fresenius health partners esco overview · 5/23/2019  · fresenius health partners esco overview....

For Internal Purposes Only.

May 23, 2019

Glenda Wooten

Senior ESCO Program Manager

Fresenius Health Partners ESCO Overview

For Internal Purposes Only.

The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.

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Disclaimer

For Internal Purposes Only.

Renal Care in a Value-Based Model

Opportunities

The Nephrologist is the

principal care provider for

the ESRD patient and

are involved in most

major care decisions

The ESRD patients are

in the dialysis clinic three

times a week making it

the logical medical home

Fragmented Care

negatively impacts the

patient’s quality of life

and increases the risk of

hospitalizations

This is a resource

intensive cohort of

patients, with annual

costs 10 times that of an

average Medicare

patient

Challenges

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For Internal Purposes Only.

End Stage Renal Disease Seamless Care Organization or ESCO

Partnerships between CMS, nephrologists and dialysis providers

Accountable for all facets of their matched beneficiaries’ care

Share savings with CMS if matched beneficiaries’ expenditures decrease and quality is maintained or improved

Share losses if beneficiaries’ expenditures increase

Understanding ESCOs

CMS

ESCO

Dialysis Units Nephrology Practices

Others

Medicare FFS Beneficiaries

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For Internal Purposes Only.

Patient Eligibility

Enrolled in Medicare Parts A and B

Medicare is primary payer

Not be enrolled in a Medicare Advantage plan,

cost plan, or other non-Medicare Advantage

Medicare managed care plan

Not be affiliated with an existing shared

savings program

At least 18 years of age & reside in the US

Not received a kidney transplant in the last 12

months

Matching through “first touch”

Receive at least 50% of annual dialysis

services in the ESCO’s market area

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For Internal Purposes Only.

Beneficiary matching is based on the dialysis unit

Initial matching is preliminary

Final matching for shared savings/loss is retrospective

Beneficiaries retain all of their freedom of choice

Medicare continues to pay claims

Patient Attribution

Note: A beneficiary will be removed from the ESCO’s list of aligned beneficiaries for the entire Performance Year if the patient received more than 50 percent of his or her dialysis services from one or more Dialysis Facilities outside of the Market of the ESCO during the Performance Year. *

*Beginning in 2018 (PY3) geographic exclusions may apply.

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For Internal Purposes Only.

Fresenius – 6 ESCO’s

DCI – 3 ESCO’s (Nashville, Spartanburg, Newark)

DaVita – 3 ESCO’s (Phoenix, Miami and Philadelphia)

Non-Large Dialysis Organizations

• Rogosin Kidney Care Alliance (NY)

October 2015 – December 2016

Initial 13 ESCO Programs

For Internal Purposes Only.

Fresenius – 24 ESCO’s

DCI – 5 ESCO’s (Nashville, Spartanburg, Newark, Kansas City, Pittsburgh)

DaVita – 3 ESCO’s (Phoenix, Miami, Philadelphia)

Non-Large Dialysis Organizations (1 ESCO each)

•Rogosin Kidney Care Alliance – NY

•Northeast Ohio Renal Alliance – Cleveland

•The Gotham City Kidney Care ESCO – NY

•Northwest Kidney Alliance – Seattle

ESCO Programs 2017 to present: 36 Total

For Internal Purposes Only.

Fresenius ESCO Experience

ESCO/Location Seamless Care of Atlanta Seamless Care of Houston

Seamless Care of Central

Alabama Seamless Care of Indianapolis

Seamless Care of Central

Illinois Seamless Care of Las Vegas

Seamless Care of Central North

Carolina Seamless Care of Louisiana

Seamless Care of Central

Texas Seamless Care of Maryland

Seamless Care of Charlotte

Seamless Care of

Massachusetts Seamless Care of Chicago Seamless Care of Michigan

Seamless Care of Columbia Seamless Care of Minneapolis

Seamless Care of Dallas Seamless Care of New York

Seamless Care of Delaware Seamless Care of Philadelphia

Seamless Care of Erie Valley Seamless Care of Portland

Seamless Care of Gulf Shore Seamless Care of San Diego

2015 – 6 Cohort 1 ESCO’s

2017 - 24 ESCO’s

For Internal Purposes Only.

Care Navigation Unit

For Internal Purposes Only.

CNU Focus:

to reduce

unnecessary

hospital

admissions

CNU is a team of nurses, social workers and service operations specialists who provide 24/7 coordination of care support

Care Navigation Unit (CNU)

Monitors patients real time allowing for “just in time”

interventions to find solutions and remove

obstacles

Increasing communication between key stakeholders

in a fragmented system

Empowered to take extraordinary measures to safely coordinate care at

the lowest level of intensity

24/7 access to all patient data contained in the dialysis center EHR

Caring for >48,000* patients in various programs across

North America

* As of October 2018

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For Internal Purposes Only.

CNU Focus: Reduce Unnecessary Hospitalizations

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For Internal Purposes Only.

1%

10%

16% 16%

12%

10% 8%

6% 5%

3% 3%

11%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Same 2 4 6 8 10

Admits LOS

CNU Focus: Reduce Unnecessary Hospitalizations

$7,541

$9,128

$10,133

$10,568

$0 $5,000 $10,000 $15,000

Same

1

2

3

Avg Cost/day

0-3 day stays are often treatment adherence

related

All admits are high cost DRG

w/MCC

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For Internal Purposes Only.

FHP Care Navigation Unit Coordination

• Scheduling medical appointments

• Coordinating home health services

• Obtaining DME covered by health

plan

• Locating community resources

• Coordination of transportation

• Provide short term

transports during

temporary disruption of

permanent transportation

• Locate long term solutions

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For Internal Purposes Only.

Predictive Analytics and Clinical Insights: FHP teams have developed technology and predictive models to identify a list of high risk members, enabling the front line CNU to reach out in advance of clinical issues either telephonically or face to face.

Clinical Member Surveillance

Multiple hospital

admissions and /

or ER visits < 90

days

Local CNU,

Provider or

Clinic Insight

and Requests

Clinical

Indicators

EOL Predictive

Model

Weekly No Show

Predictive Model

Hospitalization

Risk Predictive

Model

High Visibility Member List

Incident

Members

F2F Visits by CNU RN

Contact the CNU at

mycarenav@fmc-

na.com with member

needs & F2F requests

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For Internal Purposes Only.

Safe and Effective

Care Coordination

Providing care

opportunities in outpatient

setting

● Reduce unnecessary ‘emergency’ services

● Reduce unnecessary hospital admissions

● Reduce unnecessary hospital re-admissions

For Internal Purposes Only.

Quality

For Internal Purposes Only.

Quality Categories - 2017

• Combination of claims data and chart review 10 Hybrid Measures

• All based on claims or other CMS documentation – upside is that shared savings strategies work in tandem with 2 of these measures.

3 Standardized Ratio Measures

• KDQOL – This is a Health Outcome Survey (HOS) methodology

• ICH-CAHPS – uses Dialysis surveys conducted for Dialysis Clinic Quality

7 Survey Measures

• Patient Safety and Clinical Quality of Care 6 QIP Results

Total of 26 measures

For Internal Purposes Only.

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Quality Categories -2018

9 Hybrid Measures

Standardized Ratio Measure

•2 measures of patients on transplant waitlist

• standardized ratio of First kidney transplant waitlist

•percentage of Prevalent patient on a waitlist

•Based on medical records and CMS Data Warehouse

Transplant Wait List

2 Surveys

ICH CAHPS & KDQOL

Total of 19 Measures

Based on hospital claims or CMS Clinical Data Warehouse

Combination of claims data and medical records

For Internal Purposes Only.

3 - Hybrid Measures

1 - Standardized

Ratio Measure

1 - Survey

Total of 5 Measures

Quality Categories- 2019

Combination of Medicare claims data and medical record data

• Influenza, Depression, Advance Care Plan

Hospital claims or other CMS documentation

ICH-CAHPS – dialysis survey conducted for Dialysis Clinic Quality

• 6 Domains

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For Internal Purposes Only.

PY 1 Results – All 13 ESCOs

For Internal Purposes Only.

Questions??????

For Internal Purposes Only.

Glenda Wooten, RN, MN, NEA-BC

Senior ESCO Program Manager

glenda.wooten@fmc-na.com

Cell – (704) 412-0004

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Contact Information