The ACO Model/Capabilities Framework and Collaborative. Wes Champion Senior Vice President Premier Healthcare Alliance

Transcription

1 The ACO Model/Capabilities Framework and Collaborative Wes Champion Senior Vice President Premier Healthcare Alliance

2 Roadmaps to Serve as a Bridge from FFS to ACO Current FFS System What are the underpinning building blocks? Accountable Care Organization Foundational Philosophy: Triple Aim Measurement 1

3 The ACO Model A group of providers willing and capable of accepting accountability for the total cost and quality of care for a defined population. Payer Partners Insurers Employers States CMS Core Components: People Centered Foundation High-Value Network Population Health Data Mgmt ACO Leadership Payor Partnerships 2

4 The Capabilities Framework 3

5 Capabilities Framework: Sample Subset ACO Component Capability Operating Activity (Note: System in most instances refers to a functional operating acivity that may include operating processes, staff and in some instances an IT component that enables operations) Tools / Deliverables PCP Practice Profliling and Selection System Medical Home Program/Operations Manual Patient Outreach System Open Access Scheduling System Models - Best Practices Team Based Care System Program/Operations Manual A. Deliver Patient Centered Primary Care Preventive Care Improvement System Best Practices for preventive health optimization and evidence based guidelines Evidence Based Care System Best Practices, care pathways for common office based services Expanded PCP Capabilities Best Practices, care pathways for urgent office based services Integrated Mental Health System Electronic Patient Response Systems Best Practices, metrics and standard reports 4

6 Capabilities Framework: Status and Weight Methodology 5

7 Capabilities Framework: Demonstration of Scoring System ACO Component Capability Operating Activity Status Weight Total Score Per "Operational Activity" Total Score Per Capability Percent of Implementation per Capability Patient Registries B. Optimize Chronic, Acute and Preventative Care Reminder System Evidence Based Best Practices System % Dynamic Reporting Systems Disease Management System Status of Capability 0 = applicable to 0% of services for the intended ACO population 1 = applicable to 1-5% of services for the intended ACO population 2 = applicable to 6 20% of services for the intended ACO population 3 = applicable to 21 50% of services for the intended ACO population or a successful demonstration / pilot on less than < 21% that is easily scalable across the health system 4 = applicable to > 50 % of services for the intended ACO population or Standard Operating Procedure (SOP) for entire health system 6

8 Capabilities Framework: Status per Component Example for 7

9 Capabilities Framework: Overall Score Example 8

10 ACO Roadmap: What to Focus on When Timeline outlining recommended implementation activities: How, When, Who should be focused on ACO Implementation within your organization. Recommended Activities typically include Process Redesign, as well as deployment of new processes, systems, and tools. Timeline can be tailored to specifically focus on implementing elements strictly required to contract with Medicare, or with commercial payor[s]. ACO Component Capability Operating Activity (Note: System in most instances refers to a functional operating acivity that may include operating processes, staff and in some instances an IT component that enables Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 People Centered Foundation People Centered Foundation People Centered Foundation People Centered Foundation People Centered Foundation People Centered Foundation People Centered Foundation A. Involve People in Decisions that Affect their Health Care B. Provide People with Easy Access to Health Care Defined Pathway for Individuals from the ACO Community to Provide Input to Health System Changes Individualized Care Plans Direct Care Management Support System Open Access Scheduling System System for Providing People 24X7 Access to Services C. Activate Individuals Systems that Give People Access to Health to Take Responsibility Information for their Own Health Patient Remote Monitoring System Sample

11 Twelve Major Start-up Actions for ACO Implementation Step Starter Action 1 C-Suite and Board endorsement of ACO strategy 2 Identify Administrative and Medical Champions 3 Define intended targeted ACO population(s) for an ACO Model 4 Assess the ACO populations health needs, risks and medical costs 5 Define ACO provider network to support populations(s) 6 Identify an internal implementation executive team 7 Define and implement an ACO legal structure 8 Conduct a Pro Forma to evaluate the ACO financial impact 9 Define and communicate a burning platform for transformation 10 CEO to CEO discussions with targeted payor(s) 11 Forge clinical integration across the continuum of care 12 Define and implement an action plan for ACO Roadmap 10

12 Premier s Two ACO Collaborative Tracks ACO Implementation Collaborative ACO Readiness Collaborative Early ACO implementation Pursue CMS/national payer contracts Build out core ACO capabilities Tool kits, best practices Benchmark against peers Accelerate learning and population management capabilities Prominent national leadership Explore accountability initiatives Maximum learning and shared lessons Stay abreast of ACO development Opportunity to access collaborative for limited tool kits Gap analysis to pinpoint focus areas Learn about population management Preparation for local leadership as ACO moves forward 11

13 Premier s ACO Collaborative Structure Oversight Steering Committee External Advisory Panel Premier Collaborative Management Team ACO Readiness Collaborative ACO Implementation Collaborative 12

14 ACO Implementation Collaborative Members As of 10/15/10 WA CA OR NV ID AZ UT MT WY CO NM ND SD NE KS OK MN IA MO AR WI IL MI IN KY TN OH W V SC PA VA NC NY VT NH ME RI CT NJ DE MD DC MA TX LA MS AL GA FL

15 ACO Readiness Collaborative Members As of 10/15/10 WA CA OR NV ID AZ UT MT WY CO NM ND SD NE KS OK MN IA MO AR WI IL MI IN KY TN OH W V NC SC PA VA NY VT NH RI CT NJ DE MD DC ME MA TX LA MS AL GA FL

16 Implementation Collaborative Baseline* * As of 10/21/10, Includes data from 20 of the 24 members 15

17 Key Statistics* Expected Population & Number of Lives Populations: Self-insured; Medicare Advantage; Commercial; Medicare/Medicaid Number of Lives: 1,396,600 Payer Partnerships Medicare / Medicaid; Trump Enterprises Health New England Community Care Managed Health Plans of Oklahoma Blue Cross / Blue Shield Health Plans New West United Coventry SummaCare Aetna Harvard Pilgrim * Includes data from 15 of the 24 members 16

18 The Proposed Phase I Measures Premier ACO Collaborative - Phase 1 Measure Set - FINAL DRAFT 10/19/