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ACO, PCMH, PCSP The Ingredients for a Medical Neighborhood. Presented by: Cindy Friend, RN, BSN, MSN, MBA/HCA Executive Consultant November 8, 2013. Healthcare Reform Future of Healthcare PCMH PCSP ACO Payment Reform Healthcare Organization Fundamentals

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aco pcmh pcsp the ingredients for a medical neighborhood

ACO, PCMH, PCSP The Ingredients for a Medical Neighborhood

Presented by:

Cindy Friend, RN, BSN, MSN, MBA/HCA

Executive Consultant

November 8, 2013

slide2

Healthcare Reform

Future of Healthcare

PCMH

PCSP

ACO

Payment Reform

Healthcare Organization Fundamentals

Organize, Prioritize & Strategize

Agenda

slide3

Healthcare Reform

  • ACO
  • PCMH
  • ARRA/MU
  • PQRS/eRx
  • HIPAA
slide4

The Future of Healthcare

  • Medical Neighborhoods
  • ACO
  • PCMH
  • Meaningful Use
  • HIPAA, PQRS & eRx
slide5

The Medical Neighborhood

Hospital

Pharmacy

Lab/Rad

Home Health

Patients

Payers

LTC/Rehab

Employers

Government

Physicians/Clinics

slide6

The Name Means the Same

ACO

PHO

CIN

IDN

ICO

CCO

slide7

PCMH – Patient Centered Medical Home

PCSP – Patient Centered Specialty Practice

ACO – Accountable Care Organization

Medical Neighborhood Foundation

slide8

Today vs. Tomorrow

Source: The University of Oklahoma-Tulsa (revised)

slide9

Primary Care Providers

Recognition programs

NCQA 2011Standards

Includes Stage 1 Meaningful Use Requirements

PCMH

slide10

Started with 38 in 2008

Over 6,000 medical practices

Almost 30K clinicians

49 States

~15% of all primary care practices

PCMH Numbers

Source: The Commonwealth Fund

Source: Market Watch, Business Wire, 2013

slide11

PCMH Standards

Source: NCQA

slide12

Specialty practices

NCQA recognition program

Launched end of 3/2013

Includes Stage 1 and Stage 2 Meaningful Use Requirements

PCSP

slide13

PCSP Standards

Source: NCQA

slide14

Community collaborations

Almost 500 ACOs among private and public payers

Accreditation available

ACO

slide15

Number of ACOs

Source: Levitt Partners, 2013

slide16

Medicare Reimbursement

Source: Dartmouth Atlas, 2010

slide17

Medicare ACOs

Source: RUPRI Center for Rural Health Policy Analysis, 2013

slide18

ACO by State

Source: Levitt Partners, 2013

slide19

ACO Standards

Source: NCQA

slide20

Aetna and WellSpan form ACO (10/11/13)

River Health applies for MSSP (8/30/13)

Memorial Hermann Physician Network and BCBS of Tx (9/18/13)

Rutgers and Robert Wood Johnson Medical School form ACO (10/16/13)

More than 300 Physicians Join Brown & Toland’s ACO with Cigna (10/15/13)

The Effort Continues

slide21

Payment Reform

Source: United Healthcare

slide23

Shared Governance

Legal, Policy & Compliance

Operations

Finance

Population Management

Risk Management

Performance Reporting

Business

slide24

IT Infrastructure

Clinical Systems & Tools

Regulations

Data Analytics

Reporting Requirements

ACO Connectivity

Patient Connectivity

Health Information Exchange

Technical

slide25

Staff Assessment, Engagement & Education

Population Management

Evidenced-Based Care Management

Care Coordination

Care Transitions

Care Planning

Clinical

slide26

Clinical Workflow

Patient Engagement

Quality Measures

Performance Analysis

Quality Improvement

PCMH Practice/ Recognition

Clinical

slide28

Initiate stakeholder outreach and education

Establish a separate entity with authority and accountability

Conduct organizational assessments, improve deficiencies, and obtain recognition

Improve medical management

Identify technology requirements and implement systems

Establish performance evaluation, reporting, and improvement process

Develop a strategic plan and execute!

Organize, Prioritize & Strategize

slide29

For more information, please contact:

Cindy Friend, RN, BSN, MSN, MBA/HCA

cfriend@beaconpartners.com

443.413.6901