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Advocate Good Shepherd Physician Partners


Advocate Good Shepherd Physician Partners April 23, 2012 ANNUAL MEETING – PowerPoint PPT presentation

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Title: Advocate Good Shepherd Physician Partners

Advocate Good Shepherd Physician Partners
  • April 23, 2012

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

PHO Highlights
  • Dick McDonough, MD
  • President, AGSPP

APP Organizational Chart withAGSPP
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,
Non-Voting Representatives Debra OConnor, MD,
Medical Director
Annual Election
  • 2 year Term expiring 2014
  • J. Dean Feldman, MD
  • Michelle Roig, MD
  • 1 year Term expiring 2013
  • Mark Gross, MD

Good Shepherd Hospital Update
  • Karen Lambert, President

Becoming a Population Health Management Enterprise
  • Scott Kent
  • VP, Field Operations, APP

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

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

APPs New Approaches to Medicare
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

What Is the Medicare Shared Savings Program?
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

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

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

Whats In It For Physicians?
  • Improved Coordination of Care Benefits Your
  • 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
  • 6 Million If Quality Score Averages 80

Blue CrossMedicare AdvantageContract
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

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

In-Network Care Coordination
Why Is In-Network Care Important?
  • Keeping Care in APP Network Is Good for
    Patients, Good For Doctors Good for Advocate

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

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

Good for Financial Performance
  • Contracts Represent Over 60 of All Physician
  • 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

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

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)

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)

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
  • Earnings Up to 120 per Admission
  • 3 Earnings Tiers for 2012

What Do You Need to Do?
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
  • 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

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

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

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

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

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

Incentive Distribution Model
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

2011 CI Year-End Results
Final Results Post Reconsideration Process
Single Fund, Single Distribution
  • One Program, One Set of Measures, One Set of
  • 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

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
Advocate Physician PartnersCombined Incentive
Fund Distribution History2007-2011( in
Advocate Good Shepherd Physician
PartnersPhysician Incentive Fund Distribution
History2007-2011( in millions)
Questions Answers
Check Distribution
  • Birdie Chow, PHO Director

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