Principles and Pracitces of Accountable Care Transformation

© 2015 Health Catalyst
www.healthcatalyst.com
Proprietary and Confidential
c
May 2015
Principles and Practices
of Accountable Care
Transformation

Today’s Presentation
2
State of Value-Based Payment
Near-Term Priorities for
Accountable Care
Driving toward Population
Health Management

www.healthcatalyst.comProprietary and Confidential
State of Value-
Based Payment

Broad Support for
Value-Based Payment
4
Source: HHS Press Release, January 26, 2015
2016
30%
55%
Alternative
Payment Models
(ACOs, bundled
payments, etc)
Other VBP
Programs
2018
50%
40%
Alternative
Payment Models
Other VBP
Programs
HHS Value-Based Payment Goals
Health Care
Transformation Task Force
“Health Care Transformation
Task Force is an industry consortium
that brings together patients, payers,
providers and purchasers to align
private and public sector efforts to
clear the way for a sweeping
transformation of the U.S. health
care system
…We believe so strongly in our
mission that our payer and provider
members commit to put 75 percent
of their respective businesses
operating under value-based
payment arrangements that focus on
the Triple Aim by January 2020.”

2015 HealthLeaders Media industry survey, n=580
Still in a Pilot Phase
10%
28%
33%
6%
11%
4%
3%
4%
0%
5%
10%
15%
20%
25%
30%
35%
Not pursuing Investigating Pilot underway Pilot done,
rollout not
scheduled
Pilot done,
rollout
scheduled
Rollout nearly
done
Full rollout Do not know
Organization Status on Value Based Payment

Proprietary and Confidential 6
Kaufman Hall Survey Update April 2015
Anticipating a Tipping Point
22%
42%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Aug 14 Feb 15
7%
22%
0%
5%
10%
15%
20%
25%
Aug 14 Feb 15
Hospitals with More Than 10% of
Revenue from Value-Based Contracts
Hospitals Anticipating More than 50% of Revenue
from Value-Based Contracts in 24 Months

Poll Question #1
7
What percentage of your organization’s revenue
comes from value-based contracts today? 130
respondents
 Less than 10% - 61%
 11-30% - 29%
 31-50% - 5%
 More than 50% - 5%

Poll Question #2
8
What types of value-based contracts
are most prevalent at your organization? – 134
Respondents
 Fee-for-service plus bonus – 27%
 Bundled payments – 12%
 Shared savings – 20%
 None of the above – 26%
 All of the above – 15%

Fee for Service Fee for Value
The Common Denominator:
Reduce Costs, Improve Quality
9
Cost
Payment
Cost
Payment

Balancing Short-Term Imperatives
with Long-Term Transformation
10
Short-term goal:
Successfully Manage At-Risk Contracts
Owner: Accountable Care Team
Long-term goal:
Transform the Care Delivery System
Owner: Care Delivery Team
Cost
Accountable Care
Population Health Management

Near-Term Priorities
for Accountable Care

Contract Management
12
Focus Area Key Questions
When
Considering
New At-Risk
Contracts
• Which patient populations I want to manage under at-risk contracts?
• Where I can meaningfully drive down costs (and which areas already have low
costs and or minimal variation in care)?
• Which performance measures will best represent my organization?
• Which payers are a good partner (sufficient volume of patients, mutually
beneficial benefit design, willing to provide data)?
Today’s
At-Risk
Contracts
• How am I performing relative to contractual targets?
• How are key utilization metrics trending?
• What percentage and type of services am I sending out of network? Why?
• Who are my high-risk, high-cost patients?
• How am I performing on performance measures like the ACO 33?
• Do I have an understanding of areas of high cost and variation within my ACO?
On a Journey without a Map

Network Management
Moving Beyond our Four Walls
13
How do I reduce
costs? How do I
improve referral
patterns?
Who are my
best (lowest
cost, highest
quality)
partners?
How do I reduce
leakage?
Partners
Out-of-Network
In Network
Manage
Leverage data on leakage
and referrals to pinpoint
opportunities to improve the
performance of your
provider network.
Optimize
Overlay information about
your patient population’s
needs and your provider
population (including
accessibility, cost, and
quality) to identify gaps.

Care Management
14
21.0%
49.5%
65.2%
75.0%
81.7%
97.3%
2.7%
0%
20%
40%
60%
80%
100%
Top 1% Top 5% Top 10% Top 15% Top 20% Top 50% Bottom 50%
Percent of Population, Ranked by Health Care Spending
Concentration of Health Care Spending
in the U.S. Population, 2010
(≥$53,238) (≥$18,086) (≥$10,044) (≥$6,696) (≥$4,639) (≥$829) (<$829)
PercentofTotalHealthCareSpending
Source: Kaiser Family Foundation calculations using data from U.S. Department of Health and Human Services, Agency for
Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), Household Component, 2010.
Today: High-Risk, High-Cost Patients

Care Management
15
Identify
Right patients
Right care
Right provider
Intervene
Plan
Execute
Adjust
Assess
Compliance
ROI
Care Management
Identify the highest risk,
highest cost patients in need
of care management.
Patient Engagement
Care management will not
be the most appropriate
intervention for every
patient. As you target more
populations with a wider
array of interventions, this
becomes patient
engagement. The
principles—identify,
intervene, assess—remain.
Tomorrow: Patient Engagement

Performance Monitoring
16
Minimizing Burden, Maximizing Value
“[T]he total number of health and health care measures in use today is unknown. Nonetheless,
reference points such as CMS Measure Inventory, which catalogs nearly 1,700 measures in use
by CMS programs, indicate that they number in the thousands…Change is clearly needed.
The rapid proliferation of interest in, support for, and capacity for new measurement
activities has paradoxically blunted the effectiveness of those efforts.”
Institute of Medicine, Vital Signs, 2015

A Note about Data
17
• Claims Data—
• Key to providing an out-of-network view of care.
• Supports critical analyses related to PMPM performance,
leakage, and some performance measures.
• Clinical Data—
• Not only more comprehensive and timely, but it’s available
in advance of signing the at-risk agreements.
• Key to patient risk, referral, and performance measures.
Clinical or Claims Data? Both are Key

Driving toward Population
Health Management

The Long-Term Vision:
Transforming Care Delivery
19
Short-term goal:
Successfully Manage At-Risk Contracts
Owner: Accountable Care Team
Long-term goal:
Transform the Care Delivery System
Owner: Care Delivery Team
Cost
Accountable Care

Outlier Management
# of
Cases
Current Condition:
Significant Volume and Variation
# of
Cases
Option 1: “Punish the Outliers”
or “Cut Off the Tail”
Mean
Focus on
Minimum
Standard
Metric
Excellent OutcomesPoor Outcomes Excellent OutcomesPoor Outcomes
Outlier Management
• Set a minimum standard of quality
• Focus improvement effort on those not meeting the minimum standard

Excellent OutcomesPoor Outcomes
# of
Cases
Excellent Outcomes
# of
Cases
Option 2: Identify Best Practice
“Narrow the curve and shift it to the right”
Mean
Poor Outcomes
Inlier Management
(Focus on Better Care)
Inlier Management
• Identify evidenced based “Shared Baseline”
• Focus improvement effort on reducing variation
• Often those performing the best make the greatest improvements
Current Condition:
Significant Volume and Variation

Improvement Prioritization
22
22
Care Process Families by Resources Consumed (High to Low)
TotalResourcesConsumed
Top 10 Care Process
Families account for 34%
of the opportunity
Top 40 Care Process
Families account for 80%
of the opportunity

Choosing a Place to Start
23
Key Process Analysis
Total Net Revenue
AdjustedCoefficientofVariation

Doing Well by Doing Good
= Negative Impact = Positive or Negative = Positive Impact
Care Process Family
Knowledge Asset
Discounted
FFS
Per Diem
Per Case Bundled Per Case
Condition
Capitation
Full
Capitation
CMS Commercial CMS Commercial
Workflow
Diagnostic Variation
Standing Orders
Medication Selection
Triage
Patient Safety
Ambulatory
Treatment and
Monitoring
Indications for
Referral
Indications for
Intervention

Creating a Case for Quality
25
Dr. J.
15 Cases
$60,000 Avg. Cost Per Case
Mean Cost per Case = $20,000
$40,000 x 15 cases =
$600,000 opportunity
Total Opportunity = $600,000
Total Opportunity = $1,475,000
$35,000 x 25 cases =
$875,000 opportunity
Cost Per Case, Vascular Procedures

For more information…
26
State of the Industry
Value-Based Reimbursement: The New Reality
On-Demand Webinar, Bobbi Brown, May 2015
Accountable Care Transformation Framework
White paper, Dr. David Burton
https://www.healthcatalyst.com/whitepaper/aco-
requirements-transformation-framework/
Health Care: A Better Way
Book, Dr. John Haughom, et all
https://www.healthcatalyst.com/ebooks/healthcare-
transformation-healthcare-a-better-way/
Analytic
System
Content
System
Deployment
System

Readying Your Organization
for Value-Based Payment
27
• Don’t underestimate the value of data in driving your transition to value-based payment;
you will need access to a wide variety of data sources to do meaningful analyses which
will be key to successfully managing your current at-risk contracts in addition to coming
to the table prepared for future contract negotiations
• Develop a plan for tacking each of the five short-term competencies, including: at-risk
contracting, network management, care management, performance monitoring, and
improvement prioritization. What are your capabilities in each of these areas today?
Where are your gaps and weaknesses? What data is available to drive decision making?
• Consider your organization’s timeline for true care transformation. Are you in a market
that is moving rapidly toward value-based payment? Or are you still in an early pilot
building phase? Will this journey take place in the next year or two or the next decade?
• Prioritize your care transformation efforts, identifying opportunities for improvement and
evaluating how closely your current payment models align with your proposed initiatives.
Consider opportunities to approach your payers proactively, around meaningful
improvement initiatives, to get paid for value.

Upcoming Webinar
Introducing Health Catalyst Academy: An
Innovative Approach for Accelerating Outcomes
Improvement
Tommy Prewitt, MD, Director, Healthcare Delivery Institute and Bryan
Oshiro, MD, Chief Medical Officer, Health Catalyst
 Wednesday, May 27, 1-2pm ET
 https://pages.healthcatalyst.com/2015-05-
27APProgramWebinarMasterEmail.html
28

Healthcare Analytics Summit 15
Here’s a sneak preview …
Industry-leading Speakers
Jim Collins
Best-selling author of Good to
Great, Great by Choice, Built to
Last, and How the Mighty Fall
Ed Catmull
Co-founder of Pixar
President of Pixar and Walt
Disney Animation Studios
Daryl Morey
Houston Rockets
General Manager and Managing
Director of Basketball
Operations
Amir Rubin
Stanford Health Care
President and CEO
Timothy G. Ferris, MD, MPH
Partners HealthCare
Senior Vice President of
Timothy Sielaff, MD, PhD,
FACS
Allina Health
Chief Medical Officer
Summit highlights
3-day Agenda
We’ve increased the time of this year’s summit to allow for more
sessions, topics, and networking.
CME Accreditation for Clinicians
This activity has been approved for AMA PRA Category 1 Credits™.
More Case Study Sessions
Health system case studies addressing even more clinical, technical,
operational, and financial examples.
Hands-On Experiences
Examples, vignettes, and audience-based activities demonstrate
principles in fun and memorable ways.
Analytics-Driven Engagement
Real-time polling, networking, Q&A, and gamification experiences; plus,
i-beacon location technology.
Networking
Experience networking options that use analytics creatively to help you
find and connect with others.
Pre-Summit Classes and Training
An early half-day of pre-session classes and training options specifically
for Health Catalyst clients.
3X the sessions
8 keynotes, 25 breakouts, 25-40 analytics walkabout mini-sessions
f
Early Registration Pricing, Optimized For Teams
Buy 1
(save $300)
$395/Pass
(through May 31)
Buy 3
(save $1,098)
$329/Pass
(through May 31)
Buy 5
(save $2,000)
$295/Pass
(through May 31)

Question and Answer

Principles and Pracitces of Accountable Care Transformation

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Andere mochten auch

Andere mochten auch (18)

Ähnlich wie Principles and Pracitces of Accountable Care Transformation

Ähnlich wie Principles and Pracitces of Accountable Care Transformation (20)

Mehr von Health Catalyst

Mehr von Health Catalyst (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Principles and Pracitces of Accountable Care Transformation

Hinweis der Redaktion