Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care...
Transcript of Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care...
![Page 1: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/1.jpg)
Accountable Care Organizations, Bundled Payments, and the
Future of Health Care
David Harlow JD MPHTHE HARLOW GROUP LLC
blog • healthblawg.comtwitter • @healthblawg October 27, 2011
![Page 2: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/2.jpg)
Interactive Housekeeping . . .
• Questions and comments– Webinar chat window– Livetweeting the webinar, and a real-time
tweetchat -- #ACOchat -- http://j.mp/ACOchat
• Links to all government ACO issuances from October 20 – http://j.mp/ACOfinal
![Page 3: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/3.jpg)
We are challenged by shifting sands
![Page 4: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/4.jpg)
High-performing health care providers can be integrated into
high-performing health care systems
![Page 5: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/5.jpg)
What are the federales trying to
accomplish?
The “Triple Aim”
Better careBetter health Lower costs
![Page 6: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/6.jpg)
ACO: Getting more elegant
![Page 7: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/7.jpg)
ACO is one tool to get providers to manage a population of
patients
![Page 8: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/8.jpg)
How? Financial incentives.
$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
BillingsDartmouth Everett Forsyth
GeisingerMarshfield
Middlesex Park Nicollet St. John's
Michigan
Yr 1 Yr 2
Yr 3 Yr 4
Yr 5
Graphic courtesy Jaan Sidorov, Disease Management Care Blog
![Page 9: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/9.jpg)
Whatisan
ACO?
![Page 10: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/10.jpg)
ACO BasicsSingle entityThree-year commitmentOne-way or two-way risk-sharingPCPs and broader network 5000 patient minimum
33 performance measuresPatient engagementPatient-centerednessStark/AKSIRSAntitrust
![Page 13: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/13.jpg)
ACO regulations coordinate
across numerous Federal
agencies
![Page 14: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/14.jpg)
All in all, ACO risk/reward ratio seems skewed
![Page 15: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/15.jpg)
IT infrastructure cost estimate >$1.5m
![Page 16: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/16.jpg)
More details from the ACO rules, and traps for the unwary
![Page 17: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/17.jpg)
Rolling start dates due to lateness in finalizing rules
![Page 18: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/18.jpg)
Over 60% of health care provider executives said earlier this year
they intend to form an ACO
![Page 19: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/19.jpg)
Culture of Collaboration
![Page 20: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/20.jpg)
Opportunities for physician-led ACOs
![Page 21: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/21.jpg)
Even if an ACO is not in your immediate future, these principles
will affect you
Bundled Payments
Commercial ACOs
Pay for Performance
Other Innovations
![Page 22: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/22.jpg)
MSSP is just one arrow in the quiver
•Medicare Shared Savings Program – “Traditional” ACO•Advance Payment Initiative•Pioneer ACO•Other CMS Innovation Center Initiatives
![Page 23: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/23.jpg)
CMS Bundled Payment Initiative
Bundled Payments
ACO “lite”MS-DRG-specificGainsharing
. . . Bundled Payment Pilot - 2013
![Page 24: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/24.jpg)
Care Coordination Initiatives
![Page 25: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/25.jpg)
Commercial plans are non-standardized
![Page 26: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/26.jpg)
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
![Page 27: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/27.jpg)
What can you do now to prepare for the future?
![Page 28: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/28.jpg)
Physicians are central to
the development
of an accountable
care organization
![Page 29: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/29.jpg)
You cannot manage what you do not measure
![Page 30: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/30.jpg)
Opportunity for all providers: Be the go-to (cost-effective) guys (or gals)
![Page 31: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/31.jpg)
![Page 32: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/32.jpg)
.
![Page 33: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/33.jpg)
![Page 34: Accountable Care Organizations, Bundled Payments, and the ...€¦ · Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH T HE H ARLOW](https://reader034.fdocuments.us/reader034/viewer/2022042612/5f5bb88ec605743a0b5301f0/html5/thumbnails/34.jpg)
for contact info txt dharlow to 50500or scan the QR code
harlowgroup.nethealthblawg.com
twitter.com/[email protected]
Thank You David Harlow JD MPHTHE HARLOW GROUP LLC