on the right path: a move from volume to value · measurement and value-based incentives group...

On the Right Path: A Move from Volume to Value

February 29, 2016 Robert Anthony, Deputy Director, Quality

Measurement and Value-Based Incentives Group (QMVIG)

Center for Clinical Standards and Quality (CCSQ) Centers for Medicare & Medicaid Services (CMS)

Conflict of Interest Robert Anthony Has no real or apparent conflicts of interest to report.

Learning Objectives • Describe 2016 CMS Quality Strategy • Discuss HHS Secretary Burwell’s Delivery System Reform Goals, including

MIPS and APMs • Explain how MIPS is a streamlined approach using facets of existing CMS

quality programs

Working Toward Value and Quality The CMS Quality Strategy guides the activities of all agency components working together toward health care transformation. The Strategy: Builds on the foundation of the CMS Strategy and the HHS

National Quality Strategy (NQS). Prioritizes six goals for success. Illustrates continued collaboration through a participatory,

transparent and collaborative process with a wide array of stakeholders.

The 2016 CMS Quality Strategy Mission

Optimize health outcomes by

leading clinical quality

improvement and health system

transformation.

CMS Quality Strategy Aims and Goals

CMS Quality Strategy Goals and Foundational Principles

Administration’s Goals for Payment Reform

Goal #1 • 30% of Medicare payments are tied to quality or

value through alternative payment models by the end of 2016, and 50% by the end of 2018

Goal #2 • 85% of all Medicare FFS payments are tied to

quality or value by the end of 2016, and 90% by the end of 2018

The Future: Merit-Based Incentive Payment System (MIPS) Shifting Medicare Reimbursements from Volume to Value

In January 2015, the Department of Health and Human Services announced new goals for value-based payments and APMs in Medicare:

MACRA is part of a broader push towards value and quality

2016 2018 New HHS Goals:

30%

85%

50%

90%

The new Merit-based Incentive Payment System helps to link fee-for-service

payments to quality and value.

The law also provides incentives for participation in Alternative Payment Models

in general and bonus payments to those in the most

highly advanced APMs

0%

All Medicare fee-for-service (FFS) payments (Categories 1-4)

Medicare FFS payments linked to quality and value (Categories 2-4)

Medicare payments linked to quality and value via APMs (Categories 3-4)

Medicare Payments to those in the most highly advanced APMs under MACRA

MACRA moves us closer to meeting these goals…

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a bipartisan legislation signed into law on April 16, 2015.

What does Title I of MACRA do?

• Repeals the Sustainable Growth Rate (SGR) Formula • Changes the way that Medicare rewards clinicians for value

over volume • Streamlines multiple quality programs under the new Merit-

Based Incentive Payments System (MIPS) • Provides bonus payments for participation in eligible

alternative payment models (APMs)

What is “MACRA”?

Through MACRA, HHS aims to:

• Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value.

• Over time, expand the opportunities for a broad range of providers to participate in APMs.

• Minimize additional reporting burdens for APM participants.

• Promote understanding of each physician’s or practitioner’s status with respect to MIPS and/or APMs.

• Support multi-payer initiatives and the development of APMs in Medicaid, Medicare Advantage, and other payer arrangements.

MACRA Goals

MACRA streamlines those programs into MIPS:

There are currently multiple individual quality and value programs for Medicare physicians and practitioners:

MIPS changes how Medicare links performance to payment

Physician Quality Reporting Program

(PQRS)

Value-Based Payment Modifier

Medicare EHR Incentive Program

Merit-Based Incentive Payment System (MIPS)

A single MIPS composite performance score will factor in performance in 4 weighted performance categories:

MIPS Composite

Performance Score

Quality Resource use

Clinical practice

improvement activities

Meaningful use of

certified EHR technology

How Will Physicians and Practitioners Be Scored Under MIPS?

Weighted Performance Categories

Quality MeasuresResource UseClinical Practice Improvement ActivitiesMeaningful Use of EHRs

25% 30%

30% 15%

MIPS Performance Categories

The Secretary is required to specify clinical practice improvement activities. Subcategories of activities are also specified in the statute, some of which are:

MIPS: Clinical Practice Improvement Activities

• Secretary shall solicit suggestions from stakeholders to identify activities. • Secretary shall give consideration to practices <15 EPs, rural practices, and EPs

in underserved areas.

• Performance assessment in four categories using weights established in the statute

• Weights may be adjusted if there are not sufficient measures and activities applicable for each type of EP, including assigning a scoring weight of 0 for a performance category.

• EHR weighting can be decreased and shifted to other categories if Secretary estimates the proportion of physicians who are meaningful EHR users is 75% or greater (statutory floor for EHR weight is 15%)

• Performance threshold will be established based on the mean or median of the composite performance scores during a prior period

• The composite performance score will range from 0 – 100 • The score will assess achievement & improvement (when data

available)

MIPS Composite Performance Score:

• Based on the MIPS composite performance score, physicians and practitioners will receive positive, negative, or neutral adjustments up to the percentages below.

• MIPS adjustments are budget neutral. A scaling factor may be applied to upward adjustments to make total upward and downward adjustments equal.

MAXIMUM Adjustments

Adjustment to provider’s base rate of

Medicare Part B

payment

Merit-Based Incentive Payment System (MIPS)

*4% *5% *7% *9%

2019 2020 2021 2022 onward

-4% -5% -7%

-9%

*MACRA allows potential 3x upward adjustment BUT unlikely

How much can MIPS adjust payments?

• Make available timely (“such as quarterly”) confidential feedback reports to each MIPS EP starting July 1, 2017.

• Provide information about items and services furnished to the EP’s patients by other providers and suppliers for which payment is made under Medicare to each MIPS EP, beginning July 1, 2018.

• Make information about the performance of MIPS EPs available on Physician Compare.

To implement MIPS, CMS will:

More on MIPS

There are 3 groups of physicians and practitioners who will NOT be subject to MIPS:

1

FIRST year of Medicare participation

Participants in eligible Alternative Payment

Models who qualify for the bonus payment

Below low volume threshold

Note: MIPS does not apply to hospitals or facilities

Are there any exceptions to MIPS adjustments?

MIPS adjustments

MIPS only

APM-specific rewards

+ MIPS

adjustments

APMs

eligible APM-

specific rewards

+ 5% lump

sum bonus

eligible APMs

• APMs—and eligible APMs in particular—offer greater potential risks and rewards than MIPS.

• In addition to those potential rewards, MACRA provides a bonus payment to providers committed to operating under the most advanced APMs.

Potential value-based financial rewards

What should I do to prepare for MACRA? Look for future educational activities

Look for a proposed rule in spring 2016 and provide

comments on the proposals. Final rule targeted for early fall 2016.

Questions ?

Join CMS Sessions at HIMSS16 Title Session Time & Location

Tuesday, March 1 CMS EHR Incentive Programs in 2015 through 2017

Overview 26 10:00 a.m. – 11:00 a.m.

Palazzo B

CMS Listening Session: EHR Incentive Programs in 2018 & Beyond

56 1:00 p.m. – 2:00 p.m. Palazzo B

A Special Session with ONC and CMS (Presentation by Dr. Karen DeSalvo and Andy Slavitt)

N/A 5:30 p.m. – 6:30 p.m. Rock of Ages Theatre

Wednesday, March 2 CMS Listening Session: Merit-Based Incentive

Payment System (MIPS) 101 8:30 a.m. – 9:30 a.m.

Palazzo B

CMS Electronic Clinical Quality Measurement (eCQM) Development and Reporting

131 11:30 a.m. – 12:30 p.m. Palazzo B

Thursday, March 3

Interoperability Showcase: eCQM Submissions N/A 10:00 a.m. – 11:00 a.m. Booth #11954

CMS Person and Family Engagement: Incentivizing Advances that Matter to Consumers

234 1:00 p.m. – 2:00 p.m. Palazzo B

Visit CMS Office Hours at Booth 10309

Office Hours Topic Time Tuesday, March 1

Merit-Based Incentive Payment System (MIPS) 11:30 a.m. – 12:30 p.m.

Booth #10309

Quality Measurement Development and Reporting 12:30 p.m. – 1:30 p.m.

Booth #10309

EHR Incentive Programs 2:30 p.m. – 3:30 p.m.

Booth #10309

Wednesday, March 2 Merit-Based Incentive Payment System (MIPS)

10:00 a.m. – 11:00 a.m. Booth #10309

EHR Incentive Programs 11:00 a.m. – 12:00 p.m.

Booth #10309


Booth #10309

Thursday, March 3 Merit-Based Incentive Payment System (MIPS)

9:30 a.m. – 10:30 a.m. Booth #10309

EHR Incentive Programs 11:00 a.m. – 12:00 p.m.

Booth #10309


Booth #10309

On the Right Path: A Move From Volume to Value February 29th, 2016

Shawn Griffin, MD, CQIO, Memorial Hermann

Conflict of Interest Shawn Griffin, MD has no real or apparent conflicts of interest to report.

Agenda • New Data, New Systems, New Partners (Technology

and otherwise) • High Reliability Hospitals / Developing Aligned

Physicians • Aligning Primary Care Networks • Powering Population Management • Improving Population Health • Evolving Provider Incentives

Learning Objectives • Discuss the implications of health information technology in

moving from volume to value (i.e., changes in sources of data, how we connect to other systems and partners, etc.)

• Identify the need for interoperability and data analytics to guide care in value-based care models

• Share Examples of Inpatient Interventions to Decrease SSE’s • Share Successful Methods to Engage Ambulatory Providers

in Population Management Using Reporting, Analytics, and Office Support

• Evaluate the Impact on Improved Population Health and Savings

STEPS Value in this Presentation • This presentation will discuss programmatic areas related to the

following STEPS Values • T – Treatment / Clinical • E – Electronic Secure Data • P – Patient Engagement Population Management • S – Savings

Memorial Hermann Health System • Largest Not-for-Profit Health System in Southeast Texas • 13 hospitals -- ~2,800 licensed beds • MH-TMC – one of busiest Level 1 Trauma centers in US • 24,000 Employees, 5,500 Affiliated Physicians • $4.5B Annual Revenue • $438M Annual Community Benefit • Most Successful Medicare Shared Savings Programs ACO

with >$110M in savings in first two performance years • MSSP ACO with ~1800 participating physicians, but only

~10% employed • Over 300 different EMR databases among participating

providers in ACO

Evolutions at Memorial Hermann • Hospital Centered Thinking and Contracting to

Population Management • Staff Physicians to IPA to Clinically Integrated

Network to ACO • Relationship of Antagonism between MHHS and

Physicians to Written Compact to Culture of Alignment

• Physician Participation to Contract Incentives to Strategic Incentives

Memorial Hermann Health System

35

We Started Many Years Ago…

5 Key Strategic Inflection Points Clinical Programs Committees (CPCs) (2000) Clinical Integration (2005) The Physician Compact (2008) The Patient-Centered Medical Home (PCMH)

(2011) The Accountable Care Organization (ACO) and Single Signature Contracting (2012)

36

CREATING HIGH RELIABILITY HOSPITALS

Authority of the CPCs

Delegation from the health system

Protocols (creating and measuring EBM practices and order set templates) Performance (setting and monitoring progress against established quality

standards and protocols) Products (drives the standardization of vendors, formularies, supply chain

decisions) Payment (Pay for performance goals, co-management agreements, ACO

project metrics, PCMH elements) Projects (ED to ED transfer policy, CT scanning in pediatric head trauma,

standardized order sets in Observation units, service line, credentialing and privileging standards) Program Rationalization (Consolidation and concentration of clinical service

delivery – i.e. open heart and joint programs)

38

39

MHMD Clinical Programs Committee & Subcommittees

MHMD Board of Directors

Clinical Programs Committee

H&V

Cardiology

CV Surgery

Neuro

Neurology

Neurosurgery

Woman/Child

Neonatal

OB/Gyn

Surgery

Anesthesia

Bariatrics

Orthopedics

ENT

Allergy

Medicine

Critical Care

Emergency

Ad hoc

Hospital Medicine

Post Acute

Oncology

Oncology

Contract

Imaging

Pathology

Primary Care

Adult PCP

Peds

Peer Review

Clinical Ethics & Palliative Care

Order Set Editorial Board

Informatics

Acute Surgery

510 Evidence-Based Practice Recommendations made by CPCs in 2014

Selected MEC-Approved CPC & SQC Safety & Quality Guidelines

• Real-Time Ultrasound for Central Line Insertion

• Real-Time Ultrasound for Cath Lab Central Punctures

• OB Safety Training

• Prevention of Retained Foreign Bodies Policy

• DVT/PE Prophylaxis

• Bariatrics Privileging and Leveling

• Moderate and Deep Sedation Privileging

• Peer Review for Physician-Related SSEs

• Clinical Escalation Policy

• Postoperative Pulse Oximetry Monitoring

13

41

Safety & Quality Guideline MEC Approval

Clinical Programs Committee

Critical Care Surgery Medicine

MHMD Board of Directors

Hospital MECs (11)

System Board Quality Committee

“Up and Over”

CPC Subcommittee(s):

42

Med Exec Up or Down Vote

This document is privileged and confidential Quality Committee or Peer Review work product under Hospital Committee Privilege contained in the Texas Health and Safety Code §161.031 & §161.032, or Medical Peer Review under the Medical Practice Act, Texas Occupations Code, §151.001 et. seq.; and the Medical Peer Review immunity provided by federal law, the Health Care Quality Improvement Act, 42. U.S.C. 11101, et. seq.

Acute Hemolytic Transfusion Reactions

Hospital Acquired Conditions “Never Events”

Transfusion Events Jan 2007 - June 2015

2,139,000 Adjusted Admissions

11,601,000 Adjusted Pt Days

1,061,000 Transfusions

44

This document is privileged and confidential Quality Committee or Peer Review work product under Hospital Committee Privilege contained in the Texas Health and Safety Code §161.031 & §161.032, or Medical Peer Review under the Medical Practice Act, Texas Occupations Code, §151.001 et. seq.; and the Medical Peer Review immunity provided by federal law, the Health Care Quality Improvement Act, 42. U.S.C. 11101, et. seq.

Acute Hemolytic Transfusion Reactions

Hospital Acquired Conditions “Never Events”

Transfusion Events Jan 2007 - June 2015

2,139,000 Adjusted Admissions

11,601,000 Adjusted Pt Days

1,061,000 Transfusions

45

Zero

46

HAI Hospital Scorecards

Number of HAIs in one month

47

HAI Hospital Scorecards

Number of HAIs in one month

Central Line Associated Bloodstream Infections Ventilator Associated Pneumonias

Surgical Site Infections Retained Foreign Bodies Iatrogenic Pneumothorax

Accidental Punctures and Lacerations Pressure Ulcers Stages III & IV

Hospital Associated Injuries Deep Vein Thrombosis and/or Pulmonary Embolism

Deaths Among Surgical Inpatients with Serious Treatable Complications

Birth Traumas Serious Safety Events

Hospital Acquired Infections, Conditions and Patient Safety Indicators

48








49








50







MH Southeast Hospital Iatrogenic Pneumothorax

MH Southeast Hospital MH Southeast Hospital MH Southeast Hospital

22 Months Zero Iatrogenic Pneumothorax

51

MH Southeast Hospital Real Time Ultrasound Guidance

52

1st Memorial Hermann Hospital >90% Ultrasound Compliance ICU Safe Practice Guideline:

Real-time ultrasound guidance will be used for placement of all central venous catheters,

whenever possible.

High Reliability Certified Zero Award

1. Zero Events

2. 12 Consecutive Months

3. Certified Zero Category 54

High Reliability Certified Zero Awards 2011-2015

ICU Central Line Associated Bloodstream Infections (15) ICU Catheter Associated Urinary Tract Infections (5)

Hospital-Wide Central Line Associated Bloodstream Infections (5) Ventilator Associated Pneumonias (23)

Surgical Site Infections Retained Foreign Bodies (40) Iatrogenic Pneumothorax (18)

Accidental Punctures and Lacerations (3) Pressure Ulcers Stages III & IV (28)

Hospital Associated Injuries (5) Deep Vein Thrombosis and/or Pulmonary Embolism (1)


Birth Traumas (12) Obstetric Trauma in Vaginal Deliveries with Instrumentation (2)

Serious Safety Events 1&2 (13) Serious Safety Events 1 & 2 for 1000 Days (2)

All Serious Safety Events (1) Early Elective Deliveries (4)

Manifestations of Poor Glycemic Control (15) 55

192

MH Northwest: Zero Retained Foreign Bodies

Zero Retained Foreign Bodies x 60 Months

56

MD/Nursing OR Count Policy

Mandatory RFID Scanning

MH Children’s: Zero Ventilator Associated Pneumonias

57

Zero Ventilator Associated Pneumonias x 48 Months

Ventilator Bundle Compliance

MH Katy: Zero Central Line Blood Stream Infections Hospital-Wide

Zero CLABSIs Hospital-Wide x 17 Months

58

Central Line Bundle Compliance

MH Sugar Land: Zero ICU Catheter Associated UTIs

Zero ICU CAUTIs x 24 Months

59

CAUTI Bundle Compliance

MH Woodlands: Zero Hospital Acquired Injuries

Zero Hospital Injuries x 21 Months

60

CLINICAL INTEGRATION

Clinical Integration (2005) Participating physicians must participate

• Selecting quality measures • Reporting performance • Determining performance targets (setting realistic

goals) • Participate in committee work, performance

feedback, and quality improvement activities • Time, effort and IT infrastructure all required

Those who do not participate even after remediation, must be removed!

The MHMD Compact (2008)

MHMD agrees to: Maintain primary loyalty to physicians Negotiate well to align incentives Include physicians in work and decision making Provide clear and timely information

• Membership Criteria, Quality Measure Scoring • Accountability / Improvement Process • Contract, Financial Performance

Provide physicians with information, services, and education to ensure high quality and ease practice burdens Seek feedback from its physicians Maintain confidentiality Communicate, communicate, communicate Make meetings worthwhile and engaging Create leadership training programs

63

The MHMD Compact

Physicians agree to: Practice evidence-based medicine Uphold regulatory, quality, and safety goals Report quality data Meet CI criteria Come to meetings and performance feedback sessions Pay attention to information from MHMD Accept decisions by physicians in MHMD committee settings Be flexible, share ideas Collaborate with colleagues and hospitals Behave as professionals

64

WHAT ELSE IS NEEDED TO MANAGE POPULATIONS? WHAT ABOUT OUTPATIENT?

65

Discounts Liability Ins Group Purchasing

Single Signature Contracts

Clinical Integration | Accountable Care Organization

Physician Training HCC

Documentation ICD-10 CMEs

MU University Physician University

Practice Transformation EMR

Point of Care NCQA

Practice Assessment

Patient Access

Patient Portal

Pt Engagement Patient Education

Gap Reports At Risk/High Risk

Physician Report Cards

Supp Medicine Post Acute

Ambulatory ICU

UC/AH Retail Clinics

Care Mgmt Disease Mgmt

Health Coaches Preventive Care

The Patient-Centered Medical Home (2011)

Informed Physician Better Care Great Experience

Quality Innovation

GNE Program

Data Claims Files

EMR data Lab Rx

Technology

Selecting Practices for Advanced Primary Care Practices (APCP’s) • Nominations from aligned PCP’s • Visits by practice facilitators • Grading of each office capabilities

– Employment, Compatible EMR, On CPC’s, reported PQRS for CI, etc.

• Goal to have 100 in “first wave” - 200 expressed interest

• Specific incentive plan built – funded by system

67

Program Benefits to APCP’s • Help with NCQA Certifications, Bridges to

Excellence, and Disease Program qualification • Brings in PMPM moneys and greater bonus

opportunities • Relieves offices of some care management duties • Network control necessary for risk management

68

Patient Centered Medical Home Growth

69

113

124 188

210 279

Jan 2012 Mar 2012 Mar 2013 Jun 2013 Sep 2013

47 NCQA

Primary Care Network >350 Adult & Pedi Medical Home Physicians

West Region 73 APCPs

Region Leaders – Dr. Ankur Doshi & Dr. David Reininger

SW Region 82 APCPs

Region Leader – Dr. John Vanderzyl

North Region 62 APCPs

Region Leader – Dr. John Walker

Northeast Region 26 APCPs

Region Leader – Dr. Tejas Mehta

Central Region 55 APCPs

Region Leader – Dr. Kevin Giglio

Southeast Region 52 APCPs

Region Leaders – Dr. Maqsood Javed & Dr. Adnan Rafiq

STRATEGIC REPORTING

71

Population Health Data

72

Claims Based Reporting

MHMD Summary Report by POD Population PCP and Averages Jan-Mar 2013

73

Regional Performance Reporting

MHMD CI-APCP Report by (A) POD by Population

74

Individual Physician Score Card

ED Visits Per 1K By (A) POD By (X) Population of PCPs Jan-Mar 2013

75

Report on CI-PCPs with Patients who have incurred overall cost of over $50K

76

High Cost Patient Report

Advanced Analytics SMART Registry

77

Quality and Contract Metric Registries (Rolling Out Now)

INCENTIVE EVOLUTION

78

Incentive Strategy

• Incentives begin to satisfy requirements or drive early adoption of strategic behaviors

• Start simple and clearly measurable • Educate regarding drivers of earning incentives and align to payer strategic goals

• As analytics improves, sharpen measures • Unearned incentives physicians roll into carryover funds – Money doesn’t go away

79

Evolution of Incentives

Start - Drive Adoption of Strategic Behaviors

Middle -Transition to Drive Behaviors of Value to Program

End - Sunset Program When Behavior Ingrained

80

Transparent Measures with Periodic Updates of Performance

Continually Challenging Physicians

81

The Metrics Required for Participation in CI Network

81

CI Network Existence

Met

rics

Req

uire

d fo

r Par

ticip

atio

n

• Active CI member in good standing with the program

• Attends one campus meeting

• Completes 1 CME


• Attends one campus meeting

• Completes 2 CMEs • Attains 50% quality

reporting threshold


• Attends two campus meetings

• Completes 5 CMEs • Attains 80% quality

reporting threshold

CI Program 2011

CI Program 2012

Population-Based Contracts

82

Physician Level Scorecard - 2012

APCP Incentive – 2014

Participation Targets Opp per physician

Adopt standardized data fields to support data collection (CCR3) $2,000

HCC Coding and Training Participation Medicare risk adjustment – Medicare Advantage Increase .05 Increase .10 Increase .15

$2.50 PMPM $5.00 PMPM $7.50 PMPM

Improved Care Coordination Regional Performance 3% $1,000 5% $2,000 >7% $3,000

$3,000

Working with embedded Care Coordinators / Clinical Pharmacist as per care management protocol* $2,000

$7,000 +PMPM 83

Original MSSP Distribution Model

Earned Performance Payment

Tier 1.0

PCP Preferred Distribution Care Coordination Fee

$3 PMPM x Member/PCP Attribution

ACO Preferred Distribution Population Mgt. Innovation Fund

6%

One Time Reimbursement Direct ACO Organizational Costs

$500,000

Tier 2.0 (Balance After Tier 1.0)

2.1 Part A – Facility Fund Surplus 2.2 Part B – Professional Fund Surplus

Physicians = 25% Hospital = 75% Physicians = 100%

ACO Participant Groups/Phy = 50%

ACO Affiliate Groups/Phy = 50%

ACO Participant Groups/Phy = 60%

ACO Affiliate Groups/Phy = 40%

1.1 1.2 1.3

84

2015 Incentive Simplification

Single Incentive Program

MSSP

Payer 2

Payer 1

85

Bonus Pools 2015

• Source • Potential

86

Contract Bonus Contract 1 $1.1M

Contract 2 $252K

Contract 3 $1.8M

Contract 4 $2.03M

Contract 5 $408K

MSSP $7.5-8.0M

Contract 7 $2.2M

Total $15.3-15.8M

87

2015 Proposed Incentive Model

APCPs 1. 100% MSSP Quality

Reporting for PY2 2. 100% Responsiveness

to Medicare audit in defined timeframe

3. Attain Quality metrics as defined

****Any funds not paid will return to MHMD****

All Other CI Specialists

1. CPC or Credentialing Committee meeting

attendance (majority of meetings must be

attended) 2. Evidence of PQRS,

MU, or Levy Letter for XXX time period

Incentive Pool

CI Attendance or Approved Alternative Meeting / CME

Completion / Current with ECW AR

In-network Utilization based on claims

analysis

Decrease Cost determined by attaining shared savings

Gateway

Represent deduction

s to maximum

bonus payout by Provider

Represent deduction

s to maximum

bonus payout by Provider

APCP Quality Metrics (2015) Quality Metrics Source Allocation Threshold

50% Payout Target 75%

Payout Distinguished 100% Payout

A1c Control (% over 9) MSSP Quality 17% 25% tile 75%tile 100%tile

Hypertension Control (<140/90)

MSSP Quality 17% 25% tile 75%tile 100%tile

ER visits per 1,000 vs Third Party Marketscan Benchmark Claims* 17% 95% of

Benchmark At

Benchmark 105% of

Benchmark

Communication of Doctor ACO Measure #2

CAHPS Scores 17% 25% tile 75%tile 100%tile

Rating of Doctor ACO Measure #3

CAHPS Scores 17% 25% tile 75%tile 100%tile

Generic Usage vs Third Party Marketscan Benchmark Claims* 17% 95% of

Benchmark At

Benchmark 105% of

Benchmark

88

POPULATION HEALTH METRICS IMPROVE

Clinical Economics Improved

0 50 100 150 200

CT Scans and MRIs /1,000

High -Tech RadiologyVisits /1,000

Impactable Surgical BedDays /1,000

Impactable Medical BedDays /1,000

Impactable Surgical Admits/1,000

Impactable Medical Admits/1,000

Impactable Admits /1,000

Effic

ienc

y M

etric

s

90

ACO Network, YOY performance

27.1% lower

26.6% lower

28.3% lower

47.0% lower

5.7% lower

42.4% lower

47.8% lower

50%55%60%65%70%75%80%85%90%95%

100%

Asthma:Use of

appropriatemedications

Breastcancer

screening

Cervicalcancer

screening

Colorectalcancer

screening

Diabetes:Lipid profile

Diabetes:HemoglobinA1c testing

Payer NationalAverage

2014 MHMD Performance

Clinical Quality Improved

Better Cost and Quality for Employers

92

Efficiency Results TARGET RESULT DELTA “Impactable” Medical Admissions/1,000 55.0 16.7 69.6%

Potentially Avoidable ER Visits/1,000 95.4 65.7 31.1%

High Tech Radiology Visits/1,000 170.3 149.0 12.5%

CT Scans and MRIs/1,000 66.3 60.5 8.7%

15% lower

20% increase

Enrollment 2014

2015

Medical Costs Target

Actual

BEST IN THE COUNTRY MSSP PERFORMANCE

93

MSSP Performance Year 1 (18mo)

94

MSSP ACO State Total Savings ACO Share

Memorial Hermann Accountable Care Organization

TX $57.83 M $28.34 M

Palm Beach Accountable Care Organization, LLC

FL $39.57 M $19.34 M

Catholic Medical Partners-Accountable Care IPA, Inc. NY $27.92 M $13.68 M

Southeast Michigan Accountable Care, Inc. MI $24.68 M $12.09 M

RGV ACO Health Providers, LLC TX $20.24 M $11.90 M

ProHEALTH Accountable Care Medical Group, PLLC

NY $21.91 M $10.74 M

Triad Healthcare Network, LLC NC $21.51 M $10.54 M

WellStar Health Network, LLC GA $19.88 M $9.74 M

Accountable Care Coalition of Texas, Inc. TX $19.10 M $9.36 M

PY1 Performance

95

PY1 Quality Score

MHACO – 82.8%

96

MSSP Performance Year 2 (12mo)

97

MSSP ACO State Total Savings ACO Share

Memorial Hermann Accountable Care Organization TX $52.93M $22.72M

Palm Beach Accountable Care Organization, LLC FL $32.17M $14.46M

Physician Organization of Michigan ACO MI $27.07M $12.08M

Oakwood ACO, LLC MI $19.07M $8.15M

Millennium ACO FL $17.49M $7.98M ProHEALTH Accountable Care Medical Group, PLLC NY $17.15M $8.02M

Allcare Options, LLC FL $16.99M $6.06M Qualuable Medical Professionals, LLC VA, TN $16.62M $7.41M

Accountable Care Coalition of Texas, Inc. TX $16.04M $6.34M

PY2 Performance

98

PY2 Quality Score

99

Final Thoughts/Opinions • There are no silos in medicines, there are “castles” of

information and influence that give their owner’s power. • Make friends with your organizational HIPAA-chondriac. You

may have to overcome them at some point. • Consistent transparency of process and data support ongoing

physician alignment. Data is shared to support improvement, not “shaming.”

• There is currently no unified software platform that has all the functionality needed for robust population health management on a comprehensive data warehouse.

• Efficient scalability is the greatest challenge in population management.

Questions

• [email protected] • Office: 713-338-5420

mailto:[email protected]

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