Accountable Care: A Path Toward the Triple Aim?

1. G8 April 11, 2014 Accountable Care:A Path Toward the Triple Aim? Trissa Torres, MD, MSPH Senior Vice President Institute for Healthcare Improvement

2. Agenda ACOs… • Why • What • Progress • Toward Success

3. International Comparison of Spending on Health, 1980–2010 Total health expenditures aspercent of GDP Average spending on healthper capita ($US PPP) Notes: PPP = purchasing power parity; GDP = gross domestic product. Source: Commonwealth Fund, based on OECD Health Data 2012.

4. Wealthier, Not Healthier Source:Institute of Medicine. U.S. Health in International Perspective: Shorter Lives, Poorer Health. Available at: http://www.iom.edu/Reports/2013/US-Health-in-International-Perspective-Shorter-Lives-Poorer-Health.aspx

5. Social Spending Source: Bradley EH, Elkins, BR, Herrin J, Elbel B. “Health and social services expenditures: associations with health outcomes.” BMJ Quality & Safety. March, 2011. http://qualitysafety.bmj.com/content/early/2011/03/28/bmjqs.2010.048363.abstract

6. An all too familiar scenario It’s scary when I can’t breathe. I miss my family. Sometimes I’m just too tired to go to the doctor.

7. An all too familiar reaction I know what she needs, but not how to help her. If only someone could check on her. I don’t have the time or the resources.

8. Affordable Care Act (ACA) “Obamacare” Increasing Coverage, Changing Care Models President Obama signs the Affordable Care Act. (3/23/2010) Encouraging Integrated Health Systems &Launch of ACO Pioneer Program(1/1/12) Improving Preventative Health Coverage & Launch of SSP ACO model (1/1/13) Prohibiting Discrimination Due to Pre-Existing Conditions or Gender (1/1/14) Bring Down Health Care Premiums (1/1/11) 2014 2013 2010 2011 2012 Provide Free Preventative Care(9/23/2010) Open Enrollment in the Health Insurance Marketplace Begins (10/1/13) Increase Access to Services at Home and in the Community (10/1/1/11) Understanding and Fighting Health Disparities (3/1/12) Establishing the Health Insurance Marketplace (2014) Prohibit Denying Coverage of Children Based on Pre-Existing Conditions (9/23/2010) Source: U.S. Department of Health and Human Services

9. Accountable Care Organization (ACO) Definition An ACO is an organization of health care providers that agrees to be accountable for the overall care and cost of care for assigned beneficiaries

10. Health of a Population Per Capita Cost Experience of Care

11. Determinants of Health and Their Contribution to Premature Death Proportional Contribution to Premature Death Adapted from: McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff (Millwood) 2002;21(2):78-93.

12. Triple Aim = Managing Populations

13. ACOs are a Payment Mechanism

14. Accountable Care Organizations (ACOs) Now over 600 ACOs across the country Source: Leavitt Partners Center for Accountable Care Intelligence

15. ACO Growth Source: Leavitt Partners Center for Accountable Care Intelligence

16. ACO Growth by Organization Source: Leavitt Partners Center for Accountable Care Intelligence

17. Growth in Covered Lives Serving over 18 million people Source: Leavitt Partners Center for Accountable Care Intelligence

18. Preliminary ResultsGovernment Sponsored ACOs Source: The Commonwealth Fund and U.S Department of Health and Human Services

19. Patient/caregiver experience 7 measures Timely, communication, specialist access, health promotion, shared decision making, perceived health status Care coordination & patient safety 6 measures Readmissions, ASC Admissions for CHF, EMR, Med Rec, Fall Risk CMS ACO Quality Metrics Preventive health 8 measures Influenza Immun, Pneumococcal, Wt screening, Tobacco assessment & intervention, Depression Screen, CRC Screen, Mamm Screen, BP assess At-risk populations 12 measures Composite scores for management of Diabetes, Hypertension, Ischemic Vascular Disease, Heart Failure, Coronary Artery Disease

20. What might success look like?

21. Population Management

22. Managing Services for a Population Community, Family and Individual Resources Coordination Goals Delivery of Services at Scale Needs Assessment for Segment Service Design Population Segmentation Population Outcomes Integrator Feedback Loops Feedback Loops

23. Activities of a Population Management Learning System

24. Enabling and Constraining Factors • Leadership • Integrated Data Systems • Improvement Infrastructure (Learning System) • Provider and Stakeholder Engagement • Leveraging Financial Models

25. New Mental ModelsHow Leaders Think About Challenges and Solutions Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.org.

26. High-Impact Leadership BehaviorsWhat Leaders Do to Make a Difference Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.org.

27. IHI High-Impact Leadership FrameworkWhere Leaders Focus Efforts Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.org.

28. Population Management Assessment

29. Health of a Population Per Capita Cost Experience of Care

30. Improved provider experience I am thrilled we are helping Mrs. Jones. My team has come together. Her family, church, and community have all come together to help too.

31. An all too familiar scenario I don’t feel lonely anymore. I’m not afraid. Dr. Patel’s team helps me.

32. Recommendations to Accelerate the Journey… • “Act for the individual and learn for the population” • Understand what it truly takes to improve care for individuals • Leverage the richness of individual organizational learning • Create learning systems that enable ACOs to share with and learn from one another • Create more opportunities to convene representatives from the provider, payor, and health information technology communities