MaineHealth ACO in. Context W 5

Transcription

1 MaineHealth ACO in Who? Context W 5 What? Why? When? HoW? 1

2 Who? 2

3 The MaineHealth ACO is all of the MaineHealth member hospitals plus St. Mary s Regional Medical Center and all of the physicians in Community Physicians of Maine Maine Medical Center, Lincoln County Healthcare, Pen Bay Healthcare, Southern Maine Medical Center, Western Maine Healthcare, Waldo County Healthcare Over 1,000 physicians spanning both hospital-employed and independent practices It is the entire MMC PHO! 3

4 What? is an ACO? does it do? 4

5 An ACO is: A group of healthcare providers who agree to work together and assume responsibility for improving the quality and reducing the cost of care for their patients 5

6 Providers in an ACO deliver patient-centered care: Put the beneficiary and family at the center Coordinate care over time and all care settings Attend carefully to care transitions Manage resources carefully and respectfully Proactively manage each patient s care Evaluate data to improve care and patient outcomes Innovate and try new models of care Invest in team-based care and workforce 6

7 Over time, ACO providers may be paid differently: But, THERE IS NO CHANGE TODAY TO HOW YOU CURRENTLY BILL FOR OR RECEIVE PAYMENT At the end of the CMS measurement period, providers may be eligible for an additional payment at the end of the year The amount they receive depends on their performance on specific quality metrics and how successfully they collaborate with patients & other ACO providers to reduce the cost of care In later years, there may be changes to billing and payment but these will not occur today. 7

8 Why? 8

9 ACOs are part of a national effort to improve healthcare Source: May The Commonwealth Fund. Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices and Quality 9

10 Despite this spending, our citizens are less healthy Rates of Obesity in Adult Populations of Industrialized Nations United States Canada England Germany Norway Switzerland Japan 0% 5% 10% 15% 20% 25% 30% 35% 40% Source: Latest Available Data. National Obesity Observatory. National Health Service. United Kingdom. 10

11 When? 11

12 Our ACO just signed its first contract: As of July 1 st, 2012 Medicare is measuring our ACO including your practice and providers on: How well we achieve specific quality targets and Whether we are able to reduce the overall cost of care for our Medicare patients The rest of this talk will address some of the specific things you need to do TODAY and in the FUTURE in order for us to be successful 12

13 MSSP Quality Measures Measure Domains Number Method Approach (subject of future webinars) Patient Experience 7 Survey CMS conducts survey ACO conducts survey Care Coordination / Patient Safety 3 Claims CMS reported measure based on claims data Care Coordination / Patient Safety 1 EHR Incentive Program CMS reported measure based on claims data Care Coordination / Patient Safety Preventive Health 8 GPRO Tool At risk population 12 GPRO Tool 2 GPRO Tool* CMS defines the denominator for each measure based on random sampling *GPRO is a CMS Web-Based Quality Reporting Tool ACO provides numerator information available via claims and clinical data Practices without EHR that connects with the ACO data system will enter data into a web based portal or provide extract file Data submitted via GPRO Tool

14 What is the Timeline? Member Performance Review Program Practice visits to discuss ACO Data review and analysis Care Coordination activities Patient Centered Medical Home Implementation July 2012 Sep-Oct 2012 Oct-Nov 2012 Feb 2013 Ongoing Medicare Shared Savings Program Kick off Letters sent to all assigned beneficiaries Informational webinars conducted Data tools piloted Quality Data reporting to CMS

15 How? 15

16 16 Strategy for Achieving the Triple Aim: Primary Care Our primary care practices will operate as Patient Centered Medical Homes, and be financed to do so Care Coordination MaineHealth will assess, consolidate and/or reorganize system-wide care coordination resources to ensure the right focus on the right patients Information Technology Improve information available to clinicians at the point of care by aggregating real-time claims and select EMR information Transparency A physician-led peer review program will focus on reducing unwarranted variation in care

17 What does it mean to you? Beginning now. Actively participate in the Member Performance Review Program Engage in quality reporting Implement CG-CAHPS survey Assess your practice as it relates to the Patient Centered Medical Home (PCMH) and Neighborhood

18 What does it mean to you? Over time.. PCMH and neighborhood implementation Implement team based care Identify and utilize community resources Utilize care transitions and care management resources Enhanced Care Coordination Improved communications among caregivers Utilize Guides to Care and Referrals Engage in data review Identify and reduce practice variations Identify at risk patients and triage to identified resources

19 Upcoming Patient Notification Activities All Medicare Shared Savings Program ACOs are required to notify patients that: Your provider(s) is participating in the MHACO Your provider(s) is eligible for additional Medicare payments or may be financially responsible to Medicare for failing to provide efficient, cost-effective care Medicare claims data for your patients may be shared with our ACO at the ACO s request They can Opt Out of this data sharing by completing a form or calling MEDICARE. 19

20 Patient Notification. The MMC PHO/MHACO will mail your Medicare Patients a letter with the required information Practices have been requested to help by Submitting address information to the MMC PHO for Medicare patients Providing practice letterhead Being prepared to answer patient questions and conduct first visit notifications 20