ACOs and Post-Acute Care:

Transcription

1 ACOs and Post-Acute Care: Implications and Strategies for Providers Partner and Managing Director Leavitt Partners Michelle L. Templin Vice President Strategic Business Development Managed Health Care Associates, Inc. Objectives Explain the defining characteristics of accountable care organizations (ACOs), the various models of ACOs, and the types of programs/payment arrangements that they participate in. Recognize the historical evolution of the ACOs and the prevalence and geographic distribution of ACOs in a changing health care industry. Define the potential roles that post-acute care providers and other ancillary providers can play in ACOs and the consequences, both positive and negative, of ACO participation. Kennecott Copper Mine 1

2 Kennecott Landslide: April 10, 2013 Health Industry Change Is Inevitable What Is Accountable Care? Improve the individual experience of care Improve population health Reduce the cost of health care for populations Outcomes Oversee the provision of clinical care Coordinate the provision of care across the continuum of health services Invest in and learn to use appropriate IT to manage population health Processes Bear financial risk for the measured health of a population Align incentives to encourage the production of high-quality health outcomes Structure 2

3 ACO Sponsoring Entities Community-Based Organizations Physician Groups Hospital Systems Insurers Payer Participation Is Diverse 6 Public Program Only 69 Private Contracts Only Both Public and Private None CMS Plays a Major Role Medicare Shared Savings Program Medicaid Pioneer 344 3

4 # of ACOs Accountable Care Organizations and Post-Acute Care: Physicians & Hospitals Are Leading Q Q Q Q Q Q Q Q Q Q Q Q Physician Group Hospital System Insurer Other ACO Formation is not Uniform Estimated ACO Penetration by State Distribution by HRR Shows Hot Spots Estimated ACO Penetration by Hospital Referral Region2014 4

5 Lives 1/1/10 3/1/10 5/1/10 7/1/10 9/1/10 11/1/10 1/1/11 3/1/11 5/1/11 7/1/11 9/1/11 11/1/11 1/1/12 3/1/12 5/1/12 7/1/12 9/1/12 11/1/12 1/1/13 3/1/13 5/1/13 7/1/13 9/1/13 11/1/13 1/1/14 Steady Growth of ACO Covered Lives Covered Lives Over Time ACO Lives Focused in a Few States Estimated ACO Penetration by State ACO Covered Lives Show Hot Spots Estimated ACO Penetration by Hospital Referral Region 5

6 Early Results: Cautious Optimism ¼ shared in savings Average savings of $4.8M MSSP Pioneer 40% saved CMS saved $33M ACOs received $76M Medicaid Commercial Very little information on results Few results released 5 reasons PAC matters to ACOs 1. 37% of Medicare FFS beneficiaries use PAC services 2. ACOs focus on the continuum of care 3. PAC has the potential to lower costs - Prevention of readmissions - Use of lower-cost PAC settings 4. PAC accounts for nearly 1/3 of procedure costs 5. PAC costs are highly variable What Do ACOs Want? PAC providers willing to partner, not necessarily at risk Demonstrated quality and cost reduction - Supported by credible data - Low 30-day readmission Convenient geographic locations Technology (EMR, HIE) Open communication 6

7 A Spectrum of Partnership Options Full integration - Hospitals which already own SNFs - Systems looking to acquire PAC providers Informal pairings - Most likely form of partnership - May easily pair with hospitals or physician groups Co-development of care coordination protocol - Least amount of risk, lowest opportunity for savings Partnership: Benefits More access to resources Better, coordinated patient care Financial - Share in savings or receive bonuses Market share - ACOs will work in-network with PAC providers reducing admissions to out-of-network providers Getting a seat at the bargaining table - Details of ACO and PAC relationships are being worked out now Important Competencies Evidence-based practice - Use of aligned care protocols Patient/family centered self-care - Patient/family goal setting - Medication awareness - Self-symptom management and interventions Transitional care and system navigators Effective electronic exchange - Provider to provider - Patient/family to provider (telehealth, video/audio interface) Real-time data management and decision-making 7

8 Moving Forward Evaluate your current services - Do you provide what hospitals and PCPs need? - Do you collect the right data? Research your most likely ACO partners - What are their specific needs? - Analyze their clinical and claims data when possible - Determine how you can be essential to their ACO Explore current funding opportunities - Shared risk ventures - Grants - Demonstration projects Be proactive and get a seat at the table now 8