Accountable Care Organizations - The Camel's Nose Is In the TentPresentation Transcript
Accountable Care Organizations The Camel’s Nose Is In The Tent David Harlow JD MPH THE HARLOW GROUP LLC 23rd AnnualLouisiana Society of Hospital Attorneys blog • healthblawg.com Health Law Symposium twitter • @healthblawg November 8, 2012 Baton Rouge, LA
We are challenged by shifting sands
High-performing health care providers can be integrated intohigh-performing health care systems
What are thefederales trying to accomplish?The “Triple Aim” Better care Better health Lower costs
ACO: Getting more elegant?
ACO: Drop in the bucket?
ACO: Getting more elegant?
ACO is one tool to get providers to manage a population of patients
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. Johns MichiganGraphic courtesy Jaan Sidorov, Disease Management Care Blog
Proposed Rule versus Final Rule http://j.mp/ACOchart
Final ACO quality measures http://j.mp/ACOqualitymeasures
ACOregulationscoordinate across numerous Federal agencies
All in all, ACO risk/reward ratio seems skewed
IT infrastructure cost estimate >$1.5m
Success requires both:Conversion ofhealth systemdata to actionableintelligence & Clinical Integration
More details from the ACOrules, and traps for the unwary
Over 60% of health care providerexecutives said they intend to forman ACO before the rules were out
Culture of Collaboration
Opportunities forphysician-led ACOs
Even if an ACO is not in yourimmediate future, these principles will affect you Bundled Commercial Payments ACOs Pay for Other Performance Innovations
Commercial plans are non-standardized
Jeff Goldsmith: Suggests 3commercial ACO payment systems for 3 different types of providers Primary • Risk-adjusted capitation Emergency • Fee-for- service Specialty • Bundled payments
Bundled Payments MSSP is just one arrow Comprehensive Primary Care Initiative Financial Alignment Initiative in the quiver FQHC Advanced Primary Practice Demo •Medicare Shared Savings Program Graduate Nurse Education Demo – “Traditional” ACO Health Care Innovation Awards Independence At Home Demo •Advance Payment Initiative Initiative to Reduce Avoidable •Pioneer ACO Hospitalizations Among Nursing •Other CMS Innovation Center Initiatives Facility Residents Innovation Advisors Program Medicaid Emergency Psychiatric Demo Medicaid Incentives for the Prevention of Chronic Diseases Million Hearts Partnership for PatientsCommunity-based Care Transitions Program State Innovation Models Initiative Strong Start for Mothers andFor details, see: innovations.cms.gov/initiatives/ Newborns