one aco - ehcca.com · just capturing 80% of our hospital discharges can help increase your...

How One ACO Saved Money

Kelly A. Conroy

Formerly The Founding CEO Palm Beach ACO

1Copyright 2014 Triple Aim Advisory Group

Brookings Presentation June 2014

PBACO

• Track and Start date July 1, 2012• State(s) Florida• Advanced Payment? No• Are any of the ACO participants

hospitals? No

• Number of practitioners ~300• Number of assigned beneficiaries was 28,000• Percent EHR penetration, and number of EHR platforms used 70% and 15

EHR Platforms• 1st

Year Interim Results/”You only have to be this tall…”• “Simple is Huge”



How We Did It

• Embrace the Rules

• Savings Focus (Top 5)• Physician Engagement

• Revenue• Assignment

• Outcomes/GPRO

• Patient Engagement



Embrace the Rules

• The Rules Work!

• MSSP Application and Meaningful Participation– Meaningful Participation = Time + Effort

• CMS Annual and

Quarterly Reports

• Claims Data (CCLF) Files

4

Evolution/ValueEvolution/ValueExtinction/VolumeExtinction/Volume

Copyright 2014 Triple Aim Advisory Group


Moving Forward

Source: Medicare Shared Savings Program Aggregate Expenditure/Utilization Report



Physician Engagement

• Belief in Program• Increase Practice Revenue

– Annual Wellness Visits and TCM Visits

• Stratify PCPs (One Room Schoolhouse)– “Why am I on team B?”

• Key Performance Indicators (KPI)• GPRO• ACO Participant Composite Score (Boats)



Patient / Caregiver Experience

Care Coordination / Patient Safety

Preventive Health

At Risk Population

How Well Your Doctors Communicate

Falls: Screening for Fall Risk

Mammography Screening

Beneficiaries with IVD with complete lipid profile

and LDL control < 100mg/dl

89.56%89.56%

26.26%26.26%

52.64%52.64%

41.07%41.07%



ACO Participant Composite Shared Savings/Losses



Revenue

• Annual Wellness Visits• Subsequent Visits (audit)• Transitional Care Management Visits• See Patients More• Patients not seen in 6 months• Lost Patients List (CMS Quarterly Reports)

Access9



ACO Members Have Collected Over $75,000 for

TCM Codes Already!

Just Capturing 80% of Our Hospital Discharges Can

Help Increase Your Practice’s Revenue…..

ACO Members Potential Collections

≈$900,000

An Average Practice of 500 FFS Pts. An Average Practice of 500 FFS Pts.

could equate to $28,500could equate to $28,500

Transitional Care Management (TCM) 2013 CPT Codes

You’re doing this anyway.

Why not get paid for it?

CPT 99495 allowable: $173.13


You’re doing this anyway.

Why not get paid for it?





ACO Performed < 20% of Wellness Visits YTD 2013 on ASSIGNED PATIENTS!!!!

•Available to patients WITH NO CO‐INSURANCE•Includes 11/33 REQUIRED Quality Measures•PAID AT $115.99 EACH (G0402, G0438, G0439)$115.99 x 80% of 28,500 assigned beneficiaries

=$2,644,572 of Additional Practice Revenue

Wellness Visits

Ask Us More After The Meeting!



Assignment• Keep your arms around your flock

• Work Lost Patient Lists

• Patients Not Seen in 6 Months

• New Patients• Subsequent Visits• Snowbirds• Annual Wellness Visits and TCM Visits

Loyalty * Trust * WOW



Data ‐

Patient Assignment: Lost Patients

ACO sees 75,000 patients at least once per year.

ACO is assigned only 38% of those patients or 28,500.

If ACO receives assignment on 5,000 more patients per year at $700

(315 FFS + 425 Savings)

PMPY Rev/Savings = $3,500,000

Work Those Work Those ““Lost PatientLost Patient””

reports!reports!



ACO Patient Assignment

Based on Plurality –

Opportunity to See you patients more!



LOST PATIENTS LIST



Source: Storan Technologies

15

Other PCPs Report

• List of OTHER PCPs seeing your Patients



Source: Storan Technologies

16

Keep your arms around your flock…



Utilization

• Community Stakeholder Expectations– Healthy Competition/Recognition

• Inform‐a‐doc Form

• “D”

Category

• Medicare Risk Adjustment (MRA) Coding



Community Healthcare Patient Flow



Distribution: Acuity and Cost

Each bar

represents

approximately

20% of your

patient

population!

20%

20%

20%

20%

20%



D. Long Duration, Co‐Morbid, Chronically Ill Patients

Known pathology over the past ten years with multiple admissions

and poor control. High Costs exist and

costs are likely to rise in current year. If existing control is lost, uncontrollable costs ensue.

•3 >

Chronic Diseases •With over 2 Hospital Related Admissions•With over 3 ER Related Admissions•With History of Active Cancer Treatment •With Documented Medication Non‐Compliance•With Advance Cognitive Status•With Depression•With Advancing Frailty•With a fatigued caregiver•With Dialysis dependent•With Oxygen Dependent Respiratory•With Hemiplegia •With Wound Care needs



Outcomes

• Annual Wellness Visit ‐

11/33 ACO Quality Measures (GPRO)

• GPRO Report Cards– Can’t evolve what you don’t measure

• Patient Satisfaction – 7/33 ACO Quality Measures (GPRO)

• See Patients More and TCM Initiatives



GPRO Outcomes Do you know how many Wellness Visits you did NOT do this year?

GPRO Wellness Visit 11/33 Quality MeasuresPreventative Health Domain1.Influenza2.Pneumococcal3.Adult weight screen and f/u4.Tobacco use and intervention5.Depression Screening6.Colorectal cancer screening7.Mammography screening8.Proportion of Adults 18+ who had their blood pressure measured within the proceeding 2 yearsCare Coordination domain9. Screening for Fall riskAt Risk Population Domain10. Diabetes Composite (Aspirin use)11. Ischemic vascular disease (use aspirin and other antithrombotic)



Patient Satisfaction

• “Triple Whammy”

– Represents 7/33 Quality Measures = 21%!

– Satisfaction = More Visits = More FFS Revenue

– Improves Assignment



Patient Satisfaction –

“The Big 7” Hang a Poster in your office”

–

“We Care”

Actual Measures1. Getting Timely Care, Appt, and Information 2. How Well Your Doctors Communicate 3. Patients’ Rating of Doctor 4. Access to Specialists 5. Health Promotion and Education6. Shared Decision Making 7. Health Status/Functional



Patient Engagement

• Opt Out Letter (Data Sharing)• Medication List

• Inform‐a‐Doc Form– Shared Decision Making

– Patient Agenda for Visit• Message from Medicare



Dear Patient,

Happy Birthday from Medicare! We wish you well in the upcoming year and want to remind you of the preventive services Medicare offers to help you stay healthy.

Our records show that you have not taken advantage of some of the preventive services which are available to you now or in the future and listed in the table below. Please talk with your doctor to decide which ones are right for you.To see more details of the services you are eligible for, visit www.MyMedicare.gov and select "Preventive Services" under the "My Health" tab. Or, talk to your doctor for more information.

Remember, Medicare is your partner in health.

Sincerely, Centers for Medicare & Medicaid Services.

Please do not reply to this email, as we are not able to respond to messages sent to this address.

This e-mail was sent by Centers of Medicare and Medicaid Services based upon the request in your MyMedicare.gov profile. To stop receiving e-mails,please unsubscribe from our mailing list by signing in to www.mymedicare.gov and clicking on the "My Account" link in the banner.

Re: Message From Medicare

Name Eligibility DatePSA 07/01/2013ANNUAL WELLNESS VISIT 01/01/2012OBESITY COUNSELING 11/29/2011HIGH INTENSITY BEHAVIORAL COUNSELING 11/08/2011CARDIOVASCULAR DISEASE (BEHAVIORAL THERAPY) 11/08/2011

ALCOHOL MISUSE SCREENING 10/14/2011

DEPRESSION SCREENING 10/14/2011PROSTATE 01/01/2011PPV 01/01/2011COLORECTAL 01/01/2011CARDIOVASCULAR 01/01/2011ABDOMINAL AORTIC ANEURYSM 01/01/2011DIABETES 01/01/2011



http://www.mymedicare.gov/

http://mymedicare.gov/

http://www.mymedicare.gov/

Annual Inpatient Expenses:28,500 Pts. x $2,750 (inpatient per capita)

= $78,375,000

5% Reduction In Unnecessary Hospitalization (open

access to patients between 5pm‐9pm + weekends)

= $3,918,750 Annual Savings

Sign‐Up: Get Your Card Ordered Today!

Million $$$

Card



• REQUIRED – IT’S THE LAW• FINES INCREASED TO $50K ‐

$1.5M

• ACO Guaranteed ALL Members ARE compliant• EACH MEMBER promised to comply

(participant agreement)

• OMNIBUS CHANGES –

09/23/13

HIPAA

Ask Us More After The Meeting!



No One Can Solve the Problem Better Than a Physician!

Kelly A. Conroy, CEOTriple Aim Advisory [email protected]



mailto:[email protected]

one aco - ehcca.com · just capturing 80% of our hospital discharges can help increase your...

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