Delivering Health Care – and Savings? Cost Containment

Delivering Health Care – and Savings? Cost Containment Through Accountable Care March 1, 2012 2012 Health Policy Roundtables

Welcome! 2012 Health Policy Roundtables for Legislators February 2: Essential Health Benefits February 16: Reining in Growth in Health Spending March 1: Cost Containment through Accountable Care March 15: The Boomer Challenge 2

Today's Discussion The driving cost of fragmented health care Two new models of health care in Colorado: Medicare Pioneer ACO Medicaid ACC 3

The Current Delivery System is Fragmented Primary care providers may be unaware their patient has been to the hospital. Patients may be subjected to unnecessary, repetitive tests. A Dartmouth Institute study suggests 30 percent of care is unnecessary. 1 1 The Dartmouth Institute, “Reflections on Geographic Variations in U.S. Health Care”, 2010. 4

What is Accountable Care? 5

Principles of Accountable Care Provider leadership Emphasis on primary care Active and proactive care coordination Electronic Health Records for care coordination and disease management Community-based collaboration Payment reform Patient Centered Medical Home 6 {

How Accountable Care Works 7

Payment Reform Under Accountable Care 8

Accountable Care in Colorado Medicare Pioneer ACO Medicaid ACC 9

Why a State Legislator Should Care About Medicare Medicare covers almost 10% of Colorado’s population Opportunities to improve care and reduce costs Can we learn, apply and scale the results to other payers? 10

Medicare Pioneer Accountable Care Organization (ACO) Physician Health Partners (Denver) Provides care coordination and business process improvement services for physician practices Established in 1996, a collaborative of 260 providers, serves 450,000 patients in metro area One of 32 Medicare Pioneer ACOs in the U.S. Will serve up to 28,000 Medicare patients 11

Medicare ACO Implementation Year 1 Year 2 Year 3 2012 2013 2014 ACO shares 60% of savings or loss above benchmark ACO shares 70% of savings or loss above benchmark Eligible to move to a populationbased payment Must report (not meet) 33 quality measures Payment tied to meeting 25 of 33 quality measures Must engage ACO with nonMedicare payers 12

The Accountable Care Collaborative 13

Colorado’s Accountable Care Collaborative (ACC) A Colorado-grown Medicaid cost containment strategy One of a handful of states at the forefront Began development in 2009, implemented in spring of 2011 ACC aligns with principles of accountable care Seven regional ACOs 14

The ACC’s Seven RCCOs 15

Three Pillars of ACC 16

How Enrollees May Benefit A pregnant woman with mental health needs visited the emergency room 28 times over 6 months. 17

Medicaid ACC Implementation 18

Variation and Common Threads Across Regions Led by “culture change” RCCOs function as independent ACOs The importance of relationships Leveraging existing knowledge and expertise Genesis of the RCCO Community-driven approaches to care coordination 19

SDAC: The Potential of Data Provides layers of insight into cost drivers across organizational levels: RCCO performance within region on emergency department use, hospital re-admissions and imaging Practice/clinic comparisons using risk-adjusted data Clinician data facilitates clinical practice improvement Patient data identifies high-risk patients 20

Moving Forward 21

Continued Payment Reform 22

Accountable Care: Challenges and Opportunities “Culture change” Initial investment Attribution process Based on preserving choice of provider Not breaking any existing relationship with a PCP Real-time health information 23

Salud Family Health Centers, Commerce City Jeff Bontrager 720.382.7075 [email protected] 24