Population Health in
2016: Know How to
Move Forward
Mike Maus
VP Enterprise Strategy
This event is live as of
We spend more
on health care than
Canada does…
on everything.
0
2
4
6
8
10
12
14
16
18
Health expenditure as a share
of GDP, public and private
Source: OECD Health Statistics 2014
3
Pu...
And we compete
on quality of care with…
Costa Rica.
Source: CMS, “2013 Annual Report of the Boards of Trustees of the
Federal Hospital Insurance
and Federal Supplementary Med...
2018: 90%
of Medicare
payments
tied to quality.
2020: 75% of
commercial
plans will be
value-based.
Jan 2015. http://www.hh...
Three types of bundled payment programs
7
Penalty-based
MU
Meaningful Use
PQRS
Physician Quality
Reporting System
VBM
Valu...
Three types of bundled payment programs
8
Penalty-based
MU
Meaningful Use
PQRS
Physician Quality
Reporting System
VBM
Valu...
Three types of bundled payment programs
9
Penalty-based
MU
Meaningful Use
PQRS
Physician Quality
Reporting System
VBM
Valu...
10
Pioneer ACO
2012 MSSP
2013 MSSP
2014 MSSP
Private ACO
23
114
106
123
240
742 ACOs Total
52%
of US population lives
near...
$342M shared savings
payments
✔
$4M average shared
savings payment
✔
Only 26% of ACOs
earned shared savings payments
✗
11 ACOs failed to report✗
94 ACOs hit the benchmark
but received no savi...
Medicare Shared
Savings Program
(MSSP) Quick View
• No Downside
Risk
• Retrospective
Attribution
50
%
• Upside and
Downside Risk
• Retrospective
Attribution
• Upside and
Do...
Low Risk Patients
Rising Risk Patients
High Risk Patients
Near term high cost
Highly-
automated,
virtualized
engagement
16
Focus on data management
solutions….
17
…with little ability to realize value
and extract results
athenahealth’s
Approach
Network
services
Population
health
management
Patient access
and care
coordination
Inpatient
services
Electronic health
re...
Population
health
management
22
Data Sources
CLINICAL SYSTEMS
Allscripts
Meditech
EPIC
eClinicalWorks
GE Centricity
Cerner
NextGen
PAYERS
CIGNA
AETNA
A...
v
Network
Data
Our population health services approach:
Over the past five years, athenahealth
clients achieved strong results
24
45%Improvement in
1st year ACO33
quality scores
...
Our clients include some of the most
forward-thinking provider organizations
25
Our MSSP
ACO Guarantees
You’ll receive
ACO Shared Savings.
Pay us only if you do.
Pay us nothing if you don’t
We will go a...
Questions
27
Thank You
Population Health in 2016: Know How to Move Forward
of 28

Population Health in 2016: Know How to Move Forward

Accountable care organizations (ACOs) present a significant opportunity to reduce health care expenditures and ensure quality care. Successfully managing the transition to an ACO is one of the most difficult challenges facing health organizations today. The key is to focus on the risk contract and approach population health management in a staged, incremental way.
Published on: Mar 4, 2016
Published in: Healthcare      
Source: www.slideshare.net


Transcripts - Population Health in 2016: Know How to Move Forward

  • 1. Population Health in 2016: Know How to Move Forward Mike Maus VP Enterprise Strategy This event is live as of
  • 2. We spend more on health care than Canada does… on everything.
  • 3. 0 2 4 6 8 10 12 14 16 18 Health expenditure as a share of GDP, public and private Source: OECD Health Statistics 2014 3 Public Government Spend Private Spend
  • 4. And we compete on quality of care with… Costa Rica.
  • 5. Source: CMS, “2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds,” May 31, 2013, available at: http://downloads.cms.gov/files/TR2013.pdf; Projected Medicare Fee-for- service Payment Cuts per the ACA 2014 2015 2016 2017 2018 2019 2020 Projected number of Medicare beneficiaries 54M 56M 57M 59M 61M 63M 64M -14B -21B -25B -32B -42B -53B -64B Source: CMS, “2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds,” May 31, 2013, available at: http://downloads.cms.gov/files/TR2013.pdf
  • 6. 2018: 90% of Medicare payments tied to quality. 2020: 75% of commercial plans will be value-based. Jan 2015. http://www.hhs.gov/news/press/2015pres/01/20150126a.html
  • 7. Three types of bundled payment programs 7 Penalty-based MU Meaningful Use PQRS Physician Quality Reporting System VBM Value-Based payment Modifier program Incentive-based CCM Chronic Care Management TCM Transitional Care Management PCMH Patient Centered Medical Home Risk-based ACO, MSSP Capitation Bundles
  • 8. Three types of bundled payment programs 8 Penalty-based MU Meaningful Use PQRS Physician Quality Reporting System VBM Value-Based payment Modifier program Incentive-based CCM Chronic Care Management TCM Transitional Care Management PCMH Patient Centered Medical Home Risk-based ACO, MSSP Capitation Bundles MIPS (2018) APMs (2018)
  • 9. Three types of bundled payment programs 9 Penalty-based MU Meaningful Use PQRS Physician Quality Reporting System VBM Value-Based payment Modifier program Incentive-based CCM Chronic Care Management TCM Transitional Care Management PCMH Patient Centered Medical Home Risk-based ACO, MSSP Capitation Bundles MIPS (2018) APMs (2018)
  • 10. 10 Pioneer ACO 2012 MSSP 2013 MSSP 2014 MSSP Private ACO 23 114 106 123 240 742 ACOs Total 52% of US population lives near an ACO 14% of US population treated by an ACO
  • 11. $342M shared savings payments ✔ $4M average shared savings payment ✔
  • 12. Only 26% of ACOs earned shared savings payments ✗ 11 ACOs failed to report✗ 94 ACOs hit the benchmark but received no savings ✗
  • 13. Medicare Shared Savings Program (MSSP) Quick View
  • 14. • No Downside Risk • Retrospective Attribution 50 % • Upside and Downside Risk • Retrospective Attribution • Upside and Downside Risk • Prospective Attribution 14 MSSP Shared Savings Bonus Payments 60 % 75 % Track 1 Track 2 Track 3
  • 15. Low Risk Patients Rising Risk Patients High Risk Patients Near term high cost Highly- automated, virtualized engagement
  • 16. 16 Focus on data management solutions….
  • 17. 17 …with little ability to realize value and extract results
  • 18. athenahealth’s Approach
  • 19. Network services Population health management Patient access and care coordination Inpatient services Electronic health records Revenue cycle management Ambulatory services Revenue cycle management Electronic health records
  • 20. Population health management
  • 21. 22 Data Sources CLINICAL SYSTEMS Allscripts Meditech EPIC eClinicalWorks GE Centricity Cerner NextGen PAYERS CIGNA AETNA Anthem United CMS BCBSMA Harvard Pilgrim AGGREGATED PATIENT DATA PHARMACY BENEFIT MANAGEMENT Caremark Envision ESI REGIONAL LABS Quest Diagnostics LabCorp Converge Diagnostics We aggregate data across multiple sources in the cloud
  • 22. v Network Data Our population health services approach:
  • 23. Over the past five years, athenahealth clients achieved strong results 24 45%Improvement in 1st year ACO33 quality scores 16%Increase in network utilization retention 63%of our MSSP clients earned shared savings payment 55%Bend in medical cost trend (lower spending growth)
  • 24. Our clients include some of the most forward-thinking provider organizations 25
  • 25. Our MSSP ACO Guarantees You’ll receive ACO Shared Savings. Pay us only if you do. Pay us nothing if you don’t We will go at risk for our fee
  • 26. Questions 27
  • 27. Thank You

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