Slide 1: Mark R. Anderson, FHIMSS, CPHIMS, CEO of AC Group, Inc.
Mark R. Anderson, FHIMSS, CPHIMS CEO of AC Group, Inc.
Slide 2: Agenda
Agenda • Mark Anderson Webinar Presentation • Polling and Q&A Session • Sponsor Overview
Slide 3: Ask a Question
Ask a Question Use the Q&A box If watching in the WebEx window, on the right side, there is a Q&A box where you can type in your question and send. If you don’t see it, click the Q&A icon on the top to make it appear. If watching in full screen, move mouse pointer to top center and the menu pops dow
Slide 4: Today's Industry Expert
Today’s Industry Expert Mark Anderson, FHIMSS, CPHIMS is a leading expert in ACOs and Physician Practice Management Best Practices • 40+ Years In Healthcare IT • CIO at 4 IDNs • Spent over $2B in HCIT • National Speaker > 1,000 sessions since 2001 • Consultant to over 25,000 physicians and over 200
Slide 5: Questions for Today
Questions for Today 1. Are ACOs improving quality while reducing costs? 2. Why is the payment system changing? 3. What is Value Based Reimbursement? 4. What do you need for VBR? 5. With the proposed changes to reimbursement, will you need new technology solutions? 6. What are the software needs? 7.
Slide 6: Question 1: Are ACOs improving quality while reducing costs?
Question 1 Are ACOs improving Quality while reducing costs? • The simple answer: It depends • Let’s look at a few statistics
Slide 7: Medicare Shared Savings Program: Year Performance of Participating ACOs
Medicare Shared Savings Program: Year 1 Performance of Participating ACOs (2013) 27 % (60 ACOs) 24 % (52 ACOs) reduced spending, but earned shared savings not enough to earn bonus 3 % (6 ACOs) achieved 46 % (102 ACOs) did savings, but did not not achieve savings successfully report 220 Medicare Shar
Slide 8: The Changing Market
The Changing Market 100% Full population care 80% Partial population care 60% 40% Condition-based care 20% Episode care Fee-for-service 0% 2010 2015 2020 Source: “The View from Healthcare’s Front Lines: An Oliver Wyman CEO Survey”
Slide 9: Question 2: Why is the payment system changing?
Question 2 Why is the payment system changing? • Lets look at a few examples of why the healthcare reimbursement model is changing…
Slide 10: 10
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Slide 11: Per Capita Health Spending
Per Capita Health Spending Each year, the US spends roughly 2x the amount on health care as the next most spending country
Slide 12: The System Too Often Fails to Provide Higher Quality Care
The System Too Often Fails to Provide Higher Quality Care Adults receive about half Adherence to Quality Indicators of recommended care: Breast Cancer 75.7% 54.9% = Overall care Prenatal Care 73.0% 54.9% = Preventive care Low Back Pain 68.5% 53.5% = Acute care Coronary Artery Disease 68.0% Hypertens
Slide 13: Why is there an urgency to change?
Why is there an urgency to change? Healthcare CMS Projections for National Healthcare Spending (Amount in Billions) spending $5,000 CY 2003 - 2018 21.0% growth. $4,353 $4,500 $4,062 20.3% 20.0% $4,000 National Health Expenditures (billions) $3,790 19.3% 19.8% $3,541 $3,500 National Health Expenditur
Slide 14: Where does the money go?
Where does the money go? Other Rx Home Physician/Clinical Other Health Hospital Care Personal Services Spending* Drugs Health 30.5% 15.9% Health Care† 20.3% 10.1% 8.2% 14.9% *- includes, for example, administration and net cost of private health insurance, public health activity, research, and struc
Slide 15: Question 3: What is Value Based Reimbursement?
Question 3 What is Value Based Reimbursement? • Healthcare is moving to Accountable Care for Patients with Chronic Diseases • Initially started with Medicare when CMS established Accountable Care Organizations (ACOs) • Payments were based on quality improvement and improved outcomes • Only included
Slide 16: Achieving Success: Making the "Triple Aim" Possible
Achieving Success Making the “Triple Aim” Possible Engaged Communities Engaged Patients • Proactive care processes • Identified and incorporated patient goals • Identified patients • Focused on continuity and coordination • Focused on wellness • Facilitated communication channels • Community resourc
Slide 17: Chronic Diseases
Chronic Diseases Specific diseases: Obesity Diabetes Depression and other mental disorders Chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivity Cardiovascular disease Celiac disease
Slide 18: Fee for Service vs. Value Based Reimbursement
Fee for Service vs. Value Based Reimbursement Value Based Fee for Service 100% 80% 60% 40% 20% 0% 1995 2000 2005 2010 2015 2018
Slide 19: Question 4: What do you need for VBR?
Question 4 What do you need for VBR? 1. Make sure you have enough primary care physicians and other clinicians to provide comprehensive preventive and chronic care 2. Restructure physician comp to align provider incentives with value-based care 3. Create patient centered medical homes or use existin
Slide 20: Question 5: Will you need new technology solutions?
Question 5 With the proposed changes to reimbursement, will you need new technology solutions? • The simple answer is yes, the current technology solutions are built around current fee-for-service billing • In 2018 we are moving towards ‘Value-Based Reimbursement” (VBR) • VBR is like a capitated pro
Slide 21: Question 6: What are the software needs?
Question 6 What are the software needs? 1. Single Clinical and Financial database 2. Care Coordination software and Services 3. Population Health Management (PHM) 4. Patient Engagement software and Services 5. Best Practice Clinical Guidelines 6. Exception reporting of Clinical Alerts 7. Point of Ca
Slide 22: Care Coordination Requires Connecting All of the Care Providers
Care Coordination Requires Connecting All of the Care Providers Ancillary Hospitals Departments Employers Physicians Patient Clinical Data & Physician Portal Physician Office Homecare Solutions Providers Retail Pharmacy Broad Community Connectivity Patients Payers & PBMs ACOs are best positioned to
Slide 23: Question 7: Where is the real value in exchanging data within a community?
Question 7 Where is the real value in exchanging data within a community? Sharing of hospital data 65% of Value with physicians Sharing of physician 25% of Value data with the hospital Sharing of 10% of Value patient data between providers Source: AC Group Report on data exchange published in Fall o
Slide 24: Connecting the Providers
Connecting the Providers Security and Access Control Enterprise Master Patient Index Patient Event Information Patient Demographics, Social & Family, Clinical Information Medication Details, Laboratory Results, Insurance Details NextGen AthenaHealth Provider to Provider to Provider Provider Connecti
Slide 25: Question 8: Summary and what should I do next?
Question 8 Summary and what should I do next? The healthcare reimbursement model is changing away from Fee-for- service to VBR To compete in the new market, health systems and ACOs will need Next-Generation Enterprise wide technology built for clinicians Physician should lead the development o
Slide 26: Poll and questions for Mark…
Poll and questions for Mark…