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Accountablecare Service Organization
- 1. Accountablecare Service Organization™Investingin the Future of Healthcare
- 2. Healthcare SpendingHealth spendingwill rise by 5.8% each year from 2010 to the end of 2020.
- 3. In 2020 healthcare will account for one-fifth of America’s economy.
- 4. The federal governmentwill pay for a greater share than ever before.Recent reform in the federal Medicare program changes the way health care is organized and paid for. What does it mean? The rules lay out a new path for doctors, hospitals and other providers of care to form teams called "accountable care organizations," which save money by better coordinating medical services for Medicare patients.
- 5. Under the rules,teams that treat patients for less money would be rewarded financially by the government if they also meet certain measures of quality.Recent reform in the federal Medicare program changes the way health care is organized and paid for. What are ACOs? A form of managed care that differs from health maintenance organizations (HMOs)
- 6. Run by doctorsor hospitals, rather than by insurance companies
- 7. To qualify asan ACO, doctors or hospitals must be able to provide primary care for at least 5,000 patientsAccountable Care OrganizationsWho will be affected? 45 million seniors will ultimately get their care this way
- 8. 5 million Medicarepatients will participate through 1000 ACOs that will be licensed on January 1, 2012How much money will be saved?Up to $960 million*during the first three years (65% of which goes to the ACOs!)How?Caregivers required to share medical records
- 9. Required to administerpreventive care
- 10. And required to"invest in keeping people healthy”* Source: U.S. Department of Health and Human Services
- 11. What are thequality standards?Patients' experiences in getting careThe extent to which care is coordinatedPatients' safetyThe degree of emphasis on preventive healthThe effectiveness in treating patients who are sick and frail
- 12. Accountablecare Service Organization™(ASO™)Anational service organization for Accountable Care Organizations (ACOs)
- 13. Establishing at least25 ACOs by January 1, 2012, and 75 more over the first half of 2012
- 14. At least adozen of these 5000-patient ACOs in the Los Angeles metro area ACO–IN–A–BOX™ASO provides 100% of the requirements needed for an ACO License.
- 15. While we willaccept direct fees for these services, we also provide our services for no upfront money in exchange for a 25% equity stake in the new ACO.
- 16. We then activelycoordinate with our ASO partners to offer Wellness programs that help the new ACO succeed in saving money and increasing quality.ASO Toolkit™Doctors, medical groups, medical associations and hospitals can utilize our services for everything they need to create a licensed ACO.
- 17. ASO Toolkit™Business ServicesCost-SavingsProgramsShared Marketing ServicesPartner Wellness Programs
- 18.
- 19. Business ServicesFormulates acustomized business plan
- 20. Uses state-of-the-art techniquesto make sound financial projections
- 21. Analyzes the fundamentalsfacing each emerging ACODarwin “Trey” Miller is an associate economist with the RAND CORPORATION and holds a Ph.D. in Economics from Stanford University. He is currently working on a chapter in a book for the Gates Foundation. Trey’s firm will build all of the business documents and provide all the analysis needed to place emerging ACO’s in the cross-hairs of the ACO Review committee.
- 22. Legal ServicesPrepares andfiles all necessary documents to establish ACOs
- 23. Distills federal regulationsand provides expert legal counsel
- 24. Prepares contracts betweenACOs and our service partnersRuss Frandsen is a 35-year veteran attorney who heads up the ASO legal team. He was Caltech MIT Enterprise Forum Committee Chair from 1998-2000 and again from 2003-2007. He sits on the Board of Directors for the Association for Corporate Growth.
- 25. Electronic Medical RecordsAdheresto federal government requirements
- 26. Allows patient tomonitor their own health care and that of their spouse
- 27. Motivates them tofollow up and stay involvedWoody Anderson was a director of insurance and health programs for the 241 hospitals in the Southern California Hospital Association working with physician groups as well as ancillary medical facilities and medical organizations. He is well-suited for the task of running the ASO.
- 28. ASO Toolkit™Business ServicesCost-SavingsProgramsShared Marketing ServicesPartner Wellness Programs
- 29.
- 30. Clinical TrialsOffer patientsa chance to receive new and innovative treatments that are not yet available to the general public
- 31. Offer hope toill patients while representing substantial savings to ACO participants
- 32. ACOs generate revenueby shifting costs to the clinical trial Over 112,667 trials with locations in 175 countries** Source: www.clinicaltrials.gov
- 33. Adult Stem CellClinical TrialsAdult stem cells – and their capacity to treat diseases – have become a driving force in the field of biotechnology.
- 34. Thanks to regeneratingmechanisms found in stem cell therapies, we can better address diseases, mental ailments, aging, and thousands of other health concerns.
- 35. Included in ourclinical trial program, we will screen patients to determine those with the highest projected healthcare costs and attempt to match them to clinical trials using stem cell therapy. Adult Stem Cell TreatmentDr. Stanley Jones, a Houston orthopedic surgeon, has been a staunch advocate for the healing properties of adult stem cells since last year, when he says he was effectively cured of his debilitating arthritis after being injected with his own stem cells in Japan.
- 36. Presidential frontrunner Gov.Rick Perry used our program recently to treat recurring back pain by implanting stem cells during surgery.
- 37. ASO president WoodyAnderson has had remarkable results with adult stem cell therapy to cure his fibromyalgia.Travel MedicineProvides patients the opportunity to receive high cost procedures in 141 countries.
- 38. Focuses on ethnicpatients, particularly immigrants.
- 39. For example, aKorean patient requiring a heart bypass has the opportunity to receive that procedure in Korea, where he or she may have relatives.
- 40. The ACO canpay for the service out-of-pocket at a savings of 50-60% and come out ahead under the Medicare Shared Savings Program. Generic Prescription ProgramThe average Medicare patient spends $3,741 per year on prescription drugs.
- 41. The ACO couldsave up to 60% or more per patient from switching these brand name prescriptions to generic alternatives.** Source: Haas, et. Al. 2005
- 42. Mail-Order Prescription Drugs40%of the prescribed drugs are not taken as physician directs, therefore the condition may worsen.
- 43. Our mail-order drugsystem minimizes prescription drug costs for ACO patients as well as enhances patient care.ASO Toolkit™Business ServicesCost-Savings ProgramsShared Marketing ServicesPartner Wellness Programs
- 44.
- 45. Medical FoodsOptimizes medicationdose level for patients
- 46.
- 47. Reducing the sideeffects associated with high dose pharmaceuticalsPractitioners and patients use this system to monitor all-important health indicators.
- 48. By using aWellness Index score, providers and patients alike can track health and prevent the onset of many chronic diseases.
- 49. This wellness technologyis cost effective, simple to implement, and proven effective. The ACO will offer a monthly pre-paid METRO PASS to each participant.
- 50. The Metro WellnessProgram will increase health and quality of life while reducing cost to the ACO.
- 51. Program will motivateseniors to stay interested in the world around them.
- 52. Partnered with theStanford School of Medicine, AgeLoc is the result of 27 years of nutraceutical research.
- 53. AgeLoc technology identifies,targets, and resets youth gene clusters, literally reversing the signs of aging.
- 54. AgeLoc improves thethree dimensions of vitality – physical vigor, mental acuity, and sexual health. AGELOC Senior Scientist Jia-Shi (Josh) Zhu, Ph.D., is also an adjunct professor in the Department of Applied Biology and Chemical Technology at Hong Kong Polytechnic University.
- 55. Pre-paid YMCA MembershipsAnational leader in physical fitness and community programs with over 2,600 facilities across the country offering physical, recreational, nutritional, and educational activities.
- 56. Patients who visittheir YMCA 12 times per month will have their gym membership paid for by the ACO.
- 57. These communities becomesocial gathering places for seniors, greatly enhancing both health and wellness.ASO Toolkit™Business ServicesCost-Savings ProgramsShared Marketing ServicesPartner Wellness Programs
- 58.
- 59. Targeted Marketing ApproachThemarketing platform will target ethnic communities in their native languages through media outlets such as Univision.
- 60. We will alsotarget our ACOs through local churches and other various community groups.
- 61. We will usehyper local ad campaigns on websites such as the local editions of Catholic Online.Each ACO starts with 5000 patients.
- 62. ASO provides eachACO with proven marketing programs to double their patient base to 10,000 within three years.The ACO model will incentivize doctors to reduce healthcare costs by cutting unnecessary services and by considering the costs of the services they provide.
- 63. The only wayto fill beds under such a scenario is to compete for patients.
- 64. Therefore a well-designedmarketing and PR campaign must be an integral component of any ACO.ASO partner organizations BannerCaswell Productions and Ethnic Media Marketing Inc. have a combined 35-year track record in health media. EMMI has implemented successful marketing campaigns for ethnic communities since the 80’s while the Banner brand has been in television since the 50’s, producing classic TV series such as Candid Camera and The Carol Burnett Show. In the 2000’s, BCP produced all the media for the eHealth Network.
- 66. ASO FoundersWoody Anderson– President & CEORuss Frandsen– General Legal CounselTrey Miller – EVP, Business & Policy StrategyEdmund Carlson – EVP, Non-profit & Gov’t RelationsDavid Gustafson – EVP, Hospital RelationsBen Caswell – EVP, Marketing & Bus. DevelopmentChuck Banner – EVP, Media and ProductionJessica Beavers – Manager of Operations
- 67. Board of DirectorsEdmundCarlson – ChairmanWoody AndersonRuss FrandsenTrey MillerDavid GustafsonBen CaswellChuck BannerJessica BeaversWilliam SchifferliThomas C. BlakeAl LieferKai Nigard_______________________________________
- 68. Advisory BoardsPHYSICIANWilliam E.Shell, MD – ChairmanWalter Jayasinghe, MD, MPHChris Wilmouthe, MDLou Acosta, MDErlindaDy Grey, MDFouad I. Ghaly, MDJorge Carreon, MDDr. MalinaKeith Mootoo, MDSteve Cohen, MDKen Kroll, MDJames P. Watson, MD, FACSJacob N. Flores, MDMarcel S. Filart, MDAndre Berger, MDBUSINESSAl Pirnia – ChairmanThomas R. Bradford, Esq.Lance MillerSteven PowersLloyd E. StollPaul S. HorvitzWilliam V. AlkhasianKing M. HuangFrank Wheaton, Esq.Chris DurkeeMaria TownsendKrystyna H. SlezakJenny YoonMartin Roy MervelRev. E. Dale Click
- 69. ASO History (2006– 2011)In 2006, Woody Anderson began developing an HMO strategy that incorporated a wellness program that focused on travel medicine and clinical trials – as a way to reduce the cost of American healthcare and increase the quality to the patient.
- 70. In 2008, heexpanded into the emerging field of Adult Stem Cell Therapy with RNL BIO.
- 71. In September 2009,Congress passed the H.R.3590 Patient Protection and Affordable Care Act, and Woody’s strategy shifted from HMO to ACO development in California.
- 72. In June, 2011,the strategy expanded nationally to cover existing ACOs under development as well as to establish new ACOs… and the ASO was formed.
Editor's Notes
- #3 Anew report, published in Health Affairs on July 28th, paints a daunting picture. Health spending will rise by 5.8% each year from 2010 to the end of 2020, according to actuaries at the Centres for Medicare and Medicaid Services (CMS). In 2020 health care will account for one-fifth of America’s economy. The federal government will pay for a greater share than ever before.http://www.economist.com/node/21524889
- #4 The Obama administration proposed much-anticipated rules Thursday to spur changes in the way that health care for older Americans is organized and paid for. Here are key details:1 What does it mean? The rules lay out a path for doctors, hospitals and other providers of care to form teams called "accountable care organizations," which, supporters say, would save money by better coordinating medical services for Medicare patients. Under the rules, teams that treat patients for less money would be rewarded financially by the government if they also meet certain measures of quality.2 What are ACOs? They are a form of managed care that differs from health maintenance organizations, which were widely unpopular. ACOs are run by doctors or hospitals, rather than by insurance companies. Some ACOs already have sprung up, but the federal law enacted a year ago to overhaul the nation's health care system tries to spur their development by weaving them into the large Medicare program. To qualify as an ACO, the rules say, the doctors or hospitals that run one must be able to provide primary care for at least 5,000 patients.3 Who would be affected? The Obama administration hopes many of the more than 45 million seniors and others who rely on Medicare will ultimately get their care this way; the administration's early estimates are that 1.5 million to 4 million people would participate by 2014. But it remains unclear how many doctors will sign up to start ACO's next year.4 How much would be saved? Health and Human Services officials predicted Thursday that the Medicare ACOs will save the financially strained program $510 million to $960 million during the first three years after they go into effect next January.5 What do patients have to do? Unlike in Medicare Advantage, the managed-care part of Medicare, patients will not sign up for an accountable care organization. Instead, they will be assigned to one after the fact if their primary doctor belongs to it. The rules call for patients to be told whether their main doctors belong to an ACO.6 What do critics say? Some doctors fear that the new approach will unfairly give the advantage to larger systems that can afford the computerized databases and other resources needed to coordinate care with hospitals and specialists. Critics have worried that the arrangements could become large health-care monopolies that could suppress competition for patients and, as a result, drive up costs.7 What do supporters say? Donald Berwick, a Health and Human Services administrator, said ACOs would help unite what has been fragmented care for older patients who have several chronic medical problems, which sometimes are treated by doctors who do not communicate with one another. He said ACOs encourage doctors, hospitals, nurses and other care-givers to share medical records, emphasize preventive care and "invest in keeping people healthy.”8 How do the rules help new ACOs? Unlike well-developed ACOs, newer organizations will be shielded from any downside risk for the first two years.9 How will quality be assessed? The 65 standards by which an ACO's quality will be judged fall into five areas. They are patients' experiences in getting care; the extent to which care is coordinated; patients' safety; the degree of emphasis on preventive health; and the effectiveness in treating patients who are sick and frail. Other rules are intended to prevent doctors or other care providers that band together from violating antitrust laws.
- #5 The Obama administration proposed much-anticipated rules Thursday to spur changes in the way that health care for older Americans is organized and paid for. Here are key details:1 What does it mean? The rules lay out a path for doctors, hospitals and other providers of care to form teams called "accountable care organizations," which, supporters say, would save money by better coordinating medical services for Medicare patients. Under the rules, teams that treat patients for less money would be rewarded financially by the government if they also meet certain measures of quality.2 What are ACOs? They are a form of managed care that differs from health maintenance organizations, which were widely unpopular. ACOs are run by doctors or hospitals, rather than by insurance companies. Some ACOs already have sprung up, but the federal law enacted a year ago to overhaul the nation's health care system tries to spur their development by weaving them into the large Medicare program. To qualify as an ACO, the rules say, the doctors or hospitals that run one must be able to provide primary care for at least 5,000 patients.3 Who would be affected? The Obama administration hopes many of the more than 45 million seniors and others who rely on Medicare will ultimately get their care this way; the administration's early estimates are that 1.5 million to 4 million people would participate by 2014. But it remains unclear how many doctors will sign up to start ACO's next year.4 How much would be saved? Health and Human Services officials predicted Thursday that the Medicare ACOs will save the financially strained program $510 million to $960 million during the first three years after they go into effect next January.5 What do patients have to do? Unlike in Medicare Advantage, the managed-care part of Medicare, patients will not sign up for an accountable care organization. Instead, they will be assigned to one after the fact if their primary doctor belongs to it. The rules call for patients to be told whether their main doctors belong to an ACO.6 What do critics say? Some doctors fear that the new approach will unfairly give the advantage to larger systems that can afford the computerized databases and other resources needed to coordinate care with hospitals and specialists. Critics have worried that the arrangements could become large health-care monopolies that could suppress competition for patients and, as a result, drive up costs.7 What do supporters say? Donald Berwick, a Health and Human Services administrator, said ACOs would help unite what has been fragmented care for older patients who have several chronic medical problems, which sometimes are treated by doctors who do not communicate with one another. He said ACOs encourage doctors, hospitals, nurses and other care-givers to share medical records, emphasize preventive care and "invest in keeping people healthy.”8 How do the rules help new ACOs? Unlike well-developed ACOs, newer organizations will be shielded from any downside risk for the first two years.9 How will quality be assessed? The 65 standards by which an ACO's quality will be judged fall into five areas. They are patients' experiences in getting care; the extent to which care is coordinated; patients' safety; the degree of emphasis on preventive health; and the effectiveness in treating patients who are sick and frail. Other rules are intended to prevent doctors or other care providers that band together from violating antitrust laws.
- #6 Major U.S. health insurers, including Aetna Inc., Humana Inc. and WellPoint Inc., are retooling to become more than just health plans, in the wake of the federal health-care overhaul that is changing the rules for the industry’s core business.Diversification plans, touted in meetings with investors this year, include stepped up acquisitions and partnerships that will allow the companies to employ doctors directly, deliver health-information technologies, and participate in new hospital-doctor groups known as accountable-care organizations.Wall Street Journal; May 12, 2011
- #13 SET-UP SERVICES
- #28 Natural HealthlinkA study published in the Journal of the American Pharmaceutical Association found that 21.3% of community-dwelling patients 65 years or older were using at least one drug inappropriately prescribed. Moreover, many of these drugs have side effects or interactions. Natural Healthlink is a program to help patients reduce their reliance on prescription drugs. The program ensures that the drugs patients are taking are necessary, and helps patients shift towards natural alternatives wherever possible.
- #30 NuSkin - AgeLocPartnered with the Stanford School of Medicine, Nu Skin's product line, AgeLoc, is an anti-aging product platform and the outcome of 27 years of nutriceutical research. AgeLoc technology identifies, targets, and resets youth gene clusters containing multiple genes, literally reversing the signs of aging. The unique aspect of AgeLoc is that it identifies the sources, our genes, and through the introduction of nutriceutical formulas, changes the activity level of targeted genes.Doctors will benefit from offering NuSkin’s products because it represents a cash sale. The benefits of receiving income from channels that need little or no day to day attention is what large wealth is based on. The doctor can reasonably expect to recoup his investment and start turning a profit well within the first year. NuSkin creates a revenue stream independent of mandated reimbursements rates.
- #31 YMCAResearch at the National Cancer Institute suggests that daily exercise and social interaction are both shown to decrease the risk of deadly and costly diseases like diabetes, heart disease, and cancer. YMCA is national leader in physical fitness and community programs with over 2,600 facilities offering physical, recreational, nutritional, and educational activities, many of which are targeted at the health and wellness of seniors. YMCA also offers programs, such as, free yoga, cycling, Zumba, Tai-Chi, Qi-Gong as well as aquatic exercise programs that focus on wellness or keeping seniors active in spirit, mind, and body. YMCAs also provide a social gathering place for seniors, as well as social programs, camping trips, special events, presentations, and personal assistance, such as, legal assistance and health counseling.YMCA has agreed to offer its corporate discount rate of $45/month per patient to each of our ACOs. Patients who visit their YMCA 12 times per month will have their gym membership paid for by the ACO. ACOS will not be liable for gym dues when patients who enroll in the program do not visit 12 times per month. The patient who does not meet the required amount will be ineligible for the program in subsequent months unless they re-apply.
- #33 MARKETING