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ACOs: Core Features and Implications    for Care Delivery Charles DeShazer, MD
Overview ,[object Object],[object Object],[object Object],[object Object],[object Object]
What is an Accountable Care Organization (ACO)?
Genesis of the ACO Concept ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What is an Accountable Care Organization (ACO)? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Why is ACO formation being supported by the government?
US Healthcare System is in disarray ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Exhibit ES-1. Overall Ranking Note: * Estimate. Expenditures shown in $US PPP (purchasing power parity). Source: Calculated by The Commonwealth Fund based on 2007 International Health Policy Survey; 2008 International Health Policy Survey of Sicker Adults; 2009 International Health Policy Survey of Primary Care Physicians; Commonwealth Fund Commission on a High Performance Health System National Scorecard; and Organization for Economic Cooperation and Development,  OECD Health Data, 2009  (Paris: OECD, Nov. 2009).     AUS CAN GER NETH NZ UK US OVERALL RANKING (2010) 3 6 4 1 5 2 7 Quality Care 4 7 5 2 1 3 6 ,[object Object],2 7 6 3 5 1 4 ,[object Object],6 5 3 1 4 2 7 ,[object Object],4 5 7 2 1 3 6 ,[object Object],2 5 3 6 1 7 4 Access 6.5 5 3 1 4 2 6.5 ,[object Object],6 3.5 3.5 2 5 1 7 ,[object Object],6 7 2 1 3 4 5 Efficiency 2 6 5 3 4 1 7 Equity 4 5 3 1 6 2 7 Long, Healthy, Productive Lives 1 2 3 4 5 6 7 Health Expenditures/Capita, 2007 $3,357 $3,895 $3,588 $3,837* $2,454 $2,992 $7,290 Country Rankings 1.00–2.33 2.34–4.66 4.67–7.00
Exhibit 1. International Comparison of Spending on Health, 1980–2007 Note: $US PPP = purchasing power parity. Source: Organization for Economic Cooperation and Development,  OECD Health Data, 2009  (Paris: OECD, Nov. 2009). $7,290 $2,454 16% 8% Average spending on health per capita ($US PPP) Total expenditures on health as percent of GDP
Threefold variation in per capita spending Source: Peter Orszag, N Engl J Med, 2007
The lack of a relationship between quality and  Medicare spending, by state, 2004 Composite Measure of Quality of Care Source: Data from AHRQ and CMS.
Tweaking will not help… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Rationale for promoting the ACO model ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How are ACOs different in design and operation?
How is this Different from IDS Strategy of Late 1990’s? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Changing Hospital Incentives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Reimbursement Models and Delivery Structure Source: ACO Toolkit. Brookings-Dartmouth Collaborative 2011
Key Functions an ACO Must Perform ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Patient Attribution ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Shared savings: Overview ,[object Object],[object Object],[object Object],[object Object],[object Object]
Developing a Budget ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ACO and Payment Continuum Source: ACO Toolkit. Brookings-Dartmouth Collaborative 2011
Manage Payment Models and Incentives ,[object Object],[object Object],[object Object],[object Object],[object Object]
Performance Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Performance Reporting Highly Dependent on IT Infrastructure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Health Information Technology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What are the critical success factors for ACOs?
What are the Challenges to ACO Development ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ACO Critical Success Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How should providers evolve to or participate in ACOs?
ACO Considerations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Critical Success Factors for Primary Care Effectiveness in an ACO ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
In closing, Berwick comments… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object], “ Successful redesign of health care is a community by community task. That’s technically correct and it’s also morally correct, because in the end each local community  — and only each local community – actually has the knowledge and the skills to define what is locally right.”

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Accountable Care Organization (ACO) Tutorial

  • 1. ACOs: Core Features and Implications for Care Delivery Charles DeShazer, MD
  • 2.
  • 3. What is an Accountable Care Organization (ACO)?
  • 4.
  • 5.
  • 6. Why is ACO formation being supported by the government?
  • 7.
  • 8.
  • 9. Exhibit 1. International Comparison of Spending on Health, 1980–2007 Note: $US PPP = purchasing power parity. Source: Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009). $7,290 $2,454 16% 8% Average spending on health per capita ($US PPP) Total expenditures on health as percent of GDP
  • 10. Threefold variation in per capita spending Source: Peter Orszag, N Engl J Med, 2007
  • 11. The lack of a relationship between quality and Medicare spending, by state, 2004 Composite Measure of Quality of Care Source: Data from AHRQ and CMS.
  • 12.
  • 13.
  • 14. How are ACOs different in design and operation?
  • 15.
  • 16.  
  • 17.
  • 18. Reimbursement Models and Delivery Structure Source: ACO Toolkit. Brookings-Dartmouth Collaborative 2011
  • 19.
  • 20.
  • 21.
  • 22.
  • 23. ACO and Payment Continuum Source: ACO Toolkit. Brookings-Dartmouth Collaborative 2011
  • 24.
  • 25.
  • 26.
  • 27.
  • 28. What are the critical success factors for ACOs?
  • 29.
  • 30.
  • 31. How should providers evolve to or participate in ACOs?
  • 32.
  • 33.
  • 34.

Editor's Notes

  1. Key Topics: Organization and governance Accountability for performance IT Culture
  2. What is the problem the ACO is trying to solve?
  3. Patient Attribution Case Mix adjustment Budget development
  4. From Health Affairs blog, http://healthaffairs.org/blog/2010/09/14/berwick-brings-the-triple-aim-to-cms/