, per capita cost Population health: obesity, htn, diabetes Overuse: drug eluting stents v non Underuse: medical v interventional Misuse: percutaneous v open revascularization Variability: resources, procedures, outcomes, cost Value Based Purchasing: rehospitalization

32 Accountable Care Organizations MOVING TO THE ACCOUNTABLE CARE COMMUNITY

33 The Medicare shared savings program as the funding source for ACOs may not be viable in Washington state Therefore, ACOs may not be viable in Washington State The tenets of accountable care are appropriate Implementing them will not only improve quality and cost, but create strategic market advantage for successful organizations

34 As a community, take on the characteristics of a high-value healthcare system or organization (clinical integration, business integration, systems integration) Hold each other accountable We will have different, community-wide conversations about services, who should provide them, how they should be reimbursed, who gets to participate, etc Need to deliver on value proposition, not just for consumers and patients, but provider members

35 Take Home Message: Your Charge Create and participate in a clinically integrated community of providers accountable for equitable access to high-value health care services This is consistent with our mission and values