Dr. Daniel Berman DBA/HCA,MSN,RN,FACHE,FACATA,LHCRM Healthcare Thought Leader Clinical Benefits and Decision Making in the Creation of the Coordinated Care Organizations

Important Trends in the Locus of Care By 2018, Acute Care Beds in Community Hospitals with present Bed Level at 300 will have 50% less Acute Care Beds. 60% of all Hospital Admissions will be ICU admissions only. 70% of all surgical procedures will be outpatient procedures. 90% of all care will no longer be financed as fee for service but rather under a capitated dollar.

Present Attitudes of the Consumers Recent Wall Street Journal Poll of 250,000 healthcare consumers showed that the top seven priorities for healthcare relied more on cost not quality: 1) Co-Payments 2) Cost of Drugs 3) Cost of Hospitalization 4) Big Drop 5) Then quality 6) Liking Physician 7) Patient Outcomes

Questions and Contact Dr. Daniel Berman dberman@healthcarethoughtleadersjip.net

Coordinated Care Organizations Healthcare Systems are Consolidating at rapid rate Study was done of the Coordinated Care System in Summitt, NJ area Found: There was a 20% drop in the cost of care per episode versus not in a coordinate care organizations There was a 556Billion dollar saving in Healthcare for a five year period before coordinated organizations in place (Fiscal Times, June 2012)

Advantages to Coordinated Care Kathleen Sebelius, Secretary of Public Health http://www.hhs.gov/secretary/about/index.html

Advantages to Coordianted Care Patient Care experiences Care Coordination Patient Safety Prevention Population Health

Economic Advantage to Coordinated Care Medical Cost Offset- Is the cost of a Costly Coordinate Delivery System with Intensive Monitoring and Case Management Less Costly then the cost of Care and without this In 2003-2004, at the Aids Healthcare Foundation we found that the cost of an intensive monitoring program of the patients with cost outliers to recognize cost savings of over 60% when intensive program used.

Program Included Intensive Patient Education Intensive Telephonic Monitoring Intensive monitoring of patients following protocols and assigned patient care services Intensive home health visits Psychological Counseling

Development of Clinical Services in ACO Using Fiscal Costs of Diseases determine the tops three most costly diseases in the geographic area to be covered. These might change based upon region of the US. They are typically A) Cardiac B) Respiratory C) Diabetes D) HIV and Cancer

Development of Programs What Clinical Services are needed both pre-hospital, acute care, rehabilitation, and outpatient care What management systems including management and IT need to be in place What Capital needs to be in place to carry out this care What Outcomes Management and Evaluation Systems What Care and Care Systems Protocols (These need to be answered for all services covered) (That is why Medical Cost Offset data is important)

Development of Services The clinical services is less than the revenue generated Each Disease state has its own unique cost of the disease and cost of the care. A mistake that ACO make is to use the average cost and not the cost per disease in their calculations of cost and delivery of care

Development of Services Each Disease must have its own clinical protocols and clinical pathways and have a cost of the disease and cost of care with protocols be outlined

Success of the Clinical Integration of the Coordinated Care System Need to be based On importance and Risk Pool of insurance coverage: Geographic Determinants Social Determinants Racial and Cultural Composition of the insured Epidemiological Results of the population

Success of Clinical Integration Each Disease must have its own complete clinical care system with ot without the same providers. A common mistake it to often have as same as every thing to meet economies of scale. Presently before a contract is bidded on the executives and fiscal experts gather data and costs and then bid the contract The future is going to be in reverse

Future of Coordinated Care No longer is Care going to be provided by one system just because they have history or providing services Proposed Steps A) An Epidemiological and Social Epidemilogical assessment of geographic area that health system is operating in B) A Community Needs Assessment C) A Community Health Asset Analysis of the area of operation D) An economic analysis of the cost of disease in the area

Future of Coordinated Care E) An economic analysis of each disease state wanting an ACO for F) An Economic Analysis of the cost of care for that disease Pre-hospital Hospital Rehab Outpatient

Future of Coordinated Care G) A description of all the services and systems affixed with that disease and affixed cost. H) Only after doing all these steps can you decide whether it is cost effective and or profitable to develop a Coordinate Care System