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Aco blended narr1
Aco blended narr1
Aco blended narr1
Aco blended narr1
Aco blended narr1
Aco blended narr1
Aco blended narr1
Aco blended narr1
Aco blended narr1
Aco blended narr1
Aco blended narr1
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  • 1. Accountable Care Organizations“Shifting Gears”<br />Presented by Jeff Squier<br />Executive Director NEWHVN<br />
  • 2. What is an “ACO”?<br />(Accountable Care Organization)<br /><ul><li>Provider-led organizations held accountable for cost and quality targets for a defined population
  • 3. An alternative to the current fee-for-service payment system included in the Health Reform law
  • 4. Can use different payment models and varying degrees of provider risk</li></li></ul><li>“Why Now?” and What is Different<br />Why is integration and Risk Contracting Back on the Table?<br /><ul><li> “Great Recession”
  • 5. Return of health care cost inflation
  • 6. New evidence – perverse cost/variation/quality relationship
  • 7. Patient Protection and Accountable Care Act </li></ul>What is Different This Time Around?<br />1990s<br />Today<br /><ul><li>Primary care capitation
  • 8. Solo, small group physicians
  • 9. No system of Care visibility
  • 10. Clinton reform failed
  • 11. Killed by an economic boom
  • 12. Insurer-led HMOs
  • 13. Slices and dices of risk
  • 14. Better delivery system integration
  • 15. Much better IT, information
  • 16. Obama reform passed
  • 17. Slow growth prospects
  • 18. Provider-led ACOs</li></ul>CARE = Clinical Alignment and Resource Effectiveness; HMO = health maintenance organization<br />IT = information technology<br />Confidential and Proprietary 2010 Sg2<br />
  • 19. Why now?<br />Average spending on healthper capita ($US PPP)<br />Total expenditures on healthas percent of GDP<br />International Comparison of Spending on Health, 1980–2007<br />16%<br />$7,290<br />8%<br />$2,454<br />Note: $US PPP = purchasing power parity.<br />Source: Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).<br />
  • 20. Deaths per 100,000 population*<br />* Countries’ age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke, and bacterial infections.<br />See report Appendix B for list of all conditions considered amenable to health care in the analysis.<br />Data: E. Nolte and C. M. McKee, London School of Hygiene and Tropical Medicine analysis of World Health Organization mortality files (Nolte and McKee 2008).<br />Mortality Amenable to Health Care<br />HEALTHY LIVES<br />Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008<br />
  • 21. A Seismic Shift in Thinking<br />The future “value-based payment cycle” will need reliability equal to the current revenue cycle<br />FFS World<br />Value-Based World<br />6<br /><ul><li> Access/ Continuity
  • 22. Care Coordination
  • 23. Comprehensive
  • 24. Patient Self Mgmt
  • 25. Etc.</li></ul>Documentation<br />Guidelines<br />Protocols<br />Contract<br />Coding<br />Service<br />Statement<br />Service<br />Outcome<br />Bonus $$$<br />Bill<br />Quality Report<br />Cash $$$<br />Salary Plus Bonus<br />RVUs, Rev minus Exp<br />(Oblivious to quality, safety, etc.)<br />
  • 26. Physicians &amp; Hospitals have a steep ambulatory care learning curve<br />Is an Emergency Hospital Admission a…<br />Good Thing!?... <br />Fill a bed, take x-rays do a procedure<br />…an Ambulatory Sentinel Event? <br />OR<br />$$$$$<br />7<br /><ul><li> Missed appointment?
  • 27. Unable to get into clinic?
  • 28. Failed to fill prescription?
  • 29. Unable to get Rx refill?
  • 30. PC / specialty miscommunication?
  • 31. Patient misunderstanding
  • 32. Failure to listen to patient?
  • 33. Missed lab or xray report?</li></ul>Copyright 2010 – BDC Advisors <br />
  • 34. Shared Savings<br />Bundle payment<br />“Medium Risk”<br />Pay for Performance<br />“Low Risk”<br />Global Payment<br />“High Risk”<br />Transparency<br />Pay for coordination<br />“No Risk”<br />
  • 35. Existing ACO Pilots &amp; Programs<br />
  • 36. What we know: <br />Payor Readiness<br />Government Payors / Other Initiatives<br />CommercialPayors<br />NEWHVN’s ACO Opportunities <br />WI Payment Reform Initiative<br />Anthem BC.BS<br />UHC<br />CMS<br />Humana<br />WPS<br /><ul><li>NEWHVN selected as ACO
  • 37. Transition to Shared Savings</li></ul>NEWHVN asked to participate in pay-4-performance program<br />Want to discuss ACO options through NEWHVN<br />Expand existing pay-4-performance plan<br /><ul><li>Shared savings
  • 38. Center for Medicare &amp; Medicaid Innovation (CMMI)
  • 39. Partial capitation
  • 40. Bundled payment -- Knee
  • 41. Diabetes alternative care &amp; payment model</li></ul>10<br />
  • 42. ACO Challenges (to start!)<br />Leadership commitment<br />Adequate population size<br />Primary Care Base<br />Physician Leadership<br />IT integration<br />Care Management<br />Infrastructure to support<br />11<br />
  • 43. ACO Next Steps:<br /><ul><li> Learn and explore
  • 44. Engage and educate
  • 45. Discuss with your colleagues</li></ul>Questions or Comments:<br />Contact me at <br />920.831.1918 (Fox Valley phone #)<br />920.445.7211 (Green Bay phone #)<br />Email –<br />M:D-NEWHVNLibraryPresentationsNEWHVN presentationsACOTalkACOBlended.pptx<br />