Pioneer ACO Press Conference
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HHS Secretary Kathleen Sebelius makes an announcement about Pioneer Accountable Care Organizations. The Pioneer ACO Model is a payment initiative for health care organizations made available under the Affordable Care Act.
Pioneer ACO Press Conference
GOOD AFTERNOON EVERYONE, AND THANK YOU VERY MUCH FOR BEING WITH US TODAY. BEFORE I BEGIN, I WANT TO ACKNOWLEDGE OUR GREAT HEALTH LEADERS HERE WITH ME TODAY, THE HEAD OF OUR MEDICARE AND MEDICAID INVASIONS CENTER AND OUR DEPUTY MEDICARE ADMINISTRATOR WHO IS ALSO ON THE STAGE. AND I ESPECIALLY WANT TO RECOGNIZE THE HEALTH LEADERS WHO TRAVEL HERE FROM AROUND THE COUNTRY FOR THIS VERY IMPORTANT ANNOUNCEMENT. THANK YOU FOR BEING HERE TODAY AND THANK YOU FOR THE CRITICAL WORK YOU DO EACH AND EVERY DAY. TODAY WE ARE TALKING A HISTORIC STEP TO IMPROVED HEALTH CARE IN AMERICA. UNDER THE AFFORDABLE CARE ACT, 32 LEADING HEALTH SYSTEMS AND PHYSICIAN'S ORGANIZATIONS HAVE BEEN SELECTED TO TEST A NEW MODEL OF CARE IN WHICH THEY WILL TRANSFORM THEIR PRACTICES TO EMPHASIZE PREVENTION, IMPROVED CARE COORDINATION, CUT WASTE AND PUT A GREATER FOCUS ON PATIENT'S NEEDS. THESE PIONEER ACCOUNTABLE CARE ORGANIZATIONS WILL IMPROVE CARE FOR OVER 860,000 MEDICARE BENEFICIARIES. AND ARE ESTIMATED TO SAVE THE MEDICARE TRUST FUND UP TO $1.1 BILLION OVER THE NEXT FIVE YEARS AND BECOME ROLE MODE ELSE FOR THE REST OF THE COUNTRY AS WE MOVE TOWARDS A FUTURE IN WHICH ALL AMERICANS GET BETTER CARE. TODAY'S ANNOUNCEMENT COMES AT A TIME WHEN THERE IS AN UNPRECEDENTED UNDERSTANDING THAT WE NEED TO IMPROVE HEALTH CARE. DESPITE HAVING WORLD'S BEST DOCTORS AND NURSES, THE MOST ADVANCED TECHNOLOGY AND THE FINEST HOSPITALS IN THE WORLD, AMERICA CONTINUES TO DIE SOONER THAN OUR PEERS AROUND THE WORLD. EACH YEAR, HEALTH CARE COSTS CONSUME A GREATER SHARE OF OUR PAYCHECKS, CORPORATE BALANCE SHEETS AND LOCAL STATE AND FEDERAL BUDGETS WITH NO SIGN OF SLOWING DOWN ON THEIR OWN. BUT FORTUNATELY, THIS IS ALSO A TIME OF UNPRECEDENTED UNDERSTANDING ABOUT HOW TO MAKE IMPROVEMENT HAPPEN. IN THE LAST 2 1/2 YEARS, I HAVE HAD THE PRIVILEGE OF VISITING SOME OF THE LEADING HEALTH SYSTEMS AROUND THE COUNTRY THAT ARE ALREADY HARD AT WORK CHANGING THE WAY THEY DELIVER CARE TO PREVENT ILLNESS, TO HELP PATIENTS MANAGE THEIR CHRONIC CONDITION, TO IMPROVE CARE TRANSITIONS AND TO REDUCE MEDICAL ERRORS. THESE SYSTEMS HAVE HEALTHIER AND HAPPIER PATIENTS AND HAPPIER HEALTH CARE PROVIDERS. AND PERHAPS MOST IMPORTANT OF ALL, MANY OF THEM ARE FINDING THAT DOING CARE THE RIGHT WAY CAN ACTUALLY BRING DOWN COSTS. AT A TIME WHEN THERE ARE THOSE IN WASHINGTON WHO SAY WE HAVE NO CHOICE BUT TO MAKE SOME OF THE MOST DRAMATIC CUTS TO OUR HEALTH CARE PROGRAMS EVER PROPOSED, THE LEADING HEALTH SYSTEMS ACROSS AMERICA ARE SHOWING THERE IS A BETTER PATH FORWARD. IN ORDER TO WIDEN THAT PATH, SO IT CAN INCLUDE ALL PATIENTS AND ALL PROVIDERS, WE NEED TO GET RID OF THE SIGNIFICANT OBSTACLES STANDING IN THE WAY OF IMPROVEMENT, AND THAT IS REALLY WHAT TODAY'S ANNOUNCEMENT IS ALL ABOUT. THE PIONEER ACCOUNTABLE CARE PROGRAM IS ONE OF THE SEVERAL ORGANIZATIONS CREATED BY THE AFFORDABLE CARE ACT TO HELP HEALTH CARE PROVIDERS WHO WANT TO IMPROVE CARE. FOR THE FIRST TWO YEARS, IT WORKS LIKE A SUPER-CHARGED VERSION OF THE MED CARED SHARED SAVINGS PROGRAM -- MEDICARE SHARED SAVINGS PROGRAM, IF THEY CAN LOWER THEIR COSTS BY IMPROVING CARE, FOR EXAMPLE FOLLOWING UP ON DISCHARGED PATIENTS SO THEY DON'T END UP BACK IN THE HOSPITAL, THEN THE PIONEERS GET A SHARE OF THE SAVINGS. FOR PIONEER ACOs IT'S EVEN A HIGHER PERCENTAGE OF THE SAVINGS. NOW TODAY, TOO MANY HOSPITALS LOSE RESOURCES WHEN THEY HELP PREVENT UNNECESSARY READMISSIONS. AFTER ALL, A HOSPITAL WITH EMPTY BEDS IS ONE THAT IS NOT MAKING ANY MONEY. IN THE SHARED SAVINGS MODEL, THESE INCENTIVES ARE FLIPPED. SUDDENLY, KEEPING YOUR PATIENTS HEALTHY AND OUT OF THE HOSPITAL BECOMES A SUSTAINABLE BUSINESS MODEL. AND PIONEER ACOs WILL TAKE THIS MODEL FURTHER IN TWO WAYS; FIRST IF THEY ARE SUCCESSFUL, THEY HAVE THE OPTION IN THE THIRD YEAR MOVING TOWARDS A NEW PAYMENT SYSTEM WHERE THEY NOT ONLY GET PAID BASED ON HOW MANY PROCEDURES THEY DO BUT ON HOW WELL THEIR PATIENTS DO. SECOND, THEY COMMITTED TO MAKING SIMILAR PAYMENT ARRANGEMENTS WITH OTHER PRIVATE AND PUBLIC PAYERS BESIDES MEDICARE. IN OTHER WORDS, THEIR COMMITTED TO FOCUSING THEIR ENTIRE PRACTICE AROUND THESE NEW GOALS. NOW THIS ANNOUNCEMENT WOULDN'T BE POSSIBLE WITHOUT THE HARD WORK OF OUR STAFF HERE AT THE DEPARTMENT, OUR PARTNERS THROUGHOUT THE FEDERAL GOVERNMENT, AND ESPECIALLY THE 32 PIONEER ACOs REPRESENTED HERE TODAY. IT'S NOT EASY TO CHANGE WAYS OF DELIVERING CARE THAT HAVE BEEN IN PLACE FOR DECADES. BUT THESE PIONEER HEALTH ORGANIZATIONS HAVE AGREED TO TAKE ON THE CHALLENGES BECAUSE THEY BELIEVE THAT IF THEY DELIVER BETTER CARE, THEIR ORGANIZATIONS WILL ULTIMATELY THRIVE. SO I WANT TO TAKE ANOTHER MOMENT TO SAY TO EACH OF THE LEADERS HERE TODAY, THANK YOU. THANK YOU FOR STEPPING UP TO SHOW US WHAT THE FUTURE OF HEALTH CARE WILL LOOK LIKE. BUT THE MOST IMPORTANT QUESTION WE NEED TO ASK ANY OF OUR HEALTH CARE SYSTEM IS, WHAT DOES IT MEAN FOR THE PATIENTS? FIRST, IT'S IMPORTANT TO NOTE WHAT WON'T CHANGE. THIS WON'T LIMIT CONSUMER CHOICES AT ALL. EVEN IF YOUR DOCTOR IS PART OF AN ACO, YOU CAN STILL CHOOSE ANY PROVIDER YOU WANT AND YOU'LL STILL HAVE ALL THE GUARANTEED MEDICARE BENEFITS. BUT HERE IS WHAT COULD CHANGE: YOUR DOCTOR MAY BE ABLE TO SPEND MORE TIME WITH YOU BECAUSE SHE WON'T HAVE TO RUSH OFF 10 MINUTES AFTER TO DO ANOTHER VISIT. SHE COULD HAVE A LITTLE MORE TIME TO TALK TO ALL THE SPECIALISTS SO THAT YOU WON'T HAVE TO FILL OUT THE SAME FORM OVER AND OVER AND OVER EVERY TIME YOU HAVE AN APPOINTMENT. SHE MAY BE ABLE TO WORK WITH YOU TO HELP YOU MANAGE YOUR CONDITIONS AND STAY HEALTHIER WITHOUT WORRYING ABOUT WHETHER SHE IS GOING TO SHOULD TO BILL FOR THAT OR NOT. WE HOPE THAT OTHER PHYSICIAN ORGANIZATIONS AND HOSPITALS WILL FOLLOW IN THE FOOTSTEPS OF THE PIONEER ACOs BUT THERE IS NOT ONE SINGLE PATH TO BETTER CARE. THAT'S WHY THROUGH THE AFFORDABLE CARE ACT AND OTHER EFFORTS, WE ARE GIVING PROVIDERS A MENU OF OPTIONS FOR PROVEN CARE. THEIR SHAVED SAVINGS MODELS IN HOSPITALS AREN'T QUITE READY FOR THE THIS PROGRAM. WE HAVE STARTED A PARTNERSHIP FOR PATIENTS THAT HAS ALREADY SIGNED UP MORE THAN 3000 HOSPITALS AND NUMEROUS EMPLOYERS AND OTHER PARTNERS TO REDUCE MEDICAL ERRORS AND UNNECESSARY READMISSIONS. AND WE RECENTLY ISSUED A HEALTH CARE INVASION CHALLENGE ASKING INNOVATORS AROUND THE COUNTRY TO COME TO US WITH THEIR BEST IDEAS FOR LOWERING COSTS BY IMPROVING CARE. WE'LL PICK THE TOP IDEAS, GIVE THEM MONEY TO TEST THEM, AND IF THEY WORK, WE'LL BE ABLE TO IMPLEMENT THEM ON A NATIONAL SCALE SO PATIENTS AND PROVIDERS WON'T HAVE TO WAIT TO REAP THE BENEFITS. THIS IS AN INCREDIBLE MOMENT. THE AFFORDABLE CARE ACT HAS GIVEN US A PLATFORM, A HUGE OPPORTUNITY TO IMPROVE CARE AND HEALTH CARE PROVIDERS ARE MOVING FORWARD TO SEIZE THAT OPPORTUNITY LIKE NEVER BEFORE. BUT AMONG ALL THESE INNOVATORS, PIONEER ACOs V. A VERY SPECIAL ROLE. THEY WON'T JUST IMPROVE CARE FOR THEIR PATIENTS, THEY WILL ALSO BLAZE A TRAIL TOWARDS BETTER CARE FOR ALL AMERICANS AND I CAN'T WAIT TO SEE WHAT LIES AHEAD. AGAIN, THANK YOU ALL FOR BEING HERE WITH US TODAY AND NOW I'D LIKE TO TURN IT OVER. Y. THANK YOU VERY MUCH, MADAM SECRETARY, IT'S A HISTORIC DAY AND I HAH FOR THE LEADERSHIP AND SUPPORT YOU PROVIDED IN GETTING US TO THIS DAY. I ALSO WANT TO THANK THE HARDWORKING AND DEDICATED PIONEER ACO TEAM LED BY RICH AND TROY FROM OUR SEAMLESS CARE GROUP AND MOST DIRECTLY BY THE BRILLIANT AND TERRIBLY REMARKABLY EFFECTIVE LEADER,FOR GETTING US HERE. I MUST SAY THAT EVERY PIONEER THAT I HAVE SPOKEN WITH HAS GONE OUT OF THEIR WAY TO REMARK UPON THE CUSTOMER SERVICE ETHIC THAT HAS BEEN DEMONSTRATED BY THE TEAM. THEY SET A NEW STANDARD FOR CUSTOMER SERVICE, FOR BEING A TRUSTWORTHY PARTNER THAT WE WILL ALL WORK HARD TO LIVE UP TO. I ALSO WANT TO THANK JOHN BLUM, MY COLLEAGUE HERE AT CMS AND THE CENTER FOR MEDICARE, WHOSE TEAM CONTINUED TO WORK VERY HARD IN THE LONG HOURS TO IMPLEMENT THE MEDICARE SHARED SAVINGS PROGRAM. I HOPE THE LEVEL OF COORDINATION AND TEAMWORK THAT IS CHARACTERIZED THE WORK BETWEEN JOHN'S TEAM AND THE PIONEER TEAM, IS EVIDENT TO EVERYONE INTERESTED IN ACOs. I WANT TO THANK OUR FOLLOW FAMILY PARTNERS AT HHS AND BEYOND WHO HAVE WORKED TIRELESSLY TO SUPPORT THIS WORK AND AS SEVERAL FOLKS SAID TODAY, THIS HAS BEEN WARP SPEED FOR YOU ALL AND FOR US AND WE RECOGNIZE THAT AND APPRECIATE YOUR EFFORTS. HERE IN PARTICULAR, WE WANT TO SINGLE OUT THE WORK OF OUR LEGAL AND INFORMATION SYSTEMS TEAMS AT CMS AND ALSO OUR COLLEAGUES AT THE INSPECTOR GENERAL'S OFFICE AND THE DEPARTMENT OF JUSTICE WHO WANTED US TO GET THROUGH THE WAIVER. I WANT TO THANK YOU THE 32 PIONEERS, EXECUTIVES, BOARDS, CLINICAL STAFF BY DEMONSTRATING THE COMMITMENT FOR LEADING US INTO THE FUTURE HEALTH CARE SYSTEM PRODUCING BETTER HEALTH AND BETTER CARE. THIS IS A PARTNERSHIP WE STARTED WELL BEFORE TODAY AND LOOKED OUT IN THE AUDIENCE AND SEE PEOPLE WHO HAVE BEEN COMING HERE TO CMS, TO HHS, REPEATEDLY OVER THE LAST TWO YEARS ENCOURAGING INVASIONS CENTER TEAM TO REACH OUT AND BUILD THIS RELATIONSHIP AND WE APPRECIATE YOUR PERSISTENCE AND ENGAGEMENT WITH US. WE THINK ABOUT HOW WE GOT HERE TODAY, I WAS STRUCK BY THE CIRCUMSTANCES THAT HAVE COME TOGETHER TO CREATE THIS ANNOUNCEMENT. AS MANY OF YOU KNOW, THE AFFORDABLE CARE ACT CREATED MANY NEW OPPORTUNITIES FOR CMS TO PARTNER WITH DOCTORS, NURSES AND HOSPITALS TO CREATE A BETTER HEALTH CARE SYSTEM. ONE OF THOSE OPPORTUNITIES IS THE CENTER FOR MEDICARE AND MEDICAID INVASION. AND THE INNOVATION CENTER IS TASKED WITH TESTING INNOVATIVE PAYMENT TO FIND NEW WAYS TO ACCOMPLISH THESE BETTER OUTCOMES I JUST MENTIONED. THE CENTER IS GIVING US A GREAT OPPORTUNITY TO TAKE ADVANTAGE OF ONE OF OUR NATION'S MOST EXCITING RESOURCES, YOU AND OTHERS LIKE YOU WHO ARE DOING THE INNOVATIVE WORK AROUND THE COUNTRY TRYING TO FIND WAYS TO IMPROVE THE QUALITY OF CARE FOR OUR BENEFICIARIES. EVERY DAY WE AT CMS AND HHS ARE INCORPORATING LESSONS FROM THIS WORK AND TURNING YOUR INGENUITY INTO INNOVATIVE MODELS THAT WILL SHAPE CARE DELIVERY. WHEN WE FIRST BEGAN OUR WORK ONE YEAR AGO, WE WANTED TO FIND A WAY TO PARTNER AND LEARN FROM SOME OF THE EXTRAORDINARY ORGANIZATIONS AROUND THE COUNTRY LIKE YOU ALL, WHO ARE TRANSFORMING THEIR BUSINESS MODEL AND THEIR CARE MODEL EVERY DAY. IT WAS FROM THAT IDEA THAT WE DEVELOPED THE ACO MODEL. NOW THE 32 PIONEERS ANNOUNCED REPRESENT INCREDIBLY DIVERSE AND ADVANCED GROUP OF ORGANIZATIONS THAT WERE SELECTED AFTER A FAIRLY RIGOROUS PROCESS. THE FINAL PART IN THE PIONEERS REPRESENT 18 STATES FROM THE SOUTHWEST TO THE UPPER MIDWEST TO THE NORTHEAST. THEY COME FROM RURAL, URBAN AND SUBURBAN COMMUNITIES. THEY REPRESENT A BROAD DIVERSITY OF BACKGROUNDS, SOME LARGE IPAs SOME INTEGRATED SYSTEM, SOME PHYSICIAN AND PRACTICE BASED AND SOME HOSPITAL BASED. THEY BRING A RICH INNOCENCE THEIR APPROACHES TO IMPROVING CARE AND REPRESENT SOME OF THE BEST OF WHAT OUR COUNTRY HAS TO OFFER IN DELIVERING HIGH QUALITY PATIENT-CENTERED HEALTH CARE. AS THE SECRETARY SAID, UNDER THE PIONEER MODEL, THESE ORGANIZATIONS WILL BE REWARDED FOR DELIVERING HIGH QUALITY CARE AND REDUCING COSTS TO MEDICARE. BUT WE ALSO UNDERSTAND THAT THESE ORGANIZATIONS ARE TAKING ON FINANCIAL RISKS AND WILL BE SHARING THE RESPONSIBILITY FOR MEDICARE COSTS. WE ARE INDEED BECOMING PARTNERS SHARING THE RESPONSIBILITY, OPPORTUNITIES AND MOST IMPORTANTLY, COMMITMENT TO BETTER CARE FOR PATIENTS. THE MODEL ALLOWS US TO USE A NEW PAYMENT ARRANGEMENT THAT MOVES THE ENTIRE ORGANIZATION AWAY FROM FEE-FOR-SERVICE PAYMENT TO NEW MODEL, NEW APPROACHES THAT REWARD THE DELIVERY OF COST EFFECTIVE HIGH QUALITY CARE. IT GIVES YOU THE FREEDOM TO BE MORE INNOVATIVE THAN THE WAY THEY DESIGN AND YOU DESIGN CARE FOR THE PATIENTS WHO SERVE. THEY CAN SHOW THE COUNTRY WHAT IS POSSIBLE IN DRIVING TOWARDS BETTER HEALTH AT REDUCED COSTS TO IMPROVEMENT FOR THE ENTIRE MEDICARE POPULATION. ADDITIONALLY, ALL OF THE PIONEER ACOs AGREED TO INSURE THAT OVER HALF OF THEIR REVENUES WILL COME FROM SIMILAR PAYMENT ARRANGEMENT WITH COMMERCIAL AND OTHER PUBLIC PAYORS. THESE ORGANIZATIONS ARE NOT JUST AGREEING TO NEW WORKING AGREEMENTS AND ARRANGEMENTS WITH CMS, THEY ARE AGREEING TO BE PART OF A LARGER MOVEMENT TOWARDS NEW MODELS OF CARE FOR ALL AMERICANS. PAYMENTS WILL NOT BE THE ONLY THING CHANGING UNDER THE PIONEER ACO MODEL. AT CMS, WE ARE CHANGING HOW WE THINK OF THE RELATIONSHIP BETWEEN PROVIDER AND PAYOR. WE HAVE HARD WIRED INTO THE PIONEER MODEL MEANINGFUL AND ONGOING ENGAGEMENT WITH PATIENTS THROUGH MONITORING, PIONEER STRUCTURES, COMMUNICATIONS AND PROGRAMS THAT TRACK PATIENTS EXPERIENCE OF CARE AND PLANNED AND SHARED LEARNING ACTIVITIES. WE EXPECT THE MODEL WILL CONTINUE TO EVOLVE AND IMPROVE OVER TIME AS WE ALL ENGAGED TOGETHER TO FIND ADDITIONAL WAYS TO SUPPORT THE WORK OF IMPROVING CARE. AS THE SECRETARY SAID, THE MODEL IS ONE PIECE OF THE LARGER EFFORT AT CMS TO IDENTIFY, TEST AND SPREAD NEW WAYS TO DELIVER AND PAY FOR CARE. WE CREATED A WIDE VARIETY OF ORGANIZATIONS THAT PARTNER WITH US IN THIS ENDEAVOR WHETHER THROUGH OUR BUNDLED PAYMENT FOR CARE PROGRAM, WHICH SEEKS TO PAY FOR CARE AS AN EPISODE RATHER THAN A FRAGMENT, OR INVEST IN PRIMARY CARE TRANSFORMATION AND REVITALIZATION. THERE ARE OPPORTUNITIES FOR MANY TYPES OF ORGANIZATIONS AND PROVIDERS. AND OF COURSE WE RECENTLY RELEASED THE HEALTH CARE INVASION CHALLENGE ASKING PROVIDERS AROUND THE COUNTRY TO COME TO US WITH THEIR BEST IDEAS FOR IMPROVING OUTCOMES AND LOWERING COST. SOME MAY RUSH TO LABEL THE PIONEER MODEL OR OTHER WORK AT CMS AS SIMPLE DEMONSTRATIONS. WE THINK OF IT AS MUCH MORE THAN THAT. WE THINK OF IT AS AN OPPORTUNITY TO BEGIN THIS NEW PARTNERSHIP. WE LOOK FORWARD TO BEGINNING THAT WORK AND BUILDING A BETTER HEALTH CARE SYSTEM FOR GENERATIONS TO COME. WE KNOW OUR COUNTRY NEEDS A BETTER HEALTH CARE SYSTEM THAT IS SUSTAINABLE, PRODUCING BETTER HEALTH AND CARE FOR ALL AMERICANS. TRANSFORMING HEALTH CARE MEANS ASKING LEADERS LIKE YOU ALL TODAY TO CHANGE THE BASIC CLINICAL AND BUSINESS MODELS THAT HAVE MADE YOU AND YOUR ORGANIZATION SUCCESSFUL IN THE PAST. YOU KNOW AND WE KNOW THAT THE CURRENT SYSTEM IS NOT SUSTAINABLE. YOU KNOW THAT WE HAVE TO CHANGE AND YOU ALSO KNOW THAT THE CHANGE IS DIFFICULT. IT WOULD BE EASY TO HOLD BACK. THESE PIONEERS ARE NOT HOLDING BACK. THEY ARE LEANING INTO THE CHALLENGE OF MOVING TO THE FUTURE. IN DOING SO, THEY ARE DEMONSTRATING THAT'S A GREAT AMERICAN CAPACITY FOR INNOVATIVE ENERGY AND ENTREPRENEURIAL ENDEAVORS CAN BE RELEASED TO ADDRESS A CRITICAL, SOCIAL AND HUMAN NEED, IMPROVING HEALTH CARE SO WE CAN MAKE THE BEST CARE AVAILABLE TO ALL AMERICANS. YOU ARE OPT MIDST WHO BELIEVE THAT WE CAN AND WILL DO BETTER. YOU ARE AN INSPIRATION FOR US AND WILL BE FOR OTHER HEALTH CARE LEADERS. THANK YOU VERY MUCH FOR BEING HERE. I'M HONORED NOW TO TURN THE PROGRAM OVER TO ONE OF YOUR INSPIRATIONAL LEADERS, DR. NANCY BONER, AN INTERN AND CHIEF MEDICAL OFFICER IN A HEALTH CARE SYSTEM TO FURTHER EXPLAIN WHAT TUESDAY'S ANNOUNCEMENT WILL MEAN FOR CLINICIANS AND PATIENTS. GOOD AFTERNOON, EVERYONE. ON BEHALF OF MONARCH HEALTH CARE AND ALL PIONEER ACOs, WE ARE HONORED TO HAVE BEEN SELECTED FOR THIS IMPORT AND HISTORIC INITIATIVE. WE LOOK FORWARD TO DEDICATING OUR ENERGY AND TALENTS TO HELP TO CREATE A MORE EFFECTIVE HEALTH CARE SYSTEM RESULTING IN HIGHER QUALITY CARE, BETTER EXPERIENCE FOR OUR PATIENTS, AND REDUCED GROWTH IN MEDICARE SPENDING. WE WILL ACHIEVE THESE GOALS BY PROVIDING CARE COORDINATION, SUPPORT FOR OUR PATIENTS AND THEIR PHYSICIANS WHERE AND WHEN THEY NEED IT. THE PIONEER ACO WILL WORK TO IMPROVE HEALTH WITHIN OUR COMMUNITY WITH REGARDS TO WELLNESS THROUGH ENHANCED PREVENTIVE CARE PROGRAMS. AND WILL OFFER PERSONALIZED ASSISTANCE TO PATIENTS AND THEIR FAMILIES AFTER AND BEFORE ACUTE ILLNESSES. FOR PEOPLE WITH CHRONIC DISEASES, WE ARE COMMITTED TO FORGING STRONGER DOCTOR/PATIENT RELATIONSHIPS. BUT ENSURE PATIENTS HAVE THE SUPPORT AND SKILLS THEY NEED TO EFFECTIVELY MANAGE THE CONDITIONS AND MAINTAIN INDEPENDENT LIVING. I'D LIKE TO SHARE A COUPLE OF EXAMPLES, SPECIFICALLY OF HOW MONITORING HEALTH CARE COORDINATES CARE FOR ITS PATIENTS, EXAMPLES THAT I BELIEVE REFLECT THE KIND OF PROGRESSIVE ACTIVITIES OCCURRING ELSEWHERE. THE FIRST EXAMPLE REALITIES TO PATIENT SAFETY AND MEDICATION MANAGEMENT. OUR PHARMACIST ENGAGES PARENTS WHO RELY UPON MORE THAN SIX MEDICATIONS AND MAY HAVE BEEN RECENTLY HOSPITALIZED. JUST THIS MONTHS, GIGI CONTACTED ONE OF OUR PATIENTS WHO HAD BEEN STARTED ON A HIGH RISK BLOOD THINNING MEDICATION IN ADDITION TO 20 OTHER PRESCRIPTIONS. YES, 20. PRESCRIBED BY VARIOUS PHYSICIANS WHO WERE PROVIDING CARE FOR THE PATIENT. THROUGH THE MONITORING OF THIS POTENTIAL DANGEROUS SITUATION, SHE WAS ABLE TO EDUCATE THE PATIENT SO HE COULD TAKE HIS MEDICATIONS SAFELY AND ACTUALLY STREAMLINE HIS MEDICATION REGIMEN. PATIENTS HAVE BEEN PLEASANTLY SURPRISED WHEN THEY HEAR FROM GIGI ON THE PHONE. THEY ARE GRATEFUL TO HAVE A EXPERT, REAL PERSON WATCHING TOUT FOR THEM. THE SECOND EXAMPLE DEMONSTRATES HOW WE HELP OUR PATIENTS NAVIGATE THROUGH THE COMPLEX HEALTH CARE SYSTEM. WE HELP THEM RECEIVE TIMELY AND APPROPRIATE CARE. IN OTHER WORDS, WE WANT TO ENSURE THEY RECEIVE THE RIGHT CARE AT THE RIGHT TIME. ONE OF THE WAYS WE DO THIS IS THROUGH OUR NURSE CARE MANAGERS WHO ARE DEDICATED TO A SMALL NUMBER OF PATIENTS WITH ONE OR MORE CHRONIC DISEASES. BEGINNING ABOUT 11 MONTHS AGO, ONE OF OUR NURSES NAME STAR, HELPED AN ELDERLY DIABETIC PATIENT GET THROUGH MULTIPLE SURGERIES FOR FOOT AMPUTATION INVOLVING A WOUND INFECTION AND SPECIALIZED PHYSICAL THERAPY. SHIELD PERSONALLY CALL HIM ON A REGULAR BASIS AND SHIELD CALL HIM TWICE A WEEK -- SHE WOULD ANSWER HIS QUESTIONS AND HELP HIM NAVIGATE AND UNDERSTAND WHAT THE NEXT STEP IN HIS CARE PLAN WAS AND MAKE SURE HE KEPT HIS APPOINTMENTS. THIS WEEK, THIS GENTLEMAN IS EXCITED TO MEET STAR FOR THE FIRST TIME FACE-TO-FACE. HE IS BRINGING HER HOMEMADE FOOD AND HE WANTS TO THANK HER AND HE WANTS TO SHOW HER HOW HE CAN WALK ON HIS PROSTHETIC LEG. THIS KIND OF COORDINATION THAT HAPPENS BETWEEN PHYSICIAN APPOINTMENTS ARE AMONG THE MOST AFFECT IDENTIFY TOOLS IN PREVENTING UNWANTED EMERGENCY ROOM VISITS AND HOSPITALIZATION AND CREATING A BETTER EXPERIENCE FOR OUR PATIENTS. I ONLY WISH MY OWN FATHER COULD HAVE HAD ACCESS BEFORE HE PASSED AWAY AT 86. I'M CERTAIN THAT EACH AND EVERY PIONEER ORGANIZATION HERE TODAY CAN SHARE ITS OWN SUCCESS STORIES JUST LIKE THESE. OUR CHALLENGE AND OUR GOAL IS TO SUCCESSFULLY ENGAGE PATIENTS AND ALL WHO TAKE CARE OF THEM TO WORK TOGETHER TO HELP THEM CREATE FOR THEM A SEAMLESS PATH THROUGH THIS FRAGMENTED HEALTH CARE DELIVERY SYSTEM. LIKE THE EARLY AMERICAN PIONEERS, LOUIS AND CLARK, WE ARE PREPARED FOR THIS JOURNEY BUT CANNOT KNOW NOW EVERY CIRCUMSTANCE. TO ACHIEVE THESE GOALS, WE WILL NEED TO BE INNOVATIVE, NIMBLE AND PERSEVERANCE. WE CAN ACCELERATE OUR INDIVIDUAL AND COLLECIVET SUCCESS BY SHARING OUR EXPERIENCES IN CORPORATION. BY DEFINITION, PIONEERS ARE THOSE WHO ARE WILLING TO STAND UP, EMBRACE CHALLENGES AND COMMITTED TO MAKING A POSITIVE DIFFERENCE IN THE WORLD. I THINK I CAN SPEAK ON BEHALF OF ALL THE PIONEERS WHEN I SAY WE ARE HONORED AND PROUD TO SHOULD BEEN CHOSEN FOR THIS ENDEAVOR AND LOOK FORWARD TO WORKING WITH THE INNOVATION CENTER. WE WILL PUT FORTH OUR UTMOST EFFORT TO ENSURE THIS PROGRAM SUCCEED FOR OUR PATIENTS, DEDICATED DOLLARS, AND THE COMMUNITIES WE SERVE. THE MOST IMPORTANT, ON BEHALF OF OUR GREAT NATION. THANK YOU. WITH THAT, WE WOULD BE HAPPY TO ANSWER SOME QUESTIONS IF YOU HAVE SOME QUESTIONS FOR US. RICK IS HERE AND JOHN MAY BE CALLED IN. I TOLD HER SHE GETS THE TOUGH QUESTIONS. WE'LL TAKE THE EASY ONES. YES, SIR? [OFF MIC] WE DEVELOPED A VARIETY OF MODELS, THEY START WITH SHARED SAVINGS TYPICALLY WITH SOME DOWNSIDE RISK IF YOU WILL IN THE FIRST YEAR THAT DETAILS OUR AVAILABILITY ON OUR WEBSITE. SUFFICE IT TO SAY THE MOST IMPORTANT ELEMENTS ARE BROADER RANGE OF OPPORTUNITIES AND IN THE THIRD YEAR, THE OPPORTUNITY TO TRANSITION TO A SORT OF CAPITATED-TYPE PAYMENT WHICH IS NOT PART OF THE SHARED SAVINGS PROGRAM. YES, SIR? HI, THERE. COULD YOU TALK ABOUT THE NUMBER OF APPLICATIONS OR APPLICANTS THAT WERE DENIED AND WHAT DIFFERENTIATED THOSE THAT WERE CHOSEN FROM THOSE THAT WERE NOT? WELL, I WOULD SAY ALONG THE WAY, WE RECEIVED A TOTAL OF 80 ORIGINALLY AND -- WE STARTED WITH 160 LETTERS OF INTENT. YES, WE DID HAVE -- STARTED WITH 160. 80 APPLICATIONS GRADUALLY THROUGH A PROCESS OF PANELS REVIEW OF THOSE APPLICATIONS, INTERVIEWS. WE FOUND OR FOUND OUR WAY TO THE 2 THAT YOU SEE HERE TODAY AND THAT ARE LISTED ON THE WEBSITE AND IN THE MATERIAL. SO, WE -- THERE WAS -- I WOULDN'T SAY PEOPLE WERE DENIED. I WOULD SAY WE WENT THROUGH A PROCESS THAT IDENTIFIED FOLKS WHO REALLY FELT STRONGLY ABOUT CONTINUING PARTICIPATION AND SOME WHO FELT THERE MIGHT BE OTHERS AVENUES TO PURSUE THAT WERE A BETTER FIT FOR WHERE THEY WERE IN THEIR STAGE OF DEVELOPMENT. YES. -- HOW MUCH OF THAT WOULD GO BACK TO THE HOSPITAL THAT IS ARE PARTICIPATING? THE SAVINGS, THAT'S THE NET SAVINGS THAT COME COMES BACK TO THE PROGRAM. [INAUDIBLE] THAT'S THE MEDICARE PORTION. IT VARIES DEPENDING ON THE PARTICULAR MODEL. IT'S HARD TO PROJECT GIVEN THE FACT THAT DISTRIBUTION DOLLARS WILL VARY BY THE DIFFERENT ACOs OUT THERE. BUT GIVEN THE NATURE OF THE STRUCTURE OF THE ARRANGEMENT. [OFF MIC] NO. INITIALLY FROM WHAT I UNDERSTAND, IT WAS PROJECTED THERE WOULD BE ABOUT 430 MILLION IN SAVINGS OVER THREE YEARS -- I'M SORRY. I SAW THAT THERE WAS REPORTED IN THE ORIGINAL ESTIMATE WAS THAT THERE WOULD BE ABOUT 430 MILLION IN SAVINGS OVER THREE YEARS. AND THIS IS THE FINAL NUMBER THAT CAME OUT ABOUT 1.1 BILLION OVER FIVE YEARS. THE NUMBER OF ENTITIES INVOLVED IS ABOUT THE SAME AS THE 30 ORIGINALLY PROJECTED. WHY THE DIFFERENCE? THE MEMBERSHIP NUMBERS ARE HIGHER THAN WHAT WE ANTICIPATED ORIGINALLY AND WE HAD A RANGE OF ESTIMATES AND THIS IS -- THIS NUMBER IS THE UPPER END OF THE RANGE WE HAD AN ESTIMATE FOR. ARE THESE 30 PIONEERS ALL GOING TO BE MEASURED AGAINST ONE ANOTHER IN TERMS OF HOW THEY MEET CERTAIN QUALITY MEASURES AND IF SO, WILL THAT BE PUBLICLY POSTED? YES. THE QUALITY MEASURES WE USE IN THE PIONEER PROGRAM ARE THE SAME MEASURES WE USE IN THE SHARED SAVINGS PROGRAM. WHICH ARE GOING TO BE PUBLISHED, WILL BE PUBLISHED AND AVAILABLE TO THE PUBLIC. THESE ALSO WILL BE THE SAME THAT IS SIMILAR TO METRICS USED FOR OTHER PROGRAMS SUCH AS MEDICARE ADVANTAGE AND OTHER ORGANIZATIONS AND PROGRAMS THAT YOU SEE THIS MEASURE. SO THERE WILL BE A GREAT OPPORTUNITY TO COMPARE RESULTS FROM THE PIONEERS TO MANY OTHER APPROACHES TO DELIVERING CARE. DO YOU KNOW HOW MANY ARE TRULY INTEGRATED SYSTEMS IN THE SENSE THAT THEY EMPLOY THEIR DOCTORS VERSUS THE FEE-FOR-SERVICE ARRANGEMENT? IT'S A WIDE ARRAY OF FOLKS. THERE IS A SET OF FOLKS THAT IS A LITTLE BIT OVER HALF THAT HAVE SOME COMPONENT THAT IS INTEGRATED AND THEN OTHERS ARE MORE IPA-BASED OR PHYSICIAN-MODEL BASED. SO IT'S AN ARRAY OF ARRANGEMENTS AND NETWORKS WE HAVE THAT ARE PARTICIPATING. LOOKS LIKE THERE IS SOME QUESTIONS BACK HERE. SO JUST TO RETURN TO THE APPLICATION PROCESS. SO ARE YOU SUGGESTING THAT THE APPLICANTS THEMSELVES, THE 50 SOME ODD WHO ARE NOT WITH US THIS AFTERNOON, MADE A DECISION ON THEIR OWN THAT THIS WAS NOT RIGHT FOR THEM? OR DID HHS MAKE A DECISION THAT THEY WERE NOT -- NO, THERE WAS A PROCESS THROUGH WHICH WE IDENTIFIED THOSE WHO WE THOUGHT WERE MORE LIKELY TO BE SUCCESSFUL AND WERE FURTHER ALONG IN DEVELOPING THEIR CAPABILITIES. SO THERE WERE DEFINITELY SOME THAT WE DECIDED WE FELT WERE NOT READY FOR THE PIONEER PROGRAM. BUT MANY DECIDED ALONG THE WAY THEY WANTED TO DO OTHER PROGRAMS TO MODEL ALONG THE WAY THE SHARED SAVINGS PROGRAM WAS REDESIGNED AND THERE WERE OTHER OPPORTUNITIES AS WELL. SO SOME OF BOTH. THANK YOU. I'M CURIOUS -- I TALKED TO SOME FOLKS LOOKING AT THIS WHO EXPRESS SKEPTICISM ABOUT THE SAVING THAT COULD COME FROM THE ACO PROGRAM AND THEY POINTED TO THE EXPERIENCE IN THE PGPs WHERE NOT ALL WERE ABLE TO REAP THE SHARED SAVINGS AND THIS MAY BE AS MUCH A QUESTION FOR THE PARTICIPANTS HERE AS FOR YOU GUYS. BUT WHAT GIVES YOU CONFIDENCE THIS WILL WORK OUT BETTER FOR THE HEALTH SYSTEMS INVOLVED AND MEDICARE THAN THE PGP PROGRAM MIGHT HAVE? GREAT QUESTION. WE ARE KNOW THERE ARE THREE PGP GROUPS WHO ARE PART OR IN THE PIONEER PROGRAM HERE TODAY AND WE HOPE YOU HAVE A CHANCE TO TALK WITH THEM AFTERWARDS AND THEY CAN GIVE YOU THEIR ANSWER TO THAT. I THINK WE LEARNED A LOT THROUGH THE PGP PROGRAM. THE MODEL HERE FUNDAMENTALLY IS DIFFERENT IN SEVERAL RESPECTS. ONE, THERE IS ONE YEAR OF SHARED SAVINGS WITHOUT ANY DOWNSIDE RISK EXPOSURE. OTHERS ARE GOING TO A RISK-BASED MODEL WHERE THERE IS EXPOSURE, IF COSTS EXCEED TARGETING AMOUNTS. SO THIS IS FUNDAMENTALLY DIFFERENT. IT'S A DIFFERENT PROGRAM FROM THE PGP MODEL WHERE THERE WAS NO REAL PENALTY IF YOU WILL FOR HAVING COST FEES HIGHER THAN THEY STARTED OUT. SO THAT'S NUMBER 1. NUMBER 2, WE ARE ASKING PIONEERS IN THIS INSTANCE TO REACH OUT AND ESTABLISH CONTRACTS WITH OTHER PAYORS, SO GREATER THAN 50% OF THEIR SUBJECTS NOW ALIGNED WITH THIS ALTERNATIVE APPROACH. WE BELIEVE THAT REALLY TAKES US OUT OF A WORLD WHERE PEOPLE MAY BE PURSUING TWO BUSINESS MODELS BUT NOT REALLY FULLY-FLEDGED, FULLY IN THE PROCESS OF TRANSFORMATION, TO ONE WHERE FOLKS, THE PIONEERS ARE SERIOUS ABOUT TRANSFORMING THEIR CLINICAL MODEL TO DELIVER THE OUTCOMES. WE THINK THAT'S A VERY DIFFERENT PROGRAM FROM PGP. SECRETARY, HAS AN APPOINTMENT AT THE BOTTOM OF THE HOUR SO WE WANT THO THANK HER FOR JOINING US TODAY AND RICK AND JOHN WILL CONTINUE TO ANSWER QUESTIONS. THANK YOU VERY MUCH. NEXT QUESTION, PLEASE. SUDDENLY LOST INTEREST? [LAUGHTER] SOME OF THESE PARTNERS ARE IN SOME OF THE MOST COSTLY STATES IN THE COUNTRY IN TERMS OF HEALTH CARE AS A STUDY YOU GUYS PUBLISHED A COUPLE OF WEEKS AGO SHOWED. WILL THEY EARN BONUSES JUST BASED ON DOING BETTER THAN THEY ARE DOING NOW, WHICH IS VERY EXPENSIVE CARE? OR WILL THEY BE MEASURED AGAINST LOWER COST SYSTEMS IN THE U.S.? WE HAVE A GREAT MIXTURE OF FOLKS IN THE PROGRAM FROM HIGH-COST STATES AND HIGH-COST STATES AND I WOULD LOOK AT THE LIST SO YOU CAN SEE FOLKS FROM MINNEAPOLIS, IOWA, ILLINOIS, PLACES WHERE COSTS ARE LOW AND FOLKS FROM URBAN AREAS WHERE COSTS ARE HIGH AND SUBURBAN AREAS WHERE COSTS ARE IN BETWEEN. THEY ARE ALL OVER THE MAP. EVERYONE'S PROGRAM WILL BE BASED ON THEIR EXPERIENCE. IT'S SIMILAR IN THAT REGARD TO THE APPROACH THAT WE TOOK WITH THE SHARED SAVINGS PROGRAM. RIGHT NOW THEY WILL BE JUDGED BASED ON THEIR ABILITY TO DEMONSTRATE IMPROVEMENT OVER THE HISTORICAL EXPERIENCE OF THEIR POPULATION. THAT'S CORRECT ON THE COST OF CARE SIDE. ON THE QUALITY SIDE, THEY WILL BE MEASURED AGAINST HOW THEY ARE DOING VERSUS OTHER BENCH MARKS IN THE INDUSTRY. SO EVERYONE WILL HAVE TO EXCEED THE BENCH MARKS THAT ARE OR THAT EXIST TODAY AND WILL BE DEVELOPING AS WE GO FORWARD TO ENSURE THAT THEY GET THEIR FULL REWARDS BY DEMONSTRATING THEY CAN DO A GREAT JOB IN IMPROVING CARE AND HEALTH AS WELL AS MANAGING THE COST SIDE. OTHER QUESTIONS? THAT YOU ALL VERY MUCH FOR BEING HERE TODAY.
NOTE: The transcript for this program may have been compiled from uncorrected Closed Captioning.
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Wednesday, August 1, 2012
Secretary Sebelius and WebMD held a live online discussion on women's preventive services.
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