Starting an ACO: IT Lessons Learned

Starting an ACO:

IT Lessons Learned

Robert Slepin, PMP, VP and CIO

John C. Lincoln Health Network

Nathan Anspach, SVP and CEO

John C. Lincoln Hospitals

• North Mountain Hospital

 262 Beds

 Trauma Center

 Magnet Designation

• Deer Valley Hospital

Physician Network: At a Glance

• 120 primary care providers

 Additional planned growth

• 20 specialists

• 34 locations

• NCQA PCMH Accreditation In-Process

• Patient Visits

 2011 - 263,866

 2012 - 323,144

Accountable Care Organization

• Approved by CMS July 2012

Organization of Health Care Providers

• Primary care and subspecialty physicians

• Hospitals

 Acute care

 Rehabilitation

• Post-acute providers

Health Care Providers (cont.)

• Disease management

• Mental health

Reimbursement in a Medicare ACO

• All participating providers continue to be

reimbursed by Medicare on a fee-for-service

basis

• Patients attributed to an ACO can continue to

seek care from any Medicare participating

physician, hospital or provider

Options for Medicare ACO Shared Savings

• Tier 1 – Limited risk

• Tier 2 – Risk-bearing

In either risk model, all providers continue to

bill Medicare fee-for-service using the

Calculate Shared Savings

Step One: Determine Base Spending Level

1. Determine the number of Medicare

beneficiaries in the ACO. We will use

15,000 in our example.

2. Determine the average annual spend

per beneficiary. In Phoenix, that figure is approximately $9,000.

3. Multiply 1 times 2 and the result is a very large number - $135M.

Calculate Shared Savings

Step Two: Reducing Cost

1. Hypothetical: average cost is reduced by 7.5% to $8,333 per beneficiary. 2. Multiply $8,333 times same number

of members. Total Spend is now $125M.

3. Subtract $125M from $135M and savings are $10M. The ACO takes half,

Shared Savings Possible, Not Easy

• Requires reporting performance on 33 quality

measures

• At least 50% of participating primary care

physicians using an electronic health record

• Costs of care have to be reduced, but

Four Domains of Quality Measures

• Patient/Caregiver Experience of Care

 7 measures

• Patient Safety/Care Coordination

 6 measures including electronic health record

• At-Risk Population

 12 measures, focused on diabetes, heart failure, hypertension and coronary artery disease

CMS Data Transmission

Patient Information PCP office visit Create and file HCC DiseaseRegistry 20

IT Challenge #3

IT Challenge #4

Clinical quality measure reporting

IT Challenge #5

Strategic IT

Technology Platform?

• Options

 Integrated ACO platform: Optum, Aetna or other

 Best-of-breed ACO platform: EHR, HIE and other pieces  Enterprise EHR

• Our approach

 Leverage enterprise EHR to fullest extent

 Supplement with in-house development and third party software-as-a-service where needed

o Claims data processing

Single or Multiple EHRs?

• Ideal: One EHR

• Reality: Many EHRs and paper

• Options

 Require all participants to adopt single EHR  Two-three preferred EHRs

 Any EHR, take your pick

• Our approach

 Single EHR for JCL hospitals and physician practices  Longer term – preferred EHRs and Health

FTE, Consultants or Outsource?

• Existing IT staff likely fully committed

• Significant IT resources needed

• Options

 FTE hiring/ramp-up time

 Consultant costly, and you lose investment in know-how  Outsourcing – high risk

• Our approach

Patient Engagement?

• Options

 Personal Health Record (PHR)  Patient portal

 Monitoring devices  Mobile apps or text

• Our approach

 Leverage EHR patient portal

 Promote adoption at practices and via marketing

Claims or Clinical Data?

• Claims

 Good picture of most but not all encounters  Time delay

• Clinical

 Richer data not available in claims  Real time

• Our approach

CMS Measure Reporting?

• Options

 Leverage core EHR

 Third party reporting tool  Custom software

 Manual workaround

• Our approach

 Extract data from core and legacy EHRs  Manual compilation of measures

Health Information Exchange (HIE)?

• Options

• Our approach

 Start without HIE

IT Organization?

PMO EMR _Reporting Data &

• Options

 Integrated with corporate IT  Separate IT

• Our approach