Post on 10-May-2015
Accountable Care OrganizationsThe Camel’s Nose Is In The Tent
David Harlow JD MPHTHE HARLOW GROUP
LLCblog • healthblawg.com
twitter • @healthblawg
November 8, 2012 Baton Rouge, LA
23rd AnnualLouisiana Society of Hospital Attorneys
Health Law Symposium
We are challenged by shifting sands
High-performing health care providers can be integrated into
high-performing health care systems
What are the federales trying to
accomplish?
The “Triple Aim”
Better careBetter health Lower costs
ACO: Getting more elegant?
ACO: Drop in the bucket?
ACO: Getting more elegant?
Value-Based Payment
ACO is one tool to get providers to manage a population of
patients
How? Financial incentives.
BillingsDartmouth
EverettForsyth
GeisingerMarshfield
MiddlesexPark Nicollet
St. John'sMichigan
$0
$2,000,000
$4,000,000
$6,000,000
$8,000,000
$10,000,000
$12,000,000
$14,000,000
$16,000,000
$18,000,000
Yr 1 Yr 2
Yr 3 Yr 4
Yr 5
Graphic courtesy Jaan Sidorov, Disease Management Care Blog
What is an
ACO?
ACO BasicsSingle entityThree-year commitmentOne-way or two-way risk-sharingPCPs and broader network 5000 patient minimum
33 performance measures Patient engagement Patient-centeredness Stark/AKS IRS Antitrust
ACO regulations coordinate
across numerous Federal
agencies
All in all, ACO risk/reward ratio seems skewed
IT infrastructure cost estimate >$1.5m
Success requires both:Conversion of health systemdata to actionable intelligence
Clinical Integration
&
More details from the ACO rules, and traps for the unwary
Over 60% of health care provider executives said they intend to form an ACO before the rules were out
Culture of Collaboration
Opportunities for physician-led ACOs
Even if an ACO is not in your immediate future, these principles
will affect you
Bundled Payments
Commercial ACOs
Pay for Performance
Other Innovations
Commercial plans are non-standardized
Jeff Goldsmith: Suggests 3 commercial ACO payment systems
for 3 different types of providers
•Risk-adjusted capitation
Primary
•Fee-for-service
Emergency
•Bundled payments
Specialty
MSSP is just one arrow in the quiver
•Medicare Shared Savings Program – “Traditional” ACO•Advance Payment Initiative•Pioneer ACO•Other CMS Innovation Center Initiatives
Bundled PaymentsComprehensive Primary Care InitiativeFinancial Alignment InitiativeFQHC Advanced Primary Practice DemoGraduate Nurse Education DemoHealth Care Innovation AwardsIndependence At Home DemoInitiative to Reduce Avoidable Hospitalizations Among Nursing Facility ResidentsInnovation Advisors ProgramMedicaid Emergency Psychiatric DemoMedicaid Incentives for the Prevention of Chronic DiseasesMillion HeartsPartnership for PatientsCommunity-based Care Transitions ProgramState Innovation Models InitiativeStrong Start for Mothers and NewbornsFor details, see: innovations.cms.gov/initiatives/
CMS Bundled Payment Initiative
Bundled Payments
ACO “lite”MS-DRG-specificGainsharing
. . . Bundled Payment Pilot - 2013
Medicare FFS Reimbursement
Discount incorporated
into target price
Potential shared savings
Actual cost of providing bundle of services
Bundled Payments
CMS payment
Care Coordination Initiatives
What can you do now to prepare for the future?
Physicians are central to
the development
of an accountable
care organization
You cannot manage what you do not measure
Opportunity for all providers: Be the go-to (cost-effective) guys (or gals)
.
for contact info txt dharlow to 50500or scan the QR code
harlowgroup.nethealthblawg.com
twitter.com/healthblawgdavid@harlowgroup.net
Thank YouDavid Harlow JD MPHTHE HARLOW GROUP
LLC