MaineHealth ACO in Context W 5 Who? What? Why? When? HoW? 1

Before we Begin: Upcoming ACO Webinars – Medicare Patient Notification: Medicare requirements for informing Medicare patients regarding your participation in our ACO – ACO Financial Distribution Model: How will any savings – if we earn them – be distributed among providers? – New “Value Oversight Process:” How will clinicians, practices and hospitals participate in open reviews of performance data – PHO Transparency Policy: Sharing and benchmarking performance data among similar providers – Quality Performance Reports: Medicare requirements for tracking and reporting key quality measures for our ACO 2

Who? 3

The MaineHealth ACO is all of the MaineHealth member hospitals plus St. Mary’s Regional Medical Center and all of the physicians in Community Physicians of Maine – Maine Medical Center, Lincoln County Healthcare, Pen Bay Healthcare, Southern Maine Medical Center, Western Maine Healthcare, Waldo County Healthcare – Over 1,000 physicians spanning both hospital-employed and independent practices – It is the entire MMC PHO ! 4

What? … is an ACO? … does it do? 5

An ACO is: A group of healthcare providers who agree to work together and assume responsibility for improving the quality and reducing the cost of care for their patients 6

Providers in an ACO deliver patient-centered care: – Put the beneficiary and family at the center – Coordinate care over time and all care settings – Attend carefully to care transitions – Manage resources carefully and respectfully – Proactively manage each patient’s care – Evaluate data to improve care and patient outcomes – Innovate and try new models of care – Invest in team-based care and workforce 7

Over time, ACO providers may be paid differently: – But, THERE IS NO CHANGE TODAY TO HOW YOU CURRENTLY BILL FOR OR RECEIVE PAYMENT – At the end of the CMS measurement period, providers may be eligible for an additional payment at the end of the year – The amount they receive depends on their performance on specific quality metrics and how successfully they collaborate with patients & other ACO providers to reduce the cost of care – In later years, there may be changes to billing and payment but these will not occur today. 8

Why? 9

ACOs are part of a national effort to improve healthcare Source: May The Commonwealth Fund. Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices and Quality 10

Despite this spending, our citizens are less healthy Rates of Obesity in Adult Populations of Industrialized Nations Source: Latest Available Data. National Obesity Observatory. National Health Service. United Kingdom. 11

When? 12

Our ACO just signed its first contract: – As of July 1 st, 2012 Medicare is measuring our ACO – including your practice and providers – on: How well we achieve specific quality targets and Whether we are able to reduce the overall cost of care for our Medicare patients – The rest of this talk will address some of the specific things you need to do TODAY and in the FUTURE in order for us to be successful 13

Measure Domains NumberMethodApproach (subject of future webinars) Patient Experience7Survey  CMS conducts survey  ACO conducts survey Care Coordination / Patient Safety 3Claims CMS reported measure based on claims data Care Coordination / Patient Safety 1 EHR Incentive Program CMS reported measure based on claims data Care Coordination / Patient Safety 2GPRO Tool*  CMS defines the denominator for each measure based on random sampling  ACO provides numerator information available via claims and clinical data  Practices without EHR that connects with the ACO data system will enter data into a web based portal or provide extract file  Data submitted via GPRO Tool Preventive Health8GPRO Tool At risk population12GPRO Tool *GPRO is a CMS Web-Based Quality Reporting Tool MSSP Quality Measures

What is the Timeline? July 2012 Ongoing Sep-Oct 2012 Medicare Shared Savings Program Kick off Data tools piloted Letters sent to all assigned beneficiaries Informational webinars conducted Practice visits to discuss ACO Data review and analysis Care Coordination activities Patient Centered Medical Home Implementation Oct-Nov 2012 Feb 2013 Quality Data reporting to CMS Member Performance Review Program

How? 16

Strategy for Achieving the Triple Aim: 17 Primary Care Our primary care practices will operate as Patient Centered Medical Homes, and be financed to do so Care Coordination MaineHealth will assess, consolidate and/or reorganize system-wide care coordination resources to ensure the right focus on the right patients Transparency A physician-led peer review program will focus on reducing unwarranted variation in care Information Technology Improve information available to clinicians at the point of care by aggregating real-time claims and select EMR information

What does it mean to you? Beginning now…. –Actively participate in the Member Performance Review Program Engage in quality reporting Implement CG-CAHPS survey Assess your practice as it relates to the Patient Centered Medical Home (PCMH) and Neighborhood

What does it mean to you? Over time….. –PCMH and neighborhood implementation Implement team based care Identify and utilize community resources Utilize care transitions and care management resources –Enhanced Care Coordination Improved communications among caregivers Utilize Guides to Care and Referrals –Engage in data review Identify and reduce practice variations Identify “at risk” patients and triage to identified resources

Upcoming Patient Notification Activities All Medicare Shared Savings Program ACOs are required to notify patients that: – Your provider(s) is participating in the MHACO – Your provider(s) is eligible for additional Medicare payments or may be financially responsible to Medicare for failing to provide efficient, cost-effective care – Medicare claims data for your patients may be shared with our ACO at the ACO’s request – They can “Opt Out” of this data sharing by completing a form or calling MEDICARE. 20

Patient Notification…. –Attend the upcoming Webinar on how patients will be notified and how they can “opt out” –As an intro…. The MMC PHO/MHACO will mail your Medicare Patients a letter with the required information Practices have been requested to help by Submitting address information to the MMC PHO for Medicare patients Providing practice letterhead Being prepared to answer patient questions and conduct first visit notifications –Please attend the webinar to learn more! 21

Reminder: Attend these Future ACO Webinars – Medicare Patient Notification: Medicare requirements for informing Medicare patients regarding your participation in our ACO – ACO Financial Distribution Model: How will savings – if we earn them – be distributed among providers? – New “Value Oversight Process:” How will clinicians, practices and hospitals participate in open reviews of performance data – PHO Transparency Policy: Sharing and benchmarking performance data among similar providers – Quality Performance Reports: Medicare requirements for tracking and reporting key quality measures for our ACO 22