In the land of uncertainty, a map to prepare for the ACO model
|
|
- Emma Boyd
- 8 years ago
- Views:
Transcription
1 In the land of uncertainty, a map to prepare for the ACO model PwC s PRTM Management Consulting
2 In the land of uncertainty, a map to prepare for the ACO model Is the drive to promote Accountable Care Organizations (ACOs) an intriguing idea of the moment or a lasting trend? If the latter, should healthcare providers make their move now, or wait until the early dust settles? That s a big dilemma for many hospital executives who wait in limbo until more evidence surfaces. Meanwhile, they are feeling a significant margin squeeze as costs rise, patients and Commercial payers resist further price hikes, and while further Medicare pay cuts loom around the corner. The stakes have risen, as healthcare provision is changing inexorably from an activity-based model to one in which providers and payers are rewarded for quality of patient outcomes. The ACO model merges both imperatives, but requires a long-term investment in resources and capabilities, as well as the willingness to place a big bet and change key processes and mindsets. If Medicare scales up its ACO program across the system, many commercial payers will likely follow. So there s a risk that latecomers will be left behind by early movers. A wait-and-see stance may be appropriate for some hospitals those in onehospital towns where the dominant payers do not want to move quickly into ACO mode, or large academic medical centers that can survive commercial insurance pricing pressures. Many hospitals, however, should get more aggressive about making the shift, especially if they live in a highly competitive environment or have a large Medicare population. Each provider should calculate the risk it faces in its own environment when determining how quickly to make the transition. Navigating Terra Incognita We view the ACO model as neither blip nor aberration, but rather a solid model that will grow in scope and influence as the fee-for-service paradigm diminishes. But how to proceed in a land of uncertainty where, like the blank portions of maps of old, one never knows whether here be dragons? To be successful, hospitals must both time their strategic moves correctly and accurately anticipate the actual implementation issues and their solutions. It helps to see what the industry s pioneers are doing as they push ahead with ACO experiments. Aware of the size of the opportunity, they see advantage in being first to access lower-risk capital and first to build the capabilities needed to survive lower reimbursement rates in the future. Their experiences, and our own work with hospitals on ACO strategy, suggest four areas that hospital executives to get right in order to make the ACO shift successfully. In the land of uncertainty, a map to prepare for the ACO model 1
3 1. Align the senior team with scenario-based financial modeling The entire executive team should be in lockstep with the shift to an ACO model which, of course, is easier said than done. The best way to begin is to model the organization s current cost structures, accurately modeling the potential risks of the fee-for-service model and the size of the ACO opportunity. For instance, base-case analyses may reveal the extent to which adverse changes to Medicare and Commercial reimbursement will dampen gross revenue and cause gross margin to decline. Further modeling can reveal the pros and cons of other scenarios. The model we developed for one provider showed that it would need at least an 8 percent reduction in inpatient utilization to make money, assuming no incremental market share growth. However, we showed a significant risk-based revenue opportunity with only conservative inpatient and emergency room utilization reductions (see Exhibit 1). Exhibit 1: Scenario analysis for risk-based contracting To deliver as complete a cost picture as possible, hospital executives should conduct full opportunity assessments using fast-paced executive workshops that help cut through the clutter of business model options. Seeing the hard numbers and long-term financial implications is a powerful tonic. Every executive has a significant transformation role; none should assume that the ACO shift is someone else s job. There is no shortage of tasks, given so many unknown legal, clinical, financial impacts and such an array of vested interests. But, unless the whole senior team rallies around the same strategy and commits all of their resources, the effort is likely to fail. In the land of uncertainty, a map to prepare for the ACO model 2
4 2. Choose carefully which capabilities to develop first Too rapid a transition to the ACO model will overwhelm the organization or break the budget, putting the current business model at risk. The antidote is to have a clear idea of exactly which capabilities executives will need to add to be successful in this new model, and to devise a sequenced plan to acquire those capabilities. Scenario modeling will reveal which steps best suit which circumstances. It will help to show the scope and pace of the transition needed to protect the ongoing business while striving for first-mover advantage in an ACO model. It will also indicate which kinds of capabilities require aggressive investment and which must wait until a strong risk contract is in place. A sequenced approach allows a hospital to synchronize its investment in capabilities with its risk-contracting cadence, as demonstrated by the example in Exhibit 2. This example shows how one kind of capability can be improved over time to parallel the migration in reimbursement model. Leading providers start moving toward an ACO model within their existing contracts through no-lose capabilities. Here, they develop capabilities that will not erode their current fee-for-service revenues such as improving the performance of patient length of stay while simultaneously developing the foundation for the ACO capability portfolio. Exhibit 2: Expanded capabilities drive enhanced utilization outcomes which should link to contracting In the land of uncertainty, a map to prepare for the ACO model 3
5 It is often wisest and easiest to seek initial contract modifications that allow providers to share in the upside only savings for any reduced utilization. Here, one focuses on the most complex patients who can account for a third or more of costs because of a major diagnosis as well as non-disease complicating factors. Using care management or better decision support systems, this step begins to reduce unnecessary utilization and provide an immediate improved experience for the patients. To succeed in upside only shared savings however providers must effectively target utilization that is both clinically unnecessary and currently low margin for the hospital. Careful analysis and good activity-based costing assumptions can identify this group. Moving to the next level, providers again need new contract terms that expand their ability to share in savings or risk for the populations they manage. Here, the incentives tend to broaden the population and types of services offered. To support these contracts in our example, providers could build or improve readmission prevention programs and specific disease management programs for the chronically ill. And the next step further widens services and the patient population, in our example a provider may choose to rely on such practices as telemonitoring or wellness coaching for those in relatively good health (see Exhibit 3). Exhibit 3: Each level of implementation should expand both breadth and depth of capabilities Note that such a stepwise progress does not mean partial progress. An operating model such as shared savings will not work just because it produces some benefits compared to conventional fee-for-service models. Providers that stay in the middle of the road for long with, say, a shared savings model that does not change incentives will eventually succumb to a spiral of lower margins and a lack of momentum to capture greater savings. In the land of uncertainty, a map to prepare for the ACO model 4
6 3. Involve a wide group of stakeholders in designing the new model The magnitude of change involved in moving to an ACO model can knock an organization off its hinges unless it prepares and learns to adapt. People who have measured financial success largely by the throughput of patients now have to focus on quite different goals and metrics. Patients themselves will face a big adjustment as well. The key is to design the new model, processes, and metrics with the participation of all the relevant stakeholders through a methodology best characterized as co-creation. Instead of designing the ACO in isolation in a board room or doctor s lounge, co-creation calls for the administration, physicians, staff and ultimately consumers and purchasers to collaborate at various stages of the planning to create a more personalized, tailored model of care. Stakeholders won t wholeheartedly participate in co-creation unless it produces value for them, too. They need to have a stake in designing the services; otherwise, why bother participating? Providers and payers, for instance, have a mutual interest in controlling medical costs and finding innovative solutions. So providers should turn the tables and invite payers into a more unguarded dialogue on mutual key criteria for success. A scenario mapping exercise, similar to that carried out in-house when aligning the senior management team, can be effective here. It s partly a communication of intent so that payers are aware of your plans to move to the next ACO level, for instance and partly a test of the payers operational capabilities. The discussions can help to confirm historical baseline expenses and account for risk payments. The parties can also jointly plan how to adopt relevant information technology such as high-speed Internet access, e- prescribing, disease registries, and data exchange tools. If it s hard for providers to establish trust with payers, it is even more difficult to do so with independent physicians and medical practices. The idea of changing their incentives to align with better patient outcomes can be downright daunting. When working with physicians on co-creation, a prudent approach is to win over a few at a time. When crafting new incentive programs, focus on a few practices or departments at a time. New physician-hospital alignment arrangements sometimes called comanagement or joint ventures aim to promote a collaborative care approach toward disease management that results in better patient outcomes. In the land of uncertainty, a map to prepare for the ACO model 5
7 The good news is that our early evaluations of physician-hospital partnerships indicate that financial incentives can indeed motivate the behavioral and care delivery changes needed. This higher level of quality care does not necessarily translate into higher costs. If physicians and hospitals can perfect how they work together on one service line under a co-management structure, they ll be better prepared to create an ACO or accept bundled payment. Orchestrate these efforts to appeal to early adopters the physicians most likely to gain from the ACO model and who are the most amenable to using new technology. 4. Start small but plan big We ve described a step-wise approach for design of the new ACO model. Providers identify the no-lose capabilities and first risk contracts to get comfortable with the new dynamics and new incentives. After some early wins, momentum will build to win over a wider swath of employees, patients, and other stakeholders. From the start, however, it s critical to keep the end state in sight. The cultural change is so profound that senior management will need to articulate the business case and the benefits to stakeholders again and again, so that everyone understands the opportunity that lies on the far side of the map. Without that end state as a guide, each change will seem like a mere distraction from the way we ve always done it. Over time, the ACO model should reduce utilization for the patient population and increase the potential for cost savings and better health outcomes. But the transition has to be done without destroying the current business and of course by first and foremost endeavoring to improve the lives of patients. Be clear on the big opportunity, promote it at every turn, and act boldly or not at all. In the land of uncertainty, a map to prepare for the ACO model 6
8 pwc.com/us/healthindustries pwc.com/us/hri twitter.com/pwchealth To have a deeper conversation about how this subject may affect your business, please contact: Jeff Gruen Principal jeffrey.m.gruen@us.pwc.com Cassandra Earley Manager cassandra.m.earley@us.pwc.com Brett M Hickman Partner brett.m.hickman@us.pwc.com Warren H Skea Director warren.h.skea@us.pwc.com PricewaterhouseCoopers PRTM Management Consultants, LLC, a Delaware limited liability company ( PRTM ). All rights reserved. PwC US and PRTM refers to US member firms, and may sometimes refer to the PwC network. Each member firm is a separate legal entity. Please see for further details. This content is for general information purposes only, and should not be used as a substitute for consultation with professional advisors.
MAKING THE TRANSITION TO POPULATION HEALTH MANAGEMENT
MAKING THE TRANSITION TO POPULATION HEALTH MANAGEMENT H O W T O E F F E C T I V E L Y N E G O T I A T E V A L U E - B A S E D C O N T R A C T S I N T H E N E W R E T A I L M A R K E T P I O N E E R I N
More informationAccountable Care Organizations and Behavioral Health. Indiana Council of Community Mental Health Centers October 11, 2012
Accountable Care Organizations and Behavioral Health Indiana Council of Community Mental Health Centers October 11, 2012 What is an ACO? An accountable care organization is a group of providers or suppliers
More informationEXECUTIVE SUMMARY. June 2010. Pathways for Physician Success Under Healthcare Payment and Delivery Reforms. Harold D. Miller
EXECUTIVE SUMMARY June 2010 Pathways for Physician Success Under Healthcare Payment and Delivery Reforms Harold D. Miller PATHWAYS FOR PHYSICIAN SUCCESS UNDER HEALTHCARE PAYMENT AND DELIVERY REFORMS Harold
More informationEarly Lessons learned from strong revenue cycle performers
Healthcare Informatics June 2012 Accountable Care Organizations Early Lessons learned from strong revenue cycle performers Healthcare Informatics Accountable Care Organizations Early Lessons learned from
More informationHealthcare Internal Audit: In a Time of Transition
The 2015 State of the Internal Audit Profession Study Healthcare Internal Audit: In a Time of Transition The healthcare industry in the United States is facing many challenges with the enactment of legislation
More informationFuture of Health Care: How Do You Fit In? Physician Leadership Institute February 28, 2015 Brian M. McCook, CPA
Future of Health Care: How Do You Fit In? Physician Leadership Institute February 28, 2015 Brian M. McCook, CPA Learning Objectives Industry Transitions Challenges and Changes ACO s Look at the Future
More informationThe Need to Embrace Profit Cycle Management in Healthcare
GE Healthcare The Need to Embrace Profit Cycle Management in Healthcare Justin Steinman General Manager GE Healthcare IT Top 5 Takeaways 1. Healthcare leaders need to start analyzing and controlling costs
More informationChallenging Chronic Disease Through Telehealth
CMMI Innovation Advisor Erin Denholm, Centura Health at Home: Challenging Chronic Disease Through Telehealth Erin Denholm, of Centura Health at Home, joins the Alliance for a discussion of her work with
More informationUnderstanding Developing Models of Care Integration Involving Hospitals & Physicians: Implications for Pathologists & Clinical Laboratories
Understanding Developing Models of Care Integration Involving Hospitals & Physicians: Implications for Pathologists & Clinical Laboratories Executive War College New Orleans, Louisiana May 3 5, 2011 Understanding
More informationTaking a Fresh Look at Medicare Strategy
Taking a Fresh Look at Medicare Strategy Bill Eggbeer, Managing Director, Krista Bowers, Senior Advisor, and Dudley Morris, Senior Advisor, BDC Advisors Why Focus on Medicare Now? Public attention on health
More informationHealthcare Trends 2014: Pressure Rises and Delivery Organizations Respond
Healthcare Trends 2014: Pressure Rises and Delivery Organizations Respond A Market Point-of-View September 2014 Impact Advisors LLC 400 E. Diehl Rd. Suite 190 Naperville IL 60563 1-800-680-7570 Impact-Advisors.com
More informationIntegration Strategies: Developing A Blueprint For Success
Integration Strategies: Developing A Blueprint For Success Keith E. Chew, MHA, CMPE Senior Consultant McKesson Business Performance Services www.betterrevcycle.com Keith E. Chew, MHA, CMPE Senior Consultant,
More informationModels of Value-Based Reimbursement A Valence Health Primer
Models of Value-Based Reimbursement A Valence Health Primer Today s hospitals and other healthcare providers who deliver traditional, fee-for-service medicine are in the midst of navigating significant
More informationTRANSITIONING INTO ACCOUNTABLE CARE IMPLICATIONS FOR HEALTHCARE COMMUNICATORS
COUNCIL OF ACCOUNTABLE PHYSICIAN PRACTICES An affiliate of the American Medical Group Association TRANSITIONING INTO ACCOUNTABLE CARE IMPLICATIONS FOR HEALTHCARE COMMUNICATORS Survey Results November 2012
More informationMaking the Transition into Risk-Based Payment Why Children s Hospitals Need to Accept Value-Based Care Strategies
Making the Transition into Risk-Based Payment Why Children s Hospitals Need to Accept Value-Based Care Strategies Substantial changes within the Medicaid marketplace are driving U.S. children s hospitals
More informationHRI s closer look Healthcare s alternative payment landscape
HRI s closer look Healthcare s alternative payment landscape CMS Payment Changes 2015-2018 Medicare s commitment towards quality-based payments grows. 80% 20% 85% 30% 90% 50% All Medicare payments Percentage
More informationThe 4 Pillars of Clinical Integration: A Flexible Model for Hospital- Physician Collaboration
The 4 Pillars of Clinical Integration: A Flexible Model for Hospital- Physician Collaboration Written by Daniel J. Marino, President & CEO, Health Directions November 14, 2012 Originally published by Becker
More information3M s unique solution for value-based health care
A quick guide to 3M s unique solution for value-based health care Part 2: The era of and Current trends industry changes Volume-based health care Value-based health care ICD-9 ICD-10 Inpatient care Outpatient
More informationWalden University Q & A continued from Webinar Todd Linden
Walden University Q & A continued from Webinar Todd Linden General Note: The answers to these questions are my opinion. The mountain of rules and regulations that will be produced from this legislation
More informationData: The Steel Thread that Connects Performance and Value
WHITE PAPER Data: The Steel Thread that Connects Performance and Value An Encore Point of View Randy L. Thomas, FHIMSS, Managing Director, Value April 2016 Realization Solutions, David H. Brown, Barbara
More informationPost-Acute/Long- Term Care Planning for Accountable Care Organizations
White Paper Post-Acute/Long- Term Care Planning for Accountable Care Organizations SCORE A Model for Using Incremental Strategic Positioning as a Planning Tool for Participation in Future Healthcare Integrated
More informationDRIVING VALUE IN HEALTHCARE: PERSPECTIVES FROM TWO ACO EXECUTIVES, PART I
DRIVING VALUE IN HEALTHCARE: PERSPECTIVES FROM TWO ACO EXECUTIVES, PART I A firm understanding of the key components and drivers of healthcare reform is increasingly important within the pharmaceutical,
More informationAccountable Care Organizations Understanding What They Are and How to Structure Them
Accountable Care Organizations Understanding What They Are and How to Structure Them Maria T. Currier HOLLAND & KNIGHT LLP Miami Chamber of Commerce Healthcare Subcommittee December 7, 2010 Copyright 2010
More informationPremier ACO Collaboratives Driving to a Patient-Centered Health System
Premier ACO Collaboratives Driving to a Patient-Centered Health System As a nation we all must work to rein in spiraling U.S. healthcare costs, expand access, promote wellness and improve the consistency
More informationSystems in the Act, Trying Out ACOs
A L O O K A H E A D Systems in the Act, Trying Out ACOs BY MARK CRAWFORD Catholic health care leaders are experimenting with accountable care organizations (ACOs) as a method of delivering higher quality
More informationWhat sets breakthrough innovators apart PwC s Global Innovation Survey 2013: US Summary
What sets breakthrough innovators apart PwC s Global Innovation Survey 2013: US Summary www.pwc.com/innovationsurvey 60% $250b The top innovators in our study plan to grow by more than 60 percent over
More informationAn HR perspective Focusing on the future of healthcare benefits
An HR perspective Focusing on the future of healthcare benefits May 2013 At a glance As implementation of the Affordable Care Act (ACA) proceeds toward the bellwether year of 2014, employers are confronting
More informationAccountable Care Organizations New Healthcare Opportunities for Employers
Accountable Care Organizations New Healthcare Opportunities for Employers The ACO and Employer Opportunities Since the passage of the Patient Protection and Affordable Care Act (PPACA) in 2009, the marketplace
More informationWill Your Accountable Care Organization Pilot Succeed? Predict Success with Just Four Numbers.
White Paper Will Your Accountable Care Organization Pilot Succeed? Predict Success with Just Four Numbers. Bob Kelley Senior Vice President, Healthcare Analytics Truven Health Analytics SM February 2012
More informationRVU BASED PHYSICIAN COMPENSATION AND PRODUCTIVITY
RVU BASED PHYSICIAN COMPENSATION AND PRODUCTIVITY Ten Recommendations for Determining Physician Compensation/Productivity Through Relative Value Units 2011 Merritt Hawkins 5001 Statesman Drive Irving,
More informationPopulation Health: Tales from the Front
Population Health: Tales from the Front Integrated Design and Case Study from Northwest Arkansas Objectives 1 2 3 4 Discuss current Population Health trends and approaches in the market Determine the strategies
More informationHow To Improve Health Care Value
Delivery Method Changes Accountable Care Organizations The Promise, Perils and Pathway to Value for Plan Sponsors If the potential of accountable care organizations (ACOs) is realized, they could significantly
More informationTHE FUTURE OF QUALITY HEALTHCARE: ACO S?????
THE FUTURE OF QUALITY HEALTHCARE: ACO S????? ARKANSAS LEADERSHIP FORUM Lance W. Keilers, MBA, CAPPM September 15, 2015 Learning Objectives Recognize current changes in rural hospital delivery systems Identify
More informationWhat is an Accountable Care Organization. Amit Rastogi, MD President/CEO PriMed
What is an Accountable Care Organization Amit Rastogi, MD President/CEO PriMed Goals Why is U.S. healthcare undergoing dramatic change How reimbursement structures are likely to change What is the timeline
More informationQuality Accountable Care Population Health: The Journey Continues
Quality Accountable Care Population Health: The Journey Continues Health Insights April 10, 2014 Doug Hastings 2001 Institute of Medicine 2 An Agenda For Crossing The Chasm Between the health care we have
More informationManaging the Shadow Cloud
Managing the Shadow Cloud Integrating cloud governance into your existing compliance program August 2014 Shadow IT is not a new concept and organizations are well aware of the risks associated with unauthorized
More informationThe Impact of Accountable Care Organizations on the Healthcare Industry. Dale Maxwell Senior Vice President & CFO Presbyterian Healthcare Services
The Impact of Accountable Care Organizations on the Healthcare Industry Dale Maxwell Senior Vice President & CFO Presbyterian Healthcare Services Agenda The Case for Change A New Idea, The ACO Characteristics
More informationBlueprint for Post-Acute
Blueprint for Post-Acute Care Reform Post-acute care is a critical component within our nation s healthcare system and an essential aspect of care for many patients making a full recovery possible after
More informationPOPULATION HEALTH COLLABORATIVES. 2015 Agenda Based on Evolving Trends
POPULATION HEALTH COLLABORATIVES 2015 Agenda Based on Evolving Trends ABOUT THE ACADEMY HURON INSTITUTE Innovation and time to market define success for today s Top-100 healthcare organizations. To accelerate
More informationBeyond risk identification Evolving provider ERM programs
Beyond risk identification Evolving provider ERM programs March 2016 At a glance PwC conducted research to assess the state of enterprise risk management (ERM) within healthcare providers and found many
More informationAnalytics for ACOs Integrated patient views
Analytics for ACOs Integrated patient views What s at stake? Level-setting Overview The healthcare environment is changing and healthcare organizations have challenging decisions to make. With the dramatic
More informationACOs: Six Things Specialty Practices Should Know
ACOs: Six Things Specialty Practices Should Know =TOS Newsletter, July/August 2014= Authors: John P. Schmitt, Ph.D. and J. Garrett Schmitt, MBA, PCMH CCE INTRODUCTION Do you remember the analogy of four
More informationThe Health System as the General Contractor
The Health System as the General Contractor Positioning your organization to grow with value-based care What s at stake The time to prepare is now Recent signals point to the fact that health care provider
More informationA YEAR OF THE PIONEERS
CLIENT BRIEFING AUGUST 2013 A YEAR OF THE PIONEERS CMS s report on the early results of the Pioneer ACO program contains important information. But to understand it correctly you have to remember what
More informationReforming and restructuring the health care delivery system
Reforming and restructuring the health care delivery system Are Accountable Care Organizations and bundling the solution? Prepared by: Dan Head, Principal, RSM US LLP dan.head@rsmus.com, +1 703 336 6536
More informationEmbracing Accountable Care: 10 Key Steps
Embracing Accountable Care: 10 Key Steps Sivakumar Nandiwada and Vijay Sylvestine Abstract For quite some time now, the U.S. healthcare market has been grappling with issues of spiraling costs and disparities
More informationViewPoint Accountable Care Organizations
ViewPoint Accountable Care Organizations Improving the Quality and Accountability of Care for ACOs with Web- Based Technology As an ACO, if you are finding it difficult to manage your patient populations
More informationMedicare Value Partners
Medicare Value Partners Medicare Shared Savings ACO Program Frequently Asked Questions (FAQ) Q: What exactly is a Medicare Shared Savings Program ACO? A: Medicare Shared Savings Program accountable care
More informationThe Cornerstones of Accountable Care ACO
The Cornerstones of Accountable Care Clinical Integration Care Coordination ACO Information Technology Financial Management The Accountable Care Organization is emerging as an important care delivery and
More informationQ. What is your reaction to the U.S. Supreme Court decision on healthcare reform?
Contact: Gail Rosenberg Carolinas HealthCare System 704-355-3800 (office) 704-400-3959 (cell) gail.rosenberg@carolinashealthcare.org An Interview with Carolinas HealthCare System President & Chief Operating
More informationRemarks by. Carolyn G. DuChene Deputy Comptroller Operational Risk. at the
Remarks by Carolyn G. DuChene Deputy Comptroller Operational Risk at the Bank Safety and Soundness Advisor Community Bank Enterprise Risk Management Seminar Washington, D.C. October 22, 2012 Good afternoon,
More information2019 Healthcare That Works for All
2019 Healthcare That Works for All This paper is one of a series describing what a decade of successful change in healthcare could look like in 2019. Each paper focuses on one aspect of healthcare. To
More information10 Key Concepts for Higher Sales into ACOs
By Michelle O Connor President and CEO By Michelle O Connor President and CEO CMR Institute Healthcare providers are under significant pressure from government payers, commercial health plans, and patients
More informationNew Deals Are Moving from Scale to Strategic Value
Companies historically have viewed mergers and acquisitions as a way to spur growth by bulking up : adding scale and market share by combining with another organization offering similar or complementary
More informationRe: Proposed Statement of Antitrust Enforcement Policy Regarding ACOs Participating in the Medicare Shared Savings Program, Matter V100017
The Hon. Christine Varney Assistant Attorney General Antitrust Division U.S. Department of Justice 950 Pennsylvania Avenue, N.W. Washington, DC 20530 The Hon. Jon Leibowitz Chairman Federal Trade Commission
More informationRx for practice management
Rx for practice management Spring 2015 Are you ready for the next step? The ins and outs of Stage 2 meaningful use Dissension in the ranks How to knock out physician conflicts Compensating providers for
More informationIs there an ACO in your Future? Massachusetts League of Community Health Centers Community Health Institute May 12, 2011
Is there an ACO in your Future? Massachusetts League of Community Health Centers Community Health Institute May 12, 2011 Are ACOs/Integrated Care Systems Here to Stay Why this time is different? Health
More informationFinancial Implications: The Push from Inpatient to Outpatient Care
Financial Implications: The Push from Inpatient to Outpatient Care Brian Baumgardner & Mitchell Mongell THE TRANSFORMATION TO CONSUMER-DRIVEN HEALTHCARE FINANCIAL IMPLICATIONS:THE PUSH FROM INPATIENT TO
More informationReimbursement Driving HealthCare Value, May 2014 Dublin, Ireland
Reimbursement Driving HealthCare Value, May 2014 Dublin, Ireland Professor Bob Kaplan May 2014 All health care systems around the globe face a fundamental problem. How should governments, insurance companies
More informationRealizing Hidden Value: Optimizing Utility Field Service Performance by Measuring the Right Things
Energy and Utility Insights Realizing Hidden Value: Optimizing Utility Field Service Performance by Measuring the Right Things Utilities Realizing Hidden Value About the Author Rob Milstead serves as the
More informationDeveloping a Sustainable Physician Strategy
Developing a Sustainable Physician Strategy Chicago, Illinois / April 13, 2010 1 Agenda Introduction Select Industry Trends and Healthcare Reform National Trends Impacting Hospital/ Physician Relationships
More informationAccountable Care: Clinical Integration is the Foundation
Solutions for Value-Based Care Accountable Care: Clinical Integration is the Foundation Clinical Integration Care CoordinatioN ACO Information Technology Financial Management The Accountable Care Organization
More informationPhysician compensation: How to align compensation with the needs of your medical group
PhysicianRx A business intelligence prescription for hospital leadership Fall 2011 Physician compensation: How to align compensation with the needs of your medical group Bob Wilson, Business Advisory Services
More informationGovernance Implications of Healthcare Reform
November 1, 2010 Governance Implications of Healthcare Reform Healthcare boards face tremendous uncertainties as they consider strategic moves to address the healthcare reform law. If the Act s intention
More informationCMS Physician Quality Reporting Programs Strategic Vision
CMS Physician Quality Reporting Programs Strategic Vision FINAL DRAFT March 2015 1 EXECUTIVE SUMMARY As the largest payer of healthcare services in the United States, the Centers for Medicare & Medicaid
More informationRE: CMS 1461-P; Medicare Shared Savings Program: Accountable Care Organizations
221 MAIN STREET, SUITE 1500 SAN FRANCISCO, CA 94105 PBGH.ORG OFFICE 415.281.8660 FACSIMILE 415.520.0927 February 6, 2015 Marilyn Tavenner Administrator Centers for Medicare and Medicaid Services 7500 Security
More informationComputer-assisted coding and documentation for a changing healthcare landscape
Computer-assisted coding and documentation for a changing healthcare landscape Reality is, in this new ICD-10 environment, providers will have two options: a) work harder; or b) find a new way to do things.
More informationEntering China s Private Health Insurance Market
www.pwccn.com Entering China s Private Health Insurance Market December 2015 Highlights Shifting mindsets in how the Chinese view health insurance form the basis for healthcare plan reform. China s consumers
More informationThe Accountable Care Organization: An Introduction
January 2011 The Accountable Care Organization: An Introduction The healthcare reform discussion introduced new terms and ideas and reintroduced many concepts explored in the past: value-based healthcare,
More informationHow Your Website Can Drive Patient Activation
How Your Website Can Drive Patient Activation BRIDGELINE WHITEPAPER SERIES Copyright 2014 Bridgeline Digital Inc. Bridgeline.com 1-800-603-9936 Introduction: The Digital Age & Healthcare The importance
More informationPopulation Health Management Primer
Population Health Management Primer A White Paper October 2014 Impact Advisors LLC 400 E. Diehl Road Suite 190 Naperville IL 60563 1-800- 680-7570 Impact- Advisors.com Table of Contents What Is Population
More informationUnderstanding and preparing for the impact of the Affordable Care Act
Understanding and preparing for the impact of the Affordable Care Act Care Management / P. 1 The Affordable Care Act is expected to impact access to care, change the way accountable care organizations
More informationAccountable Care Communities 101. Jennifer M. Flynn, Esq. Senior Director, State Affairs Premier healthcare alliance January 30, 2014
Accountable Care Communities 101 Jennifer M. Flynn, Esq. Senior Director, State Affairs Premier healthcare alliance January 30, 2014 Premier is the largest healthcare alliance in the U.S. Our Mission:
More informationTHE ACCOUNTABLE CARE ORGANIZATION (ACO) TRAIN IS LEAVING THE STATION: ARE YOU ON BOARD?
UNDER THE MICROSCOPE NOVEMBER 5, 2013 THE ACCOUNTABLE CARE ORGANIZATION (ACO) TRAIN IS LEAVING THE STATION: ARE YOU ON BOARD? ISSUE. A 2006 Institute of Medicine report ( Performance measurement: Accelerating
More informationSocial Security Disability Resources For Self Advocacy
Social Security Disability Resources For Self Advocacy Introduction This guide is intended to help people with multiple sclerosis (MS) advocate effectively to obtain the Social Security Disability Insurance
More informationProject BOOST: A Return On Investment Analysis
Project BOOST: A Return On Investment Analysis dsfjk Project BOOST: A Return On Investment Analysis SHM 2010 1 Reducing Hospital Readmissions: Who benefits? Who pays? The US Department of Health and Human
More informationmember of from diagnosis to cure Eucomed Six Key Principles for the Efficient and Sustainable Funding & Reimbursement of Medical Devices
Eucomed Six Key Principles for the Efficient and Sustainable Funding & Reimbursement of Medical Devices Contents Executive Summary 2 Introduction 3 1. Transparency 4 2. Predictability & Consistency 5 3.
More informationNuts and Bolts Accountable Care Organizations: A New Care Delivery Model for New Expectations
Nuts and Bolts Accountable Care Organizations: A New Care Delivery Model for New Expectations Presented to The American College of Cardiology October 27, 2012 1 Franciscan Alliance Overview Franciscan
More informationEnhancing patient care in rural communities
Enhancing patient care in rural communities Improving care, managing costs Affordable information technology Rural hospitals fill a tremendous need in communities across the country but face unenviable
More informationnew jersey chapter see page 7 see page 25
new jersey chapter see page 7 see page 25 Proposal for a Demonstration Program for Accountable Care Organizations (ACOs) in Urban, Underserved Communities in New Jersey Jeffrey Brenner by Jeffrey C. Brenner,
More informationACO s as Private Label Insurance Products
ACO s as Private Label Insurance Products Creating Value for Plan Sponsors Continuing Education: November 19, 2013 Clarence Williams Vice President Client Strategy Accountable Care Solutions Today s discussion
More informationMedicare Shared Savings Program Final Rule
Healthcare Committee Medicare Shared Savings Program Final Rule On June 9, 2015, the Centers for Medicare & Medicaid Services ( CMS ) published a final rule that, according to the agency, will update and
More informationPost-care Networks and LTACs: Finding Your Place in an ACO Model
Post-care Networks and LTACs: Finding Your Place in an ACO Model Accountable Care Organizations (ACOs) are more than just a fad. Post-care providers and LTACS in particular, will need to give careful thought
More informationCharacteristics of Accountable and Community Care Organizations (ACOs and CCOs)
ACO Definition Organization of providers that shares responsibility for providing care to patients and is accountable for the care of beneficiaries assigned to it. Major Specifically addressed in the Differences
More informationAccountable Care Organizations and Coordinated Care Organizations
ACO Definition Organization of providers that shares responsibility for providing care to patients and is accountable for the care of beneficiaries assigned to it. Major Specifically addressed in the Differences
More informationBUNDLING ARE INPATIENT REHABILITATION FACILITIES PREPARED FOR THIS PAYMENT REFORM?
BUNDLING ARE INPATIENT REHABILITATION FACILITIES PREPARED FOR THIS PAYMENT REFORM? Uniform Data System for Medical Rehabilitation Annual Conference August 10, 2012 Presented by: Donna Cameron Rich Bajner
More informationAccountable Care: Implications for Managing Health Information. Quality Healthcare Through Quality Information
Accountable Care: Implications for Managing Health Information Quality Healthcare Through Quality Information Introduction Healthcare is currently experiencing a critical shift: away from the current the
More informationA STRATIFIED APPROACH TO PATIENT SAFETY THROUGH HEALTH INFORMATION TECHNOLOGY
A STRATIFIED APPROACH TO PATIENT SAFETY THROUGH HEALTH INFORMATION TECHNOLOGY Table of Contents I. Introduction... 2 II. Background... 2 III. Patient Safety... 3 IV. A Comprehensive Approach to Reducing
More informationSelf-directed learning: managing yourself and your working relationships
A COACHING STYLE OF MANAGEMENT In this chapter we look at how you might use a coaching approach in managing people. We begin by exploring what we mean by coaching, which I regard as being primarily non-directive.
More informationICD-10 DRG Impacts at the Hospital Level
A Health Data Consulting White Paper 1056 Ave S Edmonds, WA 98020-4035 206-478-8227 www.healthdataconsulting.com ICD-10 DRG Impacts at the Hospital Level Joseph C Nichols MD Principal 12 Nov 2011 TABLE
More informationBuilding Your Retirement Portfolio
Building Your Retirement Portfolio With the Help of TIAA-CREF 111075_L01.indd 1 ABOUT TIAA-CREF: For more than 90 years, we at TIAA-CREF have dedicated ourselves to helping those who serve the greater
More informationChanging Economics in an Era of Healthcare Reform
R E F O R M Changing Economics in an Era of Healthcare Reform Nathan S. Kaufman, Managing Director, Kaufman Strategic Advisors, LLC As health systems prepare for healthcare reform, they are focusing significant
More informationPopulation health management:
GE Healthcare Population health management: Navigating successfully from volume to value In the new world of value-based care and risk-sharing compensation, success will depend on how well provider organizations
More informationSCRIPT FOR PROVIDER/ACO PHONE INQUIRIES. What is an ACO?
SCRIPT FOR PROVIDER/ACO PHONE INQUIRIES What is an ACO? An Accountable Care Organization (ACO) is a group of doctors and other healthcare providers who agree to work together with Medicare to give you
More informationACOs: Impacting the Past, Present and Future State of Healthcare
ACOs: Impacting the Past, Present and Future State of Healthcare Article By Alan Cudney, RN, CPHQ, PMP, FACHE, Executive Consultant October 2012 What are Accountable Care Organizations? Can they help us
More informationAccountable Care Organizations
Accountable Care Organizations Myth, Reality, Facts Why =System Failure Low Quality - IOM report High Cost Quality Cost disconnect Low Value Problems Disconnect between Quality and Cost Care is fragmented
More informationUsing Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare
December 2010 Using Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare CONTENTS Background... 2 Problems with the Shared Savings Model... 2 How
More informationProven Innovations in Primary Care Practice
Proven Innovations in Primary Care Practice October 14, 2014 The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA. 2014 Society for Healthcare
More informationTHE EVOLUTION OF CMS PAYMENT MODELS
THE EVOLUTION OF CMS PAYMENT MODELS December 3, 2015 Dayton Benway, Principal AGENDA Legislative Background Payment Model Categories Life Cycle The Models LEGISLATIVE BACKGROUND Medicare Modernization
More informationEmily Friedman Independent Health Policy and Ethics Analyst
Emily Friedman Independent Health Policy and Ethics Analyst Presented at the Center for Healthcare Governance National Symposium on Leading and Governing Healthcare Organizations Naples, Florida February
More information