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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 Accountable Care Organization John C. Lincoln Physician Network. John C. Lincoln Health Network Overview. John C. Lincoln Hospitals.

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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 Accountable Care Organization

John C. Lincoln Physician Network

john c lincoln hospitals
John C. Lincoln Hospitals
  • North Mountain Hospital
    • 262 Beds
    • Trauma Center
    • Magnet Designation
  • Deer Valley Hospital
    • 203 Beds
physician network at a glance
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
    • 2013 - 409,000 (projected)
accountable care organization
Accountable Care Organization

Approved by CMS July 2012

18,000 Medicare Shared Savings Program (MSSP) and Commercial members

organization of health care providers
Organization of Health Care Providers
  • Primary care and subspecialty physicians
  • Hospitals
    • Acute care
    • Rehabilitation
  • Post-acute providers
  • Home health organizations
health care providers cont
Health Care Providers (cont.)
  • Disease management
  • Mental health
  • Health and wellness
  • Patient engagement
reimbursement in a medicare aco
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

If a Medicare ACO is able to reduce the cost of caring for assigned Medicare patients and meet required quality standards, a possibility of shared savings exists

options for medicare aco shared savings
Options for Medicare ACO Shared Savings

In either risk model, all providers continue to bill Medicare fee-for-service using the normal Medicare fee schedule.

  • Tier 1 – Limited risk
  • Tier 2 – Risk-bearing

Calculate Shared SavingsStep 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. This is the base spending level.



Calculate Shared SavingsStep 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, or $5M, up to a maximum amount.



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 beneficiaries are not limited to ACO partners



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
  • Preventive Health
    • 8 measures, include a variety of screenings



ACO Cycle






IT Challenge #1

CMS transmits attribution file to ACO

ACO locates patient demographic information

ACO sends prescribed letter to attributed patients

Update to CMS with patient data sharing preferences

Patients respond/don’t respond to letter



IT Challenge #2

Disease Registries

Third Party Data Analysis Tool

CMS Data Transmission

High cost Beneficiaries

High ER Utilizers



IT Challenge #3

PCP office visit

Patient Information

Create and file HCC


Support patient outreach, care management, and data collection workflow



IT Challenge #5

Clinical quality measure reporting

Data Sources


GPRO web site data entry



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
      • Claims data processing
      • Population health analytics

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 Information Exchange

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
    • Dedicated consultant project manager – rapid start
    • Leverage central IT organization for other skills

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
    • Improve value to encourage interactions and create value

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
    • Both sources of data are necessary for success

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
    • Plan for automation for Year 2

Health Information Exchange (HIE)?

  • Options
    • Public
    • Private
    • Both
    • None
  • Our approach
    • Start without HIE
    • Next step – private HIE
    • Future – expand to public

IT Organization?

  • Options
    • Integrated with corporate IT
    • Separate IT
  • Our approach
    • Fully integrated – single CIO