Transcript WCHN PHO Functions

WCHN
PHO/ACO
Annual Meeting
Rowena Bergmans
VP, Clinical Integration and Population Health
12/7/15
“Delivery models and payment systems are changing.
The episodic approach to care, characterized by one
physician directly caring for each individual care
“event” will be replaced by a team-based
longitudinal approach across multiple facilities, sites,
practitioner type including the patients home…”
Kaufman Hall
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Overview
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Healthcare environment
Response to environmental factors
Competencies to succeed
PHO/ACO
– Foundation
– 2015 Successes
– Future
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Healthcare Environment
• Healthcare spend
– 3 Trillion Dollars 2014/ 17.5% of GDP
– $9,146 Per Capita
• Healthcare quality
– Hospital errors third leading cause of death (2013)
– Rank 37th in the world
• Physician satisfaction
– 60% would retire if they had means
– 22% of clinician time paper work
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National/Local Response
• Downward pressures on traditional delivery volumes
• Downward pressures on volume-based reimbursement
rates
• Growing demands for clinical integration
• Expansion of non-traditional competitors
• More sophisticated purchasers of care government,
payers, employers and consumers
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CMS Payment Models
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Skills Systems Will Need for Future Success
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Formation of the WCHN PHO
• The PHO/ACO is a vehicle for WCHN to develop a
physician led clinically integrated infrastructure that will
encompass both employed and aligned community
providers that will result in increased quality of care,
enhanced financial performance and improved patient
satisfaction.
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The WCHN PHO Board Structure
WCHN PHO Board
10 Physician Board Members
One Vote
5 PCP Representatives
on PHO Board
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5 Hospital (WCHN) Board
Members
One Vote
5 Specialist
Representatives
on PHO Board
5 WCHN Representatives
on PHO Board
PHO/ACO Board
PHYSICIAN REPRESENTATIVES
PCPs
Specialists
James Ahern, MD
Henry Allen, MD
Harold Kamm, MD
Cornelius Ferreira, MD
Martin Williams, MD (Secretary)
Neil Culligan, MD – Neurology
Adam Gorelick, MD – Gastroenterology
Jeffery Gorelick, MD – Urology (Chair)
Sohel M. Islam, MD – Surgeon
David Kramer, MD – Surgeon
HOSPITAL (WCHN) REPRESENTATIVES
Rowena Bergmans
Patrick Broderick, MD
Mike Daglio (Vice Chair)
Matt Miller, MD
Steve Rosenberg (Treasurer)
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WCHN PHO Functions
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Develop/maintain a provider network
Contract with health plans w/ opt-ins for individual practices
Prepare our provider community for changes in the health care
arena by:
– Seeking ways to improve quality & efficiency of health care
services provided under PHO/ACO agreements (e.g. clinical
integration, collaboration, data analytics, care management.)
– Offering member practices various optional administrative &
technology solutions (e.g. EMR, PCMH, group purchasing, etc.)
– Supporting practice managers w/ education and networking
functions
Healthcare Reform Support!
2015 PHO/ACO Membership
• 871 Providers
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282 Community
589 Employed
186 Primary Care
695 Specialists
• Value Care Alliance (VCA)
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St. Vincent's Hospital
Middlesex Hospital
Griffin Hospital
St. Vincent's Health Partners (PHO/ACO)
Griffin PHO
2015 Contracts
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Current
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Other
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Aetna Tiered Network
Future
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Aetna Commercial – Shared Savings
Aetna Medicare Advantage – Shared Savings
CMS MSSP – Shared Savings
Connecticare – Shared Savings
Harvard Pilgrim
Multiplan
US Family
Healthy CT
Cigna – 2016 – Shared Savings
Anthem – PHO/ VCA - 2016
United – PHO/ VCA - 2016
Highlights 2015
Building the infrastructure to achieve clinical integration
• Physician Leadership and Clinical Support
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– Dr. Bob Carr, Medical Director PHO/ACO
– Care Managers (2)
– PCMH Specialists
Technology and Business Intelligence
– Highline data warehouse (claims)
– Arcadia (EDW)
• Process
– CAHPS Survey Vendor (MSSP)
– Finalized shared savings methodology
– Trainings (ICD, CPT)
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Where are we headed?
• Utilization Review Accreditation Commission (URAC)
accreditation as a clinically integrated network
• Stronger partnerships with non-traditional providers
• Continue to seek out shared savings relationships
• Continue to move practices to PCMH level 3
• Introduction of behavioral health supports
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Questions…
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