IHS ACO Strategy: Population Management

IHS ACO Strategy:Population Management Kathleen Cunningham Pam Halvorson Iowa Health System Trimark Physician Group Executive Director for VP Regional Clinic Operations Accountable Care Strategies Mike Dewerff Trinity Regional Medical Center Chief Financial Officer IHS Leadership Symposium April 17, 2012

Objectives • Review IHS Vision of our Future Healthcare System • Describe the structured partnership between IHS and Regional Integrated Delivery System • Review basic payor principles for Wellmark and Medicare Contracts • Review TriHealth Pioneer ACO operational plan • Next Steps IHS Leadership Symposium, April 17, 2012

IHS Leadership Symposium, April 17, 2012

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 IHS Leadership Symposium, April 17, 2012

The Future of Our Health Care System • Clinically integrated delivery system, regionally & system-wide, with effective population management infrastructure • Branded as the preferred “high quality—high value” to patients, communities, businesses, and payors • Patient-centric, physician-driven organization • National leader for healthcare reform innovation IHS Leadership Symposium, April 17, 2012

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 IHS Leadership Symposium, April 17, 2012

ACO Defined A clinically integrated network of physicians, hospitals, and others providers committed to using and advancing the latest thinking in clinical care, quality and efficiency. Designed to achieve the triple aim: better health, better healthcare, and better value IHS Leadership Symposium, April 17, 2012

Improve the health of the people and communities we serve Population Management Population & Community Health Integrated Care Organization 1 Platform for physician engagement and collaboration to improve quality, enhance patient experience and create value Facilities & Services Provision of inpatient, outpatient and ambulatory services required to deliver comprehensive patient care Regional Integrated Delivery System System & Regional Integrated Delivery System2 Care Management Infrastructure Medical Home, Advanced Medical Team, Palliative Care, Coordinated Care Management/Population Management, Call Center Analytic Support Business and clinical analytic capabilities required to support a population focused care model System & Regional Integrated Delivery System2 2 Medical homes, palliative care programming, and advanced medical team resources to be established in each affiliate region. Call Center would be an example of a system resource. 1 Organization made up of employed and independent physicians from each affiliate region; committee structure in place in each region System IHS Leadership Symposium, April 17, 2012

Research and Development for medical care innovations; partner with business unit to create value-added programs for system-wide impact • Advanced Medical Team • Palliative Care • Post-acute Care Coordinated Care Management for IHS self-insured members expanding to all ACO members; provide care management and disease management for selected chronically ill patients. Centralized analytics to include predictive risk-modeling; evidence-based care packages and disease registry to inform physician of patient gaps-in-care; monitor patient quality and provider performance. • Oversee ACO clinical strategy deployment in selected regions; use ACO Clinical Collaborative for regional engagement ; • Population risk management • Point-of-care management • Provider performance Physician-led, clinically-integrated provider organization established to be the physician arm of ACO to improve quality and create value. Other Aligned IHS Resources: * CCT : PI/Research/Education * Business Development * Communications * Information Technology/CMIO * Decision Support IHS Leadership Symposium, April 17, 2012

IHS Leadership IHACO Infrastructure • Kathleen Cunningham, Executive Director • Lori Weih, System Administrator, ACO Program Management • Marcia Stark, ACO Director, IHDM • Dr. Mark Barnhill, Medical Director, Pop. Care Management • Raedean VanDenover, Director, Pop. Care Management • Joe Walters, Interim Manager, ACO Health Informatics • Jim Grant, Sr. Claims Analyst • Angela Rubino, Network Development/Financial Analyst Integrated Care Organization • Dr. Dave Williams, Medical Director • Gina Ross, Director, Operations • Nathan Thompson, Director, Physician Services Iowa Health System • John Hendricks, Director, IT Interoperability • Amber Lenhardt, Director, Finance Services • Tim McCulley, Director, Payor Contracting New Group • Linda Wendt, System Director of Quality Iowa Health Home Care • Monique Reese, Chief Clinical Officer IHS Leadership Symposium, April 17, 2012

Pioneer ACO CEO Thompson McDonald IHS Leadership Symposium, April 17, 2012

TriHealth Pioneer ACO:Achieving our AIM AIM: Leverage every aspect of our “community” to achieve Best Outcome for Every Patient Every Time Primary Care Community Supporting Choice through the Life Span Primary Drivers • Palliative Care • Inpatient • Home-based • Clinic • Integration with PCP • Hospice • Hospice Home • Home-based • Risk stratification • Med Therapy Management • Disease Management Coaching • Strategic Community Partners • Health-Risk Assessment • Iowa’s Healthiest State initiative • Preventive screening • Health Education and Literacy • Wellness Program • Patient access to PCP • Common screening and assessment tools • Single, patient-centric care plan • Med Therapy Management • Mental Health Action Team • Care transitions – Extended Care Facilities • ICCDM – all care settings • Advanced Medical Team • Telephonic-Telemonitoring • Strategic Healthcare Partners • Critical Access Hospitals Secondary Drivers Home/Neighborhood - Schools - Business - Healthcare Agencies - Government -Recreation - Church/Spiritual IHS Leadership Symposium, April 17, 2012

Preparing for all Payment Arrangements IHS Leadership Symposium, April 17, 2012

ACO Program Domains IHS Leadership Symposium, April 17, 2012

Wellmark ACO Baseline IHS Leadership Symposium, April 17, 2012

IHS ACO 2012 Priorities • Clinical Priorities • Advanced Medical Team • Palliative Care • Inpatient • Outpatient (home care) • Regional ACO Steering Committee • Key stakeholders to oversee ACO performance aligned with IHACO strategies • IHS Resources Assigned • Regional ACO Director • Project Manager • Analytics (EMR and claims) • IT liaison • Adaptive Design • Finance • Contracting • Communications IHS Leadership Symposium, April 17, 2012

Next Steps • Deploy 2012 ACO Priorities • Refine technology requirements and analytic services to support ACO performance at the beneficiary level, to encompass all care settings • Further advance additional payor and provider negotiations to increase ACO beneficiaries served. IHS Leadership Symposium, April 17, 2012

IHS ACO Program Contacts • ACO Program Management • Lori Weih, System Administrator, ACO Program Management • weihls@ihs.org Phone: 515-471-9791 • Population Care Management • Raedean VanDenover, IHS Director, Population Care Management • vandenRK@ihs.org Phone: 515-471-9719 • Advanced Medical Team • Monique Reese, Chief Clinical Officer, IHHC • fentonmc@ihs.org Phone: 515-557-3288 • Palliative Care • Lori Bishop, Executive Director, Statewide Palliative and Hospice, IHHC • bishoplr@ihs.org Phone: 515-727-1104 IHS Leadership Symposium, April 17, 2012

IHS ACO Strategy: Population Management