This document discusses accountable care organizations (ACOs) and ACO networks. It explains that ACOs were established by the Affordable Care Act to improve healthcare quality, access, and affordability. The document outlines key elements needed for successful ACO networks, including a culture of teamwork, primary care focus, health IT/data capabilities, and aligned financial incentives. It also discusses ACO network structures and ways providers can be incentivized to participate in ACO networks.

1. ACO Networks:
A Lynchpin of
Health Care
Reform

2. This presentation is designed
to help you
— Understand the public health purpose of accountable
care organization (ACO) networks
— Explore ACO networks’ roles in advancing the goals of
the Affordable Care Act
— Understand why your voice is critical for ACO network
design, negotiation and function

3. ACO Networks: A Lynchpin of
Health Care Reform
The Affordable Care Act (ACA) is a broad-reaching
reform law aimed at
— Making health care more affordable
— Expanding access to care for the uninsured and
underinsured
— Improving health outcomes of individuals and the
broader population.

4. Understanding ACO Networks
SO WHAT IS AN ACO?

5. Understanding ACO Networks

6. ACO Network Creation:
Payers and provider organizations moving aggressively towards ACO
implementation.

7. UnitedHealthcare Projection for ACO
Contracts
Dollars in Billions
0
10
20
30
40
50
60
2013 2017

8. Medicare Pioneer ACO Pilot Outcomes
Participant Achievement In Real Numbers
0
5
10
15
20
25
30
35
40
45
50
Achieved
quality
measures
Reduced
hospital
admissions
Received
shared
savings
Stayed in
ACO pilot
Total
participants
32 provider organizations signed up to participate in the Medicare
ACO pilot.

9. Why Should Affiliates Participate?
Becoming an early player in ACO networks can help
solidify your position as a strong partner

10. Toward Accountable Care Consortium:
Building A Successful ACO Network
— The Toward Accountable Care Consortium has outlined
these 8 essential elements for building a successful
ACO network:
— Culture of Teamwork
— Primary Care
— Adequate Administrative Capabilities
— Sufficiently Aligned Financial Incentives
— Health Information Technology & Data
— Best Practices
— Patient Engagement
— Sufficient Patient Population

11. A Culture of Teamwork
ACO network participants must:
• Embrace and leverage their growing
interdependence
• Have champions who lead the cultural
shift
• Have shared control of the governance
structure.

12. Primary Care
Primary care providers will:
• Help manage patient care across the spectrum of
participating ACO providers
• Be key drivers in helping networks meet their
quality and cost benchmarks

13. Adequate Administrative
Capabilities
There are 3 functional capabilities that all ACO
networks must possess in order to be successful:
• Financial administration
• Performance measures
• Clinical direction

14. Sufficiently Aligned Financial
Incentives

15. Health Information Technology
(HIT) and Data
ACOs will need access to three categories of data:
— Baseline data
— Performance data
— Clinical data

16. Best Practices
5 high-impact target areas for ACOs:
— Prevention and wellness
— Chronic disease Reduced hospitalizations
— Care transitions
— Multi-specialty care coordination.

17. Patient Engagement
Areas of patient engagement:
— Consumer health education and counseling
— Telemedicine and other convenience services
— Adherence with health-maintenance programs

18. Sufficient Patient Population
.

19. Provider Incentives
ACO networks can incentivize provider participants by
rewarding them for:
• Keeping costs down & patients healthy (shared
savings
• Bringing patients and families into the network
• Retaining patients and families in the network

20. Considering ACO Network Structure
— There is no definitive model for structuring an ACO
network.
— The goal is to bring together a group of providers
who will be better at delivering care to a particular
patient population and containing cost when they
work together than when they work separately.
— The ACO network should be able to address all of a
patient’s potential care needs, and should simplify
the care-delivery process.

21. Possible ACO Network Structure
Local
Health
Dept.
Nursing
Home &
Assisted
Living
Tertiary
Care
Center Community
Hospital
Hospice
Substance
Abuse
Treatment
Pharmacy
Network
Alt.
Health
Care
Fitness
& Diet
Specialty
Care &
Medical
Procedures
Lab
Services
Crisis
Center
Podiatry
Home-
Based
Medical
Equipment
Urgent
Care
Rehab./
Therapy
Ambulatory
Care
1° Care
FQHC
PP Affiliate
1° Care = Primary Care FQHC = Federally Qualified Health Center PP Affiliate = Planned Parenthood Affiliate

22. Where to go for more information and
help
— The following resources may be helpful in your ACO
exploration:
— Top questions about ACOs:
— http://www.accountablecarefacts.org/topten/why-is-
health-care-delivery-reform-as-proposed-in-the-
affordable-care-act-necessary-1
— Physician’s ACO toolkit:
— http://www.ncmedsoc.org/non_members/legislative/ac/
ACO-GuideNC.pdf

23. Where to go for more information and
help
— Rediness assessment:
— http://www.amga.org/research/research/ACO/
assessTool.pdf
— Medicaid ACO efforts:
— http://kaiserfamilyfoundation.files.wordpress.com/
2013/01/8319.pdf
— http://www.reuters.com/article/2013/07/16/us-usa-
healthcare-aco-idUSBRE96F1C220130716
— ACO Networks lessons learned:
— https://www.blueshieldca.com/employer/documents/
knowledge-center/features/EKH_ACO%20Lessons
%20Learned%20Case%20Study.pdf