community physicians of maine pioneer aco program proposal strategy cpm board meeting discussion...

Community Physicians of Maine

Pioneer ACO ProgramProposal Strategy

CPM Board Meeting Discussion

July 27, 2011


Discussion Objectives

• Communicate MaineHealth and PHO activities regarding the Pioneer ACO Program

• Engage CPM in a discussion of what this means for CPM

• Discuss how to move forward given tight timeframes and complexity of situation


We must be prepared to respond to the health reform imperative

National Conversation on Economy and Health Reform

Commitment to Payment Reform:

•CMS

•MaineCare

•Commercial

MaineHealth Must Respond

•System alignment with Triple Aim

•Changes for long term sustainability


The Pioneer Program presents a strong opportunity to advance our preparation for

health reform

MaineHealth must respond.

• System alignment with Triple Aim

• Changes for long term sustainability

Pioneer Program•Best current (not perfect!) option for CMS payment reform participation

•Our process is as important as the outcome:

• We will re-affirm capabilities for accountable care

• We will discover limitations we must address


The Pioneer Program contains several attractive design

features and poses a number of challenges

Our Strategy

•Submit a proposal for an Alternative Payment Model in coordination with the Northern New England Accountable Care Collaborative

•Recognize our structure and approach may depart from what CMS is seeking but emphasize the value our proposal presents to them

•Plan to avail ourselves of the option to withdraw if necessary


We will coordinate our responses to the Pioneer

ACO Program with our NNEACC partners

Points for Coordination

•Common format

•Joint proposal for an Alternative Payment Model

•Internal finances and risk pools are separate

•Cross reference content on technical, analytic, and quality improvement capabilities

•Propose common strategies for achieving the Triple Aim


Blumenfeld, Barry

Cawley, Jacquelyn

Cutler, Josh

Fay-LeBlanc, Renee

Fourre, Mark

Powers, James

Salvador, Doug

Wennberg, David

Wilson, Nathan

Moore, Jennifer

Nemec, Kimberly

Patstone, Andrea

Smith, Janet

Albaum, Michael

Wight, Joe

Landry, Daniel

Roy, Michael

Belair, Norm

Cox, John

Kirby, Jeffrey

McCue, Bob

McGinty, Francis

Moore, Jennifer

Moynihan, Daniel

Patstone, Andrea

Swallow, Al

Bates, Peter

Hawkins, Robert

Herlihy, Kate

Johnson, Betsy

Lafleur, Joel

Lavoie, Frank

Loiselle, Daniel

Brown, Vance

Mette, Stephen

Biscone, Mark

Caron, William

Churchill, Tim

Frank, Robert

McGinty, Francis

Petersen, Richard

Quigley, Donald

Skillings, Lois

White, Skip

Wood, Peter

Patstone, Andrea

Quality Care Model Finance Steering

MaineHealth Pioneer AC Workgroup Members ~Physicians are in bold~

Aalberg, Jeffrey

Brewster, Tom

Brown, Vance

Clark, Mike

Goldsmith, Dana

Johnson, Betsy

Stevenson, James

Wennberg, David

Arsenault, Maryanna

Cowan, Tim

Deatrick, Deb

Haynes, Margaret

Osgood, Julie

Patstone, Andrea


Subcommittee Reports

• Care Model: Jeff Aalberg

• Quality: Josh Cutler

• Steering: Stephen Mette

• Finance: Dan Landy


System Approach to PCMHThree Critical Infrastructure Elements

• HIT*

• Disease management platform• Access to care

EHRRegistrySecure messaging

•Team building•Culture modification•Office system design

•Monitoring outcomes•Coordinating care•Access to information

promotes

supports

*health information technology


Care Model Work GroupThe Triple Aim* Helps Us Focus

*In The Triple Aim* Helps Us Focus

• Return to emphasis on health • Improve care for the patient • Watch the cost

Macro integrator (Neighborhood)Resources & providers to support a population

Micro integrator (PCMH)Providers delivering carewith patient & familyat the center

Needs: infrastructure, integration and execution


Quality Work Group Section E: ACO Motivation and Capabilities

• 27. … why the Applicant organization wishes to participate in the Pioneer Model

• 28. … description of the strength of the Applicant organization's primary care infrastructure

• 29. … narrative description of the Applicant organization's ability to accomplish – Promotion of evidence based medicine– Process to ensure pt engagement and SDM processes– Care coordination– Beneficiaries’ access to medical records– Ensuring individualized care– Routine assessment of experience of care– Integration of care with community resources

• 30. Percent of providers that will attest to meaningful use by end of 2012

• 31. EHR functionality• 32. 3rd party assessments of performance (NCQA, regional multipayer

collaboratives, etc)• 33. Experience in teaching or training in care improvement


Quality Work Group Question 34

• 34. Please attach a narrative description and quantitative documentation of at least one illustrative instance in which the Applicant organization has designed, implemented, and assessed the effectiveness of specific care improvement interventions. Include information on how the problem(s) was identified, why and how the intervention(s) was selected and designed, how progress (or lack thereof) was measured, and any corrective action or adjustments made (maximum 5 pages, single spaced).


Quality Work Group Question 34

• System Capacity for QI Initiatives– CPM/PHO, CIR– MH Center for Quality and Safety– MH Clinical Integration

• How we choose initiatives (Health status/health needs assessment)

• AMI (STEMI) Program• Target Diabetes

– Rationale for choice– Data reflecting improvement– Program expansion/evolution

• Extension/translation into other management/improvement initiatives– Chronic diseases; depression; hand hygiene


• Member. An entity that infuses capital into the ACO, assumes responsibility for financial operations, and is entitled and required to share in gains and losses sustained by the ACO.

• Participant. An entity connected by ownership or by contract to the ACO that is entitled to gains and assumes responsibility for losses sustained by the ACO.

• Network Provider / Supplier. An entity affiliated by a contract to the ACO that may be eligible for certain incentive payments based on either the performance of the ACO as a whole or the entity’s established costs and quality but is otherwise not entitled or required to share in and gains or losses.

Steering Work Group MaineHealth Pioneer ACO

Definitions


• Board of Directors Decisions

– Election and annual evaluation/re-election of CEO– Adoption of annual operating and capital budget– Adoption of strategic, business, and financial plan– Development of changes in programs and services– Approval of contracts except as delegated to CEO– Operations, management, and financial oversight and

approvals

Steering Work GroupMaineHealth Pioneer ACO

Proposed Governance Structure


• Member Decisions– Initial capitalization– Future capital calls including reserve requirements– ACO debt or capital expenditure exceeding $1,000,000– Mergers, Consolidations, Dissolution, Bankruptcy/insolvency– Joint Ventures– Amendment of Articles and Bylaws– Addition of new members– Election of Directors

• Weighted by capital investment, super majority, or majority




• Board of Directors – 12 Directors

– MaineHealth 1 Management– Maine Medical Center 2 Management 1 Physician 1 Hospital Trustee – Other Members 2 Management 1 Hospital Trustee– Physicians 4 Physicians




Finance Work Group

• Disclaimer: These are my interpretations of very complex material (i.e. over my head at times).

• ACO: New LLC– ACO Contracts with MMC PHO to serve as care delivery system– All Maine Health hospital and Mid Coast become members of PHO– ACO Owners (Hospitals – limited to not-for-profit Entities) capitalize the

entity with $10 Million

• 3 Proposed Models– In all models: After achieve a 2% marginal savings, all savings are split

60% to ACO, 40% to CMS\– 1st million, and 25% of 2nd Million saved retained by ACO for any year to

cover subsequent loss.– After year 2, ACO responsible for 1st $million loss, and smaller portion of

2nd million. PHO responsible for remainder of loss


Finance Work Group Model 1

ACO

MH PHO

ACO Participants

%% Distribution of Gain

%% Share of Loss

Hospitals+45%-47.4%

Primary Care+25%-26.3%

Specialists+25%-26.3%

Contracted Network Providers +5% -0%


Finance Work Group Model 2 : Specialists may be eligible for

incentive payments (model=12.5%) if goals achieved

ACO

MH PHO

ACO Participants


%% Share of Loss

Hospitals+57.5%-75%

Primary Care+25%-25%

Specialists+12.5%-0%


Network Provider


Finance Work Group Model 3: this model established to

accommodate a Primary Care group not affiliated with PHO

ACO

MH PHO

ACO Participants


%% Share of Loss

Hospitals+57.5%-75%

Primary Care+25%*-25%*

Specialists+12.5%-0%


Network Provider

Unaffiliated Practice+25%*-25%*

**The Primary care groups share in the 25% gain / loss based on the individual performance of each


Finance Work Group Recommendation to CPM

• Workgroup felt Model 3 most favorable:– How do CPM Primary care feel about inclusion of Unaffiliated practice?– Does inclusion of unaffiliated practice offer competitive disadvantage?

• Savings must flow to CPM for distribution to practice level– Will assure Physicians remain in control of dollar flow– Docs (rather than hospitals) must receive payments to incent savings.– Money will not be equally distributed to practices but rather distributed

based on pre-determined performance standards (Quality / Cost).


Discussion

community physicians of maine pioneer aco program proposal strategy cpm board meeting discussion...

Documents

andrea slide

triple aim slide

necessary slide

health reform mainehealth

long term sustainability

complexity of situation

dan landy slide

daniel patstone