In the future, CMS polices will require that a health system's approach to a hospital patient be, 'Ask if you can send this patient home first.'
PLAINSBORO, N.J. (PRWEB) March 19, 2015
When The American Journal of Managed Care held the first meeting of the ACO and Emerging Healthcare Delivery Coalition, members were prioritizing their areas of concern, as they met the challenges of becoming an “accountable care organization.”
Today, as members gain experience they can share, Web-based sessions dig into the finest details, such as how why a Nevada ACO’s readmission year-over-year readmission rate looks high—it turns out the first year was unnaturally low. But getting into the granular is how ACOs of all kinds—large and small, new and established, urban and rural—will learn from each other over time. This is a key to the Coalition’s success, and a reason it has grown to 170 members.
The Coalition’s most recent Web-based session, in late February, featured three presentations that offered a mix of perspectives, which at various points addressed the timeline Medicare announced January 26, 2015, for shifting to value-based reimbursement: 30% of payments must be tied to these models by 2016, with 50% by 2018.
Population Health Management. Kirk Gillis, vice president of Accountable Care for Renown Health, Reno, Nevada, offered a presentation that traced his organization’s ACO evolution. Renown started small in January 2014 with only its Medicare fee-for-service clients and 250 physicians that it controlled.
This January, the Renown ACO expanded to include 9000 beneficiaries of its self-insured health plan and 30,000 lives of a health plan it controls; provider contracts are expanding to include independent primary, ancillary and specialty providers, as well as independent acute and post-acute facilities. Third-party self-insured and insured beneficiaries and rural health providers will be added in 2016, and Renown may someday bid to handle Medicaid clients for the State of Nevada.
Gillis presented a grid of results that showed steady improvement in most quality measures for the Medicare population. “This was hard work,” he said. Each part of the process: getting patients scheduled for preventive services, delivering the services, documenting results and extracting data in a way that was meaningful to providers, took great effort. Renown has updated and standardized its measures to include 40 items for use across all populations.
Renown is now engaged in evidence-based content development, to ensure continuity as patients move from ambulatory to acute care, to post-acute care. Diseases that cost the most to treat will receive attention first, Gillis said. “We have received a lot of support from the physician and clinician community,” on content development, although he said that did not happen overnight.
Care Coordination Models. Josh Luke, founder of the National Readmission Prevention Collaborative, and CEO of Memorial Hospital of Gardena, offered what he called a look at “the health system of the future,” one that will increasingly reward healthcare models that emphasize coordinated care—or, more precisely, penalize those that do not. CMS’ recent announcement about value-based reimbursement goals in Medicare is just the start, he said.
Luke’s description of what is coming for health systems involves an upheaval in mindset as much as payment models themselves. That is going to be hard for some institutions, he said, because they are still being managed by professionals who have spent decades running hospitals. “It’s a very difficult thing for senior executives, because they’ve always been paid for ‘heads on beds.’“
In the future, a health system’s approach to a hospital patient must be, “Ask if you can send this person home first.” Going home is always the least restrictive and least expensive option, and CMS policies will reward those health systems that recognize this. That means skilled nursing facilities will have to transform their thinking, too, Luke said. “They are just a cost center in the model of the future,” he said.
The new mandate to coordinate care will allow hospitals, assisted living centers, and home health organizations to align, however. As with the Renown presentation, Luke discussed the need for technology investments to gather and manage data without adding work for clinical staff, especially nurses.
A Data Sharing Solution. Jonathan Hare, CEO of WebShield Inc., discussed a new way to address the information-sharing needs that are abundant with payment models that emphasize quality measures, but challenge ACOs to connect multiple providers and other entities while maintaining patient privacy and security.
WebShield’s model lets “data drive the decisions,” Hare said. The system lets disparate users with data sharing needs delegate this responsibility to what he called a “neutral trust authority.” Different users specify “trust criteria,” which lets them outline who can see which pieces of data and for what purpose. Data are aggregated in manner that lets it be used for measurement without outsiders being able to trace it down to individual patients or providers.
About the ACO Coalition
As ACOs and other emerging delivery and payment models evolve and move away from traditional fee-for-service system models toward cost-effective and value-based care, the need to understand how these models will evolve is critical to building long-term strategic solutions. The mission of the ACO Coalition is to bring together a diverse group of key stakeholders, including ACO providers and leaders, payers, IDNs, retail and specialty pharmacy, academia, national quality organizations, patient advocacy, employers and pharmaceutical manufacturers to work collaboratively to build value and improve the quality and overall outcomes of patient care. Coalition members share ideas and best practices through live meetings, Web-based interactive sessions and conference calls. Distinguishing features are the Coalition’s access to leading experts and its small workshops that allow creative problem-solving. To learn more, click here.
CONTACT: Nicole Beagin (609) 716-7777 x 131