Presentation Transcript

1. Integrated Care OrganizatioNBest Outcome for Every Patient, Every Time

2. Agenda Today’s changing healthcare environment Positioning IHS for success The ICO’s role in the IHS ACO Organizational structure of the ICO ICO strategy
3. The Catalyst Patient Protection and Affordable Care Act (“health reform”) While important, health reform has acted as a catalyst, bringing to the forefront issues we knew existed With or without reform, the world as we know it will change
4. Typical Relationship Between the Government and Physicians
5. The Real Issues What we can all agree on Costs for patients and employers increasing Federal and State Budget deficits immense Lack of affordable access to care Increasing regulatory burdens Decreasing reimbursement for hospitals and physicians
6. The Real Issues Patients are frustrated High cost Fragmentation Lack of coordination and collaboration Quality not commensurate with cost
7. The Real Issues Physicians are frustrated Declining reimbursement Increasing regulatory burdens Lack of coordination Volume driven patient care “Being a physician isn’t what it used to be…”
8. Insanity?
9. A New Day Value will be rewarded over volume Physicians and other clinicians will be able to serve their patients Hospitals, physicians and other providers will be rewarded for managing the overall health of our communities Patients will receive coordinated and collaborative health care…not fragmentation
10. Integrated Care Organization
11. Positioning for Success Physicians and hospitals are better off working together Collaborate on initiatives that make both clinical and financial sense Preparation will require a well-organized, capable provider network with supportive infrastructure for population management
12. Potential Payment Arrangements Fee for Service Value-Based Payment Increasing Risk
13. IHS Overview Formed in December 1994 15 hospitals and 800+ employed physicians practicing in more than 76 Iowa and Illinois communities 2,600+ affiliated physicians $2.6 billion total operating revenue 22,200+ employees 4 Colleges of Nursing 2.5 million patient visits annually Mission: Improve the health of the people and communities we serve Vision: Best outcome for every patient every time
14. IHS Road Map Physician Alignment Create Value Demonstrate Value Value-Based Contracting
15. ACO Model $ - SAVINGS FOR EMPLOYER/PAYOR Projected cost based on medical inflation trends Total cost of care for defined population $MM Performance Incentives for Physicians & Hospitals Actual costs based on ACO and Medical Home collaboration 2007 2008 2009 2010 2011 2012 2013 2014 2015
16. Population Management
17. ICO Vision and Identity IHS Integrated Care Organization About Us The Integrated Care Organization (ICO) is our clinical integration platform for employed and independent physicians to work together to improve quality of care, enhance the patient experience and create more value in health care Vision Statement Best Outcome for Every Patient, Every Time
18. ICO Defined The ICO is a tax-exempt, nonprofit organization Designed by independent and employed physicians with multi-specialty group leaders from around the system Physicians intricately involved in governance and operations of the ICO
19. ICO Regional Overview
20. ICO Leadership Alan Kaplan, MD Network President Lisa Klobnak Admin. Assistant Kathy Cunningham Exec. Dir. ACO Strategies Nate Thompson Dir. of Physician Services Dave Williams, MD ICO Medical Director Gina Ross ICO Director of Operations Angela Rubino Net. Dev. / Fin. Analyst Ewa Humphrey Clinical Integration Mgr. Joe Walters Analytics Manager Amber Lenhardt Finance Tim McCulley Contracting IHS Legal Dept. Legal Counsel Ashley Atherton ACO/ICO Communications
21. ICO Governance Structure Board of Directors Operating Committee Quality Committee Future ICO Committees
22. ICO Governance Majority of Board must be “non-insiders” Delegated authority to Operating Committee
23. ICO Governance Operating Committee 16 physician & 5 non-physician members Responsible for leading the operations of the ICO Gregory Johnson, MD, Chair (Peoria) Quality Committee 9 physician & 3 non-physician members Reports to the Operating Committee Responsible for development of the ICO Quality Program Ron Iverson, MD, Chair (Dubuque)
24. ICO Operating Committee Expandable as Required PC-I = Primary care independent; PC-E = Primary care employed Spec-I = Specialist Independent; Spec-E = Specialist employed Non-Phys = Medical group leaders, IHS Chief Medical Officer & IHS Chief Financial Officer
25. ICO Quality Committee Expandable as Required PC-I = Primary care independent; PC-E = Primary care employed Spec-I = Specialist Independent; Spec-E = Specialist employed
26. ICO Strategy Establish a clinically integrated network across IHS Align independent and employed physicians on a common quality improvement platform Pursue value-based contracts that reward performance on quality metrics which are meaningful to physicians, patients, families and our communities (i.e. shared savings) Assist ICO physicians with the changing healthcare environment where quality, patient experience and value are recognized
27. ICO Engine Chronic Disease Analytics Create disease registry Aid in the management of chronically ill patients Enhance physician-to-physician communication Provide outcome measures Provide actionable information to support management of patient populations
28. ICO Engine
29. ICO Initiatives Build system-wide primary care network aligned on common set of metrics for 2012 Reward achievement of quality targets with incentive dollars IHS Self Funded Health Plan ACO Shared Savings agreement with Wellmark Restructured Wellmark Pay for Performance programs Medicare Shared Savings Program
30. Phases of Physician Engagement Phase One: System wide network of primary care physicians Phase Two: Core specialty physicians required for care of complex, chronically ill patients Cardiology Gastroenterology Endocrinology Phase Three: Full spectrum of physicians
31. 2012 Proposed ICO Metrics Quality Program Measures Chronic Care Management (Claims Data) Office visits within 30 days of hospital discharge 3 or more annual office visits for chronically ill Primary Prevention (Claims Data) Mammography Colonoscopy Pediatric well visits Thresholds based on historical performance
32. Financial Drivers for Shared Savings Shared savings driven by: Avoidable ER visits Avoidable admissions Reduction in pharmaceutical costs Reduction in duplicative ancillary tests/procedures Evidence based care guides
33. Timeline January 1, 2012 Engage primary care physicians April 1, 2012 IHS Self Funded Health Plan Wellmark ACO Shared Savings Modified QIS Program Engage core specialty physicians July 1, 2012 Engage full spectrum of physicians Medicare Shared Savings Program
34. Ideal State
35. Summary The ICO is the physician-driven quality improvement platform within the IHS ACO The ICO will create and demonstrate value through physician collaboration around the “triple aim”: Improve quality outcomes Enhance patient experience Decrease overall cost of care ICO physicians will be positioned for long-term stability and success, regardless of what happens with healthcare reform