Coastal Carolina Health Care, P.A.David Oliver, MD, ACO President - Stephen Nuckolls, CEO

•Internal Medicine•Family Practice•Emergency Medicine•Cardiology•Hematology/Oncology•Gastroenterology•Neurology•Pulmonary/CC

50+ Provider

s (2/3 PCP)

11 Clinic Locations•Imaging Center•Urgent Care•Sleep Lab•GI ASC

Integrated EHR

All Providers are MU

Experience with PHM Reporting

Practice Overview

Entered MSSP April 1, 2012 – Track 1 – No Risk

Advanced Payment Model (1)• $250,000+$36 Initial

Payment• $8 Per Beneficiary Per

Month

11,000+ Attributed Beneficiaries

$100,000,000 Estimated Claims Budget

ACO Overview

Watched Program Develop and Discussed

with Physician Leadership

Assessed Prospects for Success• Have Other Groups Succeeded? (2)• Part A and B Spending in Area (3)• >50% of our Revenue Derived from

FFS Medicare• Ability to Meet Quality Metrics• Commitment/Other Projects

Decision Process to Become an ACO

Assessed Risk of Status

Quo

Attended CMS Sponsored ADLS• Helped Inform Physician

Leadership• Showed CMS’s

Commitment to Program• Heard from Physicians

Practicing in more Highly Managed Markets

Advanced Payment

Model Offered

Decision Process to Become an ACO

CMS Estimates $1.7 Million

American Hospital Association Estimates $5.3 to $12.0 million

We Spent $200-250K

Start-up Costs

Implement Integrated Full Feature

EHR

Need Discrete Data Populated•Problem Lists, Labs, Medications, Etc. Attribute

Patients to Provider or

Practice (Who is

responsible)

Begin Reporting Population Quality Measures•We used QIO and Regional AHEC Collaborative Report

Measures Monthly

Utilize Team Approach – (Medicare’s

AWV can fund Team

Expansion)

Don’t wait until it’s all done to Join or Start ACO

Primary Care Preparations

Understand Your Market and your referral sources

Understand who is forming an ACO

Understand that you may be able to join only one

ACO

Specialty Care Preparations

Educated Providers and Staff

Review ED and

Admission Summaries

Established After Hours Nurse Triage

Line

Hired Care Managers

Next Day Appointment

s

Increased Marketing

for Our Urgent Care

Expanded Urgent Care

Access to Imaging and Laboratory

Strategies Implemented

Apr May Jun Jul Aug Sep 350

400

450

500

550

600

ACO Emergency Room Utilization

Num

ber

of V

isits

Utilization Benchmarks

1 2 3 4 5 6 200

210

220

230

240

250

260

270

280

ACO Hospital Admision Utilization

Num

ber

of A

dmis

sion

s

Utilization Benchmarks

1 2 3 4 5 6 500

550

600

650

700

750

ACO Urgent Care Utilization

Num

ber

of V

isits

Utilization Benchmarks

(1) Link to CMS Advance Payment Model Information http://innovations.cms.gov/ initiatives/aco/advance-payment/index.html

(2) Spending Differences Associated with the Medicare Physician Group Practice Demonstration – JAMA, September 12, 2012

(3) Institute of Medicine Demographic, Cost, Utilization, and Quality Comparison Information http://iom.edu/Activities/HealthServices/GeographicVariation/Data-Resources.aspx

Additional Information