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

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

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    Accountable Care Organizations - The Camel's Nose Is In the Tent Accountable Care Organizations - The Camel's Nose Is In the Tent Presentation 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?
    • 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 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
    • What is anACO?
    • 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
    • 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
    • CMS Bundled Payment Initiative BundledPayments ACO “lite” MS-DRG-specific Gainsharing . . . Bundled Payment Pilot - 2013
    • BundledPayments Medicare FFS Reimbursement CMS paymentActual cost of providing bundle of services Discount incorporated Potential shared savings into target price
    • 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 or scan the QR code harlowgroup.net healthblawg.com twitter.com/healthblawg david@harlowgroup.net