Webinar: Comprehensive End-Stage Renal Disease Care (CEC) Model – The ESCO Experience
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The webinar discusses the ESRD Seamless Care Organization (ESCO) experience, focusing on the Comprehensive ESRD Care (CEC) Model. Key topics include establishing provider networks, success factors for ESCOs, and regulatory compliance, alongside addressing audience questions and sharing resources. The session emphasizes engagement, transformation strategies, and application deadlines for interested participants.
Webinar: Comprehensive End-Stage Renal Disease Care (CEC) Model – The ESCO Experience
- 1. Comprehensive ESRD Care (CEC) Model Welcome to Today’s Webinar The ESRD Seamless Care Organization (ESCO) Experience We will begin promptly at 12 PM EST Dial-in: 1-800-832-0736 Meeting Room: *6291628# Note: All attendee phone lines are muted to prevent audio feedback. Thursday, June 8, 2016 12-1:30 PM EST
- 2. The ESRD Seamless Care Organization (ESCO) Experience Center for Medicare & Medicaid Innovation (CMMI) Centers for Medicare & Medicaid Services (CMS) U.S. Department of Health and Human Services (HHS) June 8, 2016 2
- 3. Disclaimer The comments made on this call are offered only for general informational and educational purposes. As always, the agency’s positions on matters may be subject to change. CMS’s comments are not offered as, and do not constitute legal advice or legal opinions, and no statement made on this call will preclude the agency and/or its law enforcement partners from enforcing any and all applicable laws, rules and regulations. ACOs are responsible for ensuring that their actions fully comply with applicable laws, rules and regulations, and we encourage you to consult with your own legal counsel to ensure such compliance. Furthermore, to the extent that we may seek to gather facts and information from you during this call, we intend to gather your individual input. CMS is not seeking group advice. 3
- 4. Click here to download a PDF copy of the slides along with the CEC RFA Fact Sheet Type questions here and hit “Enter” Tips for a Successful Event Telephone – All attendee phone lines are muted – This session will be recorded for posting online Webinar Environment Features – Please submit any questions you have in the Q & A box – Questions in the chat box will be answered in the order they are entered at the end of the presentation. If your question is unable to be addressed during this time, please email your questions following this webinar to ESRD- [email protected] – Download the slides in the box in the lower right corner of your screen – A short survey will be available at the end of the presentation 4
- 6. Today’s Speaker Tom Duvall, MBA Operations Analyst, Center for Medicare and Medicaid Innovation 6
- 7. Presentation Agenda • Introduction of ESCO Panelists • Discussion with ESCO Panelists about care interventions and administrative changes they made to become an ESCO • CMS presentation about what it takes to be a successful ESCO • Q&A with CMS Staff 7
- 8. Guest Speakers from Current ESCOs Lauren Stone Hollingsworth Strategic Initiatives Officer Dialysis Clinic, Inc. and Andrew Barba Director, Government Programs DaVita HealthCare Partners 8 Lisa Hobson Dialysis Care Coordination Prog. Manager Dialysis Clinic, Inc.
- 9. Questions for Panelists 1. What advice would you give to potential applicants? 2. How have you worked with provider partners, especially nephrologists, to get them interested in working with you on your ESCOs? 3. What have been the biggest changes that you’ve made by being part of the CEC Model? 4. What has surprised you the most about your time in the model? 5. What aspects, if any, would you modify in how you’ve run your ESCOs? 6. What makes you most proud about being a part of this model? 9
- 10. Panelist Question & Answer Session We will now pause to address questions from the audience to our panelists. To submit a question, please type it into the “Q & A” entry window. Questions will be answered on a “first come, first served” basis. Type questions here and hit “Enter” 10
- 11. 11 What it Takes to be a Successful ESCO CMS Presentation
- 12. Provider Networks • The most important part of the ESCO process is getting necessary providers and forming care network • All ESCOs are required to have at least one nephrologist: – Accountable for downside losses in a two-sided model – Beneficiaries are aligned through dialysis facilities, not nephrologists, so think about nephrologists who are seeing the majority of the patients in your facilities • ESCOS are not required to include specialists, but applicants are encouraged to consider relationships with specialists: – Specialists are an important part of the care delivery process – CMS Quality Reporting requires data from OP providers visited by ESCO beneficiaries 12
- 13. Provider Networks (cont’d) • ESCOs do not need to include a hospital, but need to consider relationships with hospitals: – Major source of care for ESRD patients – Many quality measures are based around patient hospitalizations • Need to think about how to keep providers in your network engaged in an ongoing process • Providers don’t need to be signed for July 15th, but need to include any potentially interested providers in your application • Provider networks can evolve over the years of the model, so they do not need to apply with providers and facilities across the full spectrum of care and can add them for future years 13
- 14. CMS Engagement • How CMS will engage with you: – Weekly executive call with leaders from all ESCOs in the model – Calls with a project officer to go over specific needs – Learning system to assist ESCOs with quality improvement – Annual face-to-face meeting with all ESCOs and other ACOs in other CMS programs • CMS will share: – Alignment reports to show aligned beneficiaries – Monthly, quarterly, and annual finance reports – Dashboard to show utilization and comparison between ESCOs – Detailed Medicare A and B claims data for all beneficiaries 14
- 15. Key Administrative Personnel Within the ESCO • Key staff to coordinate with CMS: – Liaison with CMS for Project Officer and weekly calls with all ESCOs – Lead for quality reporting purposes for data collection methods – Staff to coordinate with providers – Legal staff to understand participation agreement, waivers, and other legal documents shared by CMS – Data analytics staff to analyze claims data, financial data, and alignment data • Other Key Staff: – Representatives from the company 15
- 16. Key Lessons • Note the differences between the ESCO and the “Company”: – The Company is the corporate entity that owns the dialysis facilities and plays a role as described in the waivers – The ESCO is the separate corporate entity that is distinct from facilities and providers • ESCOs are not managed care, in that: – There is no set benchmark at the start of the year – Beneficiaries get full freedom of choice – Managed care techniques don’t work • Bring in your governing board early and regularly to ensure its included in major decisions • Create a clear organizational structure and identify key staff • Secure a data/quality reporting lead and a means for getting data from other providers • Have realistic expectations in your first year, and think about planning your care interventions in stages 16
- 17. Key Lessons (cont’d) • CMS will share the best data available, but it will not be “real-time” – Exact financial information will not be available until after the year • CMS will share claims data in a way you have never seen before and it will require specialized skills to analyze • The “Alignment Algorithm” means that not all of the ESRD beneficiaries who walk into your clinic will be aligned to your ESCO • Send in your application information as soon as possible – CMS will contact you if it appears you have multiple ESCOs in the same region to ensure this was intended • CMS is willing to work with you and answer any questions ESRD beneficiaries can choose where they want to go for care. Part of the challenge of this model is to create a network that beneficiaries will want to join. 17
- 18. Key Care Transformation Points • Your new model of care doesn’t have to be implemented all at once: – Prioritize what areas to transform first – Additional providers can be added over time • Hospital relationships are critical to form early to help identify admissions and readmissions • The learning system will work to identify those strategies that have worked for others and share with all participants • The learning system works best when participants openly share successes and lessons learned so we can all learn together and accelerate learning 18
- 19. CMMI Question & Answer Session We will now pause to address questions from the audience to our experts from the Innovation Center. To submit a question, please type it into the “Q & A” entry window. Questions will be answered on a “first come, first served” basis. Type questions here and hit “Enter” 19
- 20. Key Dates Solicitation Announced • May 19, 2016 Request for Applications Due • July 15, 2016 CMS notifies finalists of selection • September 2016 New ESCOs will begin • January 1, 2017 20
- 21. Application Process • To access the RFA, applicants must email the potential ESCO name, along with the email and name of the main ESCO contact to [email protected] • The RFA is also posted on the CEC Model website: https://innovation.cms.gov/initiatives/comprehensive-esrd- care/ 21
- 22. Additional Resources • CEC Website: https://innovation.cms.gov/initiatives/comprehensive-esrd-care/ – Press Release – Fact Sheet – Full Request for Applications – PY 1 financial methodology – Quality methodology • Waivers for model participants: https://www.cms.gov/Medicare/Fraud-and- Abuse/PhysicianSelfReferral/Fraud-and-Abuse-Waivers.html 22
- 23. Upcoming Learning Events • Webinars: – RFA and the Application June 16 (12-1 pm ET) – Finance and Quality Methodologies June 29 (4-5 pm ET) • Office Hours: Application Questions & Support – July 6 (1 – 2 pm ET) – July 12 (3 – 4 pm ET) – July 14 (12 – 1 pm ET) * Registration links for the above webinars, as well as the link to connect to office hours during the above times will be emailed to the email address you used to register for this webinar or are available here. Next Steps: Continue outreach to providers potentially interested in joining an ESCO. 23
- 24. Thank You for Participating in Today’s Learning Event! • The recording, transcript and slides from today’s event will be available on the CMMI website: https://innovation.cms.gov/initiatives/comprehensive-esrd-care/ • Also visit the CEC model website to access model-specific details, including, recordings and slides from previous learning events, a copy of the updated RFA and the new RFA fact sheet We appreciate your feedback on this webinar! Please complete this brief survey: https://www.surveymonkey.com/r/CECJune8 24
- 25. Please Provide Your Feedback • You can access the feedback survey two ways: – Option 1: Use the link that will be posted in the chat window – Option 2: Use the Feedback Survey pod to the bottom right of your screen Click this link or copy/paste into your browser Click the Post Event Survey Then click “Browse To” 25
- 26. CEC Team Contact Information Questions for the CEC TeamTom Duvall, MBA Operations Analyst Magda Barini-Garcia, MD, MPH Improvement Advisor/Medical Officer Emma Oppenheim, MPH Social Science Research Analyst For future questions pertaining to today’s event or regarding the CEC model, please email: [email protected]. Thank you! 26