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Data Analytics as a Population Health Compass
Session: # 244, Date of Session: February 14, 2019 Tim Putnam, President/CEO, Margaret Mary Health Anna Loengard MD, CMO, Caravan Health Tim- Welcome
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Conflict of Interest Tim Putnam, President/CEO of Margaret Mary Health, DHA,MBA, FACHE Salary: Margaret Mary Health Consulting Fees (e.g., advisory boards): National Rural Accountable Care Consortium, Caravan Health Anna Loengard, M.D., CMO of Caravan Health Salary: Caravan Health Ownership Interest (stocks, stock options or other ownership interest excluding diversified mutual funds): Caravan Health Tim
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Agenda Introduction Future of the Medicare Shared Savings Program
Mining Data for Success in Risk-based Models Charting Your Course: View from the CEO’s Office Steps to Take Now Tim
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Learning Objectives Understand program needs for success in the MSSP
Review of Medicare Policy and future of the MSSP Realize the power of claims data when parsed into actionable reports Explore real examples of savings opportunity in post-acute, end-of-life and part B expenses to drive better patient care and sound finances Summarize steps to take now to chart the course for ACO participation and gaining access to Medicare claims data. Tim
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Introduction Tim
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About Caravan Health 170 employees
Helping Providers Navigate the Challenges of Value-Based Payments Practice Transformation Data and Analytics Network Development Accountability and Performance Improvement 170 employees 17 Accountable Care Organizations ranging from 5,000 to 230,000 attributed lives CMS Practice Transformation Network >350 health systems >14,000 clinicians >500,000 attributed Medicare lives Anna
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Margaret Mary Health Batesville, Indiana 2014 NRACO Founding Member
~$100 Million Net CAH SHO2 ACO- AIM Funded Margaret Mary Community Hospital Henry County Memorial Hospital 2 local independent physicians 2019 moving into a consolidated ACO of SHO 1 and SHO 2 To scale up to approximately 20,000 lives. Tim
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Suburban Health ACO 2 Results
CMS 2017 Results Released 8/2018 Final MIPS Score 93.64 Actual Savings & Losses Earned Performance Payment PY Net Earned Performance Payment After AIM Quality Score $3,627,190 $1,675,430 $1,401,790 94.27 Tim
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Quality Measures Year to Year Margaret Mary Health
Benchmarks Measure Rates 2015 2016 2017 2017 Caravan Health ACOs 2016 to 2017 % Change Clinical Depression Screening/ Follow-Up Plan 60th <30th 40th 50th 24 25.16 46.04 83.00% Screening for Future Fall Risk 80th 37.25 42.28 70.47 66.67% Influenza Immunization 70th 56.86 76.56 86.07 12.42% High Blood Pressure Control 62.3 57.4 63.7 10.98% HbA1c Control * 18.18 21.94 13.27 29.94 % Statin Therapy 75.37 81.25 7.80% Tim-The REASON for participating.
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The Future of the MSSP: Heading to Risk
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Bottom Line on Final Rule
Uncertainty finally lifted for Medicare Shared Savings Program Agreement period extended from three to five years and shared savings rate increased significantly to 40% for BASIC levels A - B CMS follows through on commitment to push risk Elimination of Tracks 1, 1+, 2, and 3 and replaced with BASIC and ENHANCED options BASIC option begins with one-sided risk but requires participants to take on increasing levels of risk over the agreement period Lower revenue (physician, rural, and smaller hospital-affiliated) given extra time in non risk Continued expansion of non-financial benefits of risk participation Several significant but small changes to benchmark calculations finalized Risk score growth up to 3% over the agreement period will be recognized in updated benchmarks Annba
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Key Changes from the Proposed Rule
Improved opportunity to share in savings for BASIC option ACOs Improved opportunity to share in savings for BASIC option ACOs New “low revenue” (physician-led) ACOs may defer risk for one additional year Threshold for “low revenue” increased to ACOs with 35% or less of their attributed beneficiaries’ fee-for- service expenditures New beneficiary notifications may be provided via or online patient portal Anna
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BASIC & ENHANCED ACO Options
BASIC ENHANCED Level A Level B Level C Level D Level E Risk Upside only Two-sided Shared Savings 1st dollar savings, rate of 40% 1st dollar savings, rate of 50% 1st dollar savings, rate of 75% Shared Losses NA 1st dollar losses, rate of 30%, not to exceed 2% of revenue or 1% benchmark 1st dollar losses, rate of 30%, not to exceed 4% of revenue or 2% benchmark 1st dollar losses, rate of 30%, not to exceed nominal risk standard (currently 8% of revenue or 4% of benchmark) 1st dollar losses, rate of 1 minus sharing rate (40-75%), not to exceed 15% of benchmark QPP Status MIPS APM Advanced APM Anna
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How Do You Win in the MSSP?
Managing your patients better than fee-for-service Wellness Prevention Chronic Care Management Behavioral/Mental Health Support Post-Acute Care Accurately coding chronic conditions every year Having enough lives to reduce statistical variation 1 You win the MSSP by… 2 3 Anna Your path to... … Shared Savings
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Mining Data for Success in Risk-based Models
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Tracking Key Analytics
Use Data as a Compass Tracking Key Analytics patient care, clinician satisfaction and financial performance. Anna
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Where Do ACOs Focus For Success?
Top Priorities for Improving Efficiency, Reducing Cost 81% ↑ 65% ↑ 57% ↓ 50% ↑ 42% ↓ 40% 37% 32% 29% 28% 21% ↓ 17% 10% 12% 13% 8% Reduce avoidable emergency department visits and avoidable inpatient admissions Prevent readmissions through better care transitions Active management of high-need high-cost patients Manage/reduce post- acute-care spending and quality Reduce avoidable/unnecessary care Increase referrals to ACO- based providers/reduce network leakage Integrate behavioral Palliative care/ hospice health care into primary care settings A physician group Both (hospital and physician group equally) + A hospital Anna n = 77 n = 86 Source: Accountable Care Learning Collaborative, Western Governors University
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Key Performance Indicators
Modules Key Performance Indicators Quickly highlights common demographics, cost, and utilization metrics at the level of practices and communities Network Utilization Identifies where assignable population receives their health care, to identify network leakage and help develop a growth strategy Additional content and topics to be included in quarterly releases Key Performance Indicators Bundled Payments Post-Acute Care Facility Performance Network Utilization End-of-Life Anna
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Variation in Post-Acute-Care Costs
Mean (SD) for Non-Swing PPPY is $647 ($421) Mean (SD) for Home Health PPPY is $449 ($367) Anna
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Savings Opportunity in Post-acute Care
If Communities reduced SNF+HH PPPY to meet Caravan Health Median (among similar size communities) , the potential saving opportunity is… $115 M The average potential reduction in total PPPY is… 2.8% Anna
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Optimize SNF Partnerships
Module 1 – Key Performance Indicators Hospital Happy ACO Happy SNF Non-Swing PPPY Hospital Happy: $1418 Caravan Health: $669 All Sample reports are from Compass Modules 2018Q2 Anna
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Anna
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Optimize Home Health Partners
Module 1 – Key Performance Indicators Hospital Excel ACO Excel Home Health PPPY Hospital Excel : $831 Caravan Health: $459 All Sample reports are from Compass Modules 2018Q2 Anna
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Anna
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Facility Level Examples- Using Data to Chart the Course
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Benefits of Access to Medicare Claims Data Facility Network Utilization Analysis
Setting Total Inpatient Outpatient Post-Acute Care In-Network $10,834,803 $3,617,804 $5,703,143 $1,513,856 Out-of-Network $20,675,359 $11,665,933 $4,428,330 $4,581,096 Anna + Tim
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Facility Network Utilization Analysis-2017
Top 10 Facilities by Total Payments Name Setting Patient Count Total Inpatient Outpatient Hospice Swing Bed SNF Non-Swing Bed SNF Home Health MARGARET MARY COMMUNITY HOSPITAL INC IN 3,432 $9,178,292 $3,617,804 $5,560,488 $0 THE CHRIST HOSPITAL ON 346 $3,957,047 $3,340,774 $616,272 UNIVERSITY OF CINCINNATI MEDICAL CENTER, LLC 161 $1,731,167 $1,600,358 $130,809 ST. ANDREWS HEALTH CAMPUS 133 $1,483,337 $118,086 $1,365,252 THE WATERS OF BATESVILLE 93 $1,216,026 $187,032 $1,028,993 INDIANA UNIVERSITY HEALTH 138 $1,072,981 $894,717 $178,264 THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO 88 $811,033 $691,234 $119,799 DECATUR COUNTY MEMORIAL HOSPITAL 408 $808,216 $313,981 $494,235 MARGARET MARY HEALTH HOSPICE IIN 71 $778,608 207 $735,248 Tim
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Network Utilization Part A DRG Severity-2017
Setting Low Weight DRG Total Paid Low Weight DRG Percent of Setting Medium Weight DRG Total Paid Medium Weight DRG Percent of Setting High Weight DRG Total Paid High Weight DRG Percent of Setting In-Network $1,194,980 36.7% $1,801,555 44.9% $566,101 7.9% Out-of-Network $2,063,523 63.3% $2,214,347 55.1% $6,625,614 92.1% Tim-Snapshot- volume and revenue going out of network and why. Is it something we could be doing?
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Network Utilization Part A- Top 5 DRGs by Admission Count- Per Setting-2017
DRG Name DRG Code DRG Average Facility LOS National Average LOS Patients Served Weight Admission Count Paid Amount Rank by Admission Count In-Network SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC 871 3.9 6.4 42 Medium $458,742 1 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC 190 3.0 4.8 27 Low 37 $296,939 2 HEART FAILURE & SHOCK W MCC 291 2.9 5.8 26 $216,674 3 RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC 177 3.8 7.4 22 23 $252,147 4 MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC 470 2.8 21 High $154,142 5 Out-of-Network 2.6 45 47 $532,953 8.1 24 25 $328,302 19 $234,101 6.1 15 $188,029 PSYCHOSES 885 7.3 7.9 11 14 $85,527 Tim-What is going out of network and can we do it?
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Network Utilization Part B Professional Details-2017
Specialty In-Network Professional Paid Out-of-Network Professional Paid Patient Count Ophthalmology $0 $754,698 1,166 Ambulance service (private) $713,082 602 Orthopedic surgery $395,781 835 Ambulatory surgical center $376,150 231 Diagnostic radiology $347,517 2,656 Cardiology $259,223 1,231 Internal medicine $251,320 $253,643 1,295 Dermatology $251,841 845 Nurse practitioner $98,094 $162,991 1,529 Anesthesiology $141,175 574 Clinical laboratory (billing independently) $135,609 644 General surgery $98,652 $122,631 792 Nephrology $122,024 151 Physician assistant $51 $120,277 693 Neurology $110,990 401 Chiropractic $107,107 387 Physical medicine and rehabilitation $100,910 381 Emergency medicine $35,077 $77,842 537 Tim- A snapshot of the highest service categories going out of network. It’s part of a much longer list.
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Additional Opportunities
Anna
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Steps to Take Now for ACO Participation and Accessing Medicare Claims Data
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Consider Agreement Cycles
Track 1 2018 was the last application cycle for new Track 1 ACOs May continue out their term through performance year 2020 Will be allowed to apply for Basic option but must begin at Level B BASIC Option Interim cycle for Basic option begins July 1, Regular cycle to begin January 1, 2020 and annually thereafter Interim six month “year” does not require Level advancement Allows up to three and a half years of upside-only risk for new low revenue ACOs ENHANCED Option (ongoing) Same timeline as BASIC No time limit for participation Required start point for high-revenue ACOs experienced with risk Anna
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Consider Your ACO Options & MIPS
Participants joining the Basic option on July 1, 2019 will be considered MIPS APMs for the 2019 performance year Same rules as standard MIPS participation for data submission (minimum 90-day period) TINs weighted to yield a single ACO score Scored from APM quality measure set (no additional submission requirement) Measurement period will be 2019 calendar year (including July 1 starts) Automatic credit for ACO activities. Historically 100% As of 1/10/2019 pending release of CMS guidance documents Anna
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Consider MIPS-APM Participation Also Simplifies MIPS Reporting
All eligible providers report all categories except Promoting Interoperability (which exempts hospital-based physicians) Cost is claims-based and does not require reporting MIPS-APM All TINs report Promoting Interoperability except TINs that only include hospital-based physicians Only PCPs (and specialists that act like PCPs) report quality on a subset of patients attributed to ACO for primary care Promoting Interoperability PCPs Specialists Quality PCPs Specialists Hospital-Based EPs Promoting Interoperability PCPs Specialists Quality PCPs Improvement Activities PCPs Specialists Hospital-Based EPs Cost (Claims only) PCPs Specialists Hospital-Based EPs Anna-In a collaborative ACO of 100,000 lives, the average PCP will report 3-5 quality elements, most specialists will not report quality, everyone gets 100% on improvement activities and all patient facing clinicians will have to report on promoting interoperability. Qualified Advanced APMs Report Nothing!
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Please Complete Evaluation on the HIMSS App!
Questions???? Tim Putnam, President/CEO- Margaret Mary Health Dr. Anna Loengard, CMO, Caravan Health Please Complete Evaluation on the HIMSS App!
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