Accountable Care Organizations, Bundled Payments and the Future of Health Care
The federal government is trying to reinvent the health care system through a variety of programs. One of them is the Accountable Care Organization program for Medicare. Another is a series of initiatives from the CMS Center for Innovation, including bundled payment initiatives. Commercial insurance companies have already deployed ACO-like approaches to contracting with their provider networks, stepping away from traditional fee-for-service payment and towards pay for performance. These changes in reimbursement will drive changes in care delivery systems, and physicians need to prepare themselves to be integrated into these new systems. This presentation examines the current landscape -- including the final ACO regs -- and future opportunities for providers. David Harlow consults to provider organizations on matters including physician-hospital collaboration, and has prepared successful demonstration project applications for CMS gainsharing (PHCD) and ACE demonstrations. He can educate your organization and facilitate the conversations that need to happen among hospitals, physicians and other providers in order to find a way forward together in a rapidly-changing health care environment. Engage David Harlow as a keynote speaker or consultant to your organization: http://healthblawg.com One recent review: '@healthblawg is so good I just tend to listen vs tweet' To access a webcast of this webinar with audio, go to: http://j.mp/tgvGBH.
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Accountable Care Organizations, Bundled Payments and the Future of Health Care
- 1. Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH THE HARLOW GROUP LLC blog • healthblawg.com October 27, 2011 twitter • @healthblawg
- 2. 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
- 3. We are challenged by shifting sands
- 4. High-performing health care providers can be integrated into high-performing health care systems
- 5. What are the federales trying to accomplish? The “Triple Aim” Better care Better health Lower costs
- 6. ACO: Getting more elegant
- 7. ACO is one tool to get providers to manage a population of patients
- 8. 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
- 10. 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
- 11. Proposed Rule versus Final Rule http://j.mp/ACOchart
- 12. Final ACO quality measures http://j.mp/ACOqualitymeasures
- 13. ACO regulations coordinate across numerous Federal agencies
- 14. All in all, ACO risk/reward ratio seems skewed
- 15. IT infrastructure cost estimate >$1.5m
- 16. More details from the ACO rules, and traps for the unwary
- 17. Rolling start dates due to lateness in finalizing rules
- 18. Over 60% of health care provider executives said earlier this year they intend to form an ACO
- 21. Even if an ACO is not in your immediate future, these principles will affect you Bundled Commercial Payments ACOs Pay for Other Performance Innovations
- 22. MSSP is just one arrow in the quiver •Medicare Shared Savings Program – “Traditional” ACO •Advance Payment Initiative •Pioneer ACO •Other CMS Innovation Center Initiatives
- 23. CMS Bundled Payment Initiative Bundled Payments ACO “lite” MS-DRG-specific Gainsharing . . . Bundled Payment Pilot - 2013
- 25. Commercial plans are non-standardized
- 26. 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
- 27. What can you do now to prepare for the future?
- 28. Physicians are central to the development of an accountable care organization
- 29. You cannot manage what you do not measure
- 30. Opportunity for all providers: Be the go-to (cost-effective) guys (or gals)
- 32. .
- 34. 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 david@harlowgroup.net