CEO Roundtable American Medical Group Association

Transcription

1 CEO Roundtable American Medical Group Association Stacey Hrountas CEO, Sharp Rees-Stealy Medical Centers April 16, 2013

2 Overview of Sharp HealthCare

3 Sharp HealthCare San Diego s Health Care Leader Not-for-profit serving 3 million residents of San Diego County. Sharp has grown from one hospital in 1955 to an integrated health care delivery system. Affiliated, aligned, and integrated medical groups Fully integrated information technology systems and infrastructure Centralized system support services (human resources, information technology, clinical effectiveness, billing, accounting, payroll, marketing, etc.) Senior management has an excellent track record of marked financial and operational improvement, with an average of 18 years of service at Sharp Largest health care system in San Diego with highest market share. 4 acute care hospitals, 3 specialty hospitals, 2 affiliated medical groups, health plan, with the most complete range of health care services in San Diego Market share leader and only health system that increased market share each of the past twelve years Largest private employer in San Diego. Nearly 15,500 employees, 2,600 affiliated physicians, 2,300 volunteers

4 Organizational Structure Sharp HealthCare corporations are in bold Hospitals Sharp HealthCare* Other Affiliated Entities * Member of the Obligated Group. Sharp Rees-Stealy operates under the Sharp HealthCare corporate structure. Sharp Memorial Hospital* including: Sharp Memorial Hospital, Sharp Mary Birch Hospital for Women & Newborns, Sharp Mesa Vista Hospital, Sharp McDonald Center, and the Sharp Memorial Outpatient Pavilion Grossmont Hospital Corporation* Sharp Chula Vista Medical Center* Sharp Coronado Hospital and Healthcare Center Sharp Rees-Stealy Medical Centers* Sharp Community Medical Group (Operations not reported in Sharp s financials) Sharp Health Plan Continuous Quality Insurance, Segregated Portfolio Corporation Sharp HealthCare Foundation Grossmont Hospital Foundation Sharp HealthCare ACO, LLC

5 Overview of the System As of September 30, 2012, the system had: 2,120 licensed beds over 1,150 physicians in affiliated medical groups over $2.7 billion in annual operating revenues, and $2.6 billion in assets A typical day at Sharp HealthCare (FY2012): 230 admissions 1,250 inpatients 2,200 outpatient visits 630 emergency department visits 42 deliveries 97 surgeries 3,100 medical group physician visits (SRS)

6 San Diego s Health Care Leader SM Sharp continues to be recognized for its leadership position, not only in San Diego, but across the state and nation Malcolm Baldrige National Quality Award, 2007 Best Integrated Healthcare Network in California and 12 th Best in the Nation, 2012 MAGNET Designation for Nursing Excellence: Sharp Grossmont Hospital and Sharp Memorial Hospital Hospital and Health Networks Most Wired, 2012 Elite Status, SRSMG and SCMG, 2011 Circle of Life Award for Palliative and End of Life Care, 2012 Sharp Memorial Hospital and Sharp Grossmont Hospital named the #2 and #3 Best Hospitals in 2012 and Sharp Rees-Stealy the #1 Medical Group Information Week 500 Top Technology Innovators, 2010

7 Sharp Rees-Stealy Awards & Recognition Elite Status by California Association of Physician Groups American Medical Group Association (AMGA) Acclaim Award Honoree for Quality and Service - Office of the Patient Advocate 2010 Health Care Quality Report Card California s Top Performing Physician Group San Diego Union Tribune s Best Medical Group Certified by the Accreditation Association for Ambulatory Health Care Integrated Healthcare Association Top Performing Group in California

8 Sharp ACO Collaborations Commercial PPO Patients Sharp Community Medical Group ( SCMG ) Commercial PPO Patients SCMG and Sharp Rees- Stealy Medical Group ( SRSMG ) Pioneer ACO Medicare Feefor-Service Beneficiaries Sharp HealthCare, SCMG, SRSMG

9 Sharp Pioneer ACO John Jenrette, MD, Stacey Hrountas, Jonathon Blum, Mai Pham and Rick Gilfillan

10 Sharp HealthCare ACO Began January 1, 2012 Collaboration between Sharp HealthCare, SCMG and SRSMG All SRSMG physicians, most SCMG physicians (includes Graybill), and all Sharp hospitals

11 Beneficiary Alignment Sharp HealthCare ACO Beneficiaries PY2 Alignment PY1 SCMG 18,895 60% 65% SRSMG 8,239 26% 26% Graybill 4,451 14% 9% PY2 Aligned Beneficiaries 31, % 100%

12 Beneficiary Alignment PY1 Aligned Beneficiaries 32, Average Age PY2 Newly Aligned Beneficiaries 9, Average Age PY1 Beneficiaries Unaligned in PY2 (10,172) 32% Average Age PY2 Aligned Beneficiaries 31, Average Age

13 What Have We Accomplished? Created corporation Named leadership team Developed subcommittee structure Established provider and supplier network Formed governing body, including consumer advocate and patient representative

14 Updated: 7/27/12 Sharp ACO Subcommittee Organizational Structure Care Management Karla Ascencio Emily Awkerman Vicki Debaca Ellie Dowell Dr. Jeffrey Hay, Chair Dr. Norman Gollub Dr. John Jenrette Dr. Lynne Milgram Nancy Pratt Debi Reissman Finance Kari Cornicelli Staci Dickerson, Chair Paul Durr Brian Russon Ann Pumpian Josh Schmidt Kevin Thompson Performance Management Vonda Brown Vicki Debaca Paul Durr Dr. Jeffrey Hay Dr. John Jenrette Dr. Lynne Milgram, Chair Nancy Pratt Marketing & Communications Kathy Hutchens, Chair Bob Trocinski Todd Mills Janet Clancy Administration Alison Fleury, CEO Chris Jordan, COO Dr. Jeffrey Hay, CMO Governance Board Dr. Donald Balfour Dan Gross Alison Fleury Stacey Hrountas Dr. John Jenrette Greg Knoll Mike Murphy Bob Payne Dr. Kenneth Roth Network Operations Josh Schmidt Christopher McGlone Gerilynn Sevenikar Roger Whitney Carol Wanke, Chair Information Management / Data Exchange Analytics: Vonda Brown, Chair Vicki Debaca Chuck Deckert Dr. Jeffrey Hay Dr. John Jenrette Dr. Jerry Penso Nancy Pratt Bill Spooner Carol Wanke Transaction Processing: Melanie Betancourt Debbie Coates, Chair Chuck Deckert Paul Durr Melissa Major Debbie Ochs Elizabeth Renfree Bill Spooner Carol Valenta Carol Wanke Compliance Paul Belton, Chair Paul Durr Melissa Korican-Major

15 What Have We Accomplished? Published press and marketing materials and created initial beneficiary engagement tools Web ACO Hotline Mailed notification letters and data sharing forms Provided opt-out preference list to CMMI (2.6% for both performance years) Developed implementation plan Received and analyzed three years claims data ( ) as well as monthly claims through June 2012 for 97.4% of our aligned beneficiaries

16 What Have We Learned? PCP Alignment (77%) 67% of beneficiaries (21,436) saw a Sharp PCP in 2012 or % (3,355) saw a Sharp PCP in 2010 Unaligned Beneficiaries (23%) 17% (5,392) haven t seen a PCP in over three years 2% (500) haven t seen a Sharp PCP since % (835) opted out of data sharing 2% (499) saw a non-sharp PCP (average costs per beneficiary are 30% higher than beneficiaries aligned to a Sharp PCP)

17 What Have We Learned? Identified Opportunities 63% of 2011 inpatient costs ($78 million) originate from the ED 51% of total Part A claims costs for 2011 ($123 million) are out-of-network Skilled nursing bed days per 1,000 were 2,608 in 2011 compared to a 5% sample of Medicare fee-for-service beneficiaries in San Diego County of 1,842 (42% higher) 150 beneficiaries had 5 or more ED visits in 2011 without a corresponding admit (one beneficiary had 53) 100 beneficiaries had 5 or more hospital admits in 2011 (one beneficiary had 17) 3.5% of beneficiaries generate 21% of Part A paid claims

18 Care Management Programs Program Potential Number of Beneficiaries Touched Hospital Case Management 6, % Skilled Nursing Case Management 2, % Care Transitions 6, % Complex Case Management % Disease Management (CHF) % End-of-Life Care Management % Out-of-Network Case Management 7, %

19 Successes Care Management Programs Hospital, skilled nursing, care transitions, complex case management, disease management (CHF), end-of-life, out-of-network Medical group collaboration Improved quality metrics for senior population (EHR enhancements) Examples include fall screening, depression screening, and adult weight screening (<BMI>) Sharp Nurse Connection

20 Challenges Historical and monthly claims feeds Programming errors, delays, changing data fields (requiring reprogramming) Quarterly performance reports Programming errors, cut-off issues, delays, questions regarding benchmark methodology Withhold of 2012 Q3 by CMMI 15 months into the program, Pioneers cannot calculate their shared savings/loss position Quality Benchmarks