Providing Accountable Care: The Train is Leaving the Station

1. Providing Accountable Care: The Train is Leaving the Station Steven E. Wegner, MD JD Chair, NCMS Accountable Care Task Force Paul Cunningham, MD NCMS Accountable Care Task Force

2. Contact: Steve Wegner sew@ncaccesscare.org (919)380-9962

3. ACO What is this? …and why should I care?

4. Three Fold Variation in Per Capita Spending - Peter Orszag, N Engl J Med, 2007

5. Higher Healthcare Spending is Not Associated with Better Quality - Baicker et al. Health Affairs web exclusives, October 7, 2004

6. What is going to happen to health reform? “ Even if federal health overhaul is rejected by the Supreme Court or revamped by Congress, the market must continue to change. The system that brought us to this place is unsustainable. Employers who foot the bill for workers’ health coverage are demanding that BlueCross identify the providers with the highest quality outcomes and lowest costs.” - Brad Wilson, President of BlueCross BlueShield of North Carolina

7. What is an ACO? “ACOs consist of providers who are jointly held accountable for achieving measured quality improvements and reductions in the rate of spending growth.” - Mark McClellan, Director of the Engleberg Center for Health Care Reform at the Brookings Institution

8. Are ACOs recycled HMOs? • ACOs are not gate keeper; ACOs do not require patient enrollment. • ACOs do not require changes to benefit structures. • Can provide or manage continuum of care as a real or virtually integrated delivery system. • Are of a sufficient size to support comprehensive performance measurements. • Are capable of internally distributing shared savings payment.

9. Comparison of Different Payment Models

10. Fewer Private Practices More doctors are joining hospitals and health systems rather than go into private practice.

11. Premier

12. Premier – Collaborative Operating Plan • Triple aim: • Population health status and outcomes of care • The care experience • Total cost of care – Delivering the outcomes

13. Premier- Participation in the Collaborative • Tightly aligned physician network • Contracting capability • Large enough population base • Willingness to accept common cost and quality metrics • Sufficient data infrastructure

14. Premier- Six core ACO components are: • People-centered foundation • Health Home • High-Value network • Population health data management • ACO leadership • Payer Partnership

15. Premier- Payment Policy • Fee-for-service plus bonus • Bundled payments plus bonus • Global capitation • Partial capitation

16. Premier- Gain sharing These Principles are: • Stakeholders should identify specific targets that reduce cost. • Evaluate objectively whether these targets were met. • They should share success financially. • Should engage in a process of continued monitoring.

17. Important Measures for Primary Care • Quality • Cost effectiveness • Care-coordination

18. Initial ACO Measures – Claims-Based

19. Intermediate ACO Measures – Key Clinical and Patient Experience Information

20. How do ACOs reduce expenditures? • Reduced hospitalizations and other wastes. • Care coordination and care transition for chronic disease and complex patients. • Internal process improvement. • Informed patient choices. • Prevention and wellness.

21. Integrating Specialists • Coordination between PCPs and specialists. • Support for preventing complications in specialty care and reducing costs. • Successful ACOs will promote more effective specialists care and PCP-specialists coordination and higher-value specialty care.

22. Important Measures for All Providers • Quality • Cost effectiveness • Care-coordination

23. Important Measures for All Providers • Quality • Cost effectiveness • Care-coordination X 2 Culture of teamwork

24. Next Steps for Specialists • Best practices for specialty coordination with medical homes • Best practices for all specialty procedure registries/patient tracking for improving care-and supporting meaningful performance measurements

25. Why would providers participate? • Improved professional working environment • Realization that at some point volume and intensity will not be able to be increased further • Understanding that the care currently being delivered is not in the best interest of our country or patients • Knowledge of continued reform attempts by all healthcare stakeholders to improve quality and bend the cost curve

26. Contact: Steve Wegner sew@ncaccesscare.org (919)380-9962