Physician Leadership Through ACOs MSMA – St. Louis April 2014 Agenda • Introduction to KCMPA-ACO – Why – Who – How • Approach to Population Health • Opportunities • Future Vision “Independent Physicians are a Vanishing Breed” Trends in Profession • • • • More integration – selling practices Less independence Loss of autonomy Powerlessness Trends in Healthcare • Unsustainable Costs • Suboptimal Quality • Uninsured/Lack of Access Who Will Have Control? Adapted from: Kocher, Robert. Sahni, Nikhil R. New England Journal of Medicine. 363(27):2579-82, 2010 Dec 30. Physicians Lose: Hospitals Lose: •Income •Inpatient census •Independence •Revenue •Professionalism •Future income •Community status Hospitalcontrolled Physiciancontrolled •OP services •Bond Ratings •Ability to borrow and expansion • Future access to capital •Community influence •Influence on health care institutions and decisions •Future Prosperity Remaining Competitive Under New Payment Models Physician Leadership • KC unsuccessful bid for CPCI – Metro Med convened • CPFMC invited all independent groups • Formed IPA – Governance • Pursued funding for a year+ • Encouraged by CMS Regional Office to pursue ACO 8 Evidence-Based Coordinated Patient-Centered Clinical Integration “an active and ongoing program to evaluate and modify the clinical practice patterns of the physician participants so as to create a high degree of interdependence and collaboration among the physicians to control cost and ensure quality.” -FTC/DOJ Statements of Antitrust Enforcement Policy in Health Care, #8.B.1 (1996) 10 Marketplace Response KCMPA • • • • 270 independent physicians 44 practices Multi-specialty Coalition of the willing ACO Application and Acceptance • In late 2012, adult primary care subset of KCMPA applied to become a Medicare ACO • Accepted to both Medicare Shared Savings Program and Innovation Center Advanced Payment Program • Responsible for 12,771 Medicare FFS patients • Accountable for $108 million in total Medicare spending Eight Essential Elements of a Successful Coordinated Care System AAFP White Paper: The Family Physician's ACO Blueprint for Success – Preparing Family Medicine for the Approaching Accountable Care Era (3/29/2011) • 2013 Advance Payment Model MSSP (one of 35) • 12,000 Medicare FFS Beneficiaries • 12 Independent PCP Group Participants with 16 clinic locations (75% NCQA-PCMH level 3) • Administration, CMO, Clinical Manager, Pharmacist, CDE/Dietitian, Social Work/Behavioral Health • HIE: 8 disparate EHR systems in 6 counties → “PCMH Neighborhood” • Deployed 6 Care Coordinators – Community Resources • Quality and Performance Measures ACO Programs • Medicare Shared Savings Program ACO – Upside risk only – 50/50 share of savings • Advance Payment Model – ~$2.3 million advanced over 18 months from expected savings to build infrastructure Advance Payment ACO Model • 1st Medicare ACO in KC – still the only advance payment • Now 3 MSSP ACOs in KC, one in St. Joseph; two in Wichita • Commercial ACOs KCMPA-ACO http://innovation.cms.gov/images/Map-Advance-Payment-ACOs-GIF.gif [Source: Health Affairs Blog, February 19, 2013] 18 Our Goal • Use Medicare funds to build infrastructure and expand to commercial contracts • Prove that patients in our ACO get high quality care and cost less than if they weren’t in our ACO • 3 years to prove it – 2 years left • Provide better care – decision support, analytics, additional human resources How it Works • ACO gets full claims data on all patients • Providers continue to get Medicare FFS • ACO gets $2.3 million over 18 months • Analyze and stratify claims data • Identify opportunities to improve quality and reduce cost • Add care coordination, pharmacist, CDE Savings to Share - hopefully • Opportunity for additional $$ after quality and cost reconciliation • 30% of ACOs like us received additional $$ from CMS after their first year • We’ll find out this summer • Savings will be used to continue operations of ACO and bonus ACO practices based on quality/cost formula Population Health Physician-Led Supported By Process People Technology Focus on Quality • 33 Performance Measures • Chronic disease and prevention • Culture of QI • Internal reporting • Comparison • Improvement • Patient satisfaction Strive for Consistent Quality • Collaboration Across Community – Guidelines enacted at both IPA and ACO level – Care Contracts crossing specialties Aggregating Data Claims Analysis Reports Claims analytics can be used to optimize: • ACO savings • • Patient compliance • • By identifying high risk/high visit patients Care coordination programs • • • By reviewing high utilization of acute care services (patient, provider, practice) Through risk stratification Assigning care coordinators to high risk segments Provider/practice benchmarking Impacting Cost • • • • Disease Management (DM, CHF, COPD) Reduce Preventable Readmissions (TCM) Case management for high cost/risk patients Urgent care and/or expanded hours to reduce ED visits • Home care for high-risk patients • Reduce Hospital Acquired Infections • Patient decision aids for discretionary procedures Lower Costs: Programs of Clinical Guidance We are focused in managing high cost/high acuity patients Percent of Total Costs 5% 5% 15% 30% 40% 31% 20% Engagement Methods Coordination, Integrated Medical-Behavioral Health, Medication Therapy Management, Model of Care, Disease Management, Seminars, Web & Print Guidance Integrated Medical-Behavioral Health, Medication Therapy Management, Model of Care, Disease Management, Seminars, Web & Print Guidance Medication Therapy Management, Disease Management, Seminars, Web & Print Guidance Model of Care Web & Print Guidance 30% 8% 20% 1% Percent of Patients Investment • Each Practice invested $100 in KCMPA- ACO, LLC • Practices also invested up to $1,000 per physician in KCMPA and paid initiation fee of $150-250 per physician • Operating Capital = Advance Payment Funds Return on Investment • • • • • • • • • • Care Coordinator Clinical Pharmacist Diabetes Educator/Registered Dietitian Licensed Clinical Social Worker to address behavioral health HIPAA & Compliance Policies Practice Management Support Group Purchasing Successful PQRS/GPRO reporting Support of Clinical Manager Data Connections Area Health Systems Regional HIEs Change Management • Show members how they can succeed • A means to an end • Cash available to transform and build infrastructure Quality, Cost and Performance Strategies Change the Paradigm from “Volume” to “Value” • • • • • Data is Key to Success Significant Infrastructure Needed for Improvement Transparency with Public and Physicians Integrate Care Management and Quality to Gain Value Focus for Success Playing a New Game • Same or better quality at lower cost to the system • Get physicians thinking • A reason to engage • Physicians have the skills needed • System can’t change without you Steps for Successful Development of High-Preforming Health Care System Market Opportunity • • • • • • Media attention Employers want these capabilities Physicians and Employers aligned Make connections Employer health care coalition Chamber of Commerce 37 KCDocs4U.com • Your Health. Your Money. Your Choice. • Campaign targeted at patients and employers • Drive patients to our practices and secure commercial contracts for KCMPA 38 Year One Focus • Organizational Infrastructure • Relationships with ACO Practices – How we actually work together – Acclimating care coordinators • Data Connections • High Impact Projects High Impact Projects • Annual Wellness Visits – Patient visits = attribution – Identifies gaps in care – Revenue to practices • Transitional Care Management – – – – Script Med Rec with Clinical Pharmacist CHF Home Health Protocol Revenue to practices • Frequent Emergency Department Users • Socially Complex Patients Year Two Focus • Continue High Impact Projects • Add Behavioral Health • Referrals from Primary Care – Understand referral process – Encourage referrals between KCMPA practices – Identify best value providers – Enable communication that benefits all physicians Why Do This? • Differentiate Independent Practices – Nimble – Value seekers – Cost competitive • Allow practices to stay independent • Independent practices can do this better than hospitals • Our patients want us to… Payment Reform • Still FFS at this time • Learning to take risk • All physicians can do the same or better financially and the system can still save • Google Harold Miller Future Contracts • • • • Shared savings is a means to an end Bundled payments Risk contracts High value providers with data and sophistication • Not a race to the bottom Questions Nathan Granger, MD, MBA Chief Medical Officer 816-842-4440 nathandg1@aol.com Jill Watson, MBA, CAE Chief Executive Officer 816-977-2950 Jill.Watson@kcmetrophysicians.com 45