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.
Dr. David Muhlestein and Mathew Petersen, both of whom participate with Leavitt Partners' research on Accountable Care Organizations, co-authored the article ACO Results: What We Know So Far in Health Affairs Blog column on May 30th, 2014.
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 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
Attorney Michael James spoke to Michigan Association of CPAs yesterday on his presentation "Accountable Care Organizations 2.0". The presentation addressed the hundreds of pages of recently proposed regulations related to ACOs that represent the most dramatic overhaul of the Medicare Shared Savings Program since its inception. Other insights in the presentation:
- Current Regulatory Environment for Integrated Models
- How Environment Evolves Under Proposed Regulations
- Various Requirements Needed for ACOs
- Potential Risks Under Current ACO Models
To learn more, contact attorney Michael James at mjames@fraserlawfirm.com or 517-377-0823. Michael James is a senior attorney at Fraser Trebilcock, providing representation and counseling related to all facets of business enterprise and health care matters.
NOTE: Information contained in this presentation is only current as of the blog publish date. For updated information, refer to the Fraser Trebilcock Health Care Reform blog: fraserlawfirm.com
Dr. David Muhlestein and Mathew Petersen, both of whom participate with Leavitt Partners' research on Accountable Care Organizations, co-authored the article ACO Results: What We Know So Far in Health Affairs Blog column on May 30th, 2014.
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 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
Attorney Michael James spoke to Michigan Association of CPAs yesterday on his presentation "Accountable Care Organizations 2.0". The presentation addressed the hundreds of pages of recently proposed regulations related to ACOs that represent the most dramatic overhaul of the Medicare Shared Savings Program since its inception. Other insights in the presentation:
- Current Regulatory Environment for Integrated Models
- How Environment Evolves Under Proposed Regulations
- Various Requirements Needed for ACOs
- Potential Risks Under Current ACO Models
To learn more, contact attorney Michael James at mjames@fraserlawfirm.com or 517-377-0823. Michael James is a senior attorney at Fraser Trebilcock, providing representation and counseling related to all facets of business enterprise and health care matters.
NOTE: Information contained in this presentation is only current as of the blog publish date. For updated information, refer to the Fraser Trebilcock Health Care Reform blog: fraserlawfirm.com
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.
Succeeding in Population Health Management: Why the Right Tools MatterHealth Catalyst
The U.S. healthcare market projects that by 2022 90 million Americans will be in an ACO. The upward trend in population health management (PHM) makes the move towards risk-based contracts increasingly urgent for health systems. The industry has been largely unprepared for the shift, as it hasn’t established a clear definition of population health or solid guidelines on transitioning from volume to value. Organizations can, however, prepare for the demands of PHM by adopting a solution that manages comprehensive population health data, provides advanced analytics from new and complex challenges, and connects them with the deep expertise to thrive in a value-based landscape.
Learn some simple truths about how ACO's operate and function. Adapted from http://www.insight-txcin.org/post/why-accountable-care-organizations-succeed
Provider participation in accountable care organizations (ACOs) is becoming the new normal. As of January 1, 2016, there are 434 ACOs
in the Medicare Shared Savings Program. More than 160,000 providers now participate in an MSSP ACO. These organizations now serve
7.7 million Medicare beneficiaries residing in 49 of the 50 states. Here’s the road to the MSSP destination of shared savings.
Value-Based Purchasing and the Role of Home Care TechnologyAlayaCare
While shifting financial models is a major challenge facing healthcare, we can safely assume where that shift is heading. As it stands, there continues to be a paucity of good evidence as to how to run an effective Value-Based Purchasing (VBP) program, and definitive metrics on how it can lead to better outcomes. Thus, this shift is underway filled with far more expectations than answers.
With this guide will you learn how your home care agency can prepare, adapt and thrive in a value-based purchasing landscape with the help of modern home care technology.
What is MIPS and How it Affects My Practice?
For additional information on MIPS, you can visit: https://bit.ly/2I6TUxq, or contact us at 888-357-3226/ info@medicalbillersandcoders.com with your questions.
Click Here For More Information: https://bit.ly/3k7QS9P
Get a Free Quote: https://bit.ly/30DFr2z
#texasmedicalbillingandcodingservices #medicalbillingauditing #medicare #medicalbillingandcoding #MBC #MIPS #medicalbillingguideline #mipsaffectsmypractice
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.
Succeeding in Population Health Management: Why the Right Tools MatterHealth Catalyst
The U.S. healthcare market projects that by 2022 90 million Americans will be in an ACO. The upward trend in population health management (PHM) makes the move towards risk-based contracts increasingly urgent for health systems. The industry has been largely unprepared for the shift, as it hasn’t established a clear definition of population health or solid guidelines on transitioning from volume to value. Organizations can, however, prepare for the demands of PHM by adopting a solution that manages comprehensive population health data, provides advanced analytics from new and complex challenges, and connects them with the deep expertise to thrive in a value-based landscape.
Learn some simple truths about how ACO's operate and function. Adapted from http://www.insight-txcin.org/post/why-accountable-care-organizations-succeed
Provider participation in accountable care organizations (ACOs) is becoming the new normal. As of January 1, 2016, there are 434 ACOs
in the Medicare Shared Savings Program. More than 160,000 providers now participate in an MSSP ACO. These organizations now serve
7.7 million Medicare beneficiaries residing in 49 of the 50 states. Here’s the road to the MSSP destination of shared savings.
Value-Based Purchasing and the Role of Home Care TechnologyAlayaCare
While shifting financial models is a major challenge facing healthcare, we can safely assume where that shift is heading. As it stands, there continues to be a paucity of good evidence as to how to run an effective Value-Based Purchasing (VBP) program, and definitive metrics on how it can lead to better outcomes. Thus, this shift is underway filled with far more expectations than answers.
With this guide will you learn how your home care agency can prepare, adapt and thrive in a value-based purchasing landscape with the help of modern home care technology.
What is MIPS and How it Affects My Practice?
For additional information on MIPS, you can visit: https://bit.ly/2I6TUxq, or contact us at 888-357-3226/ info@medicalbillersandcoders.com with your questions.
Click Here For More Information: https://bit.ly/3k7QS9P
Get a Free Quote: https://bit.ly/30DFr2z
#texasmedicalbillingandcodingservices #medicalbillingauditing #medicare #medicalbillingandcoding #MBC #MIPS #medicalbillingguideline #mipsaffectsmypractice
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.
Health Reform Bracketology is a scenario-planning tool that assesses the future of specific policies and provisions within the Patient Protection and Affordable Care Act. This assessment is conducted across a myriad of different political scenarios.
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.
White Paper - Building Your ACO and Healthcare IT’s RoleNextGen Healthcare
The tools needed to capture, organize, and share healthcare data are truly evolving at the speed of light. Patient Centered Medical Homes play a vital role in the path toward accountable care and technology, staff, and workflow transformation are necessary to achieve PCMH recognition. This transformation allows healthcare providers to deliver higher quality coordinated care by streamlining and rationalizing the patient experience.
Five Macro Trends Driving Healthcare Industry Investment in 2011 and BeyondCognizant
Here are five industry trends that will strongly influence where and how healthcare ecosystem participants will invest business development and technology dollars this year and into 2012.
Imagine a healthcare system where people live long, healthy lives, receiving quality, affordable care, with clinicians nationwide collaborating to improve outcomes. That's Accountable Care! Learn the benefits of becoming an ACO in this insightful eBook.
CFO Strategies for Balancing Fee-for-Service and ValuePhytel
Moving from fee-for-service to value-based care is not easy. However, leading health systems are all following a similar blueprint that enables the move to value-based care.
Download this whitepaper to learn how:
- Bon Secours Richmond - Closed 75,801 gaps in care within 12 months, generating $7 million in revenue for chronic & preventive care, while improving quality.
- Northeast Georgia Medical Center - Decreased HbA1C levels across uncontrolled diabetes by an average of 1.6 points within 120 days.
- Riverside Medical Center - Reduced unnecessary readmissions by 40% by using automation to reach and assess patients post discharge.
- Prevea Health - Increased care management productivity by 150% by automatically identifying high risk patients, and automating patient engagement.
mHealth Israel_US Health Insurance Overview- An Insider's PerspectiveLevi Shapiro
Presentation about the US Health Insurance Sector by Lori Rund, VP, Product Management and Market Intelligence at Health Alliance Plan, a managed care organization owned by the Henry Ford Health System, with 650,000 lives. Lori is responsible for the identification, concept building, researching and business case developments for new products, services and markets. She develops and leads comprehensive market intelligence functions to help the organization better understand industry trends and identify business opportunities.
Prior to joining Health Alliance Plan, Lori was Director of Product Development and Market Intelligence at Health Alliance Medical Plans in Illinois and Director of Market Research and Strategy at Carle Clinic Association, also in Illinois.
Resetting Payer-Provider Arrangements for COVID-19 and the Evolving Improveme...Health Catalyst
As the healthcare industry recovers from COVID-19, providers are re-evaluating the financial arrangements that motivate them to improve their processes while benefiting payers and patients.
With the pandemic driving lower provider volumes and straining hospital resources, the industry has a renewed urgency for policies that drive better outcomes while lowering cost and improving revenue. Moving forward, healthcare must reset its payer-provider performance standards to the post COVID-19 environment.
Renewed approaches to the following models will consider the impact of remote care, how to reimburse telehealth services, and the need for consistent payments to providers:
1. Pay for performance.
2. Bundled payments.
3. ACOs.
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.
As the Affordable Care Act takes effect, health insurance companies will have to design and implement new healthcare models to keep up with the new consumer population.
Michael O Leavitt:
I call these speeches The Prologue Series. There is a statue behind the National
Archives that I look at nearly every day as I drive between HHS and the White
House. The statue, the work of Robert Aitken, is called “The Future.” It depicts a
woman looking up to the horizon from a book as if to ponder what she has just
read. At the base of the statue are the words from Shakespeare’s The Tempest
“What is past is prologue.”
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Aco whitepaper final
1.
2.
3.
4.
5. Following the Patient Protection and Afforda- ferral Regions (HRR) associated with the hospitals
ble Care Act’s emphasis on Accountable Care Or- that each entity utilizes.
ganizations (ACOs) and the announcement of the
Of the 164 identified ACOs, the sponsoring
Medicare Shared Savings Program, an increased
entities included hospital systems, physician groups
interest has emerged among providers and payers
and insurers with a market presence in 41 states but
to create ACOs. To date, little has been published
less than half of all HRRs. Of these entities, 99
regarding the types and locations of organizations
were primarily sponsored by hospital systems, 38
adopting principles of accountable care.
by physician groups and 27 by insurers.
As part of an ongoing national study, Leavitt
Partners identified ACOs from news releases, me-
dia reports, trade groups, collaborations and inter-
views through the beginning of September 2011.
Also included were entities that either self-
identified as being an ACOs or specifically adopted
the tenets of accountable care including financial
A clear movement is evolving within the
accountability for the health care needs of a popula-
health care industry towards the accountable care
tion, managing the care of that population and bear-
model of providing health services. Adoption of
ing that responsibility at an organizational level.
this model will vary greatly due to both regional
Leavitt Partners then mapped the market of each of
differences as well as variations among the spon-
these entities based on the States and Hospital Re-
soring entities.
6. Since the 2010 passage of the Patient Protec- ent approaches that can lead to the desired results.
tion and Affordable Care Act (PPACA), industry, To this end, the loose definition of an ACO sug-
media and national interest has grown in the con- gested by McClellan et al is the most fitting: an
cept of the Accountable Care Organization (ACO) organization that seeks “per capita improvements
1,2 3
. With backing from the White House and the in quality and cost” with some degree of accounta-
conviction of Centers for Medicare and Medicaid bility8. To clarify, an ACO must be, to some ex-
Services (CMS) leadership that they will lead to tent, financially accountable for the health care
4
better care, better results and decreased costs , needs of a population, manage the care of that pop-
Medicare has placed added emphasis on develop- ulation and bear that responsibility at an organiza-
ing ACOs as part of the Shared Savings Program5 tional level.
6
and Pioneer ACO demonstration projects. Addi-
While the “Accountable Care Organization”
tionally, private payers are experimenting with
name is of recent devise9, the concepts it embraces
ACO-centric initiatives in an effort to increase the
are not new to this period: management of and ac-
value they receive for the prices they pay by lower-
countability for health care. From the earliest ex-
ing the cost of care, improving the outcomes, or,
periments with capitated payments to the most re-
ideally, both7.
cent pioneer ACO demonstration programs, the
goal of improving outcomes while providers man-
age some degree of risk has been approached in
many different ways. To date, there is no consen-
sus regarding which models are best, and the amor-
phous concept of what an ACO consists of, what it
While there are some specific requirements to is expected to do and how it achieves its aims is yet
participate in Medicare’s demonstration programs, to be adequately defined, tested or analyzed.
ACOs can take many different forms within and Leavitt Partners Center for ACO Intelligence has
apart from Medicare. Since there are likely many begun to study the organizations that are attempting
models that will be able to achieve the same goals, to achieve the aims of an ACO without limiting the
there is little reason to define what an ACO is and, approaches the organizations may take and hope to
instead, the emphasis should be on identifying what learn which, and to what degree, approaches are
an individual ACO does and then study the differ- successful at improving the value of health care.
7. Without mandatory accreditation10 or some implementation phase; some ACOs are started by
minimum requirement to become an ACO, Leavitt hospitals and others by physician groups or insur-
Partners has sought to pinpoint ACOs by identify- ance companies; some are large integrated systems
ing two types of organizations: those that self- and others are smaller and primarily variations on
identify as ACOs and those who have been specifi- the patient-centered medical home. Starting with
cally identified as adopting the tenets of accounta- this initial list, Leavitt Partners will continue to
ble care. Leavitt Partners has used news releases, track these and future ACOs over time and evaluate
media reports, trade groups, collaborations, inter- the effectiveness of different approaches to achiev-
views and contacts within organizations through ing the goals of improving care and lowering cost.
the beginning of September 2011 to identify 164 This paper addresses the geographic growth of
ACO entities, including those that are actively ACOs in the United States and summarizes the
bearing risk and coordinating care and those that types of organizations that are implementing the
are implementing such programs. Initial review ACO model. This information is useful as it indi-
shows large variability between ACO organiza- cates the regions which should expect initial ACO
tions: some organizations have been bearing risk growth and describes the types of entities that will
and coordinating care for decades, while others drive the initial creation of ACOs.
have newly adopted the ACO model and are in an
8. 1) Dispersion of accountable care organiza- care and are backing ACOs throughout the coun-
tions varies significantly by market. There is try. The multitude of entities creating ACOs
extreme variation in the present growth of ac- have led to many different models of providing
countable care organizations with some markets care for a patient population.
having multiple ACOs with others having
none. Much ACO growth appears to be a reac- 4) Significant investment in the accountable
tion to other organizations in the market: when care model exists independent of the Medicare
one institution forms an ACO, its competitors Shared Savings Program. Though the Medi-
often follow suit. care Shared Savings Program final regulations
have been released, implementation is still in its
2) Certain regions of the United States are infancy. Regardless, ACO growth is growing
devoid of accountable care organiza- independent of Medicare as multiple entities
tions. While ACO growth is extensive in some throughout the country are already operating un-
regions, others have no current ACO activi- der accountable care payment contracts.
ty. Poorer and rural regions in particular have
little ACO growth. 5) The success of different accountable care
models is yet unproven. The overriding goal of
3) Hospitals and hospital systems are the pri- accountable care organizations is to lower costs,
mary backers of ACOs. Nearly two-thirds of improve care, or both. While there are many
ACOs identified were started by hospitals or hos- different models of providing accountable care,
pital systems. Insurers and Physician Groups, which approaches are most successful at realiz-
though, are also adopting tenets of accountable ing an ACO’s goals is still unclear.
9. Health care delivery in America is still pri- were unclear, as was often the case with large
marily a cottage industry with few national insurance companies, those ACOs were not in-
health care providers. Most health service pro- cluded on the map; of the 140 ACOs mapped,
viders are regional and are focused around one 127 did not extend beyond one state.
market area, whether because of the simplicity of
Generally, states with larger populations are
dealing with one state law, the difficulties in ex-
associated with more ACOs, though the trend in
panding beyond a relatively small footprint or for
the South, through the plains states and into the
other reasons. Figure 1 depicts the dispersion of
mountain west is toward fewer ACOs. There
ACOs at the state level. Leavitt Partners classi-
are also noticeable outliers such as Montana, the
fied state coverage based on the location of hos-
45th most populous state, which has the same
pitals affiliated with the ACO. Where ACOs
number of ACOs (three) as Illinois and Georgia,
cover multiple states, both states were depicted
the 5th and 9th most populous state, respectively.
on the map. When the geographic boundaries
10. An indicator of competition among provid- than the state map suggests: While only nine
ers is the number of ACOs in Hospital Referral states do not have ACOs, less than half of all
Regions (HRRs). Developed by the Dartmouth HRRs (144 out of 306) have an ACO. This clus-
Institute for Health Policy, the 306 HRRs are tering within HRRs suggests that competing
regional health care markets where patients are health systems are simultaneously creating
referred for tertiary care11,12. Multiple ACOs in a ACOs. This may arise from providers in a mar-
single HRR is indicative of markets where health ket who seek to match or copy what a competitor
care providers within the regions may be compet- is doing or it may be indicative of previously-
ing for the same patients. Figure 2 shows the integrated systems that are better prepared to be-
number of ACOs by HRR, determined by the come ACOs. Additionally there likely are mar-
location of hospitals affiliated with the ACO. ket-specific reasons that have previously affected
When an ACO covers multiple HRRs, all were the growth of health care entities in different are-
included on the map. When an ACO covers a as of the country which differently affect market-
poorly-defined region or is nearly national in level ACO growth.
scope, as is the case with some insurance compa-
ny sponsored ACOs, the ACO was excluded
from this map.
The smaller size of HRRs shows the trend
of entities creating ACOs in narrower regions
11. Another interesting aspect of this map is the chronic diseases14. Accordingly, it would seem
dearth of ACOs in the Southeast and Appalachi- that these regions stand to benefit the most from
an regions which consistently rank as the least coordinated care15. The reason for the lack of
healthy areas of the country13 with a high preva- ACOs in these regions is unclear.
lence of obesity, heart disease, diabetes and other
12. defined as a hospital or health system, an inde-
pendent physician association (IPA) or as an in-
surer. In actuality, some ACOs were started by
organizations that do not clearly fit into one of
these three categories and others were formed as
joint ventures. In seeking to simplify the classifi-
Traditional approaches to coordinated care cations, each organization was classified by the
have been structured around hospital systems or entity that was predominantly responsible for the
payers affiliated with hospital systems. ACOs, ACO’s creation and grouped the ACOs based on
though, can be started by any entity that is able to the state where the sponsoring entity is headquar-
cover a large number of lives and bear some tered. Table 1 shows the breakdown of the num-
form of risk for that population. Leavitt Partners ber of ACOs formed by each sponsoring entity.
defined the sponsoring entity as the organization There is a clear trend toward hospital systems
that is primarily responsible for the ACO. In sponsoring ACO development, as they accounted
evaluating the sponsoring entity, each entity was for more than 60% of all sponsoring entities.
14. With the Medicare Shared Savings Program changes to the care process, rather than radically
still to be implemented, the substantial growth of redesigning the organization to become something
Accountable Care Organizations indicates a trend fundamentally different in the future. It appears,
within the health care industry towards the account- for now, that defining oneself as an ACO represents
able care model, partially independent of govern- an acceptance of the direction the industry has been
ment incentives. With significant regional varia- headed rather than an adoption of a truly new form
tion, it is unclear, though, what is driving market- of care delivery.
level ACO growth. In some large markets, such as
Boston, ACOs are proliferating, while in other large
markets, such as Washington DC, they are not.
Market specific clustering is a prevalent feature—if
there is one ACO, it is more likely that another is
nearby. Further tracking of ACO growth and dis-
persion will provide a more sound conclusion as to
The range of entities that have sponsored
whether ACO adoption is primarily a response to
ACOs, from small IPAs to national insurance com-
competitors, indicated by future ACO growth re-
panies indicates the wide range of business models
maining concentrated around existing ACOs, or
that will ultimately provide accountable care. Un-
indicative of the success and effectiveness of the
der the Shared Savings Program, entities must be
model, thereby dispersing throughout all markets.
care providers to qualify16, but non-provider insur-
As a consensus regarding the definition of an ance companies are a major backer of ACO growth,
ACO continues to develops, evidence exists that the indicating a much broader definition of what type
basic tenets of accountable care have existed in of entity can provide accountable care. Important
many organizations for years, and only the title of insights will be drawn by observing which models
ACO is new. Preliminary review of the organiza- succeed in reaching the overriding goal of increas-
tions we have identified indicates a trend toward ing value through improving quality, lowering costs
proclaiming oneself as an ACO with only modest or both.
15. With neither a set definition nor a national method an ACO is not always clear, leading to possibly
for identifying ACOs, it is difficult to precisely inaccurate depictions of the geographic dispersion
identify and study such organizations. It is possible of ACOs. For example, some sponsoring organiza-
that some of the organizations which should be tions have a population they presently serve, but
considered ACOs are missing from our study and the ACO they have announced may only exist in
some, such as organizations that self-identify as part of the region that the sponsoring organization,
ACOs but will never ultimately adopt any type of as a whole, covers. Additionally, some ACOs are
care coordination or bear any risk for a population, organized by regional or national entities that may
may not belong. Accurate representation of all cover ill-defined patient populations in many states,
ACOs will happen with further analysis of the cur- making completely accurate determination of the
rent organizations on our list and future identifica- geographic region that the ACO covers unknowa-
tion of other ACO entities. ble.
There are also limitations with mapping where the
ACO is located. The geographic area covered by
16. 1
Goldsmith, Jeff. “Accountable Care Organizations: The Case For Flexible Partnerships Between Health
Plans And Providers,” Health Affairs 30, no. 1 (January 1, 2011): 32 -40; Steven M. Lieberman and John
M. Bertko, “Building Regulatory And Operational Flexibility Into Accountable Care Organizations And
‘Shared Savings’,” Health Affairs 30, no. 1 (January 1, 2011): 23 -31.
2
“National Accountable Care Organization Congress: Overview”, n.d., http://www.acocongress.com/
overview.html.
3
HealthCare.gov. “Accountable Care Organizations: Improving Care Coordination for People with Medi-
care”, March 31, 2011, http://www.healthcare.gov/news/factsheets/2011/03/accountablecare
03312011a.html.
4
Berwick, Donald M. “Launching Accountable Care Organizations — The Proposed Rule for the Medicare
Shared Savings Program,” New England Journal of Medicine 364 (April 21, 2011): e32.
5
Centers for Medicare & Medicaid Services. “Overview of the Shared Savings Program”, May 17, 2011,
https://www.cms.gov/sharedsavingsprogram/.
6
Center for Medicare & Medicaid Innovation. “Pioneer ACO Model”, n.d., http://innovations.cms.gov/areas
-of-focus/ seamless-and-coordinated-care-models/pioneer-aco/.
7
Delbanco, Suzanne F., et al. Promising Payment Reform: Risk-Sharing with Accountable Care Organiza-
tions (The Common wealth Fund, July 2011), http://www.commonwealthfund.org/~/media/Files/
Publications/Fund%20Report/ 2011/Jul/1530Delbancopromisingpaymentreformrisksharing%202.pdf.
8
McClellan, Mark, et al. “A National Strategy To Put Accountable Care Into Practice,” Health Affairs 29,
no. 5 (May 1, 2010): 982-990.
9
Medicare Payment Advisory Commission. Public Meeting, November 8, 2006, http://www.medpac.gov/
transcripts/1108_1109_medpac.final.pdf.
10
The National Committee for Quality Assurance (NCQA) is implementing a voluntary accreditation process;
see “Accountable Care Organization Accreditation”, n.d., http://www.ncqa.org/tabid/1312/Default.aspx.
11
For more information on HRRs, please see Dartmouth Institute for Health Policy and Clinical Practice.
“Dartmouth Atlas of Health Care”, n.d., http://www.dartmouthatlas.org/.
12
Geographic boundary files for HRRs were obtained from Dartmouth Atlas of Health Care. “Downloads”,
n.d., http://www.dartmouthatlas.org/tools/downloads.aspx#boundaries.
13
United Health Foundation. “America’s Health Rankings”, n.d., http://www.americashealthrankings.org/.
14
Center for Disease Control. “Behavioral Risk Factor Surveillance System”, August 19, 2011, http://
www.cdc.gov/brfss/.
15
Peikes, Deborah, et al. “Effects of Care Coordination on Hospitalization, Quality of Care, and Health Care
Expenditures Among Medicare Beneficiaries,” JAMA: The Journal of the American Medical Association
301, no. 6 (February 11, 2009): 603 -618.
16
Centers for Medicare & Medicaid Services. Proposed Rule: Medicare Shared Savings Program, 42 CFR
Part 425, 2011, http://www.ftc.gov/opp/aco/cms-proposedrule.PDF.