Justin T. Barnes. Future of Value-based Medicine, Accountable Care and New Payment Models

Transcription

1 Future of Value-based Medicine, Accountable Care and New Payment Models Follow Justin Ask Questions ~ #askhit Justin T. Barnes VP, Greenway Medical Technologies Co-Chair, Accountable Care Community of Practice

2 Safe Harbor Safe harbor statement under the Private Securities Litigation Reform Act of 1995: This presentation contains forward-looking statements which involve risks and uncertainties. You can identify forward-looking statements because they contain words such as believes, expects, may, should, seeks, approximately, intends, plans, estimates, or anticipates or similar expressions that relate to our strategy, plans or intentions. All statements we make relating to our estimated and projected earnings, margins, costs, expenditures, cash flows, growth rates and financial results or to our expectations regarding future industry trends are forward-looking statements. In addition, we, through our senior management, from time to time make forwardlooking public statements concerning our expected future operations and performance and other developments. These forward-looking statements are subject to risks and uncertainties that may change at any time, and, therefore, our actual results may differ materially from those that we expected. We derive many of our forward-looking statements from our operating budgets and forecasts, which are based upon many detailed assumptions. While we believe that our assumptions are reasonable, we caution that it is very difficult to predict the impact of known factors, and it is impossible for us to anticipate all factors that could affect our actual results. All forward-looking information in this presentation and subsequent written and oral forward-looking statements attributable to us, or persons acting on our behalf, are expressly qualified in their entirety by the cautionary statements. Some of the factors that we believe could affect our results include, but are not limited to: our ability to adapt to evolving technology and industry standards; our ability to implement our growth strategy; our ability to retain management and other qualified personnel; failure to prevent disruptions in service or damage to our third-party providers data centers; failure to avoid liability for the use of content we provide; regulation of the healthcare information technology industry; our ability to ensure our solutions meet industry and government standards; failure to maintain adequate security measures for our customers confidential information and personal identifiable information and their patients protected health information; our ability to expand our customer base; failure of the HITECH Act and other incentive programs to be fully implemented or funded by the government; our ability to implement our strategic relationships as currently intended; failure to establish, protect or enforce our intellectual property; restrictions in our credit facility and future indebtedness; and our ability to manage the risks involved in the foregoing. We caution you that the foregoing list of important factors may not contain all of the material factors that are important to you. In addition, in light of these risks and uncertainties, the matters referred to in the forward-looking statements contained in this presentation may not in fact occur. Accordingly, you should not place undue reliance on those statements. We undertake no obligation to publicly update or revise any forward-looking statement as a result of new information, future events or otherwise, except as otherwise required by law. Any unreleased products or services or features referenced in this or other presentations, press releases or public statements are not currently available and may not be delivered on time or at all. Customers who purchase our products or services should make the purchase decisions based upon features that are currently available. Greenway Medical Technologies, Inc. assumes no obligation and does not intend to update these forward-looking statements.

3 EHR Meaningful Use State of ARRA Over $27B available with no cap. Protected in Medicare Trust Fund Stage 1 criteria well within expectations ~ 14 EH/15 EP Core Measures & 5 Menu Stage 2 criteria well within expectations ~ 16 EH/17 EP Core Measures & 3 Menu Incentives are front-loaded so begin as soon as you can As of June, over 405,000+ care providers registered for Meaningful Use Over $15.5 billion in incentives paid to eligible providers & hospitals already! Over $438 million just to Nurses & PA s under Medicaid Meaningful Use Stage 2 Overview Chart ~ Regional Extension Centers Operations underway at various levels of execution Find your local REC ~ 3 Greenway Medical Technologies, Inc. All rights reserved. Confidential and proprietary. Not for distribution except to authorized persons.

4 The Evolution EHR Adoption Meaningful Use Over 30% of providers have comprehensive EHRs Training and usability are key Established data liquidity 300,000+ providers are estimated to achieve incentives If you don t qualify, use criteria as a playbook MU Stage 2 = PCMH foundation Value- Based Medicine Quality reporting Outcomes-based payments ACO/APM These are essential building blocks for a sustainable healthcare system

5 Value-based Medicine Overriding approach to delivery and payment reform Population management rewarding outcomes and cycle of care over episodic care and volume ACO, PCMH are well-known value models introducing shared savings, shared risk and bundled payments Affordable Care Act seeks expanded Medicare VBM models Establish national data aggregation and cost transparencies Merge with private payer models to encompass: Group and ambulatory practices (i.e. CPC initiative) Hospitals and Critical Access Hospitals Home health agencies and skilled nursing facilities

6 Patient-Centered Medical Homes: Foundation to Accountable Care Transforms organization & delivery of primary care Not limited to a location, but is an overall model of primary care delivery Five major functions and attributes: Patient-centered care Comprehensive care Coordinated care Superior access to care A system-based approach to quality and safety National Committee for Quality Assurance (NCQA) is the top recognition body for provider organizations Look for EHRs that offer PCMH auto-credits

7 Survey: Do you plan to establish a PCMH program? 36% Yes 53% No Not Sure 11% Health Information Technology: Trends and Transformations: A 2012 Snapshot. Report by Vista Branding. Sponsored by Greenway Medical Technologies, Inc.

8 Accountable For What? EHR Utilization Double-Weighted Measure in MSSP Interoperability Care Coordination Best Practices Quality and Outcomes Improvement Patient Education Patient Satisfaction

9 ACOs by Sponsored Entity Hospital System Physician Group Community-Based Insurer 202 The number of ACOs sponsored by physician groups has surpassed hospital-based ACO models as of January 2013 Leavitt Partners, Center for Accountable Care Intelligence January 2013

10 Medicare ACO Initiatives 259 MSSP ACOs voluntarily coordinate care to Medicare patients Accountable Care Coalition of Texas an ACO comprised of IPAs, medical groups and health systems, serving nearly 70,000 beneficiaries 32 Pioneer ACOs actively seek to improve patient care Sharp Healthcare ACO is comprised of an IPA, medical groups, multispecialty practices, and hospitals with over 56,000 members 35 Advance Payment ACOs have been awarded upfront payments to design care coordination infrastructure for smaller models North Country ACO is comprised of hospitals, home health agencies, mental health centers, emergency services, and physician practices *All programs found at

11 CMS Pioneer ACO Results Affordable Care Act seeks expanded Medicare VBM models First Performance Year (2012), 669,000 patients All 32 improved quality, meeting 33 CQMs All 32 met high patient satisfaction scores Financial Results Overall costs slowed: 0.3% growth within the ACOs vs. 0.8% benchmark Gross savings of $87.6 million, $33 million net savings to Medicare Trust $76 million in shared savings returned to 13 Pioneer programs 18 experienced some level of savings ACO Popularity Growing 500 applications for MSSP 3 rd round beginning Jan, to 30 million Americans currently in MSSP or private ACOs Sources: CMS; Oliver Wyman

12 Commercial ACO Initiatives Every major carrier has an ACO-type plan Aetna, Blue Cross Blue Shield, Cigna and Anthem/Wellpoint Meet quality improvement and cost reduction criteria to receive benefits Various approaches utilized across the board Shared Savings, Shared-Risk, Partial Capitation Cigna has 66 programs in 26 states Serving 700,000+ customer/patients Primary care, multi-specialty, IDNs, physician-hospital organizations Partners In Care, an ACO based in Central New Jersey with 14,000 members, is striving to achieve the triple aim of improved health outcomes, lower costs and increased patient satisfaction

13 Accountable Care Case Study Initial Results from Cigna Collaborative Accountable Care program 52 programs in 22 states (510,000 patients) Lower medical cost trend ER visit cost savings Quality Physician referrals ER visits >50% lower per-patient annual medical cost trend than traditional care methods 7% lower ER visit costs than traditional care methods 5% improvement in EBM measures 11% higher utilization of highperforming specialists 12% reduction in avoidable ER visits

14 Medicaid Expansion Strategies Effective January 1, : Federal government will pay for 100% of the difference between a state s current Medicaid eligibility level and the ACA minimum 2017: Contributions will drop to 95% After 2020: Federal contributions will remain 90% The Supreme Court's ruling on the Affordable Care Act allows states to opt in or out of the law's Medicaid expansion 28 states moving toward expansion Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, Vermont, Washington and West Virginia

15 Interoperability: What s Coming Ultimate goal is real-time interoperable data exchange Integral to improving the quality, efficiency and safety of healthcare delivery Exchange of information needs to be both interoperable and electronic across myriad information systems Mindset away from interoperability incentives to standard business practice HHS Strategy and Principles released in August to accelerate HIE Align health IT standards for quality measurement New regulations & guidance on existing programs that enables patient health information to follow them wherever they access care Advance HIE across providers including long-term, post-acute care, behavioral health and laboratory services Advance multi-stakeholder development of standards Build upon & move beyond the foundation of the Medicare & Medicaid EHR Incentive Programs & the ONC HIT Certification Program

16 Quality Measure Alignment Historic and Ongoing Alignment By Design PQRS, e-rx, Meaningful Use, CMS ACOs & PCMH Aligns care coordination toward best practices, fluid expansion Quality measures, reporting, patient satisfaction, data exchange standards Future Quality Alignments Commercial and health system ACOs, evolving value-based and alternative payment models as new or established incentive programs Medicare FFS care coordination within HR 2810 SGR fix Seeks provider group input on creating aligned measures

17 Consumerism in Healthcare Consumers are absorbing more healthcare costs Families strive to stabilize their healthcare costs Demand for innovative patient education and engagement tools Patients are shopping for care by price Personal experience with a high-deductible health plan HDHPs command when, where and how my family seeks care Required charge estimates before scheduling appointment Managed X-rays & MRIs to avoid unnecessary diagnostic tests Retail clinics as alternatives for consumers Many patients visit Walgreens and other clinics for convenience Offering lower cost and quick visits for simple treatments Consider how this impacts your patient visit volume

18 Patient Engagement Patients now taking an active role in their healthcare decisions Providers should be proactive Produce analytics on patient/ consumer population Comparing and contrasting outcomes & quality reports Technology measures to implement in your community Patient portal solutions to utilize blue button and view, download & transmit (VDT) functionality calendar invitations, phone & text reminders Customized (automatic) patient education materials that incorporate video and smart self-help tools

19 Do I Join or Form an ACO? Ask yourself the following questions: What is my organization s 3- to 5-year operating or growth plan? Do I have an ACO-Ready Community? Can I create an ecosystem that is ACO-Ready? If you are approached by an accountable care program or ACO: What are the financial or strategic incentives to join? Will you have access to bi-directional data and interoperability? Legacy vs. innovation? Standards-based interoperability? What data requirements are being asked of you? Are agreements binding or non-binding?

20 Position Your Organization 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 payors as well Knowledge is power when negotiating with payers

21 Community Accountability Assess relationships in your community with peers, associations, payers, employers & health systems Evaluate current and potential future opportunities Benchmark yourself against regional and national peers Understand how you rate in outcomes, costs, etc.. Ensure you create a network with the best providers possible: Providers will be accountable for the level of care their peers provide Ultimately, you will care who is in your network Evaluate interoperability to effectively share patient data

22 Additional Resources Greenway s Government Affairs Updates Accountable Care Strategies ( EHR MU Navigation ( Gov t Affairs ( Important Government & HHS Sites CMS Innovation Center ( HHS Breach Notification Rule ( HHS Privacy Rule ( Agency ACO Sites Medicare ACO Final Rule ( CMS Educational Events Page ( CMS ACO/ Shared Savings Page (

23 Questions or Comments? Justin T. Barnes (678)