Accountable Care Organization – Improving Care & Reducing Cost

Accountable Care Organization – Improving Care & Reducing Cost
The Participation in an ACO is purely voluntary for both providers/suppliers and beneficiaries
Introduction:
ACOs create incentives for providers and suppliers to work together to treat an individual patient across care settings – including
doctor’s offices, hospitals, and long-term care facilities. The Medicare Shared Savings Program will reward ACOs that lower their
growth in health care costs while meeting performance standards on quality of care and putting patients first.
Definition:
ACO is a group of providers and suppliers that work together to coordinate care for the Medicare Fee-For-Service beneficiaries.
ACO is an organization of providers and suppliers that agrees to be held accountable for improving the health and experience of care
for individuals and improving the health of populations while reducing the rate of growth in health care spending.
Rationale:
Better care often costs less; coordinated care helps to ensure that the patient receives the right care at the right time, with the goal
of avoiding unnecessary duplication of services and preventing medical errors.
Goal:
Deliver seamless, high-quality care for Medicare beneficiaries, instead of the fragmented care that often results from a Fee-For-
Service payment system in which different providers receive different, disconnected payments. The ACO wil l be a patient-centered
organization where the patient and providers are true partners in care decisions
Objective:
1) Better care for individuals
2) Better health for populations
3) Lower growth in expenditure
Types of ACOs:
1) ACO Professionals in group practice arrangements
2) ACO Professionals in network practice arrangements
3) ACO Professionals in partnership/joint venture with hospitals
About HCX – Subsidiary of HEALTHEC
HCX subsidiary of HEALTHEC i s an industry leader in the 'convergence' of IT and consulting for the healthcare industry. We provide diversified
Information Technology (IT) and Business Process Outsourcing (BPO) s ervices.
To know more
Vi s it our website at http://www.hcxindia.net or send an email to info@hcx.com

4) ACO Professionals in employed by hospitals
5) Other Medicare providers & suppliers
Why do we need ACOs:
1) Better care for individuals
2) Better health for populations
3) Lower the expenditure
To know more

The above illustration states why Obama came up with Obama care and how this will bring considerable changes in their GDPs.
As on date with latest report (05/01/2014) we are the 3rd largest economy (we just went ahead of Japan – next to US and China)
need to give considerable thought at the earliest about our Healthcare industry – please keep in mind we hold 2nd highest
population in the world – few decades down the line if we don’t address we will ha ve bigger problem and issues in front of us and
will eat up major portion of nation’s GDP.
Our mantra to success should be Plan Ahead – act Ahead.
To know more

Methodology:
1) Form an ACO – Hospitals/Professionals/Practitioners - Suppliers
2) Establish a governing body – Providers-Suppliers-Beneficiaries
3) Apply to CMS with plans to Improve care and decrease growing costs:
- Evidence based medicine
- Beneficiary engagement
- Coordination of care
- Report on quality & cost
4) Accepted and Approved by CMS:
- Eligibility requirement: Provider services to a minimum of 5000 Medicare beneficiaries
- Program requirements: Agree to participate for a minimum of 3 years
5) Sign agreement with CMS
6) Choose one of the two programs
- One sided model: Shared savings program only (Lower share in savings – 50%)
Sharing savings, but not losses, for the entire term of the first agreement
- Shared savings and losses program (Higher share in savings – 60%)
Sharing both savings and losses for the entire term of the agreement
7) Enroll Beneficiaries
8) Provider services – Share the data/Self-Assessment/Monitoring/Reporting
9) Monitoring by CMS:
- Claims data analysis
- Financial data analysis
- Quality data analysis
- Beneficiary surveys
- Quarterly/Annual reports
- Audits
- Site visits
10) Timely feedback to providers for continual improvement of care to beneficiaries
11) Meet the bench mark of savings to be achieved: meets the program’s quality & performance standards
12) Receive a share of the savings on its assigned beneficiary expenditures are below its own specific updated expenditure
benchmark
13) Sharing losses by requiring ACOs to repay Medicare for a portion of losses (expenditures above its updated benchmark)
14) publicly report performance & quality data
Quality of Care – Domains:
1) Patient experience
2) Care coordination
3) Preventive health
4) At-risk population
To know more

Bench Mark:
Estimate of what the total Medicare Fee-For-Service Parts A and B expenditures for ACO beneficiaries would otherwise have been in
the absence of the ACO
Minimum Savings Rate:
The MSR is a percentage of the benchmark that ACO expenditure savings must meet or exceed in order for an ACO to qualify for
shared savings in any given year
Minimum Loss Rate:
The MLR is a percentage of the bench mark that an ACO with expenditures losses at or above the MLR will be accountable for
repaying shared losses
ACOs in the one-sided model that have smaller populations will have a larger MSR and ACOs with larger populations have a smaller
MSR
Conclusion:
If an ACO meets quality standards and achieves savings and also meets or exceeds the MSR, the ACO will share in savings, based on
the quality score of the ACO. ACOs will share in all savings, not just the amount of savings that exceeds the MSR, up to a
performance payment limit. Similarly, ACOs with expenditures meeting or exceeding the MLR will sha re in all losses, up to a loss
sharing limit.
Models:
1) Medicare Shared Savings Program
2) Advance Payment Initiative
3) Pioneer ACO Model
Applied ACO:
1) Organization: Members, Start date, Key contacts
2) Governance: Compliance plan, Clinical Management
3) Financial: Strategy on achieving goals, Methodology of sharing savings
4) Data sharing: Baseline
5) Clinical processes/Patient centeredness
To know more

Accountable Care Organization – Improving Care & Reducing Cost

Recommended

Recommended

More Related Content

What's hot

What's hot (18)

Viewers also liked

Viewers also liked (18)

Similar to Accountable Care Organization – Improving Care & Reducing Cost

Similar to Accountable Care Organization – Improving Care & Reducing Cost (20)

Recently uploaded

Recently uploaded (20)

Accountable Care Organization – Improving Care & Reducing Cost