Accountable Care Organizations           The Camel’s Nose Is In The Tent                                           David H...
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?
Value-Based Payment
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                                   ...
What is anACO?
ACO BasicsSingle entity                     33 performance measuresThree-year commitment             Patient engagementOne...
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                   &                        ...
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...
Commercial plans are  non-standardized
Jeff Goldsmith: Suggests 3commercial ACO payment systems for 3 different types of providers                   Primary     ...
Bundled Payments MSSP is just one arrow                              Comprehensive Primary Care                           ...
CMS Bundled Payment Initiative BundledPayments            ACO “lite”            MS-DRG-specific            Gainsharing    ...
BundledPayments                      Medicare FFS Reimbursement                            CMS paymentActual cost of provi...
Care Coordination Initiatives
What can you do now to prepare       for the future?
Physiciansare central to     thedevelopment    of anaccountable    careorganization
You cannot manage what you do         not measure
Opportunity for all providers: Be thego-to (cost-effective) guys (or gals)
.
David Harlow JD MPHThank You   THE HARLOW GROUP LLC                   for contact info                txt dharlow to 50500...
Accountable Care Organizations - The Camel's Nose Is In the Tent
Accountable Care Organizations - The Camel's Nose Is In the Tent
Upcoming SlideShare
Loading in …5
×

Accountable Care Organizations - The Camel's Nose Is In the Tent

4,427 views
4,214 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
4,427
On SlideShare
0
From Embeds
0
Number of Embeds
2,688
Actions
Shares
0
Downloads
6
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Accountable Care Organizations - The Camel's Nose Is In the Tent

  1. 1. 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
  2. 2. We are challenged by shifting sands
  3. 3. High-performing health care providers can be integrated intohigh-performing health care systems
  4. 4. What are thefederales trying to accomplish?The “Triple Aim” Better care Better health Lower costs
  5. 5. ACO: Getting more elegant?
  6. 6. ACO: Drop in the bucket?
  7. 7. ACO: Getting more elegant?
  8. 8. Value-Based Payment
  9. 9. ACO is one tool to get providers to manage a population of patients
  10. 10. 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
  11. 11. What is anACO?
  12. 12. ACO BasicsSingle entity 33 performance measuresThree-year commitment Patient engagementOne-way or two-way risk-sharing Patient-centerednessPCPs and broader network Stark/AKS5000 patient minimum IRS Antitrust
  13. 13. Proposed Rule versus Final Rule http://j.mp/ACOchart
  14. 14. Final ACO quality measures http://j.mp/ACOqualitymeasures
  15. 15. ACOregulationscoordinate across numerous Federal agencies
  16. 16. All in all, ACO risk/reward ratio seems skewed
  17. 17. IT infrastructure cost estimate >$1.5m
  18. 18. Success requires both:Conversion ofhealth systemdata to actionableintelligence & Clinical Integration
  19. 19. More details from the ACOrules, and traps for the unwary
  20. 20. Over 60% of health care providerexecutives said they intend to forman ACO before the rules were out
  21. 21. Culture of Collaboration
  22. 22. Opportunities forphysician-led ACOs
  23. 23. Even if an ACO is not in yourimmediate future, these principles will affect you Bundled Commercial Payments ACOs Pay for Other Performance Innovations
  24. 24. Commercial plans are non-standardized
  25. 25. Jeff Goldsmith: Suggests 3commercial ACO payment systems for 3 different types of providers Primary • Risk-adjusted capitation Emergency • Fee-for- service Specialty • Bundled payments
  26. 26. 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
  27. 27. CMS Bundled Payment Initiative BundledPayments ACO “lite” MS-DRG-specific Gainsharing . . . Bundled Payment Pilot - 2013
  28. 28. BundledPayments Medicare FFS Reimbursement CMS paymentActual cost of providing bundle of services Discount incorporated Potential shared savings into target price
  29. 29. Care Coordination Initiatives
  30. 30. What can you do now to prepare for the future?
  31. 31. Physiciansare central to thedevelopment of anaccountable careorganization
  32. 32. You cannot manage what you do not measure
  33. 33. Opportunity for all providers: Be thego-to (cost-effective) guys (or gals)
  34. 34. .
  35. 35. David Harlow JD MPHThank 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

×