ACO Strategies for Interdisciplinary Management

ACOs: Strategies for
Interdisciplinary Management

Presented by:
Kris Mastrangelo
OTR/L, MBA, NHA

Speaker Disclosure

I have commercial interests in the following:

I am the CEO/President at Harmony Healthcare
International

HHI provides reimbursement and compliance
consulting for the long-term care industry

2

Welcome & Thank You

“Widen Your Gaze”
~Sherlock Holmes

Copyright © 2012 All Rights Reserved Harmony Healthcare International, Inc. 3

Objectives

The learner will be able to summarize
goals of ACOs
The learner will be able to identify and
articulate examples of the ACO process
The learner will be able to identify
strategies for interdisciplinary
management of ACOs


Accountable Care Organizations

“It is not the strongest of the species
that survive, nor the most intelligent
that survive. It is the one that is the
most adaptable to change.”
~Charles Darwin


Accountable Care Organizations

“Voluntary groups of physicians, hospitals, and other health
care providers that are willing to assume responsibility for the
care of a clearly defined population of Medicare beneficiaries
attributed to them on the basis of patients’ use of primary care
services.
If an ACO succeeds in both delivering high-quality care or
improving care and reducing the cost of that care below what
would otherwise have been expected, it will share in the
savings it achieves for Medicare.”

The New England Journal of Medicine (NEJM), October 20, 2011
Making Good on ACOs’ Promise – The Final Rule for the Medicare Shared Savings Program
Donald M. Berwick MD, Administrator, CMS


Team Medicine

First building blocks of integrated
team medicine: Model, data and
leadership
Create a care team that maximizes
impact for patients
Build a physician culture of
multidisciplinary practice


Team Medicine

1. An integrated, flexible physician
model

“Multispecialty group medical practice
maximized physicians’ abilities to care for
patients through doctor-to-doctor
consultation, through the training and
mentoring of young physicians, and through
the inherent quality controls built into the
group”


Team Medicine

2. Physician-Friendly Data
Yields evidence-based medicine


Team Medicine

3. Rethink physician leadership
“We recruit physicians with a sense that we’re a
group practice. We stand for quality. We measure
quality and results. We think it’s important that we
tell patients we’re going to give them the kind of
quality they deserve. You then orient, evaluate, and
promote people based on the same set of values and
expectations. Eventually you end up with a culture
that is very comfortable with a focus on
quality, measurement, comparison, and
improvement.”
Jack Cochran, MD


Healthy Bones:
Tests and Prescriptions to Prevent
Problem:
In 2010, osteoporosis was the ninth most costly major illness
among the top 5% highest cost Medicare beneficiaries
In 2005, 2 million fractures cost the United States $17 billion
for both acute and long-term care. By 2025, the annual
fracture rate is expected to increase by 50% to about 3 million
at a cost of $25 billion per year.
On average, 24% of patients presenting with a osteoperosis-
related fracture die within one year, and the mortality rate of
men exceeds women
Only 21% of women age 67 or older who have had an
osteoporosis-related fracture had a bone mineral density test
or a drug prescription to treat or prevent osteoporosis in the
six months after the fracture
* Information provided by Kaiser Permanente


Healthy Bones
Solution:
Care managers, primary care physicians, and surgeons
use daily reports generated from the electronic health
record to identify members at risk for osteoporosis
and fractures
Care managers coordinate care for these patients to
close care gaps
Working together, the team provides patients with
education, screening, treatments, and monitoring as
needed. The multidisciplinary team includes:
Orthopedic
surgeons, endocrinologists, gerontologists, family
practitioners, internists, rheumatologists, gynecologists
, physical therapists, disease/care
managers, radiologists and member education

Healthy Bones
Impact:
Annual bone density screening rates increased by
474% from 2002 to 2009
People on anti-osteoporosis medications
increased by 214% from 2002 to 2009
Over 45% reduction in rate of hip fractures
(preventing >1400 hip fractures) by 2010
If the Healthy Bones approach were adopted in
the United States, the country could achieve a 25%
reduction in the rate of hip fractures, preventing
75,000 hip fractures per year


Improvement Standard
As the New York Times reported on its front page Tuesday,
Reuters (10/24, Morgan) reports that the Obama
Administration has proposed a settlement to a class-action
lawsuit, promising to broaden current Medicare regulations
to allow coverage to "maintain the patient's current
condition or ... prevent or slow further deterioration."
Previously, beneficiaries had to demonstrate improvement to
continue to receive coverage, the change will likely benefit
thousands of Americans with degenerative conditions like
multiple sclerosis, Parkinson's, and cerebral palsy.

An HHS spokeswoman said the settlement merely "clarifies"
current policy, and continued, "We expect no changes in
access to services or costs."


The case, Jimmo v. Sebelius, resulted in a focus on
skilled service delivery in the context of maintenance
programs

Historically, patients with chronic conditions and
anticipated functional deterioration were considered
skilled for the establishment of a maintenance
program

This settlement now allows for coverage of the actual
delivery of maintenance therapy by licensed nurses
and therapy professionals

Current Medicare skilled guidelines state:

The services must be provided with the expectation,
based on the assessment made by the physician of the
patient’s restoration potential, that the condition of the
patient will improve materially in a reasonable and
generally predictable period of time,

Or the services must be necessary for the establishment
of a safe and effective maintenance program


The Proposed Settlement:
“Instead, providers, contactors, and adjudicators must recognize
“maintenance” coverage and a beneficiary’s need for skilled care that is
performed or supervised by professional nurses and therapists.”

The manual revisions will clarify that, under the Skilled Nursing Facility,
Home Health, and Outpatient Therapy maintenance coverage standards,
skilled therapy services are covered when an individualized assessment of the
patient’s clinical condition demonstrates that the specialized judgment,
knowledge, and skills of a qualified therapist (“skilled care”) are necessary for
the performance of a safe and effective maintenance program

Such a maintenance program to maintain the patient’s current condition or to
prevent or slow further deterioration is covered so long as the beneficiary
requires skilled care for the safe and effective performance of the program



Quality Care is our number one objective

Harmony embraces the OBRA 87 regulations which
require facilities to provide services to meet “the
highest practicable physical, medical and
psychological well-being” of every resident

This practice has been our standard since its inception.
This new Improvement Standard, further supports
our core values as providers of specialized services
to the post acute care population.


Continuum of Care Post Discharge

“When the asthma attack is done, the
patient goes home, and the game’s
over. No one is accountable for any of
the follow-up care.”

George Halvorson , Chairman & CEO
Kaiser Permanente


ACOs: Strategies for Interdisciplinary Management
To be continued…

To hear more about these introductory slides,
and all that is still to come, please join me:

• Saturday, April 13th
• 8:30-10:00am
• Room Kissimmee A

Kris Mastrangelo, President & CEO
Harmony Healthcare International
http://www.harmony-healthcare.com/
Tweet me your questions! @KrisMastrangelo


ACO Strategies for Interdisciplinary Management

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