At the end of last year, NAPH met with Dr. Rick Gilfillan who heads the Center for Medicare and Medicaid Innovation (CMMI). He encouraged us to submit a proposal for a safety net accountable care organization (ACO) project centered on our members. Late last year, we received feedback from you on the framework for such an ACO project. At this point, we have developed a more detailed proposal and wanted to get your feedback before we submitted this more detailed proposal to the CMMI.

We discussed the following questions on the call:

1. How should criteria be set so that as many NAPH members who choose to can participate in a Safety Net ACO demonstration project?

2. How should patient attribution be accomplished?

3. Which Medicaid population should be included (e.g., fee-for-service (FFS) only or FFS and managed care)?

4. Which Medicaid payments should be at risk for shared savings (e.g., base payments only or base and supplemental payments)?

5. Which risk models are you ready to implement (e.g., FFS with shared savings, partial capitation, full capitation, shared savings only, or shared losses as well)?

6. How much risk are you willing to take on (e.g., are the suggested savings rates of 60-80% adequate)?

7. How would a Safety Net ACO project work in states with Medicaid managed care?

8. How can ACOs incorporate uninsured patients into a Safety Net ACO project?

These were just some of the questions that we wanted to discuss. NAPH plans to submit a proposal to Dr. Gilfillan in the next couple of weeks. Thank you for joining us on the call.

MEMBERS: Please email Alana Mallory ([email protected]) for a link to the synched webcast.

The Affordable Care Act will expand coverage for low income patients with complex needs. However, it also prescribes reductions in funding sources that are used to support hospitals that care for a disproportionate share of Medicaid and uninsured patients. Going forward safety net financing policy should support and ensure funding for core safety net missions. As new safety financing policies are developed, it is important to understand the current sources of funding for unreimbursed care.

Speaker: Sarah Mutinsky, Ropes and Gray

This webinar featured two unique safety net hospital approaches to reducing readmissions. Staff from Orlando Regional Medical Center and Hennepin County Medical Center shared the challenges they faced and strategies implemented to address care transitions.

This session was intended for organizations considering or planning for a community health needs assessment, particularly since the Affordable Care Act includes community health assessments and CMS has begun to include population health as a key component of the "Three Part Aim." ACHI Director Michael Bilton shared some of the environmental factors driving the growing interest in community health assessment, discussed the steps in a typical assessment process, and provided references to a number of tools and resources available to help hospitals and others plan and execute a valuable, high-quality community health assessment.

On this call, speakers gave an overview on the opportunities provided by the California Section 1115 Waiver, how public hospitals will be impacted, and the types of public hospital improvements that will be funded by the incentive program.

Additional Resources:
CAPH Issue Brief on Key Elements of Waiver for Public Hospital Systems

Delivery System Reform Incentive Payments (DSRIP) Plans

Speakers:
Melissa Stafford Jones, President & CEO, California Association of Public Hospitals and Health Systems

Susan P. Ehrlich, M.D., M.P.P., Chief Executive Officer, San Mateo Medical Center
Speaker Bios

A new study reveals recent trends at public hospitals and outlines challenges and opportunities for public hospitals as health reform is implemented. On this call the lead researcher discusses the study’s findings and their implication for the future of NAPH members.

Speakers:

Roxane A. Townsend, MD, Assistant Vice President for Health Systems, LSU Health Care Services Division and Acting Chief Executive Officer, Interim LSU Public Hospital

LaRay Brown, Senior Vice President Corporate Planning, Community Health and Intergovernmental Relations, New York City Health and Hospitals Corporation

Obie Zaman, MPP, Senior Project Manager, NAPH

Emergency department (EDs) overcrowding is on the rise—48% of EDs within the U.S. are at or over capacity, compared with 65% of urban hospital EDs and 73% of teaching hospital EDs. The challenges of managing patient overflows are especially acute in safety net hospitals. Insurance coverage expansion beginning in 2014 could lead to a greater shortage of primary care doctors, and thus more demand for safety net hospital ED services. Despite these obstacles, NAPH members have achieved extraordinary results navigating the most vulnerable patient populations through overwhelmed EDs. On this call hear member hospitals describe how they are improving emergency department throughput.

Speakers:

Leon L. Haley Jr., MD, MHSA, CPE, FACEP, Deputy Senior Vice-President, Medical Affairs, Chief of Emergency Medicine at Grady Health System Associate Professor and Vice-Chair of Clinical Affairs, GHS, Department of Emergency Medicine, Emory University

Ms. Susanne Greenblatt, RN, MA, Director of Nursing, Emergency Department, Bellevue Hospital Center

Rajneesh Gulati, MD, FACEP, Assistant Director of Flow, Emergency Department, Bellevue Hospital Center

Jill Brooker, Bellevue Hospital Center

Moderator: Linda Cummings, PhD, Vice President for Research

The Centers for Medicare & Medicaid Services released its long-awaited proposed rule on the Medicare Shared Savings Program (“MSSP”), establishing Medicare Accountable Care Organizations (“ACOs”). This represents another step in a long line of efforts to shift Medicare from a quantity-driven to a value-driven purchaser of health care services. The proposed MSSP would reward ACOs for delivering integrated care at lower costs while meeting quality standards.

Xiaoyi Huang, AVP for Policy, NAPH and Eva Johnson, Associate, Ropes & Gray discuss the details of the proposed Medicare ACO program, including: Eligibility Requirements, Risk-sharing models, Assignment of beneficiaries, and Quality measurement and reporting requirements.

To learn more about the MSSP, please click here for an analysis of the issues of particular relevance to NAPH members. A more detailed summary of the proposed MSSP by NAPH’s counsel at Ropes & Gray is available here.

The article, Accountability Measures-Using Measurement to Promote Quality Improvement, written by Drs. Chassin, Loeb, Schmaltz and Wachter describes a framework for evaluating measures based on their ability to improve the care delivered to individuals by maximizing health benefits to patients.

Dr. Jerod Loeb describes the model and how the Joint Commission will be applying this framework in their activities of the future. In addition, Dr. Loeb gives his perspectives on how the framework should be extended beyond the Joint Commission into the work of the National Quality Forum as they develop measures moving in to the future.

• 3/2/11: Comparative Effectiveness Research: Implications for Safety Net Providers and the Populations They Serve -Webinar

  The health reform legislation makes an important public investment in comparative effectiveness research (CER). Dr. Eugene Rich describes the politics and policies of CER, outlines options for effectively putting CER into practice, and discusses how CER can address health care disparities.

  • 2/23/11: Should Safety Net Providers Become ACOs? - Webinar

    Dr. Lawrence Casalino, a national expert on Accountable Care Organizations, discusses how safety net providers can prepare for implementation.
  • 2/17/11: Special Opportunity to Publish in the Journal of Healthcare Quality - Webinar

    The Journal for Healthcare Quality has issued a call for papers for a special issue on health care in the safety net. Dr. Maulik Joshi, editor of the Journal for Healthcare Quality, provides an overview of the journal and describes the opportunity to write for publication, shares a list of ideas for articles on the safety net, and discusses the recommended format for writing. He also identifies several resources available for authors.
  • 2/9/11: New Medicare Hospital Value-Based Purchasing Program - Webinar

    The Centers for Medicare & Medicaid Services (CMS) released a proposed rule to implement a Hospital Value-Based Purchasing (VBP) program, as required by the Affordable Care Act. As statutorily mandated, Medicare payments would be reduced beginning in fiscal year 2013 to fund incentive payments to hospitals achieving certain quality-based performance scores. Members gave feedback on the impact of the proposed rule. Member comments will guide NAPH’s submission of comments. A brief summary of the content of the proposed rule can be accessed here.

    • 2/2/11: Advancing Cultural Competence and Patient-Centered Family Care: The New Joint Commission Standards - Webinar

      Dr. Christina Cordero, Associate Project Director at the Joint Commission discusses new patient-centered communication standards recently issued by the Joint Commission’s as part of their growing focus on health equity issues. She offers highlights from The Joint Commission's new guidance monograph, Advancing Effective Communication, Cultural Competence, and Patient and Family-Centered Care: A Roadmap for Hospitals.
      
      Additional information about the patient-centered communication standards and the Roadmap for Hospitals is available on the Joint Commission Website.

      • 1/19/11: Building Accountable Care Organizations - Webinar

        Lynne Fagnani, Senior Vice President from NAPH introduces the call and describes the proposal NAPH submitted to the Center For Medicare and Medicaid Innovation to develop a safety net accountable care organization. Dr. Jay Crosson, a national expert on ACOs, describes the essential components of Accountable Care Organizations (ACO). He will describes the challenges safety net providers may face in forming an ACO and issues/barriers regarding ACO formation.
        
        Dr. Crosson is also the author of Partners in Health: How Physicians and Hospitals Can be Accountable Together.
        

        • 1/12/11: Innovative Safety Net Hospital Programs for Low-Income Elderly or Disabled Patients

          (Members Only)
          Safety net hospital leaders share information about their experience caring for low-income elderly and/or disabled patients (those dually eligible for Medicaid and Meidcare).

          Moderator: Xiaoyi Huang, AVP Policy, NAPH