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Accountable Care Organizations, Bundled Payments and the Future of Health Care


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The federal government is trying to reinvent the health care system through a variety of programs. One of them is the Accountable Care Organization program for Medicare. Another is a series of initiatives from the CMS Center for Innovation, including bundled payment initiatives. Commercial insurance companies have already deployed ACO-like approaches to contracting with their provider networks, stepping away from traditional fee-for-service payment and towards pay for performance. These changes in reimbursement will drive changes in care delivery systems, and physicians need to prepare themselves to be integrated into these new systems. This presentation examines the current landscape -- including the final ACO regs -- and future opportunities for providers.

David Harlow consults to provider organizations on matters including physician-hospital collaboration, and has prepared successful demonstration project applications for CMS gainsharing (PHCD) and ACE demonstrations.

He can educate your organization and facilitate the conversations that need to happen among hospitals, physicians and other providers in order to find a way forward together in a rapidly-changing health care environment.

Engage David Harlow as a keynote speaker or consultant to your organization:

One recent review: '@healthblawg is so good I just tend to listen vs tweet'

To access a webcast of this webinar with audio, go to:

Published in: Health & Medicine, Business

Accountable Care Organizations, Bundled Payments and the Future of Health Care

  1. 1. Accountable Care Organizations, Bundled Payments, and the Future of Health Care David Harlow JD MPH THE HARLOW GROUP LLC blog • healthblawg.comOctober 27, 2011 twitter • @healthblawg
  2. 2. Interactive Housekeeping . . .• Questions and comments – Webinar chat window – Livetweeting the webinar, and a real-time tweetchat -- #ACOchat --• Links to all government ACO issuances from October 20 –
  3. 3. We are challenged by shifting sands
  4. 4. High-performing health care providers can be integrated intohigh-performing health care systems
  5. 5. What are thefederales trying to accomplish?The “Triple Aim” Better care Better health Lower costs
  6. 6. ACO: Getting more elegant
  7. 7. ACO is one tool to get providers to manage a population of patients
  8. 8. 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
  9. 9. What is anACO?
  10. 10. 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
  11. 11. Proposed Rule versus Final Rule
  12. 12. Final ACO quality measures
  13. 13. ACOregulationscoordinate across numerous Federal agencies
  14. 14. All in all, ACO risk/reward ratio seems skewed
  15. 15. IT infrastructure cost estimate >$1.5m
  16. 16. More details from the ACOrules, and traps for the unwary
  17. 17. Rolling start dates due to lateness in finalizing rules
  18. 18. Over 60% of health care providerexecutives said earlier this year they intend to form an ACO
  19. 19. Culture of Collaboration
  20. 20. Opportunities forphysician-led ACOs
  21. 21. Even if an ACO is not in yourimmediate future, these principles will affect you Bundled Commercial Payments ACOs Pay for Other Performance Innovations
  22. 22. MSSP is just one arrow in the quiver •Medicare Shared Savings Program – “Traditional” ACO •Advance Payment Initiative •Pioneer ACO •Other CMS Innovation Center Initiatives
  23. 23. CMS Bundled Payment Initiative BundledPayments ACO “lite” MS-DRG-specific Gainsharing . . . Bundled Payment Pilot - 2013
  24. 24. Care Coordination Initiatives
  25. 25. Commercial plans are non-standardized
  26. 26. Jeff Goldsmith: Suggests 3commercial ACO payment systems for 3 different types of providers Primary • Risk-adjusted capitation Emergency • Fee-for- service Specialty • Bundled payments
  27. 27. What can you do now to prepare for the future?
  28. 28. Physiciansare central to thedevelopment of anaccountable careorganization
  29. 29. You cannot manage what you do not measure
  30. 30. Opportunity for all providers: Be thego-to (cost-effective) guys (or gals)
  31. 31. .
  32. 32. David Harlow JD MPHThank You THE HARLOW GROUP LLC for contact info txt dharlow to 50500 or scan the QR code