Accountable Care Organizations - The Camel's Nose Is In the Tent
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Accountable Care Organizations (ACOs) are a tool promoted by the Centers for Medicare and Medicaid Services to help achieve the "Triple Aim" of better care, better health, and lower costs. ACOs integrate high-performing healthcare providers into coordinated systems using financial incentives to encourage population health management. While the goals of ACOs are to improve quality and lower costs, setting them up requires significant investments in care coordination infrastructure and overcoming cultural barriers. Physicians will be central to developing successful ACO models. Overall, ACOs are one part of various bundled payment and value-based initiatives aimed at shifting to alternative payment models.
Accountable Care Organizations - The Camel's Nose Is In the Tent
- 1. Accountable Care Organizations The Camel’s Nose Is In The Tent David Harlow JD MPH THE HARLOW GROUP LLC 23rd Annual Louisiana Society of Hospital Attorneys blog • healthblawg.com Health Law Symposium twitter • @healthblawg November 8, 2012 Baton Rouge, LA
- 2. We are challenged by shifting sands
- 3. High-performing health care providers can be integrated into high-performing health care systems
- 4. What are the federales trying to accomplish? The “Triple Aim” Better care Better health Lower costs
- 5. ACO: Getting more elegant?
- 6. ACO: Drop in the bucket?
- 7. ACO: Getting more elegant?
- 9. ACO is one tool to get providers to manage a population of patients
- 10. How? Financial incentives. $18,000,000 $16,000,000 $14,000,000 Yr 1 Yr 2 $12,000,000 Yr 3 Yr 4 $10,000,000 Yr 5 $8,000,000 $6,000,000 $4,000,000 $2,000,000 $0 Billings Dartmouth Everett Forsyth Geisinger Marshfield Middlesex Park Nicollet St. John's Michigan Graphic courtesy Jaan Sidorov, Disease Management Care Blog
- 11. What is an ACO?
- 12. ACO Basics Single entity 33 performance measures Three-year commitment Patient engagement One-way or two-way risk-sharing Patient-centeredness PCPs and broader network Stark/AKS 5000 patient minimum IRS Antitrust
- 13. Proposed Rule versus Final Rule http://j.mp/ACOchart
- 14. Final ACO quality measures http://j.mp/ACOqualitymeasures
- 15. ACO regulations coordinate across numerous Federal agencies
- 16. All in all, ACO risk/reward ratio seems skewed
- 17. IT infrastructure cost estimate >$1.5m
- 18. Success requires both: Conversion of health system data to actionable intelligence & Clinical Integration
- 19. More details from the ACO rules, and traps for the unwary
- 20. Over 60% of health care provider executives said they intend to form an ACO before the rules were out
- 23. Even if an ACO is not in your immediate future, these principles will affect you Bundled Commercial Payments ACOs Pay for Other Performance Innovations
- 24. Commercial plans are non-standardized
- 25. Jeff Goldsmith: Suggests 3 commercial ACO payment systems for 3 different types of providers Primary • Risk-adjusted capitation Emergency • Fee-for- service Specialty • Bundled payments
- 26. Bundled Payments MSSP is just one arrow Comprehensive Primary Care Initiative Financial Alignment Initiative in the quiver FQHC Advanced Primary Practice Demo •Medicare Shared Savings Program Graduate Nurse Education Demo – “Traditional” ACO Health Care Innovation Awards Independence At Home Demo •Advance Payment Initiative Initiative to Reduce Avoidable •Pioneer ACO Hospitalizations Among Nursing •Other CMS Innovation Center Initiatives Facility Residents Innovation Advisors Program Medicaid Emergency Psychiatric Demo Medicaid Incentives for the Prevention of Chronic Diseases Million Hearts Partnership for PatientsCommunity-based Care Transitions Program State Innovation Models Initiative Strong Start for Mothers and For details, see: innovations.cms.gov/initiatives/ Newborns
- 27. CMS Bundled Payment Initiative Bundled Payments ACO “lite” MS-DRG-specific Gainsharing . . . Bundled Payment Pilot - 2013
- 28. Bundled Payments Medicare FFS Reimbursement CMS payment Actual cost of providing bundle of services Discount incorporated Potential shared savings into target price
- 30. What can you do now to prepare for the future?
- 31. Physicians are central to the development of an accountable care organization
- 32. You cannot manage what you do not measure
- 33. Opportunity for all providers: Be the go-to (cost-effective) guys (or gals)
- 35. .
- 37. David Harlow JD MPH Thank You THE HARLOW GROUP LLC for contact info txt dharlow to 50500 or scan the QR code harlowgroup.net healthblawg.com twitter.com/healthblawg [email protected]