chief medical officer us medical management physician community webinar...

#DrHIT @HIMSS

Steven Merahn, MD Chief Medical Officer

US Medical Management

March 18, 2015

Physician Community Webinar Series

Physician-led ACOs: Supporting Chronic Disease Management

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Welcome to the Physician Community Webinar Series Sponsored by the HIMSS Physician Community • A complimentary virtual event that will be held

monthly.

• Covers a wide range of topics on Medical Informatics, HIEs (Health Information Exchange), Standards and Interoperability, eMeasures and Quality Initiatives, and how it affects, impacts and involves physicians.

• For more information see www.himss.org/physician or contact Lauren Kaderabek at [email protected].

http://www.himss.org/physician

mailto:[email protected]

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Welcome to the Physician Community Webinar Series Sponsored by the HIMSS Physician Committee • Please insert all questions in the chat box located

on the bottom right of your screen.

• A copy of the recording and slides will be available for download within 24 hours on the Physician Community Webinar Series Archive Page www.himss.org/physician


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Moderator and Speaker

Moderator: Patricia L. Hale, MD, PhD Associate Medical Director for Informatics Albany Medical Center HIMSS Board of Directors Member

Speaker: Steven Merahn, MD Chief Medical Officer US Medical Management

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Speaker Bio: Steven Merahn, MD Steven Merahn, MD is Chief Medical Officer at US Medical Management, where he oversee clinical leadership of the for multi-state high risk ACO in the US. Dr. Merahn has had a diverse career as a physician executive, working many different sectors of the healthcare ecosystem from academic medical center administration to HIT product management and consulting.

A graduate of the Albert Einstein College of Medicine, he trained as a pediatrician and began his career as a Senior Medical Specialist with the New York City Department of Health, where he focused on policy and program development for child and family services

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USMM is the nation's leading provider of home based primary care for complex/chronic populations:

• Provide 15% of all in-home physician visits nationally • Serve over 50,000 complex patients on an annual basis; average

age 75 with 4+ conditions, 7+ medications • Operate >100 local offices across 14 States

Delivers a physician-driven, fully-integrated continuum of care model

~ 225 full time

Physicians, NPs

and PAs

Engage in over 400,000 physician house calls, 39,000 podiatric house calls, 139,000 home health visits, and 380,000 hospice patient days annually

Centralized administrative, data management, and call center operations

24x7 response to urgent escalations in illness and medical crises

Who We Are

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Continuum Model • Deliver an integrated continuum of medical services to meet patient needs in the

comfort of their own home • Physician / PCP as hub for care coordination ensuring alignment of treatment plans,

medications, etc. across delivery settings

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Results and Outcomes

• Provide enhanced access to health services and quality of life for complex populations by removing barriers to receiving care

• Integrated care model helps patients live independently longer, improves quality, promotes patient engagement, enhances medical outcomes and reduces medical costs

– 40% Reduction in All-Cause 30-Day Readmissions

– 50% Reduction in Hospital Admissions for Ambulatory-Care Sensitive Conditions

– 70% Reduction in ER Visits for Ambulatory-Care Sensitive Conditions

– 90%+ Patient Satisfaction Scores (CAHPS)

Pioneer ACO Cost Savings Independence at Home Cost Savings

Pioneer ACO Cost Savings (Year 1)Base Year Methodology (Used in ACO)Base Year Cost - Entire ACO (2011) $2,429.54USMM Control Year Cost (2012) $2,283.42USMM Cost Savings $146.12

% Savings 6.0%Medicare Advantage (For Illustrative Purposes)Patient HCC Score (Ex. Fraility Adj.) 3.13County MA Rate 4-Star (Wayne County) $847.13MA Calculated Reimbursement (2012) (ESRD Adj.) $2,728.18USMM Control Year Cost (2012) $2,283.42USMM Cost Savings $444.76

% Savings 16.3%

IAH Cost Savings Estimate (Year 1)USMM Year End IAH Beneficiaries 1,552Patient HCC Score (Incl. Fraility Adj.) 3.56CMS PMPM Average Adjusted Payment $3,322.00USMM PMPM Cost (Provided by RTI) $2,886.00USMM Cost Savings PMPM $436.00

% Savings 13.1%

USMM Estimated Total Savings $7.4M

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Today’s Top Three Take-Aways

This presentation will help participants:

• Understand the functional requirements of a population health infrastructure

• Clarify the THREE essential elements that create value in chronic care management

• Become familiar with the model for organizational mastery of population management

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Population Health Management

…is a transformational approach to

healthcare delivery that shifts the

focus from caring for patients who

self-select for care based on their

own assessment of their condition to

taking transcendent responsibility for

the health status of a cohort or

population of patients.

©2014 Steven Merahn, MD All Rights Reserved Not for publication or distribution without explicit permission of copyright holder

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HOWEVER, POPULATION HEALTH MANAGEMENT IS A METHODOLOGY FOR SYSTEMS-BASED

PRACTICE IRRESPECTIVE OF COMPENSATION MODEL

Population management has come to be associated with

evolutionary trends in payment or compensation for health

care services known variously as “accountable care” pay-for-

performance, or ‘fee-for-value”.

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…requires mastering a separate and distinct operating model from traditional care delivery, including a specialized infrastructure with its own functional requirements and

an associated set of operating capabilities.

Implementing Systems-Based Practice…


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What are the Goals for Systems-Based Practice?

• To manage variables in order to deliver or add “value”, where value is the maximum benefit for least “cost”

– Costs are not exclusively monetary: time, effort, resource allocation, burden, disruption, dissonance, reputation

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Delivering “Value”

• Delivering value requires building systems of practice that can deliver high-level quality-related performance across a population or cohort of patients using the most efficient levels of resources and services required to successfully achieve those goals.

– Program intensity is escalated and de-escalated based on patient needs, dynamics, outcomes and program efficiencies

Identifying the patients needing care is only a first step, how your

system engages and interacts with them is where the value is realized

OP

ER

ATIN

G

CO

ST

PERFORMANCE

Aetna Inc. DRAFT – Private and Confidential

In current models, patients self-select for care, which

provides little insight into the overall health status of others


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Self Selection Aligns with Fee for Service

Payer B

Payer C

Payer A Patient

A

Provider

Patient C

Patient B

Hospital

Under FFS, patients self-select for care and providers bills their payer

based on services delivered

Bill

Bill

Bill


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Population Management Supports Transition From Fee-For-Service to Fee-for-Value

17

Payer A

Patient A

Provider

Patient C

Patient B

Hospital In FFV, the Provider takes on responsibility for

quality of care and health of cohorts of patients and

renegotiates their relationships based

on value goals

In FFV, Provider compensation is based on their ‘accounting’ for their performance

against mutually agreed upon goals for

quality and health status

Report


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For population management, success is more than a full schedule and busy switchboard

Patients who do NOT come in for care

may be as important to

consider as those in the waiting room.

Aetna Inc. DRAFT – Private and Confidential

Analytics

Outreach and Engagement


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Payer A

Patient A

Provider

Patient C

Patient B

Hospital

Report Population Management

Analytics, Segmentation, Outreach, Care Management

HOWEVER, FFV requires providers to take on new roles and responsibilities, so they need to add new capabilities,

competencies and services


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Functional Requirements of Systems-Based Practice

Analytics /Reporting

Population Surveillance

Segmentation &

Targeting

Outreach & Engagement

The Functional Requirements of a Population Management Infrastructure: Systems Elements and Interaction Design ©2014 Steven Merahn, MD All Rights Reserved

Care Planning

Clinical Strategy

Resource Managed

Care Delivery

Care Coordination / Collaboration

Thresholds & Filters

System-Level Goals & Program Eligibility

Rules for Sorting &

Categorizing Data

Communication & Activation

Strategy

Resource Allocation &

Standing Orders

Programs & Services

Person-Level Goals, Shared

Decision Making, &

Coordination

Inputs


Data

Clinical, Claims, PDD,

Financial, Operational, Consumer

Generated Data

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Current View of Population Health Status

End of Life

Unstable Chronic

New Dx/Stable Chronic

Acute, Non Chronic

Wellness

The “pyramid” view of population health status reflects proportional distribution of risk and resource utilization, but does not serve as a rational basis for care planning and care delivery strategies.


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Population Health Management Requires Two-Level Care Plan Development

“Person- Level” Goals

“System-Level” Goals


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“Value” is created via the “Essential Triad”

Care Planning Care Delivery Collaboration


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Care Plan Framework


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Resource Managed Care Delivery


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Quality and Outcomes Are Humanity-Dependent

Dignity Authenticity

Integrity Empathy Sincerity Urgency

Emotive Performance

Tactical Performance

Efficiency Consistency Availability Reliability

Responsiveness Convenience

Products and Services

• Primary Care • Specialty Care • Inpatient Services • Centers • Lab • Imaging

Channels

• Call center • Web portals • Mobile apps • EHR/PHR • CRM/PRM

FINALLY… Clinical and operational performance alone is insufficient to meet the

performance goals for complex chronic care

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Improving the health status of individuals and populations fundamentally remains a human endeavor Thank You.

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Q&A

Steven Merahn, MD Chief Medical Officer US Medical Management

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Continuing Education Credit

• This program has been designated for 1 hour of CAHIMS credit.

• This program has been designated for 1 hour of CPHIMS credit.

• Download forms at www.himss.org/physician.


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March 24, 2015 | 11:00 am central

Physician-led ACO’s: Opportunities & Challenges May 20, 2015 | 3:00pm central Physician Community Webinar Series

Register today at http://www.himss.org/physician



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Physician Activities: • Physicians’ IT Symposium • Physician Community Reception • Physician Poster Sessions • Opening Reception • Physician Interoperability Showcase Tour • Education Sessions • HIMSS Spot Meetups • HIMSS15 Block Party Contact Lauren Kaderabek [email protected] to get connected

April 12-16, 2015

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chief medical officer us medical management physician community webinar...

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