Embed Size (px)
Citation preview
Know & Go!Accountable Care
Organizations
Steve LittlePresident & Chief Executive Officer
Dr. Michael DeGereVice President, Population Health Management
The Birth of Accountable Care Organizations (ACO’s)
• Patient Protection and the Affordable Care Act (“PPACA”) – aka Obamacare
• Federal government has a budget problem
• Not really, we have a healthcare problem known as Medicare
• Today’s workforce funds healthcare for every United States citizen over the age of 65
What is an ACO?
•An ACO is a network/group of doctors and hospitals that shares financial and medical responsibility for providing coordinated care to patients in hopes of improving the quality of live and limiting unnecessary spending.
Why Did Agnesian HealthCare
Join an ACO?
• Did not possess the in-house expertise to start our own ACO
• Felt that we lacked sufficient scale
• Needed to be part of a network that covered a larger geography
• Needed the credibility of an academic medical center
• Lacked ownership of an insurance company
Why Did We Choose Integrated
Health Network of Wisconsin
(IHN)
• Prior relationship with Froedtert and the Medical College of Wisconsin
• It was the only choice at the time!
Who Is IHN and Where Do
They Live? Initially – Froedtert & the Medical College of
Wisconsin, Columbia St. Mary’s, Bellin Health, ThedaCare, Asprius and Agnesian HealthCare
Today – Froedtert & the Medical College of Wisconsin, Columbia St. Mary’s, Wheaton Franciscan, Ministry Health Care, HSHS (Hospital Sisters Health System) and Agnesian HealthCare
IHN is located in Brookfield, Wisconsin and employs 82 full-time associates
Population Health
Communities’ Well-Being
Associates’ & Patients’ Well-Being
Managed Populations’ Well-Being
AHC Mission,
Vision & Values
Profile – Integrated Health Network of Wisconsin (IHN)
5,000 physicians
500 clinics
42 hospitals
Agnesian HealthCare
Columbia St. Mary’s
Froedtert Health
Hospital Sisters Health System
The Medical College of Wisconsin
Ministry Health Care
Wheaton Franciscan Healthcare
Another Wisconsin ACO
abouthealth
Aspirus Inc.
Aurora Health Care
Bellin Health
Gundersen Health System
ProHealth Care
ThedaCare
UW Health
How is an ACO Important to us?
For Agnesian HealthCare
It provides a forum to share data, improve
outcomes, share best practices and network
We become part of a larger group so we can
compete against other larger healthcare
conglomerates for contracts
What does this mean to AHC in
the next couple of years?
We are moving from a fee-for-service to a total-risk model
IHN has worked with all systems to develop a prioritized
Care Model which will help prepare us for assuming this
risk
The Care Model aligns with most things we are already
doing or are planning to do at Agnesian HealthCare
IHN Work Groups
Work Group AHC Representatives
Quality Nancy Birschbach, Mike Feudner, Sue Gullickson
Pharmacy Nancy Hyland, Katie Reinke
Inpatient Dan Blaha, Barb Gorman
Readmission Dan Blaha, Barb Gorman
Care Navigation Dan Blaha
Orthopedics Zach Pitz
Depression Jim Salasek
Other ACO Focus Areas
End-of-Life Care Strategies
Chronic Condition Management
Clinical, Evidenced-based Guidelines
Post-acute Care Alignment
Possible House Calls Program
Tools for Data Support
Crimson
Valence
HealtheIntent/HealtheRegistries
Cerner’s HealtheIntent
Cerner’s HealtheRegistries
Current Registries being piloted at AHC:
Adult Wellness
Diabetes
Heart Failure
Depression
Cerner’s HealtheIntent
How is an ACO Important to us?
To our PATIENTS and PROVIDERS…
Greater coordination of care for patients
who visit ACO member systems
The structure provides a way to assess
patient risk, communicate status and
apply best practices
Agnesian Success Story:
Staying Ahead of Hospital Admission
An AHC 64yo lung cancer patient identified by the
Crimson data system for needing Navigator
assignment.
Follow-up found issues of deconditioning, pain
management, alteration in labs and significant
medication reconciliation issues.
Agnesian Success Story:
Staying Ahead of Hospital Admission
The Navigator worked with physicians to facilitate
a referral to home health and coordinate other
community services.
Through successful intervention, the patient
experienced effective and efficient management of
her symptoms and medical needs with no
additional ED or hospital visits.
The ACO and The Mission
Just checklists and “more work?”
Does our ACO work serve our Mission? (It better!)
Compassionate Care
Hope, Health, and Wholeness
Our Mission does not only mean treating the ill
It also means continual care of the well
ACOs can change our perspective,
and how we approach our work
Today, many patients come in only when health has
deteriorated between episodes of care
Moving toward “panel management,” as well as
more complete individualized care of each patient
Reaching out to those who need to come in, before
they become ill - ACO metrics can help us to keep
track
ACO Work Group: Depression
According to the CDC, about 9 percent of adult Americans are living with depression
ACO member systems recognize the need to establish a screening tool and address access to services
AHC is leading this initiative among IHN members
ACO Work Group: Pharmacy
Medication Therapy Management for Outpatients
Short-Term Goal: Identify high risk patients
for evaluation and assistance
Long-Term Goal: Spread intervention and
support to moderate and low risk population
Agnesian Success Story:
Mammograms
In 2014, the IHN Quality Work Group
focused efforts on closing the gaps in care
for an ACO contract population.
One of these gaps was: Mammograms
Agnesian Success Story:
Mammograms
A Mammogram Call List was developed
Due/overdue patients were called an
encouraged to come in for a mammogram
Agnesian Success Story:
Mammograms
Two of these patients received a
cancer diagnosis, which may have
been less timely if calls were not
made.
Mammograms Today at AHC
Walk-In Breast Clinic at AHC
Started 1/12/2015
Visits to date
SAH: 110 patients
WMH: 28 patients
RMC: 17 patients
Lessons We Are Learning
Reminders can help patients
Reminders can help providers, too (registries)
Access and convenience make a difference
Getting Well, Staying Well
Focusing on preventive health efforts
Using evidence-based best practices
Managing chronic disease conditions
Getting Well, Staying Well
Staying ahead of acute illness
Taking care of the whole person and using
tools to assist us
Matching our Mission
Thank you!
Questions?
Comments?
