ACOs: Six Things Specialty Practices Should Know

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "ACOs: Six Things Specialty Practices Should Know"

Transcription

1 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 blind men describing an elephant? The blind men gave accurate descriptions of the parts they were holding but a complete image of an elephant did not result. Similarly, the literature about Accountable Care Organizations (ACOs) is largely authored by health policy researchers and representatives of hospital associations, medical societies, commercial payers and suppliers of various software and services used by ACOs. Each resource yields a professional perspective of an ACO but readers generally do not gain a clear understanding of an ACO specific to their needs or situation. No wonder medical providers, like orthopaedic practices, are confused about the new health care delivery model called ACOs. Therefore, the purpose of this article is intended to answer six basic questions about ACOs which are likely on the mind of interested TOS newsletter readers. The answers are not exhaustive but are based on extensive literature research and the authors years of consulting experience working with both ACO clients and orthopaedic practices. SIX QUESTIONS ABOUT ACOs 1. Is an ACO just another type of medical practice?

2 Yes and no. An ACO is a group of medical providers who come together to provide coordinated care to patients. It could take the form of an integrated health system with diverse providers under one corporate roof (single TIN) in an urban market or it could be multiple independent practices spread over a hundred mile radius. Either way, the approach to delivering care is what makes an ACO unique and different from a traditional medical practice. A good deal of collaborative planning and teamwork among ACO providers is required to execute such an approach, but the ultimate objective is to coordinate care and lower the per capita cost of healthcare. ACOs can include primary care physicians, specialists, hospitalists, hospitals, and ancillary providers all working together as a team along with care coordinators. However, the exact structure of an ACO can vary widely. In addition, ACOs are not required to include hospitals or specialists as members, only PCPs. Some ACOs will contract with specialist providers and hospitals in their service areas depending on competitive factors and demographics. ACOs provide coordinated care to a specific patient population assigned to the ACO by a payer like Medicare, a commercial insurer or a self-insured employer. The ACO providers are expected to be proactive in determining and meeting the diverse medical needs of an assigned population ranging from those who are healthy to those with chronic or terminal conditions.. The mutual goal of the ACO team members is to help patients transition their way through the continuum of healthcare providers so they receive the right care in the right place and at the right time. Traditional medical practices are historically more reactive in treating patients who come to them for care. A traditional practice strives to give high quality care but functions more

3 as a specialty silo in the healthcare continuum. Specialists rely on referrals from other physicians and treat their patients according to their own internal treatment protocols. Generally speaking, once the patient leaves the physician s office the patient or another physician is responsible for ongoing medical care. 2. How does an ACO pay its member providers? Very differently from fee for service payment. The end game for ACOs is to produce shared savings from effectively and efficiently treating assigned populations. ACO member providers treat patients coming to their practices, but use the team model described above to deliver care. Performance is measured using evidence based outcomes, quality measures, and utilization and the resultant savings ultimately determines provider compensation. One question often asked by independent providers is whether participating in an ACO will affect their current fee-for-service contracts with payers. The answer is no. If the ACO providers are independent practices, the practices continue to bill for their services using the traditional fee-for-service approach and receive revenue accordingly. In contrast, the revenue paid by the ACO is a portion of shared savings using a compensation model based on aligned incentives once the savings are realized. As a result, under most arrangements no compensation is paid at all if no shared savings are earned. Therefore, the compensation paid by an ACO to its member providers is over and above the revenue received from their independent practice. In other words, ACO compensation can essentially be thought of as a bonus payment for cutting costs and improving quality. 3. Should a specialty practice start an ACO?

4 No. An ACO s assigned patient population is based on the treatment history (E & M codes) of the primary care practitioners in the ACO. Payers look for a critical mass of primary care providers to constitute an assigned population numbering at least 5,000 insured members. Specialists are sometimes considered primary care providers when there is a long history of ongoing treatment between the specialist and an assigned insured. In short, a specialist practice is better off contracting with an existing ACO in its service area than attempting to start an ACO. 4. Are ACOs financially viable? They can be, if risk is successfully managed. The first 32 Pioneer ACOs were launched by the Centers for Medicare and Medicaid Services (CMS) in Early in 2014 CMS released their results after two years of operation. In short, only about 25% earned enough in shared savings to be considered financially successful. However, it should be noted that the Pioneer ACO program was a minimum of three years so the story is not over. After three years the Pioneer ACOs must assume some downside risk and, in return they will receive a higher portion of the shared savings. So is the risk worth it since a 25% success rate does not seem like great odds for an ACO investment? The answer is yes, but only if approached using the hard lessons learned by the Pioneer ACOs. As results are being reported in the literature, it is apparent the Pioneer ACOs which quickly focused on reducing costs through care management and population health management were the ones that succeeded. The ones that did little or nothing but collect CMS seed money did not succeed. Some of the ACOs were doomed from day one as they failed to educate their physician members as to the requirements that would be necessary for success. They erroneously assumed needed transitions in care would be seamless to their physicians and no change in

5 culture or protocol would be required. Management s attention should have been focused on those initiatives that would effectively drive shared savings to the exclusion of all other distractions. 5. How do specialty practices get involved in ACOs? They will likely be selected based on cost and quality histories. Basically, ACO providers are organized into two treatment teams, an internal and an external team. The internal teams are comprised of primary care physicians and their practice staffs. They stratify assigned populations based on health status, organize a reach out process to get patients engaged in their care e.g. come in for annual physicals, assess the population s health needs using population health analytics, and develop treatment protocols which include how to handle specialist referrals, hospital admissions and discharges as well as the use of ancillary providers. The ability to produce disease registries increases the probability of success, especially in managing high-risk patients. Certain hospitals and specialists are selected by the ACO s governance body to be members of an external care team. These external providers are not part of the primary care physicians staffs. The external member selection criteria is determined in different ways including specialist membership in integrated delivery systems, cost histories, quality performance, protocol compliance and payer preferred status. The number of orthopaedic specialists needed by an ACO will depend on the size of the insured population and its payer mix. For example, large numbers of Medicare members assigned to an ACO will dictate the need for more orthopaedic physicians than a comparable number of members aligned with commercial payers. After doing some research, an independent orthopaedic practice could make a proactive effort by

6 expressing an interest in ACO participation, thus becoming a preferred provider who receives a greater number of referrals. 6. Are there preparations an orthopaedic practice could make to enhance their likelihood of selection by an ACO? Yes. The National Committee of Quality Assurance (NCQA) has initiated a new medical home program for specialists called the Patient-Centered Specialty Practice (PCSP) Recognition Program. The NCQA website describes the PCSP program as one that recognizes specialty practices that have successfully coordinated care with their primary care colleagues and each other, and that meet the goals of providing timely access to care and continuous quality improvement. In other words, specialists undertaking the program will comply with NCQA standards for testing, referrals, care coordination and communication among providers that contribute to the CMS Triple Aim mission of lower cost, higher quality and improved health of assigned populations. SUMMARY The healthcare industry is moving aggressively away from fee for service medicine to valuebased care models like ACOs. In the last five years ACOs have increased to over 600 in the United States. It is estimated about 12 percent of the insured population is currently part of an ACO panel. Recently, three payer representatives from major insurers participating on a panel sponsored by the Medical Group Management Association (MGMA) in March 2014 stated their organizations expect to have 50 percent of their insureds in ACO like arrangements by Although ACOs are largely controlled by primary care practices, there is an important role to be played by specialists like orthopaedic practices. Primary care physicians in ACOs are aggressively looking to establish collaborative relationships with hospitals and other providers.

7 These relationships must necessarily be mission effective and long term to meet payer contractual obligations. Early specialist practice adopters who get the Triple Aim mission and can help move the ACO cost needle down will be rewarded by a portion of the shared savings. As a result, every orthopaedic practice should assess its care delivery model and position itself for the rapid growth of ACOs.

Future 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 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 information

How Health Reform Will Affect Health Care Quality and the Delivery of Services

How Health Reform Will Affect Health Care Quality and the Delivery of Services Fact Sheet AARP Public Policy Institute How Health Reform Will Affect Health Care Quality and the Delivery of Services The recently enacted Affordable Care Act contains provisions to improve health care

More information

Population Health Management: Advancing Your Position in the Journey to Value-Based Care

Population Health Management: Advancing Your Position in the Journey to Value-Based Care Population Health Management: Advancing Your Position in the Journey to Value-Based Care Webcast Session One: An Integrated Approach to Population Health Management 11 August 2015 Welcome & Introductions

More information

Banner Health Network Pioneer ACO - Physician Toolkit

Banner Health Network Pioneer ACO - Physician Toolkit & The Banner Health Network, an AIP and Banner Health partnership, present the Banner Health Network Pioneer ACO - Physician Toolkit This BHN Pioneer ACO Physician Toolkit has been developed to provide

More information

ACCOUNTABLE CARE ANALYTICS: DEVELOPING A TRUSTED 360 DEGREE VIEW OF THE PATIENT

ACCOUNTABLE CARE ANALYTICS: DEVELOPING A TRUSTED 360 DEGREE VIEW OF THE PATIENT ACCOUNTABLE CARE ANALYTICS: DEVELOPING A TRUSTED 360 DEGREE VIEW OF THE PATIENT Accountable Care Analytics: Developing a Trusted 360 Degree View of the Patient Introduction Recent federal regulations have

More information

Care Coordination and Contracting Entities: The CHC Perspective on IPAs and ACOs. Today s Discussion

Care Coordination and Contracting Entities: The CHC Perspective on IPAs and ACOs. Today s Discussion Care Coordination and Contracting Entities: The CHC Perspective on IPAs and ACOs Ohio Association of Community Health Centers June 2014 Contact Us Andrew Principe PO Box 410221, Cambridge, MA 02141 P.

More information

Cornerstone Health Care s ACO Playbook. Grace E. Terrell, MD January 17, 2012

Cornerstone Health Care s ACO Playbook. Grace E. Terrell, MD January 17, 2012 Cornerstone Health Care s ACO Playbook Grace E. Terrell, MD January 17, 2012 Mission: To be your medical home Vision: To be the model for physician-led health care in America Values: As a physician owned

More information

MAKING THE TRANSITION TO POPULATION HEALTH MANAGEMENT

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 information

NCQA Patient-Centered Medical Home. Improving experiences for patients, providers and practice staff

NCQA Patient-Centered Medical Home. Improving experiences for patients, providers and practice staff NCQA Patient-Centered Medical Home Improving experiences for patients, providers and practice staff PCMH Recognition The patient-centered medical home is a model of care that emphasizes care coordination

More information

RELIANCE CONSULTING GROUP ACCOUNTABLE CARE ORGANIZATIONS: GETTING READY FOR ACO PARTICIPATION

RELIANCE CONSULTING GROUP ACCOUNTABLE CARE ORGANIZATIONS: GETTING READY FOR ACO PARTICIPATION RELIANCE CONSULTING GROUP ACCOUNTABLE CARE ORGANIZATIONS: GETTING READY FOR ACO PARTICIPATION Ohio MGMA State Conference 8-23-13 Presented by : John P. Schmitt, Ph.D. RCG Managing Director The healthcare

More information

Crosswalk: CMS Shared Savings Rules & NCQA ACO Accreditation Standards 12/1/2011

Crosswalk: CMS Shared Savings Rules & NCQA ACO Accreditation Standards 12/1/2011 Crosswalk: CMS Shared Savings Rules & NCQA ACO Accreditation Standards 12/1/2011 The table below details areas where NCQA s ACO Accreditation standards overlap with the CMS Final Rule CMS Pioneer ACO CMS

More information

Proven Innovations in Primary Care Practice

Proven 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 information

Montefiore s Population Health Management Services. October 23, 2015

Montefiore s Population Health Management Services. October 23, 2015 Montefiore s Population Health Management Services October 23, 2015 Integrated Delivery System Our Locations 3,092 Acute Beds Across 10 Hospitals Including 132 beds at the Children s Hospital at Montefiore

More information

Elliot Smith, MD, President

Elliot Smith, MD, President Re: Butler Health System Provider-Hospital Organization, LLC Dear Provider: Butler Health System Provider-Hospital Organization, LLC ( BHSPHO ) has been created to allow the physicians, physician extenders,

More information

Leveraging e-health to Achieve Coordinated Care and Accountable Health Plenary Session II

Leveraging e-health to Achieve Coordinated Care and Accountable Health Plenary Session II Leveraging e-health to Achieve Coordinated Care and Accountable Health Plenary Session II Moderators: Jennifer Lundblad, PhD, MBA President and CEO Stratis Health Garrett Black, MBA, MHA Senior Vice President,

More information

Helping You Achieve Better Clinical and Financial Health

Helping You Achieve Better Clinical and Financial Health McKesson Business Performance Services Accountable Care Services Helping You Achieve Better Clinical and Financial Health 1 We recognized that fee-for-service would decrease and value-based care would

More information

The Accountable Care Organization: An Introduction

The 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 information

Pediatric Alliance: A New Solution Built on Familiar Values. Empowering physicians with an innovative pediatric Accountable Care Organization

Pediatric Alliance: A New Solution Built on Familiar Values. Empowering physicians with an innovative pediatric Accountable Care Organization Pediatric Alliance: A New Solution Built on Familiar Values Empowering physicians with an innovative pediatric Accountable Care Organization BEYOND THE TRADITIONAL MODEL OF CARE Children s Health SM Pediatric

More information

The 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 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 information

Is 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 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 information

Population Health Management Primer

Population 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 information

Early Lessons learned from strong revenue cycle performers

Early 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 information

ACOs and Post-Acute Care:

ACOs and Post-Acute Care: ACOs and Post-Acute Care: Implications and Strategies for Providers Partner and Managing Director Leavitt Partners Michelle L. Templin Vice President Strategic Business Development Managed Health Care

More information

The Cornerstones of Accountable Care ACO

The 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 information

Ohio s strategy to enroll primary care practices in the federal Comprehensive Primary Care Plus (CPC+) Program

Ohio s strategy to enroll primary care practices in the federal Comprehensive Primary Care Plus (CPC+) Program Ohio s strategy to enroll primary care practices in the federal Comprehensive Primary Care Plus (CPC+) Program Greg Moody, Director Governor s Office of Health Transformation Webinar for Primary Care Practices

More information

Medical Homes- Understanding the Model Bob Perna, MBA, FACMPE WSMA Practice Resource Center

Medical Homes- Understanding the Model Bob Perna, MBA, FACMPE WSMA Practice Resource Center Bob Perna, MBA, FACMPE WSMA Practice Resource Center Bob Perna, MBA, FACMPE Senior Director, WSMA Practice Resource Center E-mail: rjp@wsma.org Phone: 206.441.9762 1.800.552.0612 2 Program Objectives:

More information

6/12/2015. Dignity Health Population Health Management and Compliance Programs. Moving Towards Accountable Care. Dignity Health Poised for Innovation

6/12/2015. Dignity Health Population Health Management and Compliance Programs. Moving Towards Accountable Care. Dignity Health Poised for Innovation Dignity Health Population Health Management and Compliance Programs Julie Bietsch, VP Population Health Management Dawnese Kindelt, Senior Compliance Director, Clinical Integration June 8, 2015 Moving

More information

PHI IN THE ACO. Risk Management, Mitigation and Data Collection Issues. Online Tech Webinar May 20, 2014. Tatiana Melnik, Attorney Melnik Legal PLLC

PHI IN THE ACO. Risk Management, Mitigation and Data Collection Issues. Online Tech Webinar May 20, 2014. Tatiana Melnik, Attorney Melnik Legal PLLC PHI IN THE ACO Risk Management, Mitigation and Data Collection Issues Online Tech Webinar May 20, 2014 Tatiana Melnik, Attorney Melnik Legal PLLC Carrie Nixon, Attorney, CEO Nixon Law Group Healthcare

More information

Program Description and FAQ s 2016 Medicare Shared Savings Program Year

Program Description and FAQ s 2016 Medicare Shared Savings Program Year and FAQ s 2016 Medicare Shared Savings Program Year Who is the National Rural ACO? The National Rural ACO was formed in 2013 to pool knowledge, patients, and resources so that independent community health

More information

ACO Accreditation Frequently Asked Questions

ACO Accreditation Frequently Asked Questions ACO Accreditation Frequently Asked Questions ACO Accreditation Program Details What are ACOs, and what do they do? Accountable Care Organizations (ACO) are broad provider-based organizations that manage

More information

Accountable Care Organizations Pragmatic Issues. Steve Hester, MD, MBA, Senior Vice President and Chief Medical Officer

Accountable Care Organizations Pragmatic Issues. Steve Hester, MD, MBA, Senior Vice President and Chief Medical Officer Accountable Care Organizations Pragmatic Issues Steve Hester, MD, MBA, Senior Vice President and Chief Medical Officer Norton Healthcare Integrated Delivery Network of Five Not for Profit Hospitals 14

More information

Clinically Integrated Networks and Accountable Care Organizations

Clinically Integrated Networks and Accountable Care Organizations Clinically Integrated Networks and Accountable Care Organizations 1 Do Nothing 2 Become Someone s Employee 3 Join a Network Provider The wake up call is for POPULATION health management managing clinical

More information

Survey of Connecticut Accountable Care Organizations

Survey of Connecticut Accountable Care Organizations March 2016 Survey of Connecticut Accountable Care Organizations Accountable Care Organizations (ACOs) are a relatively new health care delivery structure serving Connecticut residents. ACOs are voluntary

More information

ESSENTIA HEALTH AS AN ACO (ACCOUNTABLE CARE ORGANIZATION)

ESSENTIA HEALTH AS AN ACO (ACCOUNTABLE CARE ORGANIZATION) ESSENTIA HEALTH AS AN ACO (ACCOUNTABLE CARE ORGANIZATION) Hello and welcome. Thank you for taking part in this presentation entitled "Essentia Health as an ACO or Accountable Care Organization -- What

More information

Enhanced Personal Health Care Program

Enhanced Personal Health Care Program Enhanced Personal Health Care Program Documents included in the Recruitment Packet: Program Summary FAQ Checklist List of Program Information Form Questions Member Medical History Plus (MMH+) access form

More information

Value-based Health Care Models. TASC 90 Webinar May 2015

Value-based Health Care Models. TASC 90 Webinar May 2015 Value-based Health Care Models TASC 90 Webinar May 2015 Definitions Accountable Care Organization (ACO) Coordinated Care Organization (CCO) Patient Centered Medical Home (PCMH) Population Health 2 Accountable

More information

Accountable Care Organizations

Accountable 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 information

The Health Care Transformation Glossary

The Health Care Transformation Glossary The Health Care Transformation Glossary which was compiled using a variety of sources helps to educate your staff, governance and community about the new language associated with transformation. Using

More information

February 21, 2011. Regina Benjamin, MD, MBA U.S. Surgeon General Office of the Surgeon General 5600 Fishers Lane, Room 18-66 Rockville, MD 20857

February 21, 2011. Regina Benjamin, MD, MBA U.S. Surgeon General Office of the Surgeon General 5600 Fishers Lane, Room 18-66 Rockville, MD 20857 February 21, 2011 Regina Benjamin, MD, MBA U.S. Surgeon General Office of the Surgeon General 5600 Fishers Lane, Room 18-66 Rockville, MD 20857 Dear Dr. Benjamin: I want to take this opportunity to express

More information

MERCY-CR/UI HEALTH CARE ACCOUNTABLE CARE ORGANIZATION Dan Fick, M.D. Timothy Quinn, M.D.

MERCY-CR/UI HEALTH CARE ACCOUNTABLE CARE ORGANIZATION Dan Fick, M.D. Timothy Quinn, M.D. MERCY-CR/UI HEALTH CARE ACCOUNTABLE CARE ORGANIZATION Dan Fick, M.D. Timothy Quinn, M.D. November, 2012 Accountable Care Organization An ACO is a group of health care providers who agree to take on a shared

More information

Program Description and FAQ s 2016 Medicare Shared Savings Program Year

Program Description and FAQ s 2016 Medicare Shared Savings Program Year and FAQ s 2016 Medicare Shared Savings Program Year Who is the National Rural Accountable Care Consortium? The National Rural Accountable Care Consortium was formed in 2013 to pool knowledge, patients,

More information

EXECUTIVE 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 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 information

ViewPoint Accountable Care Organizations

ViewPoint 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 information

ACOs: Impacting the Past, Present and Future State of Healthcare

ACOs: 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 information

Using Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare

Using 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 information

Accountable 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 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 information

ACO Definition Cont d 11/15/15. What is an Accountable Care Organization (ACO) Michelle S. McOmber, MBA, CAE CEO, Utah Medical Association

ACO Definition Cont d 11/15/15. What is an Accountable Care Organization (ACO) Michelle S. McOmber, MBA, CAE CEO, Utah Medical Association Michelle S. McOmber, MBA, CAE CEO, Utah Medical Association What is an Accountable Care Organization (ACO) Accountable Care Organizations were created through the Affordable Care Act. Definition: An ACO

More information

ACOs: What They Are and How They Work? MedChi Facts 9/17/2014. MedChi Works to Enhance Health Care for All Marylanders

ACOs: What They Are and How They Work? MedChi Facts 9/17/2014. MedChi Works to Enhance Health Care for All Marylanders ACOs: What They Are and How They Work? Maryland MGMA Annual Conference Gene Ransom CEO, MedChi September 19, 2014 MedChi Facts MedChi is the seventh oldest medical society, formed in 1799 in Annapolis,

More information

Accountable Care: Clinical Integration is the Foundation

Accountable 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 information

Medicare Value Partners

Medicare 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 information

Applying ACO Principles to a Pediatric Population UH Rainbow Care Connection: Transforming Pediatric Ambulatory Care with a Physician Extension Team

Applying ACO Principles to a Pediatric Population UH Rainbow Care Connection: Transforming Pediatric Ambulatory Care with a Physician Extension Team Applying ACO Principles to a Pediatric Population UH Rainbow Care Connection: Transforming Pediatric Ambulatory Care with a Physician Extension Team Ethan Chernin, MBA Director 1 Objectives Understand

More information

Application for GAFP/Collaborative Health Systems PCMH University Class of 2014-15 Deadline Friday, September 12, 2014

Application for GAFP/Collaborative Health Systems PCMH University Class of 2014-15 Deadline Friday, September 12, 2014 The Georgia Chapter is providing information on an opportunity for your practice to participate in a Patient Centered Medical Home University. This opportunity is in collaboration with the GA Academy of

More information

Physician Discovery Services Provide a Full Range of Physician Practice Solutions

Physician Discovery Services Provide a Full Range of Physician Practice Solutions Physician Discovery Services OUR SOLUTION Truven Health Physician Discovery Services experts provide insights into a hospital or health system s physician enterprise. With experience in physician assessment,

More information

Patient Centered Medical Homes

Patient Centered Medical Homes Patient Centered Medical Homes Paul Kleeberg, MD, FAAFP, FHIMSS CMIO Stratis Health North Dakota e-health Summit November 20, 2013 REACH - Achieving - Achieving meaningful meaningful use of your use EHR

More information

Population Health Management Helps Utica Park Clinic Ease the Transition to Value-Based Care

Population Health Management Helps Utica Park Clinic Ease the Transition to Value-Based Care CASE STUDY Utica Park Clinic Population Health Management Helps Utica Park Clinic Ease the Transition to Value-Based Care The transition from fee-for-service to value-based reimbursement has been a challenge

More information

The most significant challenge of becoming accountable is not forming an organization, it is forging one. ~ Phillip I. Roning 1

The most significant challenge of becoming accountable is not forming an organization, it is forging one. ~ Phillip I. Roning 1 Physician Involvement in ACOs The Time is Now Julian D. ( Bo ) Bobbitt, Jr., Esq. Smith, Anderson, Blount, Dorsett, Mitchell & Jernigan, L.L.P. Raleigh, NC The most significant challenge of becoming accountable

More information

The 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 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 information

Premier ACO Collaboratives Driving to a Patient-Centered Health System

Premier 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 information

The Accountable Care Organization

The Accountable Care Organization The Accountable Care Organization Kim Harvey Looney kim.looney@ 615-850-8722 3968555 1 ACOs: Will I Know One When I See One? Relatively New Concept Derived from Various Demonstration Programs No Set Structure

More information

The High Performance Rural Health Care System of the Future

The High Performance Rural Health Care System of the Future The High Performance Rural Health Care System of the Future Prepared by the RUPRI Health Panel Keith J. Mueller, PhD, Chair Andrew F. Coburn, PhD Jennifer P. Lundblad, MA, PhD A. Clinton MacKinney, MD,

More information

Continuity of Care Guide for Ambulatory Medical Practices

Continuity of Care Guide for Ambulatory Medical Practices Continuity of Care Guide for Ambulatory Medical Practices www.himss.org t ra n sf o r m i ng he a lth c a re th rou g h IT TM Table of Contents Introduction 3 Roles and Responsibilities 4 List of work/responsibilities

More information

PROVIDER ATTITUDES TOWARD VALUE-BASED PAYMENT MODELS

PROVIDER ATTITUDES TOWARD VALUE-BASED PAYMENT MODELS PROVIDER ATTITUDES TOWARD VALUE-BASED PAYMENT MODELS An Availity Research Study April, 2014 TABLE OF CONTENTS 1 Introduction 2 Definitions 3 Key Findings 5 Survey Results 6 Revenue sources and experience

More information

Federal Health Care Reform: Implications for Hospital and Physician partnerships. Walter Kopp Medical Management Services

Federal Health Care Reform: Implications for Hospital and Physician partnerships. Walter Kopp Medical Management Services Federal Health Care Reform: Implications for Hospital and Physician partnerships Walter Kopp Medical Management Services Outline Overview of federal health reform legislation Implications for Care delivery

More information

Accountable Care Organizations and Medical Home Transformation at Legacy Health

Accountable Care Organizations and Medical Home Transformation at Legacy Health Accountable Care Organizations and Medical Home Transformation at Legacy Health Melinda Muller, MD, FACP Clinical VP, Primary Care Legacy Medical Group Objectives Review the definition and history of

More information

THE ACCOUNTABLE CARE ORGANIZATION (ACO) TRAIN IS LEAVING THE STATION: ARE YOU ON BOARD?

THE 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 information

Getting Ready for 2014: The Big Year for Healthcare Reform Anne Arundel County SHRM. David Johnson jdjohnson@rcmd.com November 15, 2012

Getting Ready for 2014: The Big Year for Healthcare Reform Anne Arundel County SHRM. David Johnson jdjohnson@rcmd.com November 15, 2012 Getting Ready for 2014: The Big Year for Healthcare Reform Anne Arundel County SHRM David Johnson jdjohnson@rcmd.com November 15, 2012 0 Topics for Discussion 1. Recap of Supreme Court Decision on Affordable

More information

1/31/2012. St. Joseph Heritage Healthcare & Blue Shield of California ACO Collaborative Leveraging An IDS For Patients! Overview of Presentation

1/31/2012. St. Joseph Heritage Healthcare & Blue Shield of California ACO Collaborative Leveraging An IDS For Patients! Overview of Presentation & Blue Shield of California ACO Collaborative Leveraging An IDS For Patients! February 1 st, 2012 HASC Conference on Blurring the Lines C.R. Burke President/CEO cr.burke@stjoe.org Overview of Presentation

More information

Accountable Care Organizations: What Providers Need to Know

Accountable Care Organizations: What Providers Need to Know DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Accountable Care Organizations: FACT SHEET Overview http://www.cms.gov/sharedsavingsprogram On October 20, 2011, the Centers

More information

CMS Quality Measurement and Value Based Purchasing Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS

CMS Quality Measurement and Value Based Purchasing Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS CMS Quality Measurement and Value Based Purchasing Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS American Urological Association Quality Improvement Summit

More information

Accountable Care Organizations: What Are They and Why Should I Care?

Accountable Care Organizations: What Are They and Why Should I Care? Accountable Care Organizations: What Are They and Why Should I Care? Adrienne Green, MD Associate Chief Medical Officer, UCSF Medical Center Ami Parekh, MD, JD Med. Director, Health System Innovation,

More information

Pennsylvania s Chronic Care/ Medical Home Initiative: Transforming Primary Care

Pennsylvania s Chronic Care/ Medical Home Initiative: Transforming Primary Care Pennsylvania s Chronic Care/ Medical Home Initiative: Transforming Primary Care Ann S. Torregrossa, Esq. Director Governor s Office of Health Care Reform Commonwealth of Pennsylvania WORKING TO ACHIEVE

More information

THE FUTURE OF QUALITY HEALTHCARE: ACO S?????

THE 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 information

What is an Accountable Care Organization. Amit Rastogi, MD President/CEO PriMed

What 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 information

Improving Quality And Bending the Cost Curve: Strategies That Work

Improving Quality And Bending the Cost Curve: Strategies That Work Improving Quality And Bending the Cost Curve: Strategies That Work Lewis G. Sandy MD SVP, Clinical Advancement, UnitedHealth Group UnitedHealth Center for Health Reform and Modernization AcademyHealth

More information

Accountable 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 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 information

What you need to know about Health Reform, Accountable Care, and Collaborative Care

What you need to know about Health Reform, Accountable Care, and Collaborative Care ACO and Collaborative Care - The Basics What you need to know about Health Reform, Accountable Care, and Collaborative Care Healthcare is changing Costs vs. volume ACO Benefits How to Achieve ACO Health

More information

INTEGRATION STRATEGIES FOR A NEW HEALTH CARE ECONOMY

INTEGRATION STRATEGIES FOR A NEW HEALTH CARE ECONOMY INTEGRATION STRATEGIES FOR A NEW HEALTH CARE ECONOMY Thomas William Baker Baker Donelson Bearman Caldwell & Berkowitz, P.C. Atlanta, Georgia (404) 221-6510 tbaker@bakerdonelson.com Prepared for East Georgia

More information

CMS QCDR (Qualified Clinical Data Registry) and Other Ways PPRNet Can Help with Value-Based Payment

CMS QCDR (Qualified Clinical Data Registry) and Other Ways PPRNet Can Help with Value-Based Payment CMS QCDR (Qualified Clinical Data Registry) and Other Ways PPRNet Can Help with Value-Based Payment Cara Litvin MD, MS Assistant Professor MUSC Department of Medicine Agenda Provide an update of the current

More information

Nuts 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 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 information

Anatomy of an ACO. Through the Eyes of a Physician-owned IPA. Genesis Accountable Care Organization

Anatomy of an ACO. Through the Eyes of a Physician-owned IPA. Genesis Accountable Care Organization Anatomy of an ACO Through the Eyes of a Physician-owned IPA Genesis: IPA by the Numbers 1,400 Physicians PCPs 500 900 SCPs 700 Practices 400 Square miles in North Texas Genesis: Challenges for Change Pressure

More information

Summary of Final Rule Provisions for Accountable Care Organizations under the Medicare Shared Savings Program

Summary of Final Rule Provisions for Accountable Care Organizations under the Medicare Shared Savings Program DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Summary of Final Rule Provisions for Accountable Care Overview The Centers for Medicare & Medicaid Services (CMS), an agency

More information

CPCA California Primary Care Association

CPCA California Primary Care Association CPCA California Primary Care Association Accountable Care Organizations: Next Generation Systems for Community Health Centers? CPCA Annual Conference Sacramento, California October 10, 2014 Larry Garcia,

More information

Terry McGeeney, MD MBA, President, CEO of TransforMED

Terry McGeeney, MD MBA, President, CEO of TransforMED Terry McGeeney, MD MBA, President, CEO of TransforMED Terry McGeeney, MD MBA, President, CEO of TransforMED According to the Future of Family Medicine Report: unless there are changes in the broader healthcare

More information

Mercy: Maximizing the Value of Big Data and Analytics to Improve Patient Care

Mercy: Maximizing the Value of Big Data and Analytics to Improve Patient Care 2015 SAP SE or an SAP affiliate company. All rights reserved. Mercy: Maximizing the Value of Big Data and Analytics to Improve Patient Care To become a best-in-class Accountable Care Organization, Mercy

More information

Nuts and Bolts of. Frank G. Opelka, MD FACS American College of Surgeons. Vice Chancellor for Clinical Affairs Professor of Surgery LSU New Orleans

Nuts and Bolts of. Frank G. Opelka, MD FACS American College of Surgeons. Vice Chancellor for Clinical Affairs Professor of Surgery LSU New Orleans Nuts and Bolts of Accountable Care Organizations Frank G. Opelka, MD FACS American College of Surgeons ACS Advocacy & Health Policy, Vice Chancellor for Clinical Affairs Professor of Surgery LSU New Orleans

More information

Physicians ACO. Don McCormick President. Company Logo

Physicians ACO. Don McCormick President. Company Logo Physicians ACO Don McCormick President Company Logo Why Congress and CMS want ACOs Cost of health care is too high Quality of health care is too low Evidence for both conditions is undeniable Congress

More information

HEALTHCARE REFORM CARE DELIVERY AND REIMBURSEMENT MODELS. April 10, 2014

HEALTHCARE REFORM CARE DELIVERY AND REIMBURSEMENT MODELS. April 10, 2014 HEALTHCARE REFORM CARE DELIVERY AND REIMBURSEMENT MODELS April 10, 2014 1 MARKETPLACE UPDATE 2 MARKETPLACE - ESSENTIAL HEALTH BENEFITS 3 MARKETPLACE - METAL LEVELS 4 WHAT IS THE HEALTH INSURANCE MARKETPLACE

More information

Value-Based Programs. Blue Plans Improving Healthcare Quality and Affordability through Innovative Partnerships with Clinicians

Value-Based Programs. Blue Plans Improving Healthcare Quality and Affordability through Innovative Partnerships with Clinicians Value-Based Programs Blue Plans Improving Healthcare Quality and Affordability through Innovative Partnerships with Clinicians Issue: U.S. healthcare spending exceeds $2.8 trillion annually. 1 With studies

More information

Understanding and preparing for the impact of the Affordable Care Act

Understanding 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 information

ACOs. ACO Definition. ACO Governance. Stuart B Black MD, FAAN Chief of Neurology Co-Director: Neurosciences Baylor University Medical Center at Dallas

ACOs. ACO Definition. ACO Governance. Stuart B Black MD, FAAN Chief of Neurology Co-Director: Neurosciences Baylor University Medical Center at Dallas Stuart B Black MD, FAAN Chief of Neurology Co-Director: Neurosciences Baylor University Medical Center at Dallas ACOs ACO Definition CMS definition of ACO Accountable Care Organizations (ACOs) are groups

More information

Delivery System Innovation

Delivery System Innovation Healthcare Transformation Concepts and Definitions Our healthcare transformation process is invigorated by many stakeholders with differing backgrounds. To help them with new terms and all of us to use

More information

Accountable Care Organizations New Healthcare Opportunities for Employers

Accountable 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 information

E. Christopher Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences

E. Christopher Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences Accountable Care Organizations and You E. Christopher Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences CEO, OSU Faculty Group Practice Chair, Department of Surgery Ohio State University

More information

Accountable Care Organizations & Other Reimbursement Reforms: The Impact on Physician Practices

Accountable Care Organizations & Other Reimbursement Reforms: The Impact on Physician Practices Accountable Care Organizations & Other Reimbursement Reforms: The Impact on Physician Practices Martin Bienstock, Esq. Wilson Elser Martin.Bienstock@WilsonElser.com The New York Times Take... For the first

More information

Report to the Legislature. Primary Care Health Homes-Chronic Care Management Engrossed Substitute Senate Bill 5394 Chapter 316, Laws of 2011

Report to the Legislature. Primary Care Health Homes-Chronic Care Management Engrossed Substitute Senate Bill 5394 Chapter 316, Laws of 2011 Report to the Legislature Primary Care Health Homes-Chronic Care Management Engrossed Substitute Senate Bill 5394 Chapter 316, Laws of 2011 Washington State Health Care Authority Health Care Policy PO

More information

A white paper. Collaborative Accountable Care. CIGNA s Approach to Accountable Care Organizations. 841282 a 11/11

A white paper. Collaborative Accountable Care. CIGNA s Approach to Accountable Care Organizations. 841282 a 11/11 A white paper Collaborative Accountable Care CIGNA s Approach to Accountable Care Organizations 841282 a 11/11 Transforming the Health Care System Successfully transforming the U.S. health care system

More information

Guide to Population Health Management

Guide to Population Health Management Guide to Population Health Management presented by the Healthcare Intelligence Network Note: This is an authorized excerpt from the Guide to Population Health Management. To download the entire guide,

More information

A STRATIFIED APPROACH TO PATIENT SAFETY THROUGH HEALTH INFORMATION TECHNOLOGY

A 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 information

Health IT and Health Care Delivery and Payment Reform. August 25, 2015

Health IT and Health Care Delivery and Payment Reform. August 25, 2015 Health IT and Health Care Delivery and Payment Reform August 25, 2015 Agenda Provide background information Characterize the delivery and payment reform participation in 2013 Describe use of health IT

More information

Atrius Health ACO Initiative. Agenda

Atrius Health ACO Initiative. Agenda Atrius Health ACO Initiative November 9, 2012 Mark Yurkofsky MD Mark_yurkofsky@vmed.org 11/13/2012 1 Agenda Why the interest in the Pioneer ACO? What actually is Pioneer ACO anyway? What is Atrius Health?

More information