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Park Nicollet Health Services A Medicare Pioneer Accountable Care Organization

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Park Nicollet Health Services

A Medicare Pioneer Accountable Care Organization


1 Park Nicollet Health Services Background

2 Park Nicollet Pioneer ACO Overview

3 Pioneer ACO Financial and Quality Model

4 Upside and Downside to Pioneer ACO Data & Analytics

5 Questions and Discussion


Accountable Care Organization

ACO Team:

Daniel Trajano, MD, MBA, Sr. Med Dir. of Quality, Innovation, Population Health

Eva Gallagher, RN, PHD, Sr. Nursing Director of Quality, Innovation, Population Health

Mark Skubic, VP Government Relations

Megan Cox, Dir. Medicare Products

Sam VanNorman, Dir. Business Intelligence

Gregg Teeter, Dir. Business Analytics

Kody Koepke, Dir. Pricing & Data

Maddy Emahiser, Project Manager

Park Nicollet Accountable Care Organization

• Located in the West Metro of Minneapolis/St. Paul

• Serves ~500,000 Unique Patients/Year

• Employs 8,300 People, 1,300 are Providers

• 1 Hospital (~22K inpatient admissions/yr)

• 25+ Locations with Primary, Specialty and Surgical Specialty

Care Clinics (~2.2M ambulatory visits/yr)

• Accountable Care Contracts with All Major Payers

• PNC Fun Fact: 2011 TOUR DE CLINIC CAMPAIGN David Abelson, CEO and avid cyclist, spent 3 days riding his bike 200+ miles to 21 of our PNC sites, raising more than $55K



Pioneer ACO Program Overview: PGP Demo Sites

Pioneer ACO Program Overview: Pioneer ACO Sites

Pioneer ACO Program Overview: The

Regulatory Relationship

• Lessons Learned from PGP Demonstration

Setting the Metrics

– When negotiating with CMS you need to be aware

of the person behind the curtain.

Office of the Actuary


Demo consultants


Pioneer Program Benefited from Scars of PGP Demo

10 systems 32 Systems

Local Benchmark National

2+% Savings rate 1% Savings

Only Share Above First Dollar

Little/Late Data Monthly

No risk of loss Up and down

Pioneer ACO Program Overview

32 players with variable structures and interests in the ACO Program.

– The Twin Cities players

– Integrated systems w/hospital

– Medical Group

– Independent Practice Associations (IPAs)

– Virtual Systems

– Low Cost Systems <$9,000 per member per year

– High Cost Systems >$18,000 per member per year



Pioneer ACO Bonus Payment Overview How Do We Get Paid?

Cost Savings

(must be at least 1% to qualify)

Contracted Shared Risk


Quality Measure % (must meet quality

performance standards to qualify)

Park Nicollet Bonus


$6 M 75% 75% $3.4 M

Hypothetical Scenarios:

Model Overview

$10 M 75% 90% $6.8 M

Pioneer ACO Expenditure Benchmark Cost Savings

• The trended benchmark will be based on trends in national, not local, expenditures

• To earn the shared savings bonus payments, Park Nicollet’s per-capita expenditures (for assigned beneficiaries) must be less than the yearly target by at least 1%

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Trended Benchmark

Park Nicollet Cost

Shared Savings

Cost Savings Contracted Shared Risk


Quality Measure %

Park Nicollet Bonus


25% Patient & Caregiver Experience

1. Timely care, appointments, and information

2. How well your doctor communicates

3. Patients’ rating of doctor

4. Access to specialists

5. Health promotion and education

6. Shared decision making

7. Health status/functional status

25% Care Coordination & Patient Safety

8. Risk standardized, all cause readmission

9. Ambulatory Care Sensitive Admissions—COPD

10. Ambulatory Care Sensitive Admissions--CHF

11. Percent of PCPs who qualify for EHR incentive

12. Medication reconciliation after discharge

13. Screening for falls risk

25% Preventative Health

14. Influenza immunization

15. Pneumoccal vaccination

16. Adult weight screening and follow-up

17. Tobacco use assessment and tobacco cessation intervention

18. Depression screening

19. Colorectal cancer screening

20. Mammography screening

21. Proportion of adults 18+ who had blood pressure measured in preceding 2 years

25% At Risk Populations

22. Diabetes Composite A1C< 8

23. Diabetes Composite LDL < 100

24. Diabetes Composite BP<140/90

25. Diabetes Composite Tobacco non-use

26. Diabetes Composite ASA Use

27. Diabetes A1C poor control (>9)

28. HTN blood pressure control

29. Ischemic Vascular Disease (IVD) LDL<100

30. IVD use of ASA or other antithrombotic

31. Heart failure beta blocker for LVSD

32. Coronary artery disease composite--Drug therapy for lowering LDL

33. Coronary artery disease composite--ACE or ARB for CAD patient with diabetes and/or LVSD

Pioneer ACO Quality Measures



The Upside to Data & Analytics

– We have 3 years (and growing monthly) of all CMS claims

data for our assigned members

This will allow us to track all patient expenditures and

quantify the amount of services these patients are

receiving outside of Park Nicollet

– Unlike many of the other Pioneers, we’re on a single,

integrated platform

The Downside to Data & Analytics

– The expenditure benchmark target is still not finalized and the

details (methodology and when we will receive them) are unclear

This is troubling as we are nearly halfway through 2012 and we

don’t have a clear understanding where we are at in reducing

expenditures by ≥ 1%

– Several quality metrics, which we are required to report on

annually, have slightly different definitions from other CMS

required reporting (PGP and MU)

This will require extra time & resources to modify and report on


Park Nicollet needs to push CMS to fully standardize detail

As with PGP, the burden of Quality Reporting significant


Data & Analytics : What we need to do

– For us to make significant improvement in lowering cost and improving

quality, we need to know where we are at so we can identify opportunities

There are significant analytic challenges (as we don’t know our reality)

– Educate CMS on the realities healthcare and what it takes to support this


Park Nicollet should be the best poised to succeed in the Pioneer ACO

model (given our PGP experience and organizational structure) and this

is going to be very difficult

Lobby CMS (ideally in partnership with Allina, Fairview, and Other

Advance Pioneer ACOs)

– Leverage our analytics infrastructure wisely…and know when to buy vs.


– Understand that Epic is not built to support population health

management…currently. We need to decide whether we’re going to stumble

along with Epic until we install 2012 or buy another tool.

Questions and Discussion

1 Park Nicollet Health Services Background

2 Park Nicollet Pioneer ACO Overview

3 Pioneer ACO Financial and Quality Model

4 Upside and Downside to Pioneer ACO Data & Analytics

5 Questions and Discussion