Learn some simple truths about how ACO's operate and function. Adapted from http://www.insight-txcin.org/post/why-accountable-care-organizations-succeed
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
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
Rising Healthcare Costs: Why We Have to ChangeHealth Catalyst
With rising healthcare costs, we hear so often about rate pressures on hospitals and the risk these pressures pose for their future. With healthcare reform, the burden of rising healthcare costs is shifting from payers to providers. Hospitals need to move toward value-based reimbursement models or they will face a -15.8 operating margin by 2021.Over the last 15 years premiums and employee contributions for an average family with health insurance sponsored by an employer have risen 167%. Along with these facts, government payers are reimbursing at lower levels becoming a negative margin for hospitals. These changes are not necessarily easy and can seem overwhelming. The question is whether your hospital will be a pioneer on the trail or will delay until it’s too late. The best way to get started is to understand exactly where you are today—your current cost structure and how each area of your organization is performing in terms of quality and cost, using an EDW.
A comprehensive view of how Medical Billing works. How to prepare medical claims, patient eligibility, example insurance cards, Medicare / Medicade, authorization of services, charge entry, fee schedules, claim submissions, posting ERAs / EOBs, rejected or denied claims (and their correction), secondary claims, cycle of a claim, revenue cycle, provider info needed on a claim, evaluation and management: coding and evaluations and basic components, etc,. By Medwave Medical Billing & Credentialing at http://medwave.io.
Healthcare Industry Highlight: Revenue Cycle ManagementCascadia_Capital
In our most recent Healthcare Industry Highlight Report on Revenue Cycle Management, we outline the trends driving consolidation and increased market activity and make predictions on the outlook and future of the RCM ecosystem.
A comprehensive analysis of Apollo Hospitals [Biswadeep Ghosh Hazra and Team]...Biswadeep Ghosh Hazra
The report covers the essential strategic aspects of Apollo Hospitals which are enumerated below-
1 Executive Summary
2 Industry Overview
2.1 Nature and Size of the Industry
2.2 Key Growth drivers for the industry
2.3 Identification of Critical Success Factors (CSF)
2.4 Market Analysis based on CSFs
2.5 Industry Benchmarks
2.6 PESTEL Analysis
2.7 Porter’s Five Forces Analysis
2.8 Strategic Group Mapping
2.9 Competitive Landscape
2.10 Market Segmentation
2.11 Buying Criteria Analysis of the Industry
2.12 Key trends and future developments
3 Company Overview
3.1 Company background
3.2 Timeline with key milestones and their strategic impact
3.3 Vision, Mission, Goals, and Strategic Themes
3.4 Key Product and Service Portfolio
3.5 Core Competencies of the firm
3.6 Business Model of the organization
3.7 3rd Generation Balanced Scorecard (Amalgamation of 1st Generation BSC and Activity System Map)
3.8 SWOT Analysis
3.9 Competitor Analysis (identify competitors)
3.9.1 Based on Critical Success factors
3.9.2 Based on Financial indicators
4 Future Growth Strategy for the organization
4.1 Portfolio Analysis
4.1.1 Based on BCG Matrix
4.2 Company’s Strategic Roadmap for future
4.3 Product Market Investment Strategy
4.4 Re-imagining the Organization with
the transformed business model or Use-case based on SMAC and IOE
Dan Wellisch gave this presentation to the Chicago Technology For Vaue Based Healthcare Meetup at https://www.meetup.com/Chicago-Technology-For-Value-Based-Healthcare-Meetup/
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.
WHAT IS ACO REACH MODEL & HOW DOES IT REGULATE EFFECTIVE HEALTHCARE.pptxPersivia Inc
In the ever-evolving landscape of healthcare, the term ACO Reach has gained considerable attention. But What is ACO Reach Model, and how does it play a pivotal role in regulating effective healthcare? In this article, we will delve into the intricacies of this model, providing you with a comprehensive understanding of its significance in the healthcare industry.
Rising Healthcare Costs: Why We Have to ChangeHealth Catalyst
With rising healthcare costs, we hear so often about rate pressures on hospitals and the risk these pressures pose for their future. With healthcare reform, the burden of rising healthcare costs is shifting from payers to providers. Hospitals need to move toward value-based reimbursement models or they will face a -15.8 operating margin by 2021.Over the last 15 years premiums and employee contributions for an average family with health insurance sponsored by an employer have risen 167%. Along with these facts, government payers are reimbursing at lower levels becoming a negative margin for hospitals. These changes are not necessarily easy and can seem overwhelming. The question is whether your hospital will be a pioneer on the trail or will delay until it’s too late. The best way to get started is to understand exactly where you are today—your current cost structure and how each area of your organization is performing in terms of quality and cost, using an EDW.
A comprehensive view of how Medical Billing works. How to prepare medical claims, patient eligibility, example insurance cards, Medicare / Medicade, authorization of services, charge entry, fee schedules, claim submissions, posting ERAs / EOBs, rejected or denied claims (and their correction), secondary claims, cycle of a claim, revenue cycle, provider info needed on a claim, evaluation and management: coding and evaluations and basic components, etc,. By Medwave Medical Billing & Credentialing at http://medwave.io.
Healthcare Industry Highlight: Revenue Cycle ManagementCascadia_Capital
In our most recent Healthcare Industry Highlight Report on Revenue Cycle Management, we outline the trends driving consolidation and increased market activity and make predictions on the outlook and future of the RCM ecosystem.
A comprehensive analysis of Apollo Hospitals [Biswadeep Ghosh Hazra and Team]...Biswadeep Ghosh Hazra
The report covers the essential strategic aspects of Apollo Hospitals which are enumerated below-
1 Executive Summary
2 Industry Overview
2.1 Nature and Size of the Industry
2.2 Key Growth drivers for the industry
2.3 Identification of Critical Success Factors (CSF)
2.4 Market Analysis based on CSFs
2.5 Industry Benchmarks
2.6 PESTEL Analysis
2.7 Porter’s Five Forces Analysis
2.8 Strategic Group Mapping
2.9 Competitive Landscape
2.10 Market Segmentation
2.11 Buying Criteria Analysis of the Industry
2.12 Key trends and future developments
3 Company Overview
3.1 Company background
3.2 Timeline with key milestones and their strategic impact
3.3 Vision, Mission, Goals, and Strategic Themes
3.4 Key Product and Service Portfolio
3.5 Core Competencies of the firm
3.6 Business Model of the organization
3.7 3rd Generation Balanced Scorecard (Amalgamation of 1st Generation BSC and Activity System Map)
3.8 SWOT Analysis
3.9 Competitor Analysis (identify competitors)
3.9.1 Based on Critical Success factors
3.9.2 Based on Financial indicators
4 Future Growth Strategy for the organization
4.1 Portfolio Analysis
4.1.1 Based on BCG Matrix
4.2 Company’s Strategic Roadmap for future
4.3 Product Market Investment Strategy
4.4 Re-imagining the Organization with
the transformed business model or Use-case based on SMAC and IOE
Dan Wellisch gave this presentation to the Chicago Technology For Vaue Based Healthcare Meetup at https://www.meetup.com/Chicago-Technology-For-Value-Based-Healthcare-Meetup/
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.
WHAT IS ACO REACH MODEL & HOW DOES IT REGULATE EFFECTIVE HEALTHCARE.pptxPersivia Inc
In the ever-evolving landscape of healthcare, the term ACO Reach has gained considerable attention. But What is ACO Reach Model, and how does it play a pivotal role in regulating effective healthcare? In this article, we will delve into the intricacies of this model, providing you with a comprehensive understanding of its significance in the healthcare industry.
OPERATIONAL INTEGRATION: CREATING A HIGH-PERFORMING HEALTHCARE ORGANIZATIONEmCare
What strategies are in your arsenal to combat and conquer the thorny challenges
of healthcare reform? Reducing costs? Improving quality, productivity and efficiency? Redesigning processes? Improving the patient experience? Transforming your organization from one that delivers episodic sick care to one that nurtures wellness and personal responsibility is daunting, but absolutely necessary. While consultants
have prospered by touting the “solution-of-the-day,” a handful of approaches have gained traction. One of those is clinical integration.
IS ACO REACH PROGRAM LEADING THE WAY IN POPULATION HEALTH MANAGEMENT.pptxPersivia Inc
In today’s ever-evolving healthcare landscape, the quest for effective population health management has become paramount. Accountable Care Organizations (ACOs) have emerged as a significant player in this endeavor, with the ACO Reach Program at the forefront of innovation and transformation.
PSCI is an innovative, health care analytics company on a mission to transform health care provider economics with advanced patient and population analytics.PSCI uses a transformational approach for predicting risk of hospitalization that takes in to account of 6 dimensions - patent state - of – health, compliance, utilization , socioeconomics, access to care and perceived well –being.
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.
Building Clinical Integration as a Foundation to Become a Successful ACOPhytel
More and more healthcare organizations are recognizing that clinical integration of providers is a prerequisite to care coordination, population health management, and accountable care organizations. They also know that patient centered medical homes—the building blocks of ACOs—can thrive only in patient-centered medical neighborhoods where specialists collaborate with primary care physicians. For this cooperation to be truly effective, all of these providers must be clinically integrated. This paper explains the components of clinical integration and summarizes the kinds of information technology required for its implementation. Case studies of organizations that are building the necessary infrastructure are also included.
The Evolution of Physician Group from Patient Centric Medical HomesVitreosHealth
A Quest to Achieve Higher Quality and Bend the Employers Health Care Cost Curves. Medical Clinic of North Texas (MCNT) enjoys a stellar FY 2010 performance with Total Medical Cost trend for their managed population 2.4% better than market. We tried to understand the journey and the drivers behind the success of Medical Clinic of North Texas from its early years and its future direction.
A conversational candid discussion about web-based health insurance exchanges. What is their impact on states, insurers and consumers?
www.healthcaremedicalpharmaceuticaldirectory.com
John G. Baresky
https://www.linkedin.com/in/johngbaresky
#baresky
The establishment of web-based health insurance exchanges is a key component of healthcare reform. Their purpose, developmental challenges,patient access benefits and healthcare industry impact are discussed.
www.healthcaremedicalpharmaceuticaldirectory.com
https://www.linkedin.com/in/johngbaresky
... Healthcare Marketing Leader: Pharmaceutical, Medical Device, RPA, SaaS, Digital Marketing Strategy, Managed Care, Market Access - John G. Baresky
A primary component of healthcare reform is the establishment of web-based health insurance exchanges.
They represent challenges and opportunities for marketers, politicians, consumers and technical professionals. Quickly gain insight and understanding to this national initiative through this concise and comprehensive presentation!
www.healthcaremedicalpharmaceuticaldirectory.com
John G. Baresky
https://www.linkedin.com/in/johngbaresky
#baresky
This is from a brief workshop we did at Arizona SkySong for local health care executives. All about the current state of value-based care, accountable care organizations, and general trends we're seeing within the health care delivery space.
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.
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2. An Accountable Care Organization,
or ACO, is a network of physicians,
specialists, surgeons, and hospitals
who agree to coordinate care for a
patient population, with the goal of
improving quality care, while
eliminating unnecessary spending.
http://www.insight-txcin.org/post/why-accountable-care-organizations-succeed
3. WHY WERE
ACO’S
ESTABLISHED?
ACO’s were established by the Center for
Medicare and Medicaid Services (CMS) with
the goal to provide better care for individuals,
better health for populations, and lower
growth in expenditures (DHHS)
4. WHY
WERE
ACO’S
ESTAB-
LISHED?
It’s important to note that as
lawmakers searched for ways to
reduce the national deficit,
Medicare became a prime
target. With baby boomers
entering retirement age, the
costs of caring for the elderly
and disabled Americans were
expected to soar (Gold). ACO’s
could help cut costs, while
improving care. They became
the vehicle for implementing a
new payment model in
healthcare called “value-based
purchasing.
5. HOW DOES
AN ACO
WORK?
An ACO coordinates the communication
and medical care efforts of doctors,
imaging specialists, surgeons, hospitals,
home health caregivers, and even
pharmacies to diagnose and treat patients,
and to help them stay healthy in the
future.
6. ACO’s are designed to
change the traditional
healthcare model
through the following
ways:
7. C
A
O
Align the different component parts of patient care--
primary care, specialists, hospitals, home health care--
into an organized collective.
Oversee the quality of care of their patients by making
sure that their network is meeting performance
standards set by the CMS.
Look for ways to eliminate unnecessary spending in
order to lower the overall cost of healthcare for its
patients.
Supply that network with the technology to efficiently
communicate and coordinate patient care.
8. WHAT’S IN
IT FOR THE
ACO?
The more an ACO can reduce
costs, while maintaining quality
care and outcomes, the more
financially rewarding it can be for
everyone invested in the ACO.
9. ABOUT
TXCIN
North Texas Clinically
Integrated Network, Inc. (dba
TXCIN) is a non-profit ACO
that began in late 2014. A
small group of independent
physicians aligned to initiate
clinical integration and value-
based contracting. Partnering
with RevelationMD and its
state-of-the art information
platform, TXCIN has become
the largest independent
network of physicians in North
Texas.