Advocate Good Shepherd Physician Partners

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Advocate Good Shepherd Physician Partners

• April 23, 2012

• ANNUAL MEETING

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Agenda

• 600 PM PHO President Remarks
• 605 PM Hospital President Remarks
• 610 PM Election
• 615 PM AdvocateCare Update
• 645 PM Check Distribution

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PHO Highlights

• Dick McDonough, MD
• President, AGSPP

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APP Organizational Chart withAGSPP
Representatives
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PHO Board Composition
Physician Directors Dick McDonough, MD,
President J. Dean Feldman, MD, Secretary Fred
Locher, MD Michelle Roig, MD
Hospital Directors Don Calcagno Karen
Lambert Barry Rosen, MD George Teufel,
Treasurer
Non-Voting Representatives Debra OConnor, MD,
Medical Director
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Annual Election

• 2 year Term expiring 2014
• J. Dean Feldman, MD
• Michelle Roig, MD
• 1 year Term expiring 2013
• Mark Gross, MD

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Good Shepherd Hospital Update

• Karen Lambert, President

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Becoming a Population Health Management Enterprise

• Scott Kent
• VP, Field Operations, APP

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Accountable CareIs Here to Stay
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Costs By Age Categories
U.S. is spending much more for older population
Source Fischbeck, Paul. US-Eruope Comparisons
of Health Risk for Specific Gender-Age Groups
Carnegie Mellon University September, 2009.
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Two Years Ago

• Blue Cross Advocate/APP Faced 2 Choices
• Lower Unit Cost Now
• Partner Together/Reduce Waste
• Employers Demanding Change Even If Reform
  Overturned
• Unstoppable Market Force Unleashed
• Prepares Us for ACOs in 2012
• First Mover Advantage
• Better Patient Care ? Fulfills 2020 Vision

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What Results Have We Seen?

• 4.2 HMO Membership Growth in Last Year
• Added Blue Advantage HMO in 2011
• APP Physician Membership Growth
• 208 Total 37 PCPs
• Blue Cross PPO Shared Savings Trends Are 4.6
  Positive Thru Q3 2011
• 13 M Shared Savings in 2011 Payout
• 6.4 M HMO Full Risk Earned Funds in 2011 Payout

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APPs New Approaches to Medicare
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Planned Participation in 2 Models

• Medicare Shared Savings Program (MSSP)
• Program for Accountable Care Organizations (ACOs)
  Established in Health Reform Act
• Start Date July 1, 2012
• Medicare Advantage HMO
• New Opportunity with Blue Cross
• Targeting Age In Population
• Start Date January 1, 2013

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What Is the Medicare Shared Savings Program?
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What MSSP Isnt . . .

• MSSP Is Not a Bundled Payment Program
• MSSP Is Not a Capitated Payment Program
• All Physicians and Hospitals Continue To Submit
  Fee-for-Service Bills To Medicare
• All Physicians and Hospitals Continue To Be Paid
  by Medicare Using the Medicare Fee Schedule
• None of the FFS Payments Are Sent To APP

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APPs MSSP Details

• 3½ Year Contract Starting July 1, 2012
• No Downside (Repayment) Risk
• Up to 50 Share of Savings Based on Quality Score
• 33 Quality Measures in 4 Domains
• Pay-for-Performance Phased in Over 3 Years
• 125,000 Medicare Beneficiaries
• 1.5 Billion Annual Medical Expenses
• Estimated 50 of Spend In Network

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Why Participate in MSSP?

• Better Overall Care for Patients
• Aligns with Advocate 2020 Strategy and Vision to
  Develop Lifelong Relationships with Patients
• Extension of Clinical Integration Program
• Helps Transition to One Model of Care
• Gets Us to Critical Mass
• Prepares Us for Emerging Opportunities

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Whats In It For Physicians?

• Improved Coordination of Care Benefits Your
  Patients
• A Percentage Point Improvement In Total Cost Will
  Increase APP Incentive Pool by About 6 Million
• 1 of 1.5 Billion Annual Spend on 125,000
  Medicare Beneficiaries Is 15 Million
• APP Receives 50 of Savings Multiplied by Quality
  Score
• 6 Million If Quality Score Averages 80

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Blue CrossMedicare AdvantageContract
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Medicare Advantage Opportunity

• Blue Cross Planning Medicare Advantage
• BC Has Large Share of Medicare Supplement Market
• Targeting Younger Medicare Population (66)
• Interest In Capturing Age In Market
• BC Application Submitted to CMS In February
• Required Binding Commitment of Provider Network
• APP Would Be Central to Network, But Others
  Necessary to Satisfy CMS Geo Access Requirements

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APP Board Approved Blue Cross Medicare Advantage

• Start Date of January 1, 2013
• Global Risk Arrangement
• Responsibilities Delegated to APP
• Utilization Management
• Credentialing
• Part B Claims Payment
• Counties Included Cook, DuPage, Kane Will
• Counties Excluded Lake, Kendall, McHenry, McLean

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In-Network Care Coordination
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Why Is In-Network Care Important?

• Keeping Care in APP Network Is Good for
  Patients, Good For Doctors Good for Advocate

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Good for Patients

• Care Managers Assist Patients
• Outpatient CM for Complex Patients
• Inpatient CM for All Hospitalized Patients
• Transition Coaches After Discharge to Assure
  Follow Up with Physicians Avoid Readmissions

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Good for Quality Improvement

• Internal Transparency of APP Allows Doctors to
  Share Performance with Colleagues
• Which Can Lead to
• Mutual Efforts to Improve Performance
• Opportunities to Change Referral Patterns Based
  on Data, Not Hunch
• Clinical Patient Experience Data Is Not
  Available from Out-of-Network Providers

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Good for Financial Performance

• Contracts Represent Over 60 of All Physician
  Billings BCBS PPO, BCBS HMO, MSSP MA
• Admissions and ER Visits Outside of Advocate Lead
  to Uncontrolled Care Expenditures
• Physician Care Outside of APP Leads to
  Uncontrolled and, Often, Undocumented Care,
  Testing Expenditures
• Out-of-Network Care Compromises Patient Care
  Reduces Shared Savings

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In-Network Care Incentives

• Counseling Patients About In Network Care Takes
  Physician Time
• 2 New Incentives and 1 Established Incentive
  Encourage In Network Care
• of Hospital Days In-Network
• SCIP Performance and Increase of In-Network
  Inpatient Surgical Cases
• Current Inpatient Performance Incentive

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Improvement from Baseline in the Percentage of
In-Network Acute Care

• Includes All Non-Hospital Based Physicians
• Attributed APP PPO Patients Measured
• Weighted at 5 of the Total CI Score
• Tiered Points Allotted
• 6 Improvement Over Baseline (Top Tier)
• 4 Improvement Over Baseline (Mid Tier)
• 2 Improvement Over Baseline (Lower Tier)

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Increase in In-Network Inpatient Surgical Care If
SCIP Achieved

• SCIP Performance Targets Must Be Achieved
• Measures Improvement Over Baseline in Inpatient
  Surgical Cases
• Eligible Specialties Cardiovascular, Thoracic,
  Vascular, Colorectal, General Surgery,
  Orthopedics, and OB/Gyn
• Weighted at 5 of the Total CI Score
• Tiered Point Allocation
• 6 Improvement Over Baseline (Top Tier)
• 4 Improvement Over Baseline (Mid-Tier)
• 2 Improvement Over Baseline (Lower Tier)

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Inpatient Performance Incentive Fund

• Applies to All Doctors with Admissions
• Performance Based on LOS and Readmissions
• Payment Based on Performance Level for Practice
  Group and Volume of Admissions for Individual
  Physician
• Earnings Up to 120 per Admission
• 3 Earnings Tiers for 2012

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What Do You Need to Do?
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What Should Physicians Do?

• Sign New Physician Participation Agreement
• Sign New Business Associate Agreement
• Work with APP to Collect Names Addresses of
  Medicare Beneficiaries
• Work with APP To Facilitate Medicare Claims Data
  Sharing
• APP Required To Send Patient Letter Allowing Them
  Not To Share Medicare Claims Data
• APP Would Like Patients To Allow Data Sharing To
  Assist in Improving Patient Care

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Focus on AdvocateCare

• AdvocateCare Index
• ED Visits/1000
• Admits/1000
• Length of Stay
• 30-Day Readmissions
• Days In-Network

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SynAPPs Update
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(No Transcript)
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Specialists Live on SynAPPs as of
3/31/12(Excluding PCPs and Pediatricians)n188
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Benefits of SynAPPs

• Selected by APP Physician Task Force
• SynAPPs Program Benefits Based on 4 Criteria
• InterOperability
• Fully Integrated System (PM, EMR, Patient Portal,
  P2P, MAQ Dashboard, Lab, CIRRIS, and
  CareConnection Interfaces)
• Cost
• Lowest Cost of Full Spectrum EMRs
• Pace of Roll-Out
• Scalable Database to 3,000 Physicians
• Functionality
• Ease of Interfacing and Inclusion in CareNet Plus
• Ongoing Support from SynAPPs Team
• Robust Physician and Non-Physician User Groups
  Across APP
• Proven Track Recording Helping APP Physicians
  Achieve MU

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Meaningful Use

• 94 APP SynAPPs Physicians Have Achieved Medicare
  Meaningful Use
• Anticipated Medicare MU Incentive Dollars
  1,692,000
• 7 APP SynAPPs Physicians Have Achieved Medicaid
  Meaningful Use
• Anticipated Medicaid MU Incentive Dollars
  99,000
• Total Anticipated Meaningful Use Incentive
  Dollars to APP SynAPPs Physicians 1,791,000

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Lake Cook Orthopedic Associates

• The organization and support from the dedicated
  APP teams has made the transition to SynAPPs much
  more manageable than we had feared. People like
  Renee Witthoff have been invaluable in organizing
  our training, looking out for our best interests
  in dealing with any problems as they occurred.
  From initial introductions to the software,
  hardware upgrading, training and implementation,
  and now meaningful use, the experience and help
  of the various SynAPPs teams has been of great
  help during this process.
• Dr. Frederick Locher

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New APP Membership Criteria

• SynAPPs Required for PCPs Not Currently on an EMR
  by January 1, 2014
• New Physicians Joining APP on an EMR NOT Meeting
  Highest Current Stage of Meaningful Use Criteria
  Must Adopt SynAPPs within 12 Months
• Once Stage 2 Meaningful Use Criteria Finalized,
  Any Physician NOT on EMR Certified for Stage 2
  Will Need to Convert to SynAPPs within 12 Months

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Incentive Distribution Model
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New PCP Reimbursement

• PCP Cap Changing to FFS on July 1st, 2012
• Paid at 110 of Medicare
• Services Rendered to HMOI, Blue Advantage and
  Humana HMO Patients
• Final Monthly Capitation Payments for Paid by
  July 15th, 2012

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2011 CI Year-End Results
Final Results Post Reconsideration Process
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Single Fund, Single Distribution

• One Program, One Set of Measures, One Set of
  Incentives
• Integration of HMO Surpluses, CI Funds Shared
  Savings Dollars Into One Fund
• Creation of Value Pool Concept
• Increased Weighting On, and Eligibility for,
  Work Pool
• Must Achieve Minimum Score of 65 for Payout

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Single Incentive Fund Payout
Professional HMO Surplus 28.4 M
Facility HMO Surplus 6.4 M
CI Funding 65.2 M
AdvocateCare Shared Savings 13.0 M
Minus Infrastructure Costs, Deficits and 120 Fee
Schedule 19.5 M
Physician
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Advocate Physician PartnersCombined Incentive
Fund Distribution History2007-2011( in
millions)
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Advocate Good Shepherd Physician
PartnersPhysician Incentive Fund Distribution
History2007-2011( in millions)
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Questions Answers
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Check Distribution

• Birdie Chow, PHO Director

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Amount Paid to 120 of MC
CI Earned Unearned
Registry Work Incentive
Value Pool - PCPs
Inpatient Incentive Earned Unearned
TOTAL Earned Unearned
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Logistics for Check Distribution

• PHO Member by July 1, 2011 to be Eligible for
  Clinical Integration Distribution
• Meadow Room
• Checks Distributed by Name
• Last Name if You Are a Solo Practitioner
• Group Name if You Are in a Group Practice
• Please Designate 1 Person per Group to Obtain
  Checks