McKesson Business Performance Services Accountable Care Services Helping You Achieve Better Clinical and Financial Health 1
We recognized that fee-for-service would decrease and value-based care would increase so with the help of McKesson, we put the right infrastructure in place to succeed in an accountable care environment. McKesson Business Performance Services is in a unique position to help healthcare leaders determine their response to value-based care. We have extensive experience working with hospitals, health systems and medical groups to build and successfully manage clinically integrated networks nationwide including certified Accountable Care Organizations (ACOs). Our experience includes working with both government and commercial insurance programs to negotiate contracts and manage a range of value-based payment arrangements. These include employersponsored plans, commercial plans, Medicare Advantage, Managed Medicaid, and Medicare Shared Savings Programs. Arnold DoRosario, M.D. Medical Director PriMed Physicians and PriMed ACO Transformation to Value-based Care Our healthcare system is in the midst of a fundamental transformation as the movement from volume- to value-based reimbursement is already reshaping healthcare in America. Although change can bring uncertainty and confusion, change also creates opportunity. We believe that this transformation to value-based care creates a unique opportunity to make a profound impact both on patient health and healthcare costs. 1
2 For organizations building a viable value-based delivery model, McKesson offers the most effective path to a sustainable financial future.
Accountable Care Services: From Strategic Alignment and Consulting to Full, Turn-key Implementation and Operations Mckesson Business Performance Services (McKesson) offers the strategy, operations and technology needed to build and transform integrated networks into cost-effective, financially successful coordinated care organizations. We do this by providing expert advice along with the people, process and technology required to effectively manage change. Potential Benefits: Increased earnings potential, lower costs and better healthcare outcomes Enable profit diversification through gain- and risk- sharing models Cost-effective development and management of narrow provider networks Increased speed to market Improved physician and network alignment Improved patient access, experience and physician loyalty Enhanced payer relationships, innovative payment models and alignment of incentives Accountable Care Services No matter where you are in your journey to value-based care, we are able to help guide and support you at every stage of development. Our services include transformation consulting, network management and physician alignment and customized solutions. Transformation Consulting Control costs and maximize revenue today while mapping out a clear path to success under value-based care ACO Services Build, integrate, transform and achieve success effectively managing value-based care Value-based Network Management Improve alignment with physicians and other providers to achieve increased financial and clinical performance Customized Solutions Gain the people, resources and technology required to effectively manage the transition from volumeto value-based care 3
Transformation Consulting Case Study Snapshot PriMed, Physician-led ACO In 2011, fast-growing PriMed capitalized on its long-standing experience with patient-centered care to pursue certification as an ACO through the Centers for Medicare & Medicaid Services (CMS). Working closely with McKesson, PriMed successfully completed the complex Medicare ACO application and today is one of the largest, physician-led ACOs in Connecticut. In the months since PriMed was certified as an ACO, the group has focused on four areas in pursuit of cost control: Unnecessary admissions Hospital readmissions Congestive heart failure (CHF) admissions/readmissions High-cost imaging A care coordination center was developed to further strengthen the group s patientcentered approach, and expansion of ancillary services helped boost practice revenue by $5 million. Although the move to value-based reimbursement can lead to better clinical outcomes for patients and improved financial performance for providers, success is not guaranteed. The transition to value-based reimbursement can severely disrupt processes and strain cash flow. McKesson Business Performance Services offers a comprehensive, proven transformation path to value-based care. Our goal is to help you create a durable, economic, value-based care model, customized to your needs. Influencing factors are based on your core capabilities, local market conditions, patient share, payer trends and other factors unique to your organization. Starting with an ACO assessment: Leadership interviews and discussions Assessment of competitive and payer trends Validation and assessment of current strategy Assessment of current tactics and resource allocations Quantification of physician engagement Identification of organizational strengths and weaknesses to effectively manage a defined patient population A Key Difference We have the people, resources and technology to back up our recommendations based on the needs of our customers. We offer a full continuum of services and we have proven experience to help you build consensus and drive meaningful change. 4
Proven Approach to ACO Success Through our work with multiple ACOs and clinically integrated networks, McKesson has developed a four-pillar approach to build, integrate, transform and achieve clinical and financial success in step with the transformation to value-based care. Equally important is the ability to provide data management, analytics and reporting tools that collect data and turn it into actionable insights. We offer advanced population health software tools to help organizations quickly identify high-risk populations, establish care guidelines and meet quality reporting requirements. Our customized platform tracks claims, utilization, and near real-time electronic health record data to generate dashboard and drill down reports that help manage cost and care. And when it comes to technology, our team is completely vendor agnostic being equally comfortable working on the client s information technology platform or on ours. FOUR PILLARS BUILD INTEGRATE TRANSFORM ACHIEVE Strategic Management and Analytics Build the administrative and operational infrastructure required to navigate the local landscape of providers, facilities and payers, and develop a clear path to success Network Development Integrate and develop a network of primary care and specialty physicians along with high-quality, low-cost facilities to actively participate in a streamlined care delivery model Practice Transformation Transform patient flow and care delivery practices needed to thrive in valuebased reimbursement environments Care Coordination Achieve clinical success by tracking and communicating patient care, protocols and progress across the care continuum 5
Your Customized ACO Playbook for Better Financial and Clinical Performance Working with McKesson, our clients take advantage of the combined experience and expertise of partners who have honed a step-by-step playbook to help guide the ramp-up and effective management of an ACO. Your customized ACO Playbook by McKesson is available only to McKesson clients. Combined with our expert support, the ACO Playbook helps clients gain the knowledge and expertise needed to engage physicians, control costs, improve care quality, minimize risks and achieve successful financial and clinical outcomes. The interactive Playbook is used by the McKesson operations team to build and guide the client s ACO. It provides base templates that are customized to the client-specific information, including contracts, agreements, organizational charts, policies and procedures, and financial models, all of which can be adjusted dynamically as the client s situation evolves. Customized Solutions from One Trusted Partner No two organizations are alike in their needs, expectations and readiness for value-based care, which is why we tailor our approach for every client situation. Depending on your needs, we offer customized solutions for new and existing integrated networks and accountable care organizations. We provide resources where you need the most support, from administrative and clinical to information technology We allow you to grow and manage your own integrated network or risk arrangements quickly and cost effectively We help facilitate adoption of tested best practice methodologies We enable instant-on bandwidth and expertise so you can take advantage of market opportunities Now you have one partner you can turn to for an integrated ACO solution of people, managed services and technology. 6
Value-based Network Management Builds Alignment and Physician Engagement In addition to building integrated networks, we have a track record of successfully facilitating the creation, improvement and redesign of physician organizations including aligning physicians with the organization s ACO strategy. Our core services include: Strategic planning and governance structure Payer negotiations and development of innovative payment models Compensation design and benchmarking Utilization management Case management Quality improvement Financial analytics and reporting Claims adjudication and payment processing Case Study Snapshot St. Louis PCP Network For more than 10 years, this St. Louis physician network has achieved results with support from McKesson. Its members include up to 50 primary care physicians with an average of 5,600 patients each year. McKesson supports the organization with services that include: Payer contract negotiations and administration Physician engagement and relations RN case management Pay-for-performance administration Claims data review Data warehousing Performance report generation and distribution St. Louis PCP Network has successfully managed a range of contracts including a risk-based agreement with a major insurance company, equivalent to about $500 million in Centers for Medicare and Medicaid (CMS) premium dollars. 7
For Better Financial and Clinical Health Select McKesson No matter where you are on your journey to valuebased reimbursement, McKesson can help you: Build a financially solid path to value-based care Enhance profit through risk-sharing arrangements Build a durable economic model that is well positioned for rapid fee-for-service declines Coordinate and manage care quality for improved outcomes Engage physicians with defined clinical and financial arrangements Our experience includes: Management of over 2,000 physicians nationwide More than 200,000 commercial, Medicare and Medicaid managed care patients Experience with Medicare Advantage, Commercial, Medicare Shared Savings Plan (ACO), and Managed Medicaid 15+ years successfully managing capitation Established partnerships with provider networks nationwide McKesson has a proven track record for establishing provider networks and managing healthcare services while helping physicians and healthcare providers realize increased earnings. 8
You can improve outcomes, boost financial performance and build a sustainable future. Email ACOServices@mckesson.com or call 1.877.528.9750 for an initial consultation. 119
About McKesson Corporation McKesson Corporation, currently ranked 15th on the FORTUNE 500, is a healthcare services and information technology company dedicated to making the business of healthcare run better. We partner with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. For more information, visit www.mckesson.com. McKesson Business Performance Services McKesson 5995 Windward Parkway Alpharetta, GA 30005 www.mckesson.com/aco ACOServices@mckesson.com 1.877.528.9750 Copyright 2015 McKesson Corporation and/or one of its subsidiaries. All product or company names mentioned may be trademarks, service marks or registered trademarks of their respective companies. 01/2015 -MBPS 12