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University Hospitals Accountable Care Organization (UHACO) Department of Medicine Clinical Retreat Eric M. Yasinow, M.D. Medical Director, University Hospitals Accountable Care Organization UHACO Initiatives ACO: University Hospitals Rainbow Care Connection University Hospitals Accountable Care Organization Pediatric Medicaid ACO Commercial ACO Center for Medicare & Medicaid Innovation (CMMI) Attributed Membership: Payer(s): University Hospitals Coordinated Care Organization Medicare ACO Centers For Medicare & Medicaid Services (CMS) 70,000 181,500 50,000 Ohio Medicaid Self-Insured Plans/ Commercial Payers Medicare Traditional 2 UHACO Programs • Fee for service reimbursement to providers with potential for shared savings • Shared savings targets based on lower cost of care and quality targets met – Quality measured for preventative, disease-specific, & hospital care • All programs, except UH Employee Medical Plan, have open and/or non-tiered provider network 3 UHACO Programs Summary • Government ACO Programs: – Medicare Shared Savings Program ACO – Traditional Medicare Members – Center For Medicare & Medicaid Services – Medicaid Pediatric Members • Commercial Payor ACO Programs: – Aetna: Commercial & Medical Advantage – Anthem: Commercial & Medical Advantage – Cigna Commercial – Humana Medicare Advantage – United Healthcare: Commercial & Medical Advantage • Self-Insured Employers ACO Programs: – University Hospitals Employee Medical Plan – St. Johns Medical Center Employee Medical Plan 4 UHACO Population Health & Wellness CONFIDENTIAL © 2015 University Hospitals Health System, Inc. All rights reserved. 5 UHACO Technology Infrastructure • Master Patient Index identifying patients across UH: • Electronic Medical Record: Inpatient, Ambulatory, Emergency Department • Inpatient Registration & Billing (Soarian) • Physician Practice Registration & Billing (Athena) • Data analytics: • • • • • • Population health needs assessment Proactively identify patients for UHACO team outreach Patient engagement Network quality performance Clinical integration Provide providers with external view of patient acuity and needs 6 UHACO Master Patient Index 7 UHACO Team Outreach • Patient Navigators – Gaps in Care – Post-primary care visit follow up • Nurse Care Coordinators – Complex Case Management – High Utilizer & Transitions of Care • Pharmacist – Medication management issues – Targeted questions to assess intervention needs • Social Worker – Independence at home assessment – Barriers to care assessment • Health Educators – Goals for nutrition education and tobacco cessation CONFIDENTIAL © 2013 University Hospitals Health System, Inc. All rights reserved. 8 UHACO Patient Engagement Technologies Central point for patient messaging and tracking - Analytics to identify engagement opportunities - Provider population health tool - Customized assessments & patient goals to guide outreach - Patient education modules - Population health campaigns - Patient self-monitoring & data collection Remote monitoring technology for specific conditions 9 UHACO Quality Measures • • • • • • • • • • • • Immunizations Screenings: Cancer Screenings: Preventive Depression Diabetes Hypertension Ischemic Vascular Disease Coronary Artery Disease Asthma Bone Density Illness Treatment Hospital Measures 10 UHACO Transitions of Care • During Hospitalization: – Visit selected beneficiaries • Post-Hospitalization: – Contact beneficiary within 72 hours of discharge • Confirm Primary Care Provider (PCP) appointment • Review medications & discharge notes • Document needs assessment – Conduct follow up coordination as indicated 11 UHACO Emergency Department (ED) Activities • UHACO Outreach: – Within 72 hours of ED visit for ACO members as appropriate • Ensure follow up services scheduled where indicated • Education provided for avoidable visits – Case management for frequent ED utilizers • Technology & Workflow: – Utilizing EMR to notify PCP of ED visit – Identifying ACO members on ED Bed Board – Working with ED leadership on coordinating next day appointments with PCP if admission avoidable • Analytics: – Analyzing frequent ED utilizers by zip code to evaluate access – Evaluating trends by employer group 12 UHACO Medical Directors • Review Clinical Referrals: – All readmissions – Beneficiaries in case management – Beneficiaries requiring a new specialist relationship without a specific referral – Providers with patterns of gaps in care • Educate UHACO Network – Provide provider-specific data on • Patients • Performance • Metrics – Provide context of ACO efforts & health care reform CONFIDENTIAL © 2013 University Hospitals Health System, Inc. All rights reserved. 13 UH Coordinated Care Organization (“UHCCO”) 2014 Medicare ACO Quality Measures & Results Medicare Quality Reporting • Quality performance scores are shown as percentiles based on performance standards set by CMS • Each percentile is worth a correlated number of points – In order to receive any points for a measure, a Medicare ACO must score over the 30th percentile • The ACO Quality Score is based on the percentage score in each domain • The ACO Quality Score determines the amount of shared savings the Medicare ACO is eligible to share 15 2014 Quality Results: Overall Domain Scores Domain Points Earned Points Possible CMS Target % UHCCO Actual % Patient / Caregiver Experience 9.70 14 70% 69.29% Care Coordination / Patient Safety 11.30 14 70% 80.71% Preventive Health 13.60 16 70% 85.00% At Risk Population 12.95 14 70% 92.50% ACO Quality Score 81.88% 2012 & 2013 required only reporting of individual measures, resulting in an overall score of 100% 16 2012, 2013, 2014 Quality Results: Patient/Caregiver Experience Percentile Measure Description ACO #1 Getting Timely Care, Appointments, and Information ACO #2 How Well Your Doctors Communicate ACO #3 Patients’ Rating of Doctor ACO #4 Access to Specialists ACO #5 Health Promotion and Education ACO #6 Shared Decision Making ACO #7 Health Status/Functional Status 17 2012, 2013, 2014 Quality Results: Care Coordination/Patient Safety Percentile Measure Description ACO #8 Risk Standardized, All Condition Readmissions ACO #9 ASC Admissions: COPD or Asthma in Older Adults ACO #10 ASC Admission: Heart Failure ACO #11 % of PCPs Qualified for EHR Incentive Payment ACO #12 Medication Reconciliation ACO #13 Falls: Screening for Fall Risk 18 2012, 2013, 2014 Quality Results: Percentile Preventive Health Measure Description ACO #14 Influenza Immunization ACO #15 Pneumococcal Immunization ACO #16 Adult Weight Screening and Follow Up ACO #17 Tobacco Use Assessment and Cessation Intervention ACO #18 Depression Screening ACO #19 Colorectal Cancer Screening ACO #20 Mammography Screening ACO #21 Proportion of Adults who had blood pressure screening in last 2 years 19 2012, 2013, 2014 Quality Results: Diabetes Composite 20 2012, 2013, 2014 Quality Results: At-Risk Populations 21 2012, 2013, 2014 Quality Results: At-Risk Populations: CAD Composite 22 2015 Medicare ACO Quality Measures Measure Description ACO #34 CAHPS Stewardship of Patient Resources NEW ACO #35 Skilled Nursing Facility 30-Day All Cause Readmission Measure NEW ACO #36 All-Cause Unplanned Admissions for Patients with Diabetes NEW ACO #37 All-Cause Unplanned Admissions for Patients with Heart Failure NEW ACO #38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions NEW ACO #39 Documentation of Current Medications in Medical Record NEW ACO #40 Depression Remission at Twelve Months Status NEW 23 2015 Medicare ACO Quality Measures Measure Description Status ACO #22 Diabetes Composite: Hemoglobin A1c Control (<8%) REMOVED ACO #23 Diabetes Composite: LDL (<100mg/dL) REMOVED ACO #24 Diabetes Composite: Blood Pressure <140/90 REMOVED ACO #25 Diabetes Composite: Tobacco Non Use REMOVED ACO #26 Diabetes Composite: Aspirin Use REMOVED ACO #27 % of beneficiaries with diabetes whose HbA1c in poor control (>9%) RESCORED Diabetes: Eye Exam ACO #41 % of patients 18-75 with Type 1 & 2 Diabetes with retinal/dilated eye exam in measurement period or negative in the year prior NEW 24 UHACO Provider Engagement • Utilize University Hospitals facilities and providers • Increase access • Ask patients • if they understood the information you provided & • if you answered all their questions during visit • Get Help With Your High Utilizers • Use Electronic Medical Record for UHCCO Patient Navigator Quality Measures • Appropriately and completely capture services & diagnoses 25 UHACO Contact If you would like more information about our ACO initiatives or would like to request care coordination services for your patients, please contact us at [email protected] 26 2/08/2010 5/8/2017 University Hospitals 27 27