A presentation from the Accountable Care Organization (ACO) Summit produced August 30, 2010, by Mission Health System.

1. Accountable Care Organization (ACO) Summit Marc B. Westle, D.O., FACP August 30, 2010

2. Where Are We?

3. There are 48 million Americans without health insurance.

4. Approximately 14,000 Americans are losing their health coverage daily, and many others are paying much more than they can afford.

5. What We Know Research indicates that for every 10% increase in health insurance premiums, the number of employers that offer health insurance falls by roughly 2.5%. This is simply not sustainable and will bankrupt the country. Nationally, health insurance premiums increased 65% between 2000 and 2004. 1 This increase was greater than general inflation (9.7%) and more than 5 times the wage growth (12.2%). 2 The healthcare cost share of the GDP rose rapidly from 16.2% in 2007 to 17.6% in 2009, largely as a result of the recession, and is expected to climb to $4.5 trillion in 2019 and 19.3% of our GDP. 3

6. Accountability

8. Agenda How did we get here? 1 How does “Accountable Care” differ from the “Capitated Care” of the 1990s? 2 Patient Protection and Affordable Care Act 3 Definition of an Accountable Care Organization 4 Components of an Accountable Care Organization 5 What does this mean for me? 6 Next Steps 7 Questions 8

11. How did we get here?

23. “ Coming Together”

27. “ The Changing Landscape”

30. How does “Accountable Care” differ from the “Capitated Care” of the 1990s?

34. Patient Protection and Affordable Care Act

36. Health Reform Implementation Timeline = Coverage Provisions = Transparency Provisions = Payment Constraint Provisions = Delivery System Provisions = Quality Provisions = Geographic Variation Provision Medicaid DSH Payment Reduction Medicaid Expansion CMS Hospital Behavioral Offset relating to IPPS Hospital Wage Index Independent Payment Advisory Board Hospital Readmission Payment Reductions Geographic Variation Bonus Bundled Payments Pilot Insurance Reforms (Pre-existing conditions for children, no annual or lifetime limits, children on parents’ insurance until 26) Hospital Market Basket Reductions Hospital Value-Based Purchasing Insurance Reforms (Pre-existing conditions for adults, premium limits) Hospital Productivity Adjustments Hospital-Acquired Infections Penalties Medicare DSH Payment Reduction Medical Device Tax Accountable Care Organizations Waste, Fraud, and Abuse Provisions for Medicare and Medicaid Individual Mandate Disclosure of Industry Payments to Physicians and Teaching Hospitals KEY 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

37. Definition of an Accountable Care Organization

39. Source: Healthcare Financial Management, August 2010

40. Source: Healthcare Financial Management, August 2010

41. Components of an Accountable Care Organization

44. The Vital Role of Technology

49. Choose Your Model and Build a High-Performance System of Care Source: Sg2 2010

50. Contractual Affiliation Model

51. Much more severe than the consequences of a False-Positive “ Let’s control our destiny together”

54. What does this mean for me?

57. Stay Engaged and Let’s Work Together

58. Next Steps

60. Source: Healthcare Financial Management, August 2010

62. It Takes a Team

72. Questions