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Advocate Good Shepherd Physician Partners

Advocate Good Shepherd Physician Partners. April 23, 2012. ANNUAL MEETING. Agenda. 6:00 PM PHO President Remarks 6:05 PM Hospital President Remarks 6:10 PM Election 6:15 PM Advocate Care Update 6:45 PM Check Distribution. PHO Highlights. Dick McDonough, MD President, AGSPP.

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Advocate Good Shepherd Physician Partners

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  1. Advocate Good Shepherd Physician Partners April 23, 2012 ANNUAL MEETING

  2. Agenda 6:00 PM PHO President Remarks 6:05 PM Hospital President Remarks 6:10 PM Election 6:15 PM AdvocateCare Update 6:45 PM Check Distribution

  3. PHO Highlights Dick McDonough, MD President, AGSPP

  4. APP Organizational Chart withAGSPP Representatives

  5. 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 O’Connor, MD, Medical Director

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

  7. Good Shepherd Hospital Update Karen Lambert, President

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

  9. Accountable CareIs Here to Stay

  10. 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.

  11. 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

  12. 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

  13. APP’s New Approaches to Medicare

  14. 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

  15. What Is the Medicare Shared Savings Program?

  16. What MSSP Isn’t . . . • 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

  17. APP’s 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”

  18. 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

  19. What’s 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%

  20. Blue CrossMedicare AdvantageContract

  21. 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

  22. 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

  23. In-Network Care Coordination

  24. Why Is “In-Network Care” Important? Keeping Care in APP Network Is Good for Patients, Good For Doctors & Good for Advocate

  25. 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

  26. 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

  27. 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

  28. 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

  29. 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)

  30. 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)

  31. 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

  32. What Do You Need to Do?

  33. 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

  34. Focus on AdvocateCare AdvocateCare Index • ED Visits/1000 • Admits/1000 • Length of Stay • 30-Day Readmissions • % Days In-Network 34

  35. SynAPPs Update

  36. Specialists Live on SynAPPs as of 3/31/12(Excluding PCPs and Pediatricians)n=188

  37. 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 EMR’s • 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

  38. 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

  39. “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 Lake Cook Orthopedic Associates

  40. 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

  41. Incentive Distribution Model

  42. 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

  43. 2011 CI Year-End Results Final Results: Post Reconsideration Process

  44. 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

  45. 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

  46. Advocate Physician PartnersCombined Incentive Fund Distribution History2007-2011($ in millions)

  47. Advocate Good Shepherd Physician PartnersPhysician Incentive Fund Distribution History2007-2011($ in millions)

  48. Questions & Answers

  49. Check Distribution Birdie Chow, PHO Director

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