Data Analytics as a Population Health Compass

1. Data Analytics as a Population Health Compass Session: # 244, Date of Session: February 14, 2019 Tim Putnam, President/CEO, Margaret Mary Health Anna Loengard MD, CMO, Caravan Health

2. Conflict of Interest Tim Putnam, President/CEO of Margaret Mary Health, DHA,MBA, FACHE Salary: Margaret Mary Health Consulting Fees (e.g., advisory boards): National Rural Accountable Care Consortium, Caravan Health Anna Loengard, M.D., CMO of Caravan Health Salary: Caravan Health Consulting Fees (e.g., advisory boards): National Rural Accountable Care Consortium, Caravan Health Ownership Interest (stocks, stock options or other ownership interest excluding diversified mutual funds): Caravan Health

3. Agenda • Introduction • Future of the Medicare Shared Savings Program • Mining Data for Success in Risk-based Models • Charting Your Course: View from the CEO’s Office • Steps to Take Now

4. Learning Objectives • Understand program needs for success in the MSSP • Review of Medicare Policy and future of the MSSP • Realize the power of claims data when parsed into actionable reports • Explore real examples of savings opportunity in post-acute, end-of-life and part B expenses to drive better patient care and sound finances • Summarize steps to take now to chart the course for ACO participation and gaining access to Medicare claims data.

5. Introduction

6. About Caravan Health Helping Providers Navigate the Challenges of Value-Based Payments Practice Transformation Data and Analytics Network Development Accountability and Performance Improvement • 170 employees • 17 Accountable Care Organizations ranging from 5,000 to 230,000 attributed lives • CMS Practice Transformation Network • >350 health systems • >14,000 clinicians • >500,000 attributed Medicare lives

7. Batesville, Indiana 2014 NRACO Founding Member ~$100 Million Net CAH SHO2 ACO- AIM Funded Margaret Mary Community Hospital Henry County Memorial Hospital 2 local independent physicians 2019 moving into a consolidated ACO of SHO 1 and SHO 2 To scale up to approximately 20,000 lives. Margaret Mary Health

8. Suburban Health ACO 2 Results CMS 2017 Results Released 8/2018

9. Quality Measures Year to Year Margaret Mary Health

10. The Future of the MSSP: Heading to Risk

11. Bottom Line on Final Rule Uncertainty finally lifted for Medicare Shared Savings Program Agreement period extended from three to five years and shared savings rate increased significantly to 40% for BASIC levels A - B CMS follows through on commitment to push risk Elimination of Tracks 1, 1+, 2, and 3 and replaced with BASIC and ENHANCED options BASIC option begins with one-sided risk but requires participants to take on increasing levels of risk over the agreement period Lower revenue (physician, rural, and smaller hospital-affiliated) given extra time in non risk Continued expansion of non-financial benefits of risk participation Several significant but small changes to benchmark calculations finalized Risk score growth up to 3% over the agreement period will be recognized in updated benchmarks

12. Key Changes from the Proposed Rule Improved opportunity to share in savings for BASIC option ACOs Improved opportunity to share in savings for BASIC option ACOs New “low revenue” (physician-led) ACOs may defer risk for one additional year Threshold for “low revenue” increased to ACOs with 35% or less of their attributed beneficiaries’ fee-for-service expenditures New beneficiary notifications may be provided via email or online patient portal

13. BASIC & ENHANCED ACO Options

14. How Do You Win in the MSSP? • Managing your patients better than fee-for-service • Wellness • Prevention • Chronic Care Management • Behavioral/Mental Health Support • Post-Acute Care 1 You win the MSSP by… 2 Accurately coding chronic conditions every year 3 Having enough lives to reduce statistical variation Your path to... … Shared Savings

15. Mining Data for Success in Risk-based Models

16. Use Data as a Compass Tracking Key Analytics • patient care, clinician satisfaction and financial performance.

17. Where Do ACOs Focus For Success? Top Priorities for ImprovingEfficiency, Reducing Cost 81%↑ 65%↑ 57%↓ 50%↑ 42%↓ 40% 37% 32% 29% 28% 21%↓ 17% 13% 10%12% 8% Active managementof high-need high-cost patients Manage/reduce post- acute-care spendingand quality Reduce avoidable/unnecessary care Reduce avoidable emergencydepartment visits and avoidable inpatientadmissions Preventreadmissions through better care transitions Increase referrals toACO- based providers/reduce network leakage Integratebehavioral Palliative care/hospice health care intoprimary caresettings A physician group Both (hospital and physician group equally) + Ahospital n =77 n =86 Source: Accountable Care Learning Collaborative, Western Governors University

18. KeyPerformanceIndicators Quicklyhighlightscommondemographics,cost,andutilizationmetricsatthelevelof practicesandcommunities NetworkUtilization Identifieswhereassignablepopulationreceivestheirhealth care,toidentifynetworkleakageandhelpdevelopagrowth strategy Additionalcontentandtopicstobeincludedinquarterly releases Modules KeyPerformanceIndicators Bundled Payments Post-Acute CareFacilityPerformance Network Utilization End-of-Life

19. Variation in Post-Acute-Care Costs Mean (SD) for Non-Swing PPPY is $647 ($421) Mean (SD) for Home Health PPPY is $449 ($367)

20. Savings Opportunity in Post-acute Care If Communities reduced SNF+HH PPPY to meet Caravan Health Median (among similar size communities) , the potential saving opportunity is… $115 M The average potential reduction in total PPPY is… 2.8%

21. Optimize SNF Partnerships Module 1 – Key Performance IndicatorsHospital HappyACO Happy SNF Non-Swing PPPY Hospital Happy: $1418 Caravan Health: $669 All Sample reports are from Compass Modules 2018Q2

23. Optimize Home Health Partners Module 1 – Key Performance IndicatorsHospital ExcelACO Excel Home Health PPPY Hospital Excel : $831 Caravan Health: $459 All Sample reports are from Compass Modules 2018Q2

25. Facility Level Examples- Using Data to Chart the Course

26. Benefits of Access to Medicare Claims Data Facility Network Utilization Analysis

27. Facility Network Utilization Analysis-2017

28. Network Utilization Part ADRG Severity-2017

29. Network Utilization Part A- Top 5 DRGs by Admission Count- Per Setting-2017

30. Network Utilization Part BProfessional Details-2017

31. Additional Opportunities

32. Steps to Take Now for ACO Participation and Accessing Medicare Claims Data

33. Consider Agreement Cycles

34. Consider Your ACO Options & MIPS • Participants joining the Basic option on July 1, 2019 will be considered MIPS APMs for the 2019 performance year • Same rules as standard MIPS participation for data submission (minimum 90-day period) • TINs weighted to yield a single ACO score • Scored from APM quality measure set (no additional submission requirement) • Measurement period will be 2019 calendar year (including July 1 starts) • Automatic credit for ACO activities. Historically 100% • As of 1/10/2019 pending • release of CMS guidance • documents

35. Consider MIPS-APM Participation Also Simplifies MIPS Reporting • MIPS • All eligible providers report all categories except Promoting Interoperability (which exempts hospital-based physicians) • Cost is claims-based and does not require reporting • MIPS-APM • All TINs report Promoting Interoperability except TINs that only include hospital-based physicians • Only PCPs (and specialists that act like PCPs) report quality on a subset of patients attributed to ACO for primary care • Promoting Interoperability • PCPs • Specialists • Quality • PCPs • Specialists • Hospital-Based EPs • Promoting Interoperability • PCPs • Specialists • Quality • PCPs • Improvement Activities • PCPs • Specialists • Hospital-Based • EPs • Cost(Claims only) • PCPs • Specialists • Hospital-Based • EPs Qualified Advanced APMs Report Nothing!

36. Questions???? • Tim Putnam, President/CEO- Margaret Mary Health Tim.putnam@mmch.org 812-933-5133 • Dr. Anna Loengard, CMO, Caravan Health aloengard@caravanhealth.com916-824-3326 Please Complete Evaluation on the HIMSS App!