1. Accountable Care OrganizationsShifting Gears
Presented by Jeff Squier
Executive Director NEWHVN
2. What is an ACO?
(Accountable Care Organization)

Provider-led organizations held accountable for cost and quality targets for a defined population 3. An alternative to the current fee-for-service payment system included in the Health Reform law 4. Can use different payment models and varying degrees of provider risk

Why Now? and What is Different
Why is integration and Risk Contracting Back on the Table?

Great Recession 5. Return of health care cost inflation 6. New evidence perverse cost/variation/quality relationship 7. Patient Protection and Accountable Care Act

What is Different This Time Around?
1990s
Today

Primary care capitation 8. Solo, small group physicians 9. No system of Care visibility 10. Clinton reform failed 11. Killed by an economic boom 12. Insurer-led HMOs 13. Slices and dices of risk 14. Better delivery system integration 15. Much better IT, information 16. Obama reform passed 17. Slow growth prospects 18. Provider-led ACOs

CARE = ClinicalAlignment and Resource Effectiveness; HMO = healthmaintenance organization
IT = information technology
Confidential and Proprietary 2010 Sg2
19. Why now?
Average spending on healthper capita ($US PPP)
Total expenditures on healthas percent of GDP
International Comparison of Spending on Health, 19802007
16%
$7,290
8%
$2,454
Note: $US PPP = purchasing power parity.
Source: Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).
20. Deaths per 100,000 population*
* Countries age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke, and bacterial infections.
See report Appendix B for list of all conditions considered amenable to health care in the analysis.
Data: E. Nolte and C. M. McKee, London School of Hygiene and Tropical Medicine analysis of World Health Organization mortality files (Nolte and McKee 2008).
Mortality Amenable to Health Care
HEALTHY LIVES
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008
21. A Seismic Shift in Thinking
The future value-based payment cycle will need reliability equal to the current revenue cycle
FFS World
Value-Based World
6

Access/ Continuity 22. Care Coordination 23. Comprehensive 24. Patient Self Mgmt 25. Etc.

Documentation
Guidelines
Protocols
Contract
Coding
Service
Statement
Service
Outcome
Bonus $$$
Bill
Quality Report
Cash $$$
Salary Plus Bonus
RVUs, Rev minus Exp
(Oblivious to quality, safety, etc.)
26. Physicians & Hospitals have a steep ambulatory care learning curve
Is an Emergency Hospital Admission a
Good Thing!?...
Fill a bed, take x-rays do a procedure
an Ambulatory Sentinel Event?
OR
$$$$$
7

Missed appointment? 27. Unable to get into clinic? 28. Failed to fill prescription? 29. Unable to get Rx refill? 30. PC / specialty miscommunication? 31. Patient misunderstanding 32. Failure to listen to patient? 33. Missed lab or xray report?

Copyright 2010 BDC Advisors
34. Shared Savings
Bundle payment
Medium Risk
Pay for Performance
Low Risk
Global Payment
High Risk
Transparency
Pay for coordination
No Risk
35. Existing ACO Pilots & Programs
36. What we know:
Payor Readiness
Government Payors / Other Initiatives
CommercialPayors
NEWHVNs ACO Opportunities
WI Payment Reform Initiative
Anthem BC.BS
UHC
CMS
Humana
WPS

NEWHVN selectedas ACO 37. Transition to Shared Savings

NEWHVN asked to participate in pay-4-performance program
Want to discuss ACO options through NEWHVN
Expand existing pay-4-performance plan

Shared savings 38. Center for Medicare & Medicaid Innovation (CMMI) 39. Partial capitation 40. Bundled payment -- Knee 41. Diabetesalternative care & payment model

10
42. ACO Challenges (to start!)
Leadership commitment
Adequate population size
Primary Care Base
Physician Leadership
IT integration
Care Management
Infrastructure to support
11
43. ACO Next Steps:

Learn and explore 44. Engage and educate 45. Discuss with your colleagues

Questions or Comments:
Contact me at
920.831.1918 (Fox Valley phone #)
920.445.7211 (Green Bay phone #)
Email jcsqui@bellin.org
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