a view into accountable care - global health care · brandeis university a view into accountable...
TRANSCRIPT
Brandeis University
A View Into Accountable Care
Risk Contracting and Operating Practices in 21 Organized Delivery Systems
Robert MechanicSenior Fellow
Brandeis University
Third National ACO CongressOctober 31, 2012
Brandeis University
Research Questions
• How much risk contracting is really out there?
• How have medical groups prepared for payment reform?
• What do medical groups see as the largest hurdles?
The Study:Survey and interviews of 21 large medical groups
Brandeis University
Surveyed Groups (Fall 2011)
Atrius Health
Group Health Physicians
Mayo Clinic
Austin Regional Clinic
Health Care Partners
Oschner Health System
Billings Clinic
HealthPartners Medical Group
Palo Alto Medical Foundation
Dean Health System
Henry Ford Medical Group
Scott & White Healthcare
The Everett Clinic
Intermountain Medical Group
Sharp Rees‐Stealy Med Group
Fallon Clinic
Kaiser Permanente Med Group
Virginia Mason Medical Group
Geisinger Health System
Marshfield Clinic
Wenatchee Valley Med Center
Brandeis University
Number of FTE Physicians by Type
Note: Excludes the Permanente Medical Group.
Brandeis University
Facility and Health Plan Ownership
Source: Self-reported survey data from 21 CAPP medical groups.
Brandeis University
Payment Profile
Brandeis University
Type of contract as a percent of total patient revenue
Note: Calculated as a simple (unweighted) average (n= 21).
Brandeis University
2010 Patient Revenue by Contract Type
Source: Self-reported survey data from 21 CAPP medical groups.
FFS-based Risk-based
Brandeis University
Operating Characteristics
Brandeis University
2010 PCP Compensation Method
Source: Self-reported survey data from 21 CAPP medical groups.
FFS-based Risk-based
Brandeis University
Group Payment vs. MD Compensation
Page 12
Dean Clinic transition toward a value- based compensation plan (specialty)
FFS/VolumeBased
ValueBased Source: Craig Sammit,,MD
One example:
Page 13
98%
2%
95%
60%
20%
15%
10%10%
40%
20%
20%
15%
10%10%
0%
20%
40%
60%
80%
100%
2009 2010Option A
2010Option B
Future?
Dean PCMH Compensation Model Transition
Efficiency
Quality
Service
Panel Size
RVUs - 5%
RVUs
Salary
95% 115% 115%100%
Dean Clinic Realignment of Primary Care Compensation
Source: Craig Sammit,,MD
One example (continued)
Brandeis University
System Assets by Type of Group
Source: Self-reported survey data from 21 CAPP medical groups.
Brandeis University
Data Management Capacity
Source: Author’s analysis of self-reported survey data from 21 CAPP medical groups.
Percent of Groups Reporting “Fully Implemented”
Brandeis University
Performance Improvement Initiatives
Source: Author’s analysis of self-reported survey data from 21 CAPP medical groups.
Percent of Groups Reporting They are “Far Along”
Brandeis University
Attitude toward expanding future risk contracting (n=15)• All expect expanded risk contracting• 11 groups seeking new risk contracts• 3 were preparing for payment
system change• 1 group not interested
Brandeis University
What are the largest challenges to increasing your revenue from alternative payment contracts? (N=14)
Source: Author’s analysis of self-reported survey data from 21 CAPP medical groups.
Brandeis University
Conclusions and Issues• “Many large medical groups will need
to acquire new skills and tools to be ready for payment reform”, Health Affairs Sept 2012
• Significant challenges and cost to implement these changes broadly
• Sources of capital for infrastructure?– Insurers?– Hospitals?– Government?
Brandeis University
Hospital-Physician Alignment
Brandeis University
Provider-Insurer Alignment
Brandeis University
Brandeis University
Expert Perspectives
Jay Crosson, MDVice President of Professional Satisfaction
– Care Delivery and PaymentAmerican Medical Association
Don Rebhun, MDRegional Medical DirectorHealthcare Partners
Brandeis University
Thank You
Robert MechanicSenior Fellow
Heller School for Social Policy & Mgmt.Brandeis University
[email protected]:/healthforum.brandeis.edu