Presented by David Parpart to Wellmark's Prebacked Ignition Startups 6/27/2013.

1.
Contact:
David
Parpart,
D.C.
,
CEO
Socially
Relevant
Inc
408-­‐421-­‐9508
drparpart@impactmeds.com
What’s an ACO?

2. Accountable
Healthcare
Pla9orm
for
Pa<ent
Engagement
Solu<ons
Pharmacist
Counseling
|
Mobile
Applica<ons
|
Remote
Monitoring
Drivers of Healthcare Reform
Economics

3. Healthcare Reform Puts
6% of Hospital Revenue at Risk
2%
annual
payment
update
at
risk
by
FY2017
1%
DRG
payment
penalty
FY2013,
rising
to
3%
by
FY2015
1%
DRG
payment
penalty
for
hospitals
in
worst
quartile
beginning
FY2015
• Value-­‐based
Purchasing
• Process
of
care
• Patient
experience
Begins
FY2013
• 30-­‐Day
Readmissions
• Up
to
8
conditions
targeted
including
AMI,
HF,
PNA
• Hospital-­‐Acquired
Conditions
• Up
to
8
conditions
targeted

4. ConfidenBal-­‐
Socially
Relevant
Inc.
What’s an ACO?
ConfidenBal-­‐
Socially
Relevant
Technology

5. ConfidenBal-­‐
Socially
Relevant
Inc.
ConfidenBal-­‐
Socially
Relevant
Technology
Al a Carte All Inclusive
A Business Model
Volume vs. Capitation

6.
IMAGE
SOURCE:
NEHI
Roadmap
to
Improving
MedicaBon
Adherence,
2012
SOURCE:
New
England
Health
InsBtute,
2012
Accountable
Care
OrganizaBon
(ACO)

7. Accountable Care Organization
(ACO) Risk and Reward
Every Hospital has risk of loss/penalties
 2/3 penalized in Oct 2012
Health Organizations APPLY to form an ACO
 Assume risk
 Gain NEW REVENUE OPPORTUNITY through Medicare
Shared Saving Program
ACO’s Need New Patient Engagement Strategies
 Section H of the MSSP Application

8. ACO – Healthcare’s New Business Model
Value Based Purchasing and Shared Savings
Better Care
Experience
Lower Costs
Better
Population
Health
Metrics:
Patient Experience
Patient Activation Measures
Metrics:
Readmission Rate
Total PMPM & Trend
Metrics:
HEDIS
Cost Savings  New Revenues
Capitated Payment

9. ACO – Healthcare’s New Business Model
Example: Nephrology
Better Care
Experience
Lower Costs
Better
Population
Health
Doctor/Pharmacist/Patient
Collaboration
$178M Reduction in Part A
$ 23M Increase in Part D
$155M net savings
Cost Savings  New Revenues
Capitated Payment
$155M net savings X 60% = $90M

10. What is the Lowest Hanging Fruit
for ACO Profitability?
$700Bn
$290Bn
$30Bn
• Duplication of
Services
• Fraud
• Poor Med
Adherence
• Avoidable
Hospitalizations
ConfidenBal
Do
Not
Distribute