YOUR LOGO

Martin Pearson, President Troy Gautier, Managing Director

YOUR LOGOPage 2

Accountable Care Organizations (ACO) ACOs are the future of integrated collaborative Health Care solutions and provide the

best opportunity to improve services and reduce costs.

Alliances Progress and Revcon Alliances are professional consulting firms specialized in designing and implementing ACOs.

Our service offering provides the support and expertise to ensure successful delpoyment of your ACO and the quickest return on investment in the healthcare industry. Major workstreams include: Design – people, process, technology and lean operating models

Build – health care team, payer-provide relations, shared best practices

Optimize – assist physicians and adminsitrative staff to obtain & measure results

The following pages provide an overview of our approach and credentials. Managment consultants and business/technology process specialists

Alliance professionals with hundreds of projects building succesful ecosystems

HC IT speicalists to carry-out package selction and implement solutions

YOUR LOGOPage 3

ACO Presentation

History and Context

Legislation – Affordable Care Act

ACO Examples

How to build an ACO

Roles & Responsabilities

1

2

3

4

5RevCon Alliances and Alliances Progress

Next Steps

Contact Us

6

7

8

Index

YOUR LOGOPage 4

History - background for ACOs

Accountable Care Organizations

ACOs were created as a result of the Affordable Care Act (ACA) that was signed into law March 23, 2010.

CMS and the Congressional Budget Office agree the purpose of ACOs is to ensure quality service and reduce costs. Also, to ensure that the Medicare budget grows no faster than the rate of growth of the economy in general.

Hospital specific index of costs has historically grown at a rate double that of the consumer price index. This growth rate is unsustainable given the arrival of Baby Boomer patients in the coming years.

The ACA created a demonstration period that runs between 2012 and 2014. As of 12/31/2012 close to 200 ACOs have been established and this number is expected to double or triple by 2014.

Full implementation begins 2015 and runs to 2020 when it’s expected that virtually all Medicare payments to providers will flow through ACOs.

Better health care solutions are a moral and economic imperative !

YOUR LOGOPage 5

Context - for ACOs

Context

All ACOs have a common objective built around three core tenets:

1. Patient Satisfaction

2. Improved Outcomes

3. Affordability

An ACO’s success requires thinking about all collaboration of stakeholders and patient-centricty in a seamless care continuim.

ACOs can be considered a preferred procurement program where by Medicare only reimburses for services to its beneficiaries to providers adhearing to this program.

ACO design, build and optimization is greatly enhanced by the use of alliance professionals and consultants who understand how to make the complexities of advanced collaborative solutions work.

Better health care solutions are a moral and economic imperative !

YOUR LOGOPage 6

Legislation - Affordable Care Act (ACA)

Incentive Payments and Autorization

• Under the ACA, the Secretary of Health and Human Services established ACOs to promote best practices and funnel incentive payments to healthcare providers.

• Two ways to authorize an ACO:

1. Physician only with minimum of 5,000 Medicare enrollees where physicians own and control the network.

2. Hospital sponsorship as long as there is physician co-sponsorship with a minimum of 5,000 Medicare enrollees .

YOUR LOGOPage 7

ACO Requirements

ACA requirements to form an ACO under Medicare Shared Savings Program

• Define processes to promote the practice of evidence-based medicine and provide data to evaluate quality and cost measures.

• Build a management and leadership structure that includes administrative and clinical systems.

• Develop a formal legal structure that allows the organization to receive payments and distribute shared savings among participating providers.

• Have enough primary care providers to provide care to a minimum of 5,000 Medicare beneficiaries.

• Provide the Centers for Medicare & Medicaid Services with a list of participating primary care practitioners and specialists.

• Contract with a core group of specialist physicians.• Agree to participate in the program for a minimum of three years.

YOUR LOGOPage 8

ACO Examples in Georgia

Accountable Care Coalition of Greater Athens Georgia

The Coalition of Athens Area Physicians partnered with Collaborative Health Systems to form the ACC of Greater Athens Georgia, which is participating in the Medicare Shared Savings Program. The Coalition includes more than 230 independent physicians. Approximately 8,500 Medicare beneficiaries are covered by this ACO.

WellStar Health Network, LLC

Located in Marietta, Georgia, is comprised of partnerships between hospitals and ACO professionals, with 1,203 physicians. It will serve Medicare beneficiaries in Georgia.

Piedmont Physicians Group launched a pilot ACO with Cigna in July 2010. The ACO covers about 10,000 people in Cigna health plans. Under the pilot, Cigna pays the providers of Piedmont Physicians Group — which includes more than 100 primary care physicians — as usual for medical services, along with an additional fee for care coordination and medical home services. Physicians also get bonus payments if they meet targets for better quality and lower costs.

Piedmont Physicians Group

YOUR LOGOPage 9

Challenges to ACO Formation and Optimization

Capital Investment

Physician buy-in

Patient buy-in

Organizational Sharing

Strategies

ACO require significant up-front capital. The development of a strong IT framework alone requires a sizable capital investment. Access to capital may be challenging for some organizations but can be obtained.

• Some physicians may have concerns about relinquishing autonomy and may resist shared-payment arrangements. There is a cultural challenge to obtain agreement. Alliance professionals and facilitating consultants may be necessary at this stage.

Patients likely will be assigned to an ACO, but they also will be allowed to see providers outside of the ACO. ACOs will need to educate consumers about their role in reducing costs and improving quality.

ACOs require the coalescing of diverse provider groups to develop a new system of care with the aim of improving quality and reducing costs. The move from a “fee for service” to a “fee for outcome” system requires creative collaborative solutions: physician alignment is key.

Source: H&HN research 2011

YOUR LOGOPage 10

Design, Build and Optimize an ACO

• Create legal entity

• Assess capital strategy

• Conduct gap analysis

• Analyze market and assess ACO position

• Patient-centered processes

• Patients involved in own care and decision-making

• Primary care model refined

• Patient education

• Performance improvements

• Quality improvements

• Quality reporting

• Develop plan for physician integration

• Design strategic partnerships

• Structure comp for ACO-oriented culture

• Develop IT investment plan

• Design & implement EHR and HIE

• Real-time access of clinical data

Formalize & Funding

Formalize & Funding

Physician buy-in

Physician buy-in Patient buy-inPatient buy-in Shared EMRShared EMR Change MgmtChange Mgmt

Five crucial steps to implementing an ACO

YOUR LOGOPage 11

Stages of ACO Development – where are you today?

Wait and see – join an ACO at the 11th hour

Many organizations choosing to stay outside the process for ideological reasons will be sorry once the new Medicare juggernaut gets rolling. CMS encourages this group to find ways to connect to larger organizations.

Early Adapter – ACO has been launched

These organizations will have the funding, the physician support, the talented leadership to make decisions, and the confidence to move before theircompetitors. They will have first mover advantage.

These organizations will watch the first movers, save their own cash, and simply join by contract with what they perceive to be the dominant local ACO.

Join Up – Partner with an existing ACO

Next wave - ACO 2.0

In this approach regional competitor systems might come together with the blessing of the antitrust watchdogs to create large networks to serve regional populations more effectively..

YOUR LOGOPage 12

Roles and Responsibilities and Services Provided by Consultants

Patient centered primary care model

Patient education

Gather key decision-makers together

Agree to a governance model

Agree to operating principals

Establish a strong communications plan

Gain buy-in from key stakeholders

Provider Organizations

Executive leadership and oversight

Physician leadership and synergy developement

Drive and contract relationships with other service and technolgy providers

Prepare and facilitate meetings

Assist in implementation strategies

Operationalize decisions

Alliance professionals/consultants

Clinical managerment systems

Quality recording and reporting

Robust IT infastructure

Relations with governement entities

Relations with adminsitrative staff

Planning – short and long term

Formal reporting

Governance

Source: H&HN research 2011

YOUR LOGOPage 13

Alliances Progress and RevCon Alliances

Alliances Progress:•Experts in creative collaborative solutions and ecosystem development•20+ years in major global consultancy•Strong network of HC and IT providers

RevCon Alliances:•15+ year management level with high tech companies in the healchcare sector•Expertise in health IT, physician alignment and relationships with community providers along the continuum

YOUR LOGOPage 14

Troy J Gautier, Managing DirectorAlliances Progress1085 Richmond Glen CirAlpharetta, GA 30004Tel: 678-644-2533TroyGautier@AlliancesProgress.com

http://alliancesprogress.com/strategic-alliances/what-is-an-accountable-care-organization-aco/

Martin Pearson, CPA, PresidentRevCon Alliances2402 River Green Drive NWAtlanta, GA 30327O: 404-842-1215C: 404-374-9565martinp@revconalliances.comTwitter: revconallianceswebsite: www.revconalliances.com