Reaction to Healthcare Reform & Future: a Physician Organization s Perspective. May 15, Renaissance Health Network

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1 Reaction to Healthcare Reform & Future: a Physician Organization s Perspective May 15, 2013

2 Reaction to Healthcare Reform & Future: a Physician Organization s Perspective presented by Po Chou Chief Operating Officer

3 Agenda Health Care Reform Accountable Care Organization RHN s Reaction to It RHN s View of the Future Q&A

4 Physician Organization 255 Independent PCPs Clinically Integrated 5-county area around Philadelphia Pioneer ACO Contract Apr. 32k Medicare Beneficiaries (Apr. $320 mil expenditure) Past Experience in similar model with Commercial Payor with 120k lives ($450 mil expenditure)

5 Locations

6 Agenda Health Care Reform Accountable Care Organization RHN s Reaction to It RHN s View of the Future Q&A

7

8 2010 Healthcare Reform 3/21 - House passed the Senate-passed reform bill 3/21 House passed budget reconciliation bill that modifies Senate bill $938 B price tag The Patient Protection and Affordable Care Act (PPACA) of /23 President Obama signed Senate bill into law 3/25 Senate passed budget reconciliation portion with technical correction, requiring second vote by the House 3/25 House passed budget reconciliation bill with technical correction 3/30 - President signed final budget reconciliation bill 8

9

10 THE MEDICARE CRISIS!

11 Growing Medicare Population

12

13

14 Agenda Health Care Reform Accountable Care Organization RHN s Reaction to It RHN s View of the Future Take Home Messages

15 Accountable Care Organizations

16 What is an Accountable Care Organization (ACO)? Defined as a group of healthcare providers who accept accountability to manage the care of a patient population, the ACO has the primary focus of improving the overall health of its patients while managing the total cost of care received by them. The Patient Protection and Affordable Care Act (PPACA) of 2010

17 Genesis from HillaryCare in 1993 Managed Competition History of Accountable Care as Approach Quality Payment for Services: CMS 2003 Process: Evidence Based Medicine Guidelines Outcomes: Improvement in Quality Measures Treatment of Chronic Diseases Shared Savings for Cost Containment Emerging Payer/CMS Pilots in Episodes of Care 17

18 Medicare Shared Savings Program 3-Part Aim

19 PPACA 3-Part Aim 1. Better Health: Improve the individual experience and quality of care 2. Better Healthcare: Improve the health outcomes and health status of the population (Clinical Outcomes & Quality); and 3. Lower Cost: Reduce per capita costs of care of populations

20 Accountable Care Organization and Healthcare Reform Different Paths to Accountability: Provider Experience with the Pioneer ACO Model, the Shared Savings Program & Other Payment Models

21 Key Contractual Terms Length of Agreement: 3 years MSSP Model: Track #1 One Sided (Upside Only) Track #2 Two Sided (Upside/Downside) MSR: Varies Quality Requirement: Reporting in Year #1 and Performance Based for remaining years. Upside Potential: Varies depending on the track

22

23 MSSP Example Performance Calculation Years 1-3, Track #1

24 Calculating savings based on spending targets Projected Spending Target Spending Shared Savings Actual Spending

25

26 Our Pioneer ACO model

27

28

29 Challenges Capitalization

30 Capitalization

31 38

32

33 Challenges Capitalization Infrastructure

34 Interventions Pioneer ACO

35 Programmatic Interventions

36 Capitalization Infrastructure Data/Reporting Delays Targeting Actionable Managing Risk Challenges

37 Minimizing Risk

38 Capitalization Infrastructure Data/Reporting Delays Targeting Actionable Managing Risk Confusion by Patients Healthcare Reform ACO Challenges 45

39 Confusion

40

41

42

43 MODEL 50

44 Migration

45 Impact of Healthcare Exchanges?

46

47 Agenda Health Care Reform Accountable Care Organization RHN s Reaction to It RHN s View of the Future Q&A

48 55

49 Page 56

50 Po Chou

51 About the Speaker Po Chou Chief Operating Officer Po has over 25 years of executive leadership experience in the health care industry. He has served faculty and several C-level operations and financial roles in various for-profit, not-for-profit, and academic medical centers inclusive of Tenet Healthcare, The University of Texas Medical School, The George Washington University School of Medicine, and the Department of Health and Human Services in Washington, DC. Po is known for his expertise in strategic management, operations, finance, and health services research. He has led numerous start-ups, turn-arounds, and vertical/horizontal integrations. Po also serves as the Chief Operating Officer for (a Pioneer ACO) and provides management and consultation for Navvis Healthways Medicare Shared Savings Program ACO Clients. A graduate of George Washington University, Po holds both a M.P.H. and a M.S. from The University of Texas, and completed Dr.Ph. and Ph.D. doctoral qualifications at The University of Texas. 58

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