Best Practices and Strategies to Engage
ACOs, Incentive Programs and Emerging
Payment Models
JUSTIN T. BARNES
CHAIRMAN EMERITUS, EHR ASSOCIATION
About Justin T. Barnes
As a healthcare innovation executive and strategist, Justin is a corporate, board and policy advisor who also serves as an Entrepreneur-in-Residence with the Georgia Tech ATDC Innovation Incubator. In addition, Mr. Barnes is Chairman Emeritus of the HIMSS EHR Association as well as
Co-Chairman of the Accountable Care Community of Practice. Barnes previously was a member of the leadership team at Greenway Health where he worked for 11 years primarily serving as Vice President of Marketing, Industry Affairs, Government Relations and International Affairs.
Justin has formally addressed and/or testified before Congress as well as the last two Presidential
Healthcare Reform/Transformation
◦ Newly proposed CMS Shared Savings Program Rule focuses on more ACO flexibility, greater performance-based risk and reward as well as the use of innovative care coordination & telehealth tools
◦ In January, Medicare will start paying $42/ month to doctors to coordinate care for chronically ill
◦ Renewed chances for SGR/ FFS Reform over 3-to-5-year period. Phase in an alternative payment model that leverages outcomes & quality-based payments with a smaller fee-for-service reimbursement
State of EHR Meaningful Use
◦ HIT Policy Committee released Stage 3 recommendations ~ http://tinyurl.com/mo8fuzd ◦ Expect Proposed Rule in Fall 2015
◦ Over 501,000 care providers registered for meaningful use (415,000 have achieved MU)
◦ Over $25.4 billion in incentives paid to eligible providers & hospitals
Assessing ICD-10
Protect your investment
Continue conversion plan
◦ Education & training
Reassess health IT platform
Keep focus on long-term success
Continue to expand clinical documentation
◦ Documenting toward quality reporting is a foundation for value-based medicine
Navigating “Consumerism”
High deductible plans impact healthcare decisions
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Families striving to reduce the healthcare costs
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Engage local employers to see what plans they are offering
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Growing demand for care management resources
Retail clinics as alternatives for consumers
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Many patients visit CVS or Walgreens clinics for convenience
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Offering lower cost and quick visits for simple treatments
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Consider how this impacts your patient visit volume
Care providers should be proactive
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Create your own patient satisfaction & engagement strategy
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Produce analytics on patient/ consumer population
Sustainability & Strategy
Public & private payer goals to slow growth of healthcare costs
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Decreasing the number of duplicate tests performed
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Reducing number of patient days in hospital and readmissions
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Increase patient compliance via engagement and satisfaction
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Support legislation to stabilize SGR & modify FFS
Accountable Care &
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Over 75% of providers have EHRs
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Training and usability are key
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Established data liquidity
EHR
Adoption
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415,000+ providers have achieved incentives
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If you don’t qualify, use criteria as a “playbook”
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MU Stage 2 = PCMH/ACO foundation
Meaningful
Use
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Quality reporting
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Outcomes-based payments
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ACO/APM/VBP
Value-Based MedicineThese are essential building blocks for a sustainable healthcare system
Engage Established Incentive Models
Meaningful Use Stage 2
◦ Elements such as care coordination & patient engagement are foundations for value-based medicine
◦ Evidenced through specific core & menu items such as VDT, ToC
Patient-Centered Medical Home
◦ Specialty Medicine: Patient-centered Specialty Practice (PCSP) expands PCMH from primary care
◦ Seek EHRs that offer 16-20+ NCQA prevalidated auto credits
Accountable Care Organization
◦ Joins siloed entities: Payers, provider groups, hospitals
◦ 606+ ACOs serving 25M Americans
◦ Composition of the care delivery model is shifting
Market Evolution
Alternative Payment Models (APM) are emerging
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Focus of SGR repeal proposals
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Health plans are incentivizing patient behavior
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Low performers are being pushed out of APMs
Rise of communities of health/ecosystems
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Assess peers, benchmarks, patient volume and payer transparency
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Provider risk-based education, analytics, RCM & Data Services
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MU is a foundation for ACO, PCMH, Care Coordination futures
ACO Best Practices
As bonuses from shared savings flow to providers, some must be shared with
front-line staff to achieve “buy in” with quality care and savings goals.
Clearly define the criteria for creating narrow networks and selecting
high-performing provider groups. At the same time, providers who are still adapting to new
models must have a fair path to ACO participation.
Focus on EHR interoperability with mobile platforms to get patients more involved in
their own care.
Gather data on patient satisfaction during the course of normal workflow, so that
collecting it does not become a separate burden.
ACO Best Practices -
MSSP
Lessons Learned
Importance of strong clinical leadership
Communication and transparency
Practice redesign
Innovative care coordination
The value of data and dashboards
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Team of pharmacists managing diabetic patients
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Now using mHealth tools to
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Improve clinic efficiency
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Get patients to goal faster
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Sustain patient engagement
Meadows Regional Medical Center
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81% of self-pay is never collected
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Using a consolidated Patient Payment Platform:
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11% increase in payments
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72% of payments made in full
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37.5% reduction in spend
Position Your Practice
Utilize Health IT to increase care coordination in your community
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Focus on the importance of EHRs and meaningful use as a foundation
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Standards-based interoperability
Evaluate beneficiary volume in your organization and research if
expansion strategies are warranted
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Partner with local practices and hospitals
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New organizational structures emerging
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Identify CMS, commercial, or combined care coordination/ACO opportunities
Research the average cost for episodes of care
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Medicare is sharing cost data; inquire with commercial payers as well
Community Accountability
Assess relationships in your community with peers, associations, payers,
employers, and health systems
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Evaluate current and potential future opportunities
Benchmark against regional and national peers
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Understand how your customers rate in outcomes, costs, etc.
Ensure your organization creates a network with the best providers possible
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Providers will be accountable for the efficiency and level of care their peers provide
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Ultimately, you will care who is in your network
Evaluate interoperability to effectively share patient data
CMS Innovative Maps & Models (http://innovation.cms.gov/initiatives/map/index.html#model=)
The Centers for Medicare & Medicaid Services (CMS)
U.S. Department of Health & Human Services (HHS)
CMS Innovation Center (http://www.innovations.cms.gov/)Medicare Physician Compare (http://tiny.cc/tweqnx)
CMS Educational Events Page(http://tiny.cc/awdqnx)
Understanding HIPAA (http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html) Medicare Provider Utilization and Payment Data (http://tiny.cc/hreqnx)
