The document provides an overview of accountable care organizations (ACOs) including:
1) ACOs aim to tie provider reimbursements to quality and reduce total cost of care for assigned patients.
2) Key stakeholders include providers, payers (primarily Medicare), and patients (primarily Medicare beneficiaries).
3) The concept of ACOs originated in 2006 but builds on prior models. Successful implementation remains challenging.
4) The Patient Protection and Affordable Care Act supports the development of ACOs and other innovative models.
Este documento presenta un resumen de los conceptos y estrategias clave de la terapia estratégica. La terapia estratégica se centra en influir directamente en los clientes para producir cambios y utiliza técnicas como reestructuración, paradojas y directivas. La primera entrevista incluye etapas como la definición del problema, interacción y establecimiento de objetivos de cambio. El enfoque estratégico utiliza metáforas y anécdotas para comunicar mensajes de forma indirecta.
Como superar a timidez: 20 dicas práticasGloria Tellez
O documento fornece 20 dicas para superar a timidez, incluindo identificar situações que causam medo, avaliar pensamentos limitantes, estabelecer metas comportamentais pequenas, imaginar cenas extrovertidas e procurar ajuda profissional caso necessário.
Dokumen tersebut membahas tentang perencanaan dan pengelolaan transportasi jarak pendek untuk logistik rantai pasokan. Secara khusus membahas masalah pengaturan rute kendaraan (vehicle routing problem) dengan mempertimbangkan kapasitas kendaraan dan batasan waktu pengiriman ke pelanggan. Metode yang dijelaskan adalah clustering terlebih dahulu untuk membentuk kelompok pelanggan, kemudian merencanakan rute kendaraan untuk setiap kelomp
Uma psicoterapia amparada pelos conhecimentos oferecidos pela teoria do apego, ou também conhecida como teoria da vinculação, provê oferta de tratamento em sintonia com o que há de consistência em termos de pesquisa e compreensão de casos mais graves. Em busca da melhor psicoterapia possível, os terapeutas reconhecem a relevância da desregulação emocional como parte fundamental para o tratamento de pacientes com queixas mais difusas e complexas, em vez de alguma dificuldade traumática específica.
O documento discute os sinais de dependência química e fornece perguntas para ajudar o leitor a avaliar se ele é um adicto ou não. O texto explica que apenas o leitor pode responder a esta pergunta e encoraja a responder honestamente às perguntas para entender como o uso de drogas afetou sua vida. O documento conclui que a recuperação requer admitir que se tem um problema com drogas e colocar a recuperação em primeiro lugar.
1) O documento discute teorias e técnicas de psicoterapia para transtornos dissociativos, incluindo teorias sobre a personalidade, origem das partes do self e modelos explicativos.
2) Também aborda como diagnosticar transtornos dissociativos de acordo com os manuais CID-10 e DSM-V.
3) Fornece detalhes sobre transtornos dissociativos específicos como transtorno dissociativo de identidade, amnésia dissociativa e transtorno de despersonalização/
The document discusses ant colony optimization (ACO) algorithms. It introduces ACO as a probabilistic metaheuristic technique inspired by the behavior of ants seeking paths between their colony and food sources. It outlines the ACO metaheuristic and describes key ACO algorithms like Ant System, Ant Colony System, and MAX-MIN Ant System. The document also covers applications of ACO, advantages like inherent parallelism and efficient solutions to problems like the traveling salesman problem, and disadvantages like difficulty analyzing ACO theoretically.
This document lists design attributes that can be analyzed such as color palette, line quality, form, geometry, texture, organization, material, dimensionality, and relationship of unit to whole. It provides example images to demonstrate these attributes.
Este documento presenta un resumen de los conceptos y estrategias clave de la terapia estratégica. La terapia estratégica se centra en influir directamente en los clientes para producir cambios y utiliza técnicas como reestructuración, paradojas y directivas. La primera entrevista incluye etapas como la definición del problema, interacción y establecimiento de objetivos de cambio. El enfoque estratégico utiliza metáforas y anécdotas para comunicar mensajes de forma indirecta.
Como superar a timidez: 20 dicas práticasGloria Tellez
O documento fornece 20 dicas para superar a timidez, incluindo identificar situações que causam medo, avaliar pensamentos limitantes, estabelecer metas comportamentais pequenas, imaginar cenas extrovertidas e procurar ajuda profissional caso necessário.
Dokumen tersebut membahas tentang perencanaan dan pengelolaan transportasi jarak pendek untuk logistik rantai pasokan. Secara khusus membahas masalah pengaturan rute kendaraan (vehicle routing problem) dengan mempertimbangkan kapasitas kendaraan dan batasan waktu pengiriman ke pelanggan. Metode yang dijelaskan adalah clustering terlebih dahulu untuk membentuk kelompok pelanggan, kemudian merencanakan rute kendaraan untuk setiap kelomp
Uma psicoterapia amparada pelos conhecimentos oferecidos pela teoria do apego, ou também conhecida como teoria da vinculação, provê oferta de tratamento em sintonia com o que há de consistência em termos de pesquisa e compreensão de casos mais graves. Em busca da melhor psicoterapia possível, os terapeutas reconhecem a relevância da desregulação emocional como parte fundamental para o tratamento de pacientes com queixas mais difusas e complexas, em vez de alguma dificuldade traumática específica.
O documento discute os sinais de dependência química e fornece perguntas para ajudar o leitor a avaliar se ele é um adicto ou não. O texto explica que apenas o leitor pode responder a esta pergunta e encoraja a responder honestamente às perguntas para entender como o uso de drogas afetou sua vida. O documento conclui que a recuperação requer admitir que se tem um problema com drogas e colocar a recuperação em primeiro lugar.
1) O documento discute teorias e técnicas de psicoterapia para transtornos dissociativos, incluindo teorias sobre a personalidade, origem das partes do self e modelos explicativos.
2) Também aborda como diagnosticar transtornos dissociativos de acordo com os manuais CID-10 e DSM-V.
3) Fornece detalhes sobre transtornos dissociativos específicos como transtorno dissociativo de identidade, amnésia dissociativa e transtorno de despersonalização/
The document discusses ant colony optimization (ACO) algorithms. It introduces ACO as a probabilistic metaheuristic technique inspired by the behavior of ants seeking paths between their colony and food sources. It outlines the ACO metaheuristic and describes key ACO algorithms like Ant System, Ant Colony System, and MAX-MIN Ant System. The document also covers applications of ACO, advantages like inherent parallelism and efficient solutions to problems like the traveling salesman problem, and disadvantages like difficulty analyzing ACO theoretically.
This document lists design attributes that can be analyzed such as color palette, line quality, form, geometry, texture, organization, material, dimensionality, and relationship of unit to whole. It provides example images to demonstrate these attributes.
This document provides an overview of health insurance. It defines health insurance as insurance that covers medical and surgical expenses. It explains why health insurance is needed to protect against high, unexpected medical costs and make quality treatment affordable. It then describes different types of health insurance plans including HMOs, PPOs, and high-deductible plans. The document provides steps for obtaining health insurance, filing claims, and surrendering a policy. It also outlines advantages and disadvantages of health insurance as well as tips to avoid health insurance scams.
This patient presents with an acute exacerbation of asthma/COPD. The document reviews guidelines on asthma and COPD, including epidemiology, pathophysiology, diagnosis and treatment approaches. It also presents two case studies, one involving a 19-year old female student with asthma symptoms and another involving a 72-year old female with multiple inhalers for COPD. Treatment strategies and inhaler techniques are discussed.
The document discusses ant colony optimization (ACO), which is a metaheuristic algorithm inspired by the behavior of real ant colonies. It describes how real ants deposit pheromone trails to communicate indirectly and find the shortest path between their colony and food sources. The algorithm works by "artificial ants" probabilistically building solutions to optimization problems and adjusting pheromone levels based on solution quality, similar to how real ants reinforce shorter paths. It provides examples of how ACO has been applied to problems like the traveling salesman problem and discusses some extensions to the basic ACO algorithm.
While religious practices may appear different, many share underlying similarities centered around rituals performed to gain favor with gods. Both Voodoo and Catholicism involve rituals like dancing, chanting, or prayer intended to beg forgiveness or favor. Critical issues in religious study include difficulties differentiating beliefs due to being raised in a specific religion. Understanding different faiths promotes tolerance rather than prejudice.
We design and develop custom eLearning solutions including end-to-end training programs, translation of content into 14 languages, and conversion of instructor-led training into online formats. Our services also include rapid eLearning content development using standard authoring tools, converting courses to comply with standards like SCORM and Section 508, and integrating content with learning management systems and databases.
An introduction to INSIGHT Business Solutions, a Business Technology company based in the MENA region. Our focus is to deploy leading international ERP systems and related technologies and consulting services.
Infographic 60 Top Auto Insurance Keywords by Monthly Average Search Volume o...TPG
10 keywords were selected per category. Each category represents a stage in the buyer’s journey. Top of the funnel keyword searches involve more general questions around Car/Auto Insurance. Bottom of the funnel keywords are represented by more transactional keywords that have intent to quote/policy.
Explanation of the problems that the coinsurance provision in many builder's risk insurance policies can pose for the construction professional, and how to avoid them.
The document discusses Accountable Care Organizations (ACOs) created by the Affordable Care Act. ACOs allow groups of doctors, hospitals, and other providers to share responsibility for the cost and quality of care received by their patients. If ACOs meet quality benchmarks and reduce costs, they receive a share of the savings from insurers. The document outlines key features of ACOs such as local accountability, shared savings based on quality and cost measures, and a minimum of a 3-year contract period with Medicare.
What is an Accountable Care Organizations (ACO) How does an ACOs .pdfwasemanivytreenrco51
What is an Accountable Care Organizations (ACO)? How does an ACO\'s economics work to
manage costs and quality?
Solution
Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care
providers, who come together voluntarily to give coordinated high quality care to their Medicare
patients.
An accountable care organization (ACO) is a healthcare organization characterized by a payment
and care delivery model that seeks to tie provider reimbursements to quality metrics and
reductions in the total cost of care for an assigned population of patients. A group of coordinated
health care providers forms an ACO, which then provides care to a group of patients. The ACO
may use a range of payment models (capitation, fee-for-service with asymmetric or symmetric
shared savings, etc.). The ACO is accountable to the patients and the third-party payer for the
quality, appropriateness and efficiency of the health care provided. According to the Centers for
Medicare and Medicaid Services (CMS), an ACO is \"an organization of health care providers
that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who
are enrolled in the traditional fee-for-service program who are assigned to it.
Design and Structure
There is no single organizational model for developing an ACO. ACOs may be formed and
organized by health systems using employed and contracted physicians, by integrated delivery
systems, by physician groups (either primary care or multispecialty) or through joint ventures or
contractual relationships among providers. Regardless of the organizational structure, an ACO
must be physician-led and physician-driven. Physician leadership is critical because an ACO is
primarily a vehicle for clinical integration, not financial or risk integration. Only physicians are
able to develop, monitor and adjust clinical care protocols that can more efficiently use resources
based on documented effectiveness.
Qualifying ACOs will be assigned a pool of patients whose care the ACO will be responsible for
managing in a cost-effective and clinically appropriate manner. The ACO will need to develop
internal mechanisms for monitoring and managing costs and quality that cut across traditional
reporting lines and result in a higher degree of clinical interdependence than is typical in a less-
integrated medical community.
The PPACA states that any of the following groups of providers of services and suppliers that
have established a mechanism for shared governance are eligible to participate, in accordance
with regulations to be developed by the Secretary of Health and Human Services (HHS):
ACOs Under Health Reform
Section 3022 of PPACA requires HHS to establish a shared savings program under which
qualifying ACOs may be eligible for incentive payments. The criteria in the statute, which will
need to be further defined by regulation, include:
ACOs will be required to measure and report their progress to HHS, includ.
This document provides an overview of accountable care organizations (ACOs). It discusses that ACOs aim to improve care management, limit unnecessary expenditures, and provide patient freedom of choice while making providers financially accountable. The document outlines the principles of ACOs, their relationship to the Patient Protection and Affordable Care Act, payment models, quality measures, stakeholders, and challenges of implementing ACOs.
An Accountable Care Organization (ACO) is a provider-led organization that manages the full continuum of care for a defined patient population to improve quality and reduce costs. The US healthcare system lacks coordination and incentives for value over volume, motivating ACO development. ACOs differ from 1990s integrated delivery systems by focusing on managing performance risk rather than insurance risk through tools like bundled payments, quality tracking, and health IT. Critical functions include attributing patients, budgeting, performance measurement, and managing payment models to distribute shared savings incentives.
DeMarco and Associates and Pendulum HealthCare Corporation provide services to help organizations develop accountable care organizations (ACOs). They assist with infrastructure development, care coordination, and data analytics. Pendulum also designs, develops, and manages ACOs. An ACO aims to deliver coordinated, efficient care to a defined patient population through provider collaboration and accountability for costs and quality outcomes. Requirements include agreements between primary care physicians, specialists, and hospitals to be responsible for a minimum number of Medicare beneficiaries.
1) Dispersion of accountable care organizations varies significantly by region, with some markets having multiple ACOs and others having none. Hospitals and hospital systems are the primary sponsors of ACOs.
2) The success of different accountable care models is still unclear as implementation is ongoing and independent of government programs.
3) Significant investment in accountable care exists with over 100 ACOs identified prior to full implementation of Medicare programs. However, definitions and requirements for ACOs remain vague.
Growth and Dispersion of Accountable Care OrganizationsLeavitt Partners
Leavitt Partners’ Center for ACO Intelligence, which tracks national and regional trends related to ACOs and other emerging care delivery systems, released a white paper today entitled Growth and Dispersion of Accountable Care Organizations. This is the first report of its kind regarding the types and locations of ACOs. The report provides data-driven insights into the evolution of ACOs following federal health reform and the recent announcement of the Medicare Shared Savings Program. Data and analysis on the growth and national dispersion trends of more than 160 ACO or ACO-like organizations are highlighted.
Growth and Dispersion of Accountable Care OrganizationsLeavitt Partners
The Leavitt Partners Center for ACO Intelligence, which tracks national and regional trends related to ACOs and other emerging care delivery systems, published a white paper entitled "Growth and Dispersion of Accountable Care Organizations." This is the first report of its kind regarding the types and locations of ACOs. The report provides data-driven insights into the evolution of ACOs following federal health reform and the recent announcement of the Medicare Shared Savings Program. Data and analysis on the growth and national dispersion trends of more than 160 ACO or ACO-like organizations are highlighted.
Accountable Care Organizations: 4 Physician BenefitsGreenway Health
Why would physicians join an Accountable Care Oragnization (ACO)? This informative slide presentation gives a brief overview of ACOs, their benefits, and four reasons physicians may have for joining one.
1) Accountable care organizations (ACOs) are groups of healthcare providers that coordinate care for patients and are accountable for the quality and costs of that care.
2) The core principles of ACOs are that they are provider-led, have payments linked to quality and cost improvements, and use performance metrics to support care improvements.
3) Compared to earlier HMOs, ACOs focus not just on costs but also on quality of care and patient satisfaction, aiming to achieve the "Triple Aim" of better care, lower costs, and improved health.
This document provides an overview of health insurance. It defines health insurance as insurance that covers medical and surgical expenses. It explains why health insurance is needed to protect against high, unexpected medical costs and make quality treatment affordable. It then describes different types of health insurance plans including HMOs, PPOs, and high-deductible plans. The document provides steps for obtaining health insurance, filing claims, and surrendering a policy. It also outlines advantages and disadvantages of health insurance as well as tips to avoid health insurance scams.
This patient presents with an acute exacerbation of asthma/COPD. The document reviews guidelines on asthma and COPD, including epidemiology, pathophysiology, diagnosis and treatment approaches. It also presents two case studies, one involving a 19-year old female student with asthma symptoms and another involving a 72-year old female with multiple inhalers for COPD. Treatment strategies and inhaler techniques are discussed.
The document discusses ant colony optimization (ACO), which is a metaheuristic algorithm inspired by the behavior of real ant colonies. It describes how real ants deposit pheromone trails to communicate indirectly and find the shortest path between their colony and food sources. The algorithm works by "artificial ants" probabilistically building solutions to optimization problems and adjusting pheromone levels based on solution quality, similar to how real ants reinforce shorter paths. It provides examples of how ACO has been applied to problems like the traveling salesman problem and discusses some extensions to the basic ACO algorithm.
While religious practices may appear different, many share underlying similarities centered around rituals performed to gain favor with gods. Both Voodoo and Catholicism involve rituals like dancing, chanting, or prayer intended to beg forgiveness or favor. Critical issues in religious study include difficulties differentiating beliefs due to being raised in a specific religion. Understanding different faiths promotes tolerance rather than prejudice.
We design and develop custom eLearning solutions including end-to-end training programs, translation of content into 14 languages, and conversion of instructor-led training into online formats. Our services also include rapid eLearning content development using standard authoring tools, converting courses to comply with standards like SCORM and Section 508, and integrating content with learning management systems and databases.
An introduction to INSIGHT Business Solutions, a Business Technology company based in the MENA region. Our focus is to deploy leading international ERP systems and related technologies and consulting services.
Infographic 60 Top Auto Insurance Keywords by Monthly Average Search Volume o...TPG
10 keywords were selected per category. Each category represents a stage in the buyer’s journey. Top of the funnel keyword searches involve more general questions around Car/Auto Insurance. Bottom of the funnel keywords are represented by more transactional keywords that have intent to quote/policy.
Explanation of the problems that the coinsurance provision in many builder's risk insurance policies can pose for the construction professional, and how to avoid them.
The document discusses Accountable Care Organizations (ACOs) created by the Affordable Care Act. ACOs allow groups of doctors, hospitals, and other providers to share responsibility for the cost and quality of care received by their patients. If ACOs meet quality benchmarks and reduce costs, they receive a share of the savings from insurers. The document outlines key features of ACOs such as local accountability, shared savings based on quality and cost measures, and a minimum of a 3-year contract period with Medicare.
What is an Accountable Care Organizations (ACO) How does an ACOs .pdfwasemanivytreenrco51
What is an Accountable Care Organizations (ACO)? How does an ACO\'s economics work to
manage costs and quality?
Solution
Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care
providers, who come together voluntarily to give coordinated high quality care to their Medicare
patients.
An accountable care organization (ACO) is a healthcare organization characterized by a payment
and care delivery model that seeks to tie provider reimbursements to quality metrics and
reductions in the total cost of care for an assigned population of patients. A group of coordinated
health care providers forms an ACO, which then provides care to a group of patients. The ACO
may use a range of payment models (capitation, fee-for-service with asymmetric or symmetric
shared savings, etc.). The ACO is accountable to the patients and the third-party payer for the
quality, appropriateness and efficiency of the health care provided. According to the Centers for
Medicare and Medicaid Services (CMS), an ACO is \"an organization of health care providers
that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who
are enrolled in the traditional fee-for-service program who are assigned to it.
Design and Structure
There is no single organizational model for developing an ACO. ACOs may be formed and
organized by health systems using employed and contracted physicians, by integrated delivery
systems, by physician groups (either primary care or multispecialty) or through joint ventures or
contractual relationships among providers. Regardless of the organizational structure, an ACO
must be physician-led and physician-driven. Physician leadership is critical because an ACO is
primarily a vehicle for clinical integration, not financial or risk integration. Only physicians are
able to develop, monitor and adjust clinical care protocols that can more efficiently use resources
based on documented effectiveness.
Qualifying ACOs will be assigned a pool of patients whose care the ACO will be responsible for
managing in a cost-effective and clinically appropriate manner. The ACO will need to develop
internal mechanisms for monitoring and managing costs and quality that cut across traditional
reporting lines and result in a higher degree of clinical interdependence than is typical in a less-
integrated medical community.
The PPACA states that any of the following groups of providers of services and suppliers that
have established a mechanism for shared governance are eligible to participate, in accordance
with regulations to be developed by the Secretary of Health and Human Services (HHS):
ACOs Under Health Reform
Section 3022 of PPACA requires HHS to establish a shared savings program under which
qualifying ACOs may be eligible for incentive payments. The criteria in the statute, which will
need to be further defined by regulation, include:
ACOs will be required to measure and report their progress to HHS, includ.
This document provides an overview of accountable care organizations (ACOs). It discusses that ACOs aim to improve care management, limit unnecessary expenditures, and provide patient freedom of choice while making providers financially accountable. The document outlines the principles of ACOs, their relationship to the Patient Protection and Affordable Care Act, payment models, quality measures, stakeholders, and challenges of implementing ACOs.
An Accountable Care Organization (ACO) is a provider-led organization that manages the full continuum of care for a defined patient population to improve quality and reduce costs. The US healthcare system lacks coordination and incentives for value over volume, motivating ACO development. ACOs differ from 1990s integrated delivery systems by focusing on managing performance risk rather than insurance risk through tools like bundled payments, quality tracking, and health IT. Critical functions include attributing patients, budgeting, performance measurement, and managing payment models to distribute shared savings incentives.
DeMarco and Associates and Pendulum HealthCare Corporation provide services to help organizations develop accountable care organizations (ACOs). They assist with infrastructure development, care coordination, and data analytics. Pendulum also designs, develops, and manages ACOs. An ACO aims to deliver coordinated, efficient care to a defined patient population through provider collaboration and accountability for costs and quality outcomes. Requirements include agreements between primary care physicians, specialists, and hospitals to be responsible for a minimum number of Medicare beneficiaries.
1) Dispersion of accountable care organizations varies significantly by region, with some markets having multiple ACOs and others having none. Hospitals and hospital systems are the primary sponsors of ACOs.
2) The success of different accountable care models is still unclear as implementation is ongoing and independent of government programs.
3) Significant investment in accountable care exists with over 100 ACOs identified prior to full implementation of Medicare programs. However, definitions and requirements for ACOs remain vague.
Growth and Dispersion of Accountable Care OrganizationsLeavitt Partners
Leavitt Partners’ Center for ACO Intelligence, which tracks national and regional trends related to ACOs and other emerging care delivery systems, released a white paper today entitled Growth and Dispersion of Accountable Care Organizations. This is the first report of its kind regarding the types and locations of ACOs. The report provides data-driven insights into the evolution of ACOs following federal health reform and the recent announcement of the Medicare Shared Savings Program. Data and analysis on the growth and national dispersion trends of more than 160 ACO or ACO-like organizations are highlighted.
Growth and Dispersion of Accountable Care OrganizationsLeavitt Partners
The Leavitt Partners Center for ACO Intelligence, which tracks national and regional trends related to ACOs and other emerging care delivery systems, published a white paper entitled "Growth and Dispersion of Accountable Care Organizations." This is the first report of its kind regarding the types and locations of ACOs. The report provides data-driven insights into the evolution of ACOs following federal health reform and the recent announcement of the Medicare Shared Savings Program. Data and analysis on the growth and national dispersion trends of more than 160 ACO or ACO-like organizations are highlighted.
Accountable Care Organizations: 4 Physician BenefitsGreenway Health
Why would physicians join an Accountable Care Oragnization (ACO)? This informative slide presentation gives a brief overview of ACOs, their benefits, and four reasons physicians may have for joining one.
1) Accountable care organizations (ACOs) are groups of healthcare providers that coordinate care for patients and are accountable for the quality and costs of that care.
2) The core principles of ACOs are that they are provider-led, have payments linked to quality and cost improvements, and use performance metrics to support care improvements.
3) Compared to earlier HMOs, ACOs focus not just on costs but also on quality of care and patient satisfaction, aiming to achieve the "Triple Aim" of better care, lower costs, and improved health.
Accountable Care Organizations and Physician Joint Ventures .docxAMMY30
Accountable Care Organizations and Physician Joint Ventures
Jeffrey P. Harrison
Chapter 9
“I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient.”
—from The Hippocratic Oath (modern version)
Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale.
1
Learning Objectives
Demonstrate an understanding of the interparty relationships associated with healthcare joint ventures and accountable care organizations.
Understand some of the dynamics and controversies surrounding the concept of accountable care organizations as an alternative approach to the current marketplace.
Demonstrate a basic understanding of the patient-centered medical home with attention to how it supports network-based delivery systems.
Master the concept of physician–hospital alignment and health system integration including consumer, provider, and regulatory developments.
Assess the emerging role of medical groups and hospital-owned group practices across the continuum of healthcare services.
Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale.
2
Key Terms and Concepts
Accountable care organization (ACO)
Clinical integration
Equity-based joint venture
Hospitalist model
Integrated physician model
Medical foundation
Patient-centered medical home (PCMH)
Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale.
3
Introduction
A positive relationship between hospitals and physicians is important to the success of the US healthcare system, because hospitals and physicians can be both collaborators and competitors.
Many hospitals and healthcare systems have moved to various models of physician integration through which hospitals hope to capture market share and physicians seek financial security.
After the Affordable Care Act (ACA) was passed in 2010, physician–hospital alignment became driven by another factor: cost control and quality outcomes in the accountable care era (Reiboldt 2013).
Physicians work in a wide range of settings and serve in leadership positions that have significant responsibility for quality of care.
Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale.
4
Clinical Integration
What Is It?
Coordination of patient care between hospitals and physicians across the healthcare continuum— e.g., an accountable care organization (ACO).
Provides an opportunity to coordinate services through centralized scheduling, electronic health records, clinical pathways, management of chronic diseases, and innovative quality improvement programs.
Clinical integration is necessary to delivering high-quality, affordable care in the current environment (Jacquin 2014).
Clinical.
How to Manage Population Health Effectively in Accountable Care OrganizationsPhytel
The Affordable Care Act authorized a Medicare shared-savings program for accountable care organizations, and private payers are also contracting with ACOs. To succeed, ACOs must learn how to manage population health effectively.
The document discusses the Patient Protection and Affordable Care Act (PPACA), also known as Obamacare. It established protections for American citizens to make healthcare more affordable and accessible. The PPACA provides subsidies to lower costs and requires insurance companies to spend a minimum percentage on actual healthcare. It also increased the number of insured Americans, leading to a higher demand for physicians and changes in how hospitals are funded.
Establishing a Community-based Framework for ACOs - slide-share 120116Jennifer D.
This document discusses community-based accountable care organizations (ACOs) for Medicaid patients. It outlines that ACOs coordinate care across providers to improve quality and reduce costs. For Medicaid ACOs specifically, it is important to address social determinants of health through partnerships with community organizations. The document then discusses key components of Medicaid ACOs including payment models, quality measurement, and data analysis strategies. It provides examples from Colorado and Minnesota that have achieved cost savings and quality improvements. Finally, it argues that integrated care coordination platforms can help ACOs collect and share patient data to direct resources and invest in programs.
Accountable Care Organizations and The Medicare Shared Savings ProgramPhytel
Population Health Management, Enabled by Information Technology, Will Be Critical To Success. In 2012, the Centers for Medicare and Medicaid Services (CMS) will launch a shared-savings program with accountable care organizations (ACOs). ACOs that meet specified quality goals will be able to split with CMS any savings that surpass a minimum level. The challenge facing ACOs is choosing the right information technologies so they can track the health status of and the care provided to every one of their patients to produce significant savings or meet the quality benchmarks of CMS
Market Power, Transactions Costs, and the Entryof Accountabl.docxinfantsuk
Market Power, Transactions Costs, and the Entry
of Accountable Care Organizations in Health Care
H. E. Frech III.1 • Christopher Whaley2 •
Benjamin R. Handel3 • Liora Bowers4 •
Carol J. Simon5 • Richard M. Scheffler6
Published online: 15 July 2015
� Springer Science+Business Media New York 2015
Abstract ACOs were promoted in the 2010 Patient Protection and Affordable
Care Act (ACA) to incentivize integrated care and cost control. Because they
involve vertical and horizontal collaboration, ACOs also have the potential to harm
competition. In this paper, we analyze ACO entry and formation patterns with the
use of a unique, proprietary database that includes public (Medicare) and private
ACOs. We estimate an empirical model that explains county-level ACO entry as a
function of: physician, hospital, and insurance market structure; demographics; and
other economic and regulatory factors. We find that physician concentration by
organization has little effect. In contrast, physician concentration by geographic
Earlier versions of this paper were presented at the International Industrial Organization Conference in
Boston, the International Health Economics Association meeting in Sydney, the Allied Social Science
meetings in Philadelphia, the ACO Workshop in Berkeley, and the Bates White Health Care and Life
Science Seminar in Washington, D.C. Thanks are due to the participants of those meetings, especially
Martha Starr, Dean Rice, and Martin Gaynor for helpful comments. Thanks are also due to Sandra
Decker, Abe Dunn, Robert Obstfeldt, Jim Rebitzer, Michael Morrisey, Jessica Foster, and Lee Mobley
for helpful comments on earlier versions and to the referees and editor of this journal for more recent
useful comments.
& H. E. Frech III.
[email protected]
Christopher Whaley
[email protected]
Benjamin R. Handel
[email protected]
Liora Bowers
[email protected]
Carol J. Simon
[email protected]
1
Department of Economics, University of California, Santa Barbara, Santa Barbara, CA 93106,
USA
123
Rev Ind Organ (2015) 47:167–193
DOI 10.1007/s11151-015-9467-y
http://crossmark.crossref.org/dialog/?doi=10.1007/s11151-015-9467-y&domain=pdf
http://crossmark.crossref.org/dialog/?doi=10.1007/s11151-015-9467-y&domain=pdf
site—which is a new measure of locational concentration of physicians—discour-
ages ACO entry. Hospital concentration generally has a negative effect. HMO
penetration is a strong predictor of ACO entry, while physician-hospital organiza-
tions have little effect. Small markets discourage entry, which suggests economies
of scale for ACOs. Predictors of public and private ACO entry are different. State
regulations of nursing and the corporate practice of medicine have little effect.
Keywords Health care competition � Antitrust � Entry � Integration � Accountable
care organizations � Transactions costs � Obama plan
JEL Classification L 14 � I11 � L44 � I18 � L41
1 Introduction and Overview
The US health car ...
The document discusses bundled payments for care improvement (BPCI) initiatives created under the Patient Protection and Affordable Care Act (PPACA). It explains that PPACA aimed to move away from fee-for-service reimbursement and encourage coordinated, high-quality, lower-cost care. The Center for Medicare and Medicaid Innovation was established to test new payment models like BPCI, which link payments for multiple services during an episode of care. BPCI creates incentives to improve transitional care and reduce costs through gain-sharing arrangements between providers.
Accountable Care Organizations (ACOs) are organizations of health care providers who provide care to a group of patients. Created in an attempt to decrease the cost of service delivery and increase efficiency, value and profit, these organizations are new territory for the CPA professional. This presentation was given to the Michigan Association of Certified Public Accountants at their Healthcare Conference on April 23, 2013.
2. Table of Contents
• PART I: Introduction, History, ACO Stake holders, Core principles for all ACOs, CMS
Announcement you-tube clip
(Anthony Harding)
• PART II: Overview of ACO and Key Elements of ACO/Health Reform
• (Jolly Patel)
• PART IV: The ACO - Immediate Benefits for Delaware
• (Anthony Mbirwe)
• PART V: Conclusion
• (Jitka Gruntova)
3. Introduction
An accountable care organization The ACO is accountable to the
(ACO) is a type of payment and patients and the third-party payer
delivery reform model that seeks to for the quality, appropriateness, and
tie provider reimbursements to efficiency of the health care
quality metrics and reductions in provided.
the total cost of care for an assigned
According to the Centers for
population of patients.
Medicare and Medicaid Services
A group of coordinated health care (CMS), an ACO is "an organization
providers form an ACO, which then of health care providers that agrees
provides care to a group of patients. to be accountable for the quality,
The ACO may use a range of cost, and overall care of Medicare
payment models (capitation, fee- beneficiaries who are enrolled in
for-service with asymmetric or the traditional fee-for-service
symmetric shared savings, etc.). program who are assigned to it.
4. ACO Stakeholders
Providers-ACOs are comprised mostly of hospitals, physicians, and
other healthcare professionals. Depending on the level of integration
and size of an ACO, providers may also include health departments,
social security departments, safety net clinics, and home care services.
Payers- The federal government, in the form of Medicare, will be the
primary payer of an ACO. Other payers include private insurances, or
employer-purchased insurance.
Patients- An ACO‟s patient population will primarily consist of
Medicare beneficiaries. In larger and more integrated ACOs, the
patient population may also include those who are homeless and
uninsured.
5.
6. History
The term “Accountable Care Organization” Like the HMO, the ACO is “an entity that
was first used by Elliott Fisher – Director will be „held accountable‟ for providing
of the Center for Health Policy Research at comprehensive health services to a
Dartmouth Medical School population.“
In 2006 during a discussion at a public The ACO-model builds on the Medicare
meeting of the Medicare Payment Advisory Physician Group Practice Demonstration
Commission. and the Medicare Health Care Quality
The term quickly became Demonstration, established by the 2003
widespread, reaching its pinnacle in 2009 Medicare Prescription Drug, Improvement,
when it was included in the Patient and Modernization Act.
Protection and Affordability Care Act. Kaiser Permanente and HealthCare
Although the term ACO was not coined Partners Medical Group are two notable
until 2006, it bears resemblance to the examples of successful ACO prototypes.
definition of the Health Maintenance However, a recent study by the Medical
Organization (HMO), which rose to Group Management Association (MGMA)
prominence in the 1970s. has shown that the implementation of
ACOs is one of the toughest challenges
facing the MGMA members today
9. What Is An Accountable Care Organization (ACO)?
http://youtu.be/ULy5vjcGuDc
Consists of providers who are jointly held accountable for
achieving measured quality improvements and reductions
in the rate of spending growth
May involve a variety of provider configurations, ranging
from integrated delivery systems and primary care medical
groups to hospital-based systems and virtual networks of
physicians such as independent practice associations
Has a strong base of primary care, although hospitals are
encouraged to participate, because improving hospital care
is essential to success
10. ACOs In Perspective
Think of it like buying a television...
A TV manufacturer such as Sony may contract with many
suppliers to build a TV – like a Sony, an ACO would bring
together the different component parts of care for the
patient (primary care, specialists, hospitals, home health
care, etc.) and ensure that all of the parts work well together
The problem today is that patients are getting each part of
their health care separately – they are buying individual
circuit boards, not a whole TV
12. How Does It Differ From HMOs?
The principle difference between HMOs and ACOs is their
size
HMOs, like most insurance companies, generally have
enrollees in the hundreds of thousands compared with as
few as 5,000
HMOs function like insurance companies (they bear 100
percent of the risk that the premiums they charge will not
be enough to cover all necessary services for their
enrollees) while ACOs will bear little or no insurance risk
in their first few years
13. Key Concepts
The key concepts for ACOs are “continuum of the care”
and “quality of the care”
ACOs in the future will see incentives for providers who
keep costs down and still manage to meet specific quality
benchmarks, concentrating on prevention of chronic
diseases and efficient disease management
Keeping the costs of hospitalizations under control and
then providing quality home healthcare to patients is
essential to success
14. ACOs & The PPACA
The Patient Protection and Affordable Care Act (PPACA)
was signed into law by President Obama on March 23,2010
The PPACA’s intent is to ensure that all Americans have
access to quality, affordable health care and will create the
transformation within the health care system necessary to
contain costs
15. PPACA Titles I - III
The Patient Protection and Affordable Care Act contains
nine titles, each addressing an important component of
reform:
I. Quality, affordable health care for all Americans
II. The role of public programs
III. Improving the quality and efficiency of health care
16. PPACA Titles IV - IX
IV. Prevention of chronic disease and improving public
health
V. Health care workforce
VI. Transparency and program integrity
VII. Improving access to medical therapies
VIII. Community living assistance services and supports
IX. Revenue provisions
17. Title III
Improving the Quality and Efficiency of Health Care
The PPACA will encourage development of new Patient
Care Models starting with a new Center for Medicare &
Medicaid Innovation to be established within the Centers
for Medicare and Medicaid Services
18. Medicare & Medicaid Innovation
This new Center for Medicare & Medicaid Innovation will
have the responsibility of research, development, testing
and expanding innovative payment and delivery
arrangements
ACOs that take responsibility for cost and quality received
by patients will receive a share of savings they achieve for
Medicare
19. Requirements For ACO Status
1. A willingness to become accountable for the
quality, cost, and overall care of the Medicare
beneficiaries it treats
2. Entrance into an agreement with the Secretary of Health
and Human Services (HHS) to participate in the
program for not less than 3 years
3. A formal legal structure that allows the entity to receive
& distribute payments
20. Requirements Continued
4. The inclusion of primary care professionals that are
sufficient for the number of Medicare beneficiaries
assigned to the ACO
5. Provision to the Secretary of information regarding the
professionals who participate in the ACO and
implementation of quality and other reporting
requirements
21. Requirements Continued
6. A leadership and management structure that
includes clinical and administrative systems
7. Defined processes that promote evidence-based
medicine and patient engagement, reporting on
quality and cost measures, and care coordination
8. Demonstration that the organization meets patient-
centered criteria
22. More About ACOs
The ACO initiative was scheduled to launch in January 2012
Right now, a main source of revenue for healthcare
organizations comes from the tests and procedures
performed on patients in the current fee-for-service
payment system, but after the creation of ACOs,
organizations and providers will get paid for saving more
while still providing quality healthcare to the patients - they
will get paid for keeping patients healthy and out of the
hospital
23. Financial Savings Associated With ACOs
The Congressional Budget Office estimates that ACOs
could save Medicare at least $4.9 billion through 2019 –
less than one percent of Medicare spending during that
period, but if the program is successful it can be
expanded by the Secretary of Health and Human Services
25. Cost Considerations For The ACO
Predominately large hospital systems and big physician
groups are pursuing the ACO concept due to the large
investment required in healthcare IT and infrastructure
ACOs are designed to encourage consolidation among
hospitals and doctors which has also drawn anti-trust
scrutiny
If an ACO is not able to save money, it would be stuck
with the costs of investments made to improve care, such
as adding new nurse care managers, but would still get to
keep the standard Medicare fees
26. Who Is In Charge Of The ACO?
It’s flexible – can be hospitals, doctors, or even insurers
Some regions of the country already have large multi-
specialty physician groups that may become an ACO on
their own, likely by networking with neighboring hospitals
In other regions, large hospital systems are buying
physician practices with the goal of becoming ACOs that
directly employ the majority of their providers (because
hospitals usually have access to capital, they may have an
easier time than doctors in financing the initial
investment required by an ACO)
27. What Does This Mean For You, The Patient?
http://youtu.be/Xlq2XJ6J76g
Patients may not even know that they are part of an ACO
Doctors will want to refer patients to hospitals and
specialists within the ACO network, however patients
will still be free to see doctors of their choice outside the
network
Because ACOs will be under pressure to provide high
quality care in order to receive financial benefits, patients
should ultimately receive better care
28. The ACO - Immediate Benefits for
Delaware
Support for seniors
Last year, roughly 11,900 Medicare beneficiaries in Delaware hit the donut hole, or
gap in Medicare Part D drug coverage, and received no additional help to defray the
cost of their prescription drugs.
By August last year, 2,983 of seniors in Delaware had received their $250 tax free
rebate for hitting the donut hole
The new law continues to provide additional discounts for seniors on Medicare in
the years ahead and closes the donut hole by 2020
Free preventive services for seniors
All 140,000 of Medicare enrollees in Delaware will get preventive services, like
colorectal cancer screenings, mammograms, and an annual wellness visit without
copayments, coinsurance, or deductibles.
29. The ACO - Immediate Benefits for
Delaware
Coverage expansions
$13 million from federal government will be available for Delaware State beginning
July 1st to provide coverage for uninsured residents with pre-existing medical
conditions through a new Pre-Existing Condition Insurance Plan program, funded
entirely by the Federal government
This program is a transition to 2014 when Americans will have access to affordable
coverage options in the new health insurance system and insurance companies will
be prohibited from denying coverage to Americans with pre-existing conditions.
Small business tax credits
About 14,000 small businesses in Delaware will be eligible for the new small
business tax credit that makes it easier for businesses to provide coverage to their
workers and makes premiums more affordable.
Small businesses pay, on average, 18 percent more than large businesses for the
same coverage and health insurance premiums have gone up three times faster than
wages in the past 10 years.
30. The ACO - Immediate Benefits for
Delaware
Extending coverage to young adults
When families renew or purchase insurance on or after September
23, 2010, plans that offer coverage to children on their parents‟ policy must
allow children to remain on their parents‟ policy until they turn 26, unless the
adult child has another offer of job-based coverage in some cases
Health coverage for early retirees
An estimated 16,000 people from Delaware retired before they were eligible
for Medicare and have health coverage through their former employers.
Unfortunately, the numbers of firms that provide health coverage to their
retirees have decreased over time.
This year, a $5 billion temporary early retiree reinsurance program will help
stabilize early retiree coverage and help ensure that firms continue to provide
health coverage to their early retirees. Companies, unions, and State and local
governments are eligible for these benefits
31. The ACO - Immediate Benefits for
Delaware
Improved Access to Care
Patients‟ choice of doctors will be protected by allowing plan members in
new plans to pick any participating primary care provider, prohibiting
insurers from requiring prior authorization before a woman sees an ob-
gyn, and ensuring access to emergency care.
More doctors where people need them
Beginning October 1, 2010, the Act will provide funding for the National Health
Service Corps i.e. $1.5 billion over five years for scholarships and loan
repayments for doctors, nurses and other health care providers who work in
areas with a shortage of health professionals. And the Affordable Care Act
invested $250 million dollars this year in programs that will boost the supply of
primary care providers in this country – by creating new residency slots in
primary care and supporting training for nurses and physician’s assistants. This
will help the 14% of Delaware’s population who live in an underserved area
32. ACO’s- Summary
ACO’s = health care organizations and related set of
providers - primary care physicians, specialists, and
hospitals that are accountable for the cost and quality
of care delivered to a defined population.
The goal of the ACO’s is to deliver coordinated and
efficient care.
ACO’s that achieve quality and cost targets will receive
some sort of financial bonus, and, those that fail will
be subject to a financial penalty
33. Concept of ACO’s
ACO’s make the people and organizations that actually
provide care accountable for the quality and the cost of that
care.
Previous health reform initiatives involved insurers and
made them ultimately accountable.
34. The positive side of ACO’s
Beneficiaries/patients will be able to go anywhere for care and will
be able to use any physician.
Patients will be able to enroll for lower premiums.
New programs will be available and some programs will be
expanded. For example, some services like screenings and
vaccinations will become free.
There will be new rules. For example, lifetime limits on health
coverage will be gone.
Insurers will be limited in how they spend premium dollars and they
will no longer be able to turn people down or charge them more if
they're sick.
Some small businesses will get tax breaks to help them pay for
health insurance for their workers.
By 2019, 32 million of American citizens who don‟t have health
insurance will have it.
35. Negative side of ACO’s
ACO‟s will cost 938 billion dollars over the next ten years, according to the
Congressional Budget Office.
A lot of the savings will come from health care providers and insurers in the
Medicare program.
The fees the government pays to hospitals under Medicare won‟t be allowed to rise
as fast as they have been.
Insurance companies that provide services to people on Medicare will be paid less.
A terrible business deal for providers. In order to get any shared savings, they will
have to spend millions on consulting, systems, care managers and IT staff, give up a
dollar in immediately reduced income, and maybe, if they check all the boxes
right, get 50 or 60 cents back in 18 months.
Further, some taxes will go up too. For example, people with high earnings will pay
higher Medicare taxes.
There will be new taxes on insurers and businesses who offer high-end benefit
plans, and on companies that make medical devices and drugs.
36. Do you like the new health care law, hate it, still don’t know?
Any Questions?
Editor's Notes
http://youtu.be/ULy5vjcGuDc
source retrieved from www.democrats.senate.gov/reform.com
Source retrieved from www.integratedhealthcareassociation.org