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IHS ACO Strategy: Population Management. Kathleen Cunningham Pam Halvorson Iowa Health System Trimark Physician Group Executive Director for VP Regional Clinic Operations Accountable Care Strategies Mike Dewerff Trinity Regional Medical Center

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ihs aco strategy population management

IHS ACO Strategy:Population Management

Kathleen Cunningham Pam Halvorson

Iowa Health System Trimark Physician Group

Executive Director for VP Regional Clinic Operations

Accountable Care Strategies

Mike Dewerff

Trinity Regional Medical Center

Chief Financial Officer

IHS Leadership Symposium

April 17, 2012

objectives
Objectives
  • Review IHS Vision of our Future Healthcare System
  • Describe the structured partnership between IHS and Regional Integrated Delivery System
  • Review basic payor principles for Wellmark and Medicare Contracts
  • Review TriHealth Pioneer ACO operational plan
  • Next Steps

IHS Leadership Symposium, April 17, 2012

aco model
ACO Model

$ - SAVINGS FOR EMPLOYER/PAYOR

Projected cost based on

medical inflation trends

Total cost of care for defined population

$MM

Performance Incentives for Physicians & Hospitals

Actual costs based on ACO and Medical Home collaboration

2007

2008

2009

2010

2011

2012

2013

2014

2015

IHS Leadership Symposium, April 17, 2012

the future of our health care system
The Future of Our Health Care System
  • Clinically integrated delivery system, regionally & system-wide, with effective population management infrastructure
  • Branded as the preferred “high quality—high value” to patients, communities, businesses, and payors
  • Patient-centric, physician-driven organization
  • National leader for healthcare reform innovation

IHS Leadership Symposium, April 17, 2012

a new day
A New Day
  • Value will be rewarded over volume
  • Physicians and other clinicians will be able to serve their patients
  • Hospitals, physicians and other providers will be rewarded for managing the overall health of our communities
  • Patients will receive coordinated and collaborative health care…not fragmentation

IHS Leadership Symposium, April 17, 2012

aco defined
ACO Defined

A clinically integrated network of physicians, hospitals, and others providers committed to using and advancing the latest thinking in clinical care, quality and efficiency.

Designed to achieve the triple aim:

better health, better healthcare,

and better value

IHS Leadership Symposium, April 17, 2012

slide9

Improve the health of the people

and communities we serve

Population Management

Population & Community Health

Integrated Care Organization 1

Platform for physician engagement and collaboration to improve quality, enhance patient experience and create value

Facilities & Services

Provision of inpatient, outpatient and ambulatory services required to deliver comprehensive patient care

Regional Integrated Delivery System

System & Regional Integrated Delivery System2

Care Management Infrastructure

Medical Home, Advanced Medical Team, Palliative Care, Coordinated Care Management/Population Management, Call Center

Analytic Support

Business and clinical analytic capabilities required to support a population focused care model

System & Regional Integrated Delivery System2

2 Medical homes, palliative care programming, and advanced medical team resources to be established in each affiliate region. Call Center would be an example of a system resource.

1 Organization made up of employed and independent physicians from each affiliate region; committee structure in place in each region

System

IHS Leadership Symposium, April 17, 2012

slide11

Research and Development for medical care innovations; partner with business unit to create value-added programs for system-wide impact

  • Advanced Medical Team
  • Palliative Care
  • Post-acute Care

Coordinated Care Management for IHS self-insured members expanding to all ACO members; provide care management and disease management for selected chronically ill patients.

Centralized analytics to include predictive risk-modeling; evidence-based care packages and disease registry to inform physician of patient gaps-in-care; monitor patient quality and provider performance.

  • Oversee ACO clinical strategy deployment in selected regions; use ACO Clinical Collaborative for regional engagement ;
  • Population risk management
  • Point-of-care management
  • Provider performance

Physician-led, clinically-integrated provider organization established to be the physician arm of ACO to improve quality and create value.

Other Aligned IHS Resources:

* CCT : PI/Research/Education * Business Development

* Communications * Information Technology/CMIO

* Decision Support

IHS Leadership Symposium, April 17, 2012

ihs leadership
IHS Leadership

IHACO Infrastructure

  • Kathleen Cunningham, Executive Director
  • Lori Weih, System Administrator, ACO Program Management
  • Marcia Stark, ACO Director, IHDM
  • Dr. Mark Barnhill, Medical Director, Pop. Care Management
  • Raedean VanDenover, Director, Pop. Care Management
  • Joe Walters, Interim Manager, ACO Health Informatics
  • Jim Grant, Sr. Claims Analyst
  • Angela Rubino, Network Development/Financial Analyst

Integrated Care Organization

  • Dr. Dave Williams, Medical Director
  • Gina Ross, Director, Operations
  • Nathan Thompson, Director, Physician Services

Iowa Health System

  • John Hendricks, Director, IT Interoperability
  • Amber Lenhardt, Director, Finance Services
  • Tim McCulley, Director, Payor Contracting

New Group

  • Linda Wendt, System Director of Quality

Iowa Health Home Care

  • Monique Reese, Chief Clinical Officer

IHS Leadership Symposium, April 17, 2012

slide13

Pioneer ACO CEO

Thompson

McDonald

IHS Leadership Symposium, April 17, 2012

slide14

TriHealth Pioneer ACO:Achieving our AIM

AIM: Leverage every aspect of our “community” to achieve Best Outcome for Every Patient Every Time

Primary Care Community

Supporting Choice through the Life Span

Primary Drivers

  • Palliative Care
    • Inpatient
    • Home-based
    • Clinic
    • Integration with PCP
    • Hospice
      • Hospice Home
      • Home-based
  • Risk stratification
  • Med Therapy Management
  • Disease Management Coaching
  • Strategic Community Partners
  • Health-Risk Assessment
  • Iowa’s Healthiest State initiative
  • Preventive screening
  • Health Education and Literacy
  • Wellness Program
  • Patient access to PCP
  • Common screening and assessment tools
  • Single, patient-centric care plan
  • Med Therapy Management
  • Mental Health Action Team
  • Care transitions – Extended Care Facilities
  • ICCDM – all care settings
  • Advanced Medical Team
  • Telephonic-Telemonitoring
  • Strategic Healthcare Partners
  • Critical Access Hospitals

Secondary Drivers

Home/Neighborhood - Schools - Business - Healthcare Agencies - Government -Recreation - Church/Spiritual

IHS Leadership Symposium, April 17, 2012

preparing for all payment arrangements
Preparing for all Payment Arrangements

IHS Leadership Symposium, April 17, 2012

aco program domains
ACO Program Domains

IHS Leadership Symposium, April 17, 2012

wellmark aco baseline
Wellmark ACO Baseline

IHS Leadership Symposium, April 17, 2012

ihs aco 2012 priorities
IHS ACO 2012 Priorities
  • Clinical Priorities
    • Advanced Medical Team
    • Palliative Care
      • Inpatient
      • Outpatient (home care)
  • Regional ACO Steering Committee
    • Key stakeholders to oversee ACO performance aligned with IHACO strategies
  • IHS Resources Assigned
    • Regional ACO Director
    • Project Manager
    • Analytics (EMR and claims)
    • IT liaison
    • Adaptive Design
    • Finance
    • Contracting
    • Communications

IHS Leadership Symposium, April 17, 2012

next steps
Next Steps
  • Deploy 2012 ACO Priorities
  • Refine technology requirements and analytic services to support ACO performance at the beneficiary level, to encompass all care settings
  • Further advance additional payor and provider negotiations to increase ACO beneficiaries served.

IHS Leadership Symposium, April 17, 2012

ihs aco program contacts
IHS ACO Program Contacts
  • ACO Program Management
    • Lori Weih, System Administrator, ACO Program Management
    • weihls@ihs.org Phone: 515-471-9791
  • Population Care Management
    • Raedean VanDenover, IHS Director, Population Care Management
    • vandenRK@ihs.org Phone: 515-471-9719
  • Advanced Medical Team
    • Monique Reese, Chief Clinical Officer, IHHC
    • fentonmc@ihs.org Phone: 515-557-3288
  • Palliative Care
    • Lori Bishop, Executive Director, Statewide Palliative and Hospice, IHHC
    • bishoplr@ihs.org Phone: 515-727-1104

IHS Leadership Symposium, April 17, 2012