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What's an ACO?
 

What's an ACO?

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Presented by David Parpart to Wellmark's Prebacked Ignition Startups 6/27/2013.

Presented by David Parpart to Wellmark's Prebacked Ignition Startups 6/27/2013.

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    What's an ACO? What's an ACO? Presentation Transcript

    •   Contact:     David  Parpart,  D.C.  ,  CEO     Socially  Relevant  Inc   408-­‐421-­‐9508     drparpart@impactmeds.com     What’s an ACO?
    •  Accountable  Healthcare  Pla9orm  for  Pa<ent  Engagement  Solu<ons   Pharmacist  Counseling  |  Mobile  Applica<ons  |  Remote  Monitoring     Drivers of Healthcare Reform Economics
    • Healthcare Reform Puts 6% of Hospital Revenue at Risk 2%  annual  payment   update  at  risk  by  FY2017   1%  DRG  payment   penalty  FY2013,  rising   to  3%  by  FY2015 1%  DRG  payment   penalty  for  hospitals  in   worst  quartile   beginning  FY2015 • Value-­‐based  Purchasing • Process  of  care • Patient  experience  Begins   FY2013 • 30-­‐Day  Readmissions • Up  to  8  conditions   targeted  including  AMI,  HF,   PNA   • Hospital-­‐Acquired   Conditions • Up  to  8  conditions   targeted  
    • ConfidenBal-­‐  Socially  Relevant  Inc.   What’s an ACO? ConfidenBal-­‐  Socially  Relevant  Technology  
    • ConfidenBal-­‐  Socially  Relevant  Inc.   ConfidenBal-­‐  Socially  Relevant  Technology   Al a Carte All Inclusive A Business Model Volume vs. Capitation
    •           IMAGE  SOURCE:  NEHI  Roadmap  to  Improving  MedicaBon  Adherence,  2012   SOURCE:  New  England  Health  InsBtute,  2012     Accountable  Care  OrganizaBon  (ACO)  
    • Accountable Care Organization (ACO) Risk and Reward Every Hospital has risk of loss/penalties   2/3 penalized in Oct 2012 Health Organizations APPLY to form an ACO   Assume risk   Gain NEW REVENUE OPPORTUNITY through Medicare Shared Saving Program ACO’s Need New Patient Engagement Strategies   Section H of the MSSP Application
    • ACO – Healthcare’s New Business Model Value Based Purchasing and Shared Savings Better Care Experience Lower Costs Better Population Health Metrics: Patient Experience Patient Activation Measures Metrics: Readmission Rate Total PMPM & Trend Metrics: HEDIS Cost Savings  New Revenues Capitated Payment
    • ACO – Healthcare’s New Business Model Example: Nephrology Better Care Experience Lower Costs Better Population Health Doctor/Pharmacist/Patient Collaboration $178M Reduction in Part A $ 23M Increase in Part D $155M net savings Cost Savings  New Revenues Capitated Payment $155M net savings X 60% = $90M
    • What is the Lowest Hanging Fruit for ACO Profitability? $700Bn $290Bn $30Bn •  Duplication of Services •  Fraud •  Poor Med Adherence •  Avoidable Hospitalizations ConfidenBal  Do  Not  Distribute