• Children’s Hospital at Montefiore• Montefiore Einstein Center for Cancer Care• Montefiore Einstein Center for Heart and

Vascular Care• Montefiore Einstein Center for Transplantation

• Clinical• Translational• Health

Services

• ~1,323 Residents & Fellows• ~420 Allied Health Students• ~1,552 Graduate &

Undergraduate Nursing• ~200 Home Health Aides• ~100 Social Workers

ResearchTeaching

• Home Health Programs

• Primary Care• House Call

Program

• 8 Campuses• 6 Hospitals• 1,930 Beds• 150 Skilled

Nursing Beds• 1 Freestanding

ED

HomeCareHospitals

• Clinical support

• Network applications

• Finance• Legal• Planning• Purchasing• Compliance• Marketing• Human

Resources

• Care Management(>300K Covered Lives)

• Disease Management

• Care Coordination• Telemedicine• Pharmacy

Education

Information Technology

CorporateFunctions CMO

• Health Education• Community Advocacy• Wellness• Disease Mgmt.• Nutrition • Obesity Prevention• Physical Activity• Reduce Teen Pregnancy• Lead Poisoning Prevention

Population Health

• ~21,370 Employees• ~3,250 Medical Staff• ~3,450 Integrated Provider

Association Physicians• ~1,800 Employed MDs

• ~4,270 RN/LPN• ~3,300 NYSNA RNs

• ~10,280 SEIU/1199

Workforce

Community

Academic HealthSystem

Notable Centers of Excellence

Primary & Specialty

Care

• Advanced Primary Care

• Sub-specialty Care• Dental• School Based

Health Centers• Mobile Health

• Neuroscience• Orthopedic• Ophthalmology• OB/GYN

13

Montefiore IPA & CMO

• Formed in 1995• MD/ Hospital Partnership• Contracts with managed

care organizations to accept and manage risk

• Over 3,900 providers– 2,800 physicians

• 2,100 employed– 600 PCPs

• Established in 1996• Performs care

management delegated by health plans as well as other administrative functions, (e.g. claims payment, credentialing, contact center)

Montefiore IPA

14

1995-1996 Established the

Montefiore IPA and CMO to facilitate risk

contracts

2000Major expansion of risk membership

2011Montefiore selected

as Pioneer ACO

2012Formation of

Montefiore-led Medicaid

Health Home Program

2013Creation of Montefiore MLTC plan

and expansion of Pioneer ACO

2009Montefiore

leads creation of

Bronx RHIO Development of

care management infrastructure;

extension of care management core

competencies into network

2014 -2015DSRIP

planning and implementation;development of

commercial ACO

relationships

Montefiore’s Journey to Accountable Care

Sunset of NYS all‐payer hospital reimbursement

Affordable Care Act

Population Health Management

Managed Care Expansion

15

Montefiore’s Value‐Based Payment Arrangements 

Goal: To reach 1,000,000 covered lives

Source 2015 Population 2015 Est. Revenue($ millions)

Risk Contracts 220,000 $1,360

Shared Risk 165,000 $1,022

Medicaid Health Home (Care Coordination) 10,000 $18

Totals 395,000 $2,400

16

Institutional Keys to Success• A strong primary care network, supported by access to

specialty, ancillary and hospital care • The administrative, management and analytic capability to plan

budgets and resource needs and to support comprehensive, valid and reliable performance measurement

• Health information technology to manage patients across the continuum of care and across different institutional settings

• A physician management structure • A culture that supports and rewards continuous quality

improvement • A clear organizational mission and commitment to achieve

quality and cost efficiencies• Collaboration between payers and the provider organization

Network Keys to Success• Quality providers• Their understanding of the principles of VBP• A formal alignment on managing final risk• Willingness to examine their practice patterns

and make modifications as necessary• An MU-compliant EMR• Adherence to evidence-based protocols• The ability to practice in an environment that

emphasizes care coordination

12% Diabetes5% Dual Eligible8% Generate 55% of Medical Expense

Value‐Based Payment Begins with Robust Data Analytics  

19

Analytics alone do not identify underlying drivers of medical spend

• Unstable Housing

• Substance Abuse

• Mental Health

• Financial Distress

“Big Data” Is Not Enough

20

Social Determinants of Healthcare Costs

Based on results of over 4,000 assessments of high-risk patients conducted at Montefiore CMO21