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

Size: px
Start display at page:

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

Transcription

1 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 is a network of doctors and hospitals that shares financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending. At the heart of each patient s care is a primary care physician. One of the main ways the Affordable Care Act seeks to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks that coordinate patient care and become eligible for bonuses when they deliver that care more efficiently. ACO Definition Cont d Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program. Medicare offers several ACO programs: Medicare Shared Savings Program a program that helps a Medicare feefor-service program providers become an ACO. Apply Now. Advance Payment ACO Model a supplementary incentive program for selected participants in the Shared Savings Program. Pioneer ACO Model a program designed for early adopters of coordinated care. No longer accepting applications. 1

2 ACO Information The law takes a carrot-and-stick approach by encouraging the formation of accountable care organizations (ACOs) in the Medicare program. Providers make more if they keep their patients healthy. The health law created the Medicare Shared Savings Program. In it, ACOs make providers jointly accountable for the health of their patients, giving them financial incentives to cooperate and save money by avoiding unnecessary tests and procedures. For ACOs to work, they have to seamlessly share information. Those that save money while also meeting quality targets keep a portion of the savings. Providers can choose to be at risk of losing money if they want to aim for a bigger reward, or they can enter the program with no risk at all. Pioneer and MSSP Savings In 2014, the 20 ACOs in the Medicare Pioneer Program and 333 in the Medicare Shared Savings generated $411 million in total savings but after paying bonuses, the program resulted in a net loss of $2.6 million to the Medicare trust fund. That s far less than 1 percent of Medicare spending during that period. 2

3 ACO Core Principles While the ACO model is designed to be flexible, Mark McClellan, Elliott Fisher and others defined three core principles for all ACOs: Provider-led organizations with a strong base of primary care that are collectively accountable for quality and total per capita costs across the full continuum of care for a population of patients; Payments linked to quality improvements that also reduce overall costs; and, Reliable and progressively more sophisticated performance measurement, to support improvement and provide confidence that savings are achieved through improvements in care. Cost savings The ACO places a degree of financial responsibility on the providers in hopes of improving care management and limiting unnecessary expenditures while continuing to provide patients freedom to select their medical services. Success depends on: Clinical excellence Controlling costs by incentivizing hospitals physicians, post-acut facilities, and other providers to facilitate coordination of care delivery. Theory: By increasing care coordination, ACOs can help reduce unnecessary medical care and improve health outcomes, leading to a decrease in utilization of acute care services. According to CMS estimates, ACO implementation as described in the Affordable Care Act is estimated to lead to an estimated median savings of $470 million from HHS Goal The Department of Health and Human Services has set a goal of moving 50 percent of payments toward alternative models by Providers continue to experiment with different approaches to managing the health of populations and learn what works in practice within their unique organizations. (Incentivized to do so through CMMI) 3

4 Medicaid ACOs Expansion of Medicaid ACOs. Medicaid ACOs have grown significantly over the past year, and 16 states have now passed ACO legislation or have enacted ACO-like pilot programs. These states, including Alabama, Vermont, Oregon, New Jersey, and Utah represent a variety of different approaches ranging from capitated payments to payments closely mimicking the MSSP. Because of the large size of Medicaid programs and states ability to mandate payment models, states can accelerate the regional growth of ACOs if and when they decide to move toward accountable care. ACO Growth Leavitt Partners has been actively tracking ACOs since 2010, maintaining a database that is updated regularly from publicly available information and personal and industry interviews. Over the past year, approximately 120 organizations have become ACOs in public and private programs, bringing the total to 744 since ACO Covered Lives In addition to growth in the total number of ACOs, there has been continued growth in the number of people covered by ACO arrangements. Today a total of 23.5 million covered ACO lives. Of these, only 7.8 million are part of the Medicare ACO programs (Pioneer and MSSP), meaning that the majority of ACO volume is coming from the commercial and Medicaid sectors. 4

5 ACO Dispersion The geographic distribution of ACOs has continued to expand as ACOs have begun to form in more markets and to expand within markets. Accountable care organizations exist in all 50 states, Washington, D.C., and Puerto Rico, with the number of ACOs strongly correlated with the population (r s =.895, p<. 001). California has the most ACOs with 81, followed by Florida with 66 and Texas with 48. (See figure next slide). Number of ACOs by State, January 2015 Source: Leavitt Partners Center for Accountable Care Intelligence Growth in Number of ACO Contracts ACOs have increasingly expanded the number of contracts under which they are operating. For example, in 2011, 85 percent of ACO contracts were the organization s first contract. By 2014, only 59 percent of the contracts were first contracts. As of January 2015, 26 percent (192/744) of ACOs had more than one accountable care contract, and 10 percent (73/744) had three or more contracts. Overall, there are 1,046 known contracts for 744 ACOs. 5

6 New Accountable Care Contracts by Year Source: Leavitt Partners Center for Accountable Care Intelligence Payer Involvement The involvement of different payers has also continued to increase over the past year. January 2015, 132 different payers have entered into at least one accountable care contract, an increase of 26 since the end of These include Medicare, over a dozen state Medicaid plans, regional insurers, all of the large, national carriers, and some large, self-insured employers. Commercial payers most notably Cigna, UnitedHealth, and Aetna have significantly expanded their involvement in ACOs, with promise of more to come in 2015 (see figure next slide) Number of Payers Participating in Accountable Care, 2011 to January 2015 Source: Leavitt Partners Center for Accountable Care Intelligence 6

7 Physicians Accountable Care Solutions (PACS) Utah, Connecticut, Inland Empire (California), Colorado (County), Texas (one entity), Massachusetts, West Virginia, Pennsylvania and others participating in the PACS MSSP ACO 5700 Providers, 114,000 Attributed Lives Connecticut 131 Providers, 12,700 Attributed Lives Utah 837 Providers, 26,055 Attributed Lives Uses a software program called CareScreen to help physicians track and coordinate patient care Mainly focuses on well visits and transition visits Why State Societies Choose to Participate in an ACO Benefits Add value to Independent Members Allow Independents to Remain Independent keep competition in market Give State Medical Societies other Non-Dues Services to offer members can bring in money to run the services Changing times/remain relevant Downside Risk Tick off members that are doing their own ACOs competition PACS ACO Started 2015 No downside risk to physicians No upfront cost Shared Savings Program ACO Physicians get extra payments and shared savings UMA gets paid from shared savings Software Program CareScreen 2015 Shared Savings for all based on a few States Upside and downside to National ACO - Utah and two other states bringing in the Savings right now 7

Growth and Dispersion of Accountable Care Organizations in 2015

Growth and Dispersion of Accountable Care Organizations in 2015 Growth and Dispersion of Accountable Care Organizations in 2015 Growth and Dispersion of Accountable Care Organizations in 2015 by David Muhlestein March 31st, 2015 In January, an additional 89 provider

More information

HEALTHCARE REFORM OCTOBER 2012

HEALTHCARE REFORM OCTOBER 2012 HEALTHCARE REFORM Tracking ACO Growth Nationally OCTOBER 2012 The enclosed slides are intended to provide you with a snapshot of how private sector accountable care organizations (ACOs) have formed since

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

AHLA. Q. Medicaid ACOs: Coming to a Neighborhood Near You. Clifford E. Barnes Epstein Becker & Green PC Washington, DC

AHLA. Q. Medicaid ACOs: Coming to a Neighborhood Near You. Clifford E. Barnes Epstein Becker & Green PC Washington, DC AHLA Q. Medicaid ACOs: Coming to a Neighborhood Near You Clifford E. Barnes Epstein Becker & Green PC Washington, DC Jennifer E. Gladieux Senior Health Policy Analyst Health Policy Source, Inc. Alexandria,

More information

See page 16. Thomas A. Vallas

See page 16. Thomas A. Vallas Compliance TODAY July 2014 a publication of the health care compliance association www.hcca-info.org What s the key to successfully merging two large hospital systems? an interview with Michael R. Holper

More information

Chart 1: Total Accountable Care Organizations; Source: Leavitt Partners Center for Accountable Care Intelligence

Chart 1: Total Accountable Care Organizations; Source: Leavitt Partners Center for Accountable Care Intelligence ACO Growth Since the MSSP round 3 participants began in January 2013, nearly 200 new public and private ACOs have been formed across the country (Chart 1). During that time, physician groups have become

More information

Regions (HRR) associated with the hospitals that each entity utilizes.

Regions (HRR) associated with the hospitals that each entity utilizes. Following the Patient Protection and Affordable Care Act s emphasis on Accountable Care Organizations (ACOs) and the announcement of the Medicare Shared Savings Program, an increased interest has emerged

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

Growth and Dispersion of Accountable Care Organizations: August 2013 Update. Matthew Petersen David Muhlestein Paul Gardner

Growth and Dispersion of Accountable Care Organizations: August 2013 Update. Matthew Petersen David Muhlestein Paul Gardner Growth and Dispersion of Accountable Care Organizations: August 2013 Update Matthew Petersen David Muhlestein Paul Gardner TABLE OF CONTENTS Executive Summary..3 Methods and Data.3 Results Dispersion

More information

Accelerating Innovation in Health Care Payment and Delivery: The CMS Innovation Center

Accelerating Innovation in Health Care Payment and Delivery: The CMS Innovation Center Accelerating Innovation in Health Care Payment and Delivery: The CMS Innovation Center William J. Kassler, MD, MPH Chief Medical Officer, New England Region Center for Medicare & Medicaid Innovation We

More information

Testimony to the Senate Committee on Veterans Affairs and Health S. B. 739. February 27, 2014. What is an Accountable Care Organization or ACO?

Testimony to the Senate Committee on Veterans Affairs and Health S. B. 739. February 27, 2014. What is an Accountable Care Organization or ACO? Testimony to the Senate Committee on Veterans Affairs and Health S. B. 739 Professor Sidney D. Watson Center for Health Law Studies Saint Louis University School of Law February 27, 2014 My name is Sidney

More information

Mar. 31, 2011 (202) 690-6145. Summary of proposed rule provisions for Accountable Care Organizations under the Medicare Shared Savings Program

Mar. 31, 2011 (202) 690-6145. Summary of proposed rule provisions for Accountable Care Organizations under the Medicare Shared Savings Program DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 Office of Media Affairs MEDICARE FACT SHEET FOR IMMEDIATE RELEASE

More information

Fact sheets: Accountable Care Organization (ACO) Investment Model Fact Sheet. Accountable Care Organization (ACO) Investment Model Fact Sheet

Fact sheets: Accountable Care Organization (ACO) Investment Model Fact Sheet. Accountable Care Organization (ACO) Investment Model Fact Sheet Fact sheets: Accountable Care Organization (ACO) Investment Model Fact Sheet Date 2014-10-15 Title Accountable Care Organization (ACO) Investment Model Fact Sheet For Immediate Release Wednesday, October

More information

ACA Strategy. Why ACOs? 4/16/2014 ACCOUNTABLE CARE ORGANIZATIONS UNDER THE AFFORDABLE CARE ACT

ACA Strategy. Why ACOs? 4/16/2014 ACCOUNTABLE CARE ORGANIZATIONS UNDER THE AFFORDABLE CARE ACT ACCOUNTABLE CARE ORGANIZATIONS UNDER THE AFFORDABLE CARE ACT Stephen P. Williams, JD 864 350 5276 1984carrera@gmail.com ACA Strategy One of the main ways the Affordable Care Act seeks to reduce health

More information

OUR ACCOUNTABLE CARE ORGANIZATION (ACO) STRATEGY. Meredith Marsh Director Health Choice Care, LLC

OUR ACCOUNTABLE CARE ORGANIZATION (ACO) STRATEGY. Meredith Marsh Director Health Choice Care, LLC OUR ACCOUNTABLE CARE ORGANIZATION (ACO) STRATEGY Meredith Marsh Director Health Choice Care, LLC HEALTH REFORM The Affordable Care Act (ACA) strives to achieve the Triple AIM: Improving the experience

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

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

Quality Accountable Care Population Health: The Journey Continues

Quality 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 information

Accountable Care Organizations: An old idea with new potential. Stephen E. Whitney, MD, MBA Testimony to Senate State Affairs September 22, 2010

Accountable Care Organizations: An old idea with new potential. Stephen E. Whitney, MD, MBA Testimony to Senate State Affairs September 22, 2010 Accountable Care Organizations: An old idea with new potential Stephen E. Whitney, MD, MBA Testimony to Senate State Affairs September 22, 2010 Impetus for ACO Formation Increased health care cost From

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

Medicare Advantage Plan Landscape Data Summary

Medicare Advantage Plan Landscape Data Summary 2013 Medicare Advantage Plan Landscape Data Summary Table of Contents Report Overview...3 Medicare Advantage Costs and Benefits...4 The Maximum Out of Pocket (MOOP) Benefit How It Works...4 The Prescription

More information

INTRO TO THE MICHIGAN PIONEER ACO 101: THE BASICS. Karen Unholz, RN, BSN

INTRO TO THE MICHIGAN PIONEER ACO 101: THE BASICS. Karen Unholz, RN, BSN INTRO TO THE MICHIGAN PIONEER ACO 101: THE BASICS Karen Unholz, RN, BSN Origins of the Accountable Care Organization ACOs originated from the Patient Protection and Affordable Care Act (Healthcare Reform)

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

OBJECTIVES AGING POPULATION AGING POPULATION AGING IMPACT ON MEDICARE AGING POPULATION

OBJECTIVES AGING POPULATION AGING POPULATION AGING IMPACT ON MEDICARE AGING POPULATION OBJECTIVES Kimberly S. Hodge, PhDc, MSN, RN, ACNS-BC, CCRN- K Director, ACO Care Management & Clinical Nurse Specialist Franciscan ACO, Inc. Central Indiana Region Indianapolis, IN By the end of this session

More information

Accountable Care Organizations

Accountable Care Organizations Healthcare Association of New York State Accountable Care Organizations In 2011, in an effort to contain spiraling health care costs, HHS released new rules under the ACA aimed at helping doctors, hospitals,

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

Newsroom. The quality measures are organized into four domains:

Newsroom. The quality measures are organized into four domains: Newsroom People with Medicare will be able to benefit from a new program designed to encourage primary care doctors, specialists, hospitals, and other care providers to coordinate their care under a final

More information

DRAFT. Background About Shared Savings Program Design Features: Patient Attribution, Cost Target Calculation, and Payment Calculation and Distribution

DRAFT. Background About Shared Savings Program Design Features: Patient Attribution, Cost Target Calculation, and Payment Calculation and Distribution Background About Shared Savings Program Design Features: Patient Attribution, Cost Target Calculation, and Payment Calculation and Distribution Excerpted from Draft Narratives Developed in the CT SIM Equity

More information

The Affordable Care Act in Texas: Five Years and Counting

The Affordable Care Act in Texas: Five Years and Counting The Affordable Care Act in Texas: Five Years and Counting David W. Hilgers October 21, 2014 ACA Timeline Bill Passed 3/23/2010 2010 Eliminated pre-existing conditions for children Limited cancellation

More information

Medicare Shared Savings Program Final Rule

Medicare 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 information

LTC Division Webinar Accountable Care Organizations and LTC Pharmacy - The New Era in Health Care Delivery

LTC Division Webinar Accountable Care Organizations and LTC Pharmacy - The New Era in Health Care Delivery LTC Division Webinar Accountable Care Organizations and LTC Pharmacy - The New Era in Health Care Delivery 1 The Pioneer ACO Model James Vasquenza Jr. Vice President, Preferred Provider Network, Innovatix

More information

Look Before You Leap: Legal and Practical Obstacles with ACOs

Look Before You Leap: Legal and Practical Obstacles with ACOs Look Before You Leap: Legal and Practical Obstacles with ACOs Houston ACO Conference May 7, 2013 Edward Vishnevetsky, Esq. Coordinated Care and ACOs Coordinated Care Goal: ensure that healthcare providers

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

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

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

Medicaid Topics Impact of Medicare Dual Eligibles Stephen Wilhide, Consultant

Medicaid Topics Impact of Medicare Dual Eligibles Stephen Wilhide, Consultant Medicaid Topics Impact of Medicare Dual Eligibles Stephen Wilhide, Consultant Issue Summary The term dual eligible refers to the almost 7.5 milion low-income older individuals or younger persons with disabilities

More information

Medicare- Medicaid Enrollee State Profile

Medicare- Medicaid Enrollee State Profile Medicare- Medicaid Enrollee State Profile The National Summary Centers for Medicare & Medicaid Services Introduction... 1 Data Source and General Notes... 2 Types and Ages of Medicare-Medicaid Enrollees...

More information

STRATEGIC INNOVATIONS FOR AFFORDABLE, SUSTAINABLE HEALTH CARE:

STRATEGIC INNOVATIONS FOR AFFORDABLE, SUSTAINABLE HEALTH CARE: January 2011 STRATEGIC INNOVATIONS FOR AFFORDABLE, SUSTAINABLE HEALTH CARE: A Model for Health System Reform Environmental Scan Accountable Care Organizations Table of Contents ACCOUNTABLE CARE ORGANIZATIONS...

More information

The Obama Administration and Community Health Centers

The Obama Administration and Community Health Centers The Obama Administration and Community Health Centers Community health centers are a critical source of health care for millions of Americans particularly those in underserved communities. Thanks primarily

More information

AHLA. BB. Accountable Care Organizations and the Medicare Shared Savings Program. Troy Barsky Crowell & Moring LLP Washington, DC

AHLA. BB. Accountable Care Organizations and the Medicare Shared Savings Program. Troy Barsky Crowell & Moring LLP Washington, DC AHLA BB. Accountable Care Organizations and the Medicare Shared Savings Program Troy Barsky Crowell & Moring LLP Washington, DC Daniel F. Murphy Bradley Arant Boult Cummings LLP Birmingham, AL Terri L.

More information

Understanding Socioeconomic and Health Care System Drivers to Increase Vaccination Coverage

Understanding Socioeconomic and Health Care System Drivers to Increase Vaccination Coverage Understanding Socioeconomic and Health Care System Drivers to Increase Vaccination Coverage Jason Baumgartner Life Sciences Consulting Director, Quintiles April 2011 Discussion Topics Title: Understanding

More information

With the support of The Commonwealth Fund, NASHP is tracking state efforts to lead or participate in accountable care models that include Medicaid

With the support of The Commonwealth Fund, NASHP is tracking state efforts to lead or participate in accountable care models that include Medicaid 1 With the support of The Commonwealth Fund, NASHP is tracking state efforts to lead or participate in accountable care models that include Medicaid and Children s Health Insurance Program populations.

More information

Accountable Care Organizations: Importance to Physicians in Value Based Payment June 19, 2014 12:00-1:00pm EST

Accountable Care Organizations: Importance to Physicians in Value Based Payment June 19, 2014 12:00-1:00pm EST Accountable Care Organizations: Importance to Physicians in Value Based Payment June 19, 2014 12:00-1:00pm EST Ahmed Haque, Director of Care Transformation Health IT U.S. Department of Health & Human Services

More information

ACO Update: Trends, Results and the Future of Accountable Care

ACO Update: Trends, Results and the Future of Accountable Care ACO Update: Trends, Results and the Future of Accountable Care David Muhlestein, PhD Director of Research, Leavitt Partners September 16, 2014 Presentation Overview Basics of Accountable Care ACO Trends

More information

(In effect as of January 1, 2004*) TABLE 5a. MEDICAL BENEFITS PROVIDED BY WORKERS' COMPENSATION STATUTES FECA LHWCA

(In effect as of January 1, 2004*) TABLE 5a. MEDICAL BENEFITS PROVIDED BY WORKERS' COMPENSATION STATUTES FECA LHWCA (In effect as of January 1, 2004*) TABLE 5a. MEDICAL BENEFITS PROVIDED BY WORKERS' COMPENSATION STATUTES Full Medical Benefits** Alabama Indiana Nebraska South Carolina Alaska Iowa Nevada South Dakota

More information

Medicare Advantage Cuts in the Affordable Care Act: March 2013 Update Robert A. Book l March 2013

Medicare Advantage Cuts in the Affordable Care Act: March 2013 Update Robert A. Book l March 2013 Medicare Advantage Cuts in the Affordable Care Act: March 2013 Update Robert A. Book l March 2013 The Centers for Medicare and Medicaid Services (CMS) recently announced proposed rules that would cut payments

More information

The last eight months have seen considerable growth in the number of health care entities commencing accountable care payment arrangements. Despite large variation in models used, this growth is evidence

More information

Strengthening Medicare: Better Health, Better Care, Lower Costs Efforts Will Save Nearly $120 Billion for Medicare Over Five Years.

Strengthening Medicare: Better Health, Better Care, Lower Costs Efforts Will Save Nearly $120 Billion for Medicare Over Five Years. Strengthening Medicare: Better Health, Better Care, Lower Costs Efforts Will Save Nearly $120 Billion for Medicare Over Five Years Introduction The Centers for Medicare and Medicaid Services (CMS) and

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

Medicare Shared Savings Program

Medicare Shared Savings Program Medicare Shared Savings Program Shared Savings Program http://www.cms.gov/savingsprogram/ Centers for Medicare & Medicaid Services February 2012 Medicare Shared Savings Program (Shared Savings Program)

More information

Meeting of the Advisory Panel on Outreach and Education (APOE) Centers for Medicare and Medicaid Services March 27, 2013.

Meeting of the Advisory Panel on Outreach and Education (APOE) Centers for Medicare and Medicaid Services March 27, 2013. 701 Pennsylvania Avenue, Ste. 800 Washington, DC 20004 2654 Tel: 202 783 8700 Fax: 202 783 8750 www.advamed.org Meeting of the Advisory Panel on Outreach and Education (APOE) Centers for Medicare and Medicaid

More information

HEALTH REFORM LAW: ACCOUNTABLE CARE ORGANIZATIONS

HEALTH REFORM LAW: ACCOUNTABLE CARE ORGANIZATIONS HEALTH REFORM LAW: ACCOUNTABLE CARE ORGANIZATIONS PRESENTED AT THE NASABA 2011 CONVENTION BY: PURVI B. MANIAR Context and Background Patient Protection and Affordable Care Act of 2010 ( PPACA ) (Section

More information

Outpatient dialysis services

Outpatient dialysis services O n l i n e A p p e n d i x e s 6 Outpatient dialysis services 6-A O n l i n e A p p e n d i x Medicare spending by dialysis beneficiaries is substantial FIGURE 1-3 Figure 6 A1 Medicare population Dialysis

More information

Full Medical Benefits**

Full Medical Benefits** (In effect as of January 1, 2006*) TABLE 5a. MEDICAL BENEFITS PROVIDED BY WORKERS' COMPENSATION STATUTES Full Medical Benefits** Alabama Indiana Nebraska South Carolina Alaska Iowa Nevada South Dakota

More information

Justin T. Barnes. Future of Value-based Medicine, Accountable Care and New Payment Models

Justin T. Barnes. Future of Value-based Medicine, Accountable Care and New Payment Models Future of Value-based Medicine, Accountable Care and New Payment Models Follow Justin Barnes @HITAdvisor Ask Questions ~ #askhit Justin T. Barnes VP, Greenway Medical Technologies Co-Chair, Accountable

More information

ACOs: Six Things Specialty Practices Should Know

ACOs: 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 information

Health Policy Brief. Accountable Care Organizations.

Health Policy Brief. Accountable Care Organizations. www.healthaffairs.org 1 Health Policy Brief updated: august 13, 2010 Accountable Care Organizations. Under the health reform law, Medicare will be able to contract with these to provide care to enrollees.

More information

$7.5 appropriation $6.5 2011 2012 2013 2014 2015 2016. Preschool Development Grants

$7.5 appropriation $6.5 2011 2012 2013 2014 2015 2016. Preschool Development Grants School Readiness: High-Quality Early Learning Head Start $10.5 $9.5 $10.1 +$1.5 +17.7% $8.5 $7.5 +$2.1 +27.0% $6.5 for fiscal year 2010 Included in the budget is $1.078 billion to ensure that every Head

More information

Overview of Physician Payment System Reforms in the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2)

Overview of Physician Payment System Reforms in the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2) Overview of Physician Payment System Reforms in the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2) June 18, 2015 Prepared for The Health Collaborative akingump.com 2015 Akin Gump Strauss

More information

Marilyn Tavenner Administrator Centers for Medicare and Medicaid Services Attention: CMS-1612-FC 7500 Security Blvd Baltimore, MD 21244

Marilyn Tavenner Administrator Centers for Medicare and Medicaid Services Attention: CMS-1612-FC 7500 Security Blvd Baltimore, MD 21244 February 6, 2015 Marilyn Tavenner Administrator Centers for Medicare and Medicaid Services Attention: CMS-1612-FC 7500 Security Blvd Baltimore, MD 21244 RE: Medicare Program; Medicare Shared Savings Program:

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

Chapter Three Accountable Care Organizations

Chapter Three Accountable Care Organizations Chapter Three Accountable Care Organizations One of the most talked-about changes in health care delivery in recent decades is Accountable Care Organizations, or ACOs. Having gained the attention of both

More information

Health Care Policy Cost Index 2012: Ranking the States According to Policies Affecting the Cost of Health Coverage

Health Care Policy Cost Index 2012: Ranking the States According to Policies Affecting the Cost of Health Coverage Health Care Policy Cost Index 2012: Ranking the States According to Policies Affecting the Cost of Health Coverage by Raymond J. Keating Chief Economist Small Business & Entrepreneurship Council February

More information

State Innovation Models Initiative:

State Innovation Models Initiative: Department of Health & Human Services Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 FACT SHEET FOR IMMEDIATE RELEASE Contact: CMS Media Relations

More information

ISSUE BRIEF Accountable Care Organizations March 2009

ISSUE BRIEF Accountable Care Organizations March 2009 ISSUE BRIEF Accountable Care Organizations March 2009 Reforming Provider Payment Moving Toward Accountability for Quality and Value Introduction The ongoing debate over health care reform in the United

More information

State Oversight of ACOs

State Oversight of ACOs State Oversight of ACOs Bill Barcellona, VP FSSB Meeting May 19, 2011 California Association of Physician Groups What are the potential goals of state oversight? Provide an incentive to organize a fragmented

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

Key Design Feature Scope of services Governance Payment Measurement & Evaluation

Key Design Feature Scope of services Governance Payment Measurement & Evaluation Figure 2: Domains of State Activity Name of Initiative Key Design Feature Scope of services Governance Payment Measurement & Evaluation Support for Infrastructure Alabama Regional Organizations (RCOs)

More information

US Medicare Accountable Care Organizations (ACOs)

US Medicare Accountable Care Organizations (ACOs) James H Thrall MD Chairman Emeritus, Department of Radiology Massachusetts General Hospital Distinguished Juan M Taveras Professor of Radiology Harvard Medical School US Medicare Accountable Care Organizations

More information

Accountable Care Organizations: Reality or Myth?

Accountable Care Organizations: Reality or Myth? Written by: Ty Meyer Accountable Care Organizations: Reality or Myth? Introduction According to Steven Gerst, VP of Medical Affairs at MedCurrent Corporation, The Patient Protection and Affordable Care

More information

Payment Models Workgroup July 13, 2015

Payment Models Workgroup July 13, 2015 Payment Models Workgroup July 13, 2015 Alternative Payment Models: WHAT Are Other SIM States Doing? 2 State Innovation Models (SIM) Initiative Evaluation - Model Test CMS contracted with RTI to develop

More information

Integrating Care: Partnerships between Community-Based Organizations and Accountable Care Organizations. September 28, 2012

Integrating Care: Partnerships between Community-Based Organizations and Accountable Care Organizations. September 28, 2012 Integrating Care: Partnerships between Community-Based Organizations and Accountable Care Organizations September 28, 2012 Agenda Housekeeping/Introductions Overview of Accountable Care Organizations (ACOs)

More information

Total 15,555 191,604

Total 15,555 191,604 January 2012 Program -to -Date Medicare Eligible Professionals 8,524 132,445 Doctors of Medicine or Osteopathy 7,620 118,146 Dentists 12 198 Optometrists 436 5,928 Podiatrists 222 4,890 Chiropractors 234

More information

MEDICARE. Results from the First Two Years of the Pioneer Accountable Care Organization Model

MEDICARE. Results from the First Two Years of the Pioneer Accountable Care Organization Model United States Government Accountability Office Report to the Ranking Member, Committee on Ways and Means, House of Representatives April 2015 MEDICARE Results from the First Two Years of the Pioneer Accountable

More information

Presentation to Northwest Regional Critical Access Hospital Conference Spokane, Washington March 13, 2012

Presentation to Northwest Regional Critical Access Hospital Conference Spokane, Washington March 13, 2012 Presentation to Northwest Regional Critical Access Hospital Conference Spokane, Washington March 13, 2012 Keith J. Mueller, Ph.D. Director, RUPRI Center for Rural Health Policy Analysis Head, Department

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

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

ACO s as Private Label Insurance Products

ACO 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 information

Keith J. Mueller, Ph.D. Director, RUPRI Center for Rural Health Policy Analysis Head, Department of Health Management and Policy College of Public

Keith J. Mueller, Ph.D. Director, RUPRI Center for Rural Health Policy Analysis Head, Department of Health Management and Policy College of Public Presentation to the National Organization of State Offices of Rural Health August 29, 2012 Chicago, Illinois Keith J. Mueller, Ph.D. Director, RUPRI Center for Rural Health Policy Analysis Head, Department

More information

Medicaid Payment Reform

Medicaid Payment Reform Medicaid Payment Reform Taking Center Stage in Washington & State Capitols April 29, 2011 www.chcs.org Medicaid Payment Reform: Taking Center Stage In Washington DC Federal law CMS The Affordable Care

More information

Pioneer ACO Model: Overview

Pioneer ACO Model: Overview Center for Medicare and Medicaid Services Pioneer ACO Model: Overview AAMC Teleconference June 8, 2011 Karen Fisher, J.D. kfisher@aamc.org Jane Eilbacher jeilbacher@aamc.org Will Dardani wdardani@aamc.org

More information

November 22, 2010. RE: File code CMS-1345-NC. Dear Dr. Berwick:

November 22, 2010. RE: File code CMS-1345-NC. Dear Dr. Berwick: 601 New Jersey Avenue, N.W. Suite 9000 Washington, DC 20001 202-220-3700 Fax: 202-220-3759 www.medpac.gov. Glenn M. Hackbarth, J.D., Chairman Robert A. Berenson, M.D., F.A.C.P., Vice Chairman Mark E. Miller,

More information

2010 MHA Governance Leadership Forum: Accountable Care Organizations. Chris Rossman, Esq. Foley & Lardner LLP Detroit, Michigan

2010 MHA Governance Leadership Forum: Accountable Care Organizations. Chris Rossman, Esq. Foley & Lardner LLP Detroit, Michigan 2010 MHA Governance Leadership Forum: Accountable Care Organizations Chris Rossman, Esq. Foley & Lardner LLP Detroit, Michigan Overview Major health care payment reform under the Affordable Care Act (

More information

American College of Emergency Physicians

American College of Emergency Physicians ACEP HEALTH INSURANCE POLL RESEARCH RESULTS Prepared For: American College of Emergency Physicians September 2015 2015 Marketing General Incorporated 625 rth Washington Street, Suite 450 Alexandria, VA

More information

Mandated report: Medicare payment for ambulance services. Zach Gaumer, David Glass, and John Richardson September 6, 2012

Mandated report: Medicare payment for ambulance services. Zach Gaumer, David Glass, and John Richardson September 6, 2012 Mandated report: Medicare payment for ambulance services Zach Gaumer, David Glass, and John Richardson September 6, 2012 Mandated report on Medicare payment for ambulance services MedPAC directed to study:

More information

A/B MAC Jurisdiction 1 Original Medicare Claims Processor

A/B MAC Jurisdiction 1 Original Medicare Claims Processor A/B MAC Jurisdiction 1 Jurisdiction 1 - American Samoa, California, Guam, Hawaii, Nevada and Northern Mariana Islands Total Number of Fee-For-Service Beneficiaries: 3,141,183 (as of Total Number of Beneficiaries

More information

Preferred Provider Organization (PPO) Plans

Preferred Provider Organization (PPO) Plans CENTERS FOR MEDICARE & MEDICAID SERVICES Your Guide to Medicare s Preferred Provider Organization (PPO) Plans This official government booklet has important information about the following: Understanding

More information

ACOs may elect Track 2 without completing a prior agreement period under a one-sided model

ACOs may elect Track 2 without completing a prior agreement period under a one-sided model Financial and Regulatory Parameters for MSSP Risk Tracks in ACO Learning Network Comments and the blue box indicates LN different from ; red text indicates change from and/or LN on Transition to Two-Sided

More information

Medicare. If you have any other questions, please feel free to call us at 1-800-MEDICARE (1-800-633-4227). Sincerely,

Medicare. If you have any other questions, please feel free to call us at 1-800-MEDICARE (1-800-633-4227). Sincerely, Medicare Beneficiary Services:1-800-MEDICARE (1-800-633-4227) TTY/ TDD:1-877-486-2048 Thank you for your recent request for the Patient s Request for Medical Payment form (CMS-1490S). Enclosed is the form,

More information

June 18, 2015. 219 Dirksen Senate Building 221 Dirksen Senate Building Washington, D.C. 20510 Washington, D.C. 20510

June 18, 2015. 219 Dirksen Senate Building 221 Dirksen Senate Building Washington, D.C. 20510 Washington, D.C. 20510 June 18, 2015 The Honorable Orrin Hatch The Honorable Ron Wyden Chairman Ranking Member Senate Finance Committee Senate Finance Committee 219 Dirksen Senate Building 221 Dirksen Senate Building Washington,

More information

Medicare Advantage Plan Landscape Data Summary

Medicare Advantage Plan Landscape Data Summary Medicare Advantage Plan Landscape Data Summary Table of Contents Report Overview............................................ 3 Methodology............................................... 6 Medicare Advantage

More information

Certification of Comparability of Pediatric Coverage Offered by Qualified Health Plans November 25, 2015

Certification of Comparability of Pediatric Coverage Offered by Qualified Health Plans November 25, 2015 DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, MD 21244-1850 Certification of Comparability of Pediatric Coverage

More information

Accountable Care Platform

Accountable Care Platform The shift toward increased collaboration, outcome-based payment and new benefit design is transforming how we pay for health care and how health care is delivered. UnitedHealthcare is taking an industry

More information

STATEMENT OF ACHIEVING THE PROMISE OF HEALTH INFORMATION TECHNOLOGY BEFORE THE UNITED STATES SENATE COMMITTEE ON HEALTH, EDUCATION, LABOR & PENSIONS

STATEMENT OF ACHIEVING THE PROMISE OF HEALTH INFORMATION TECHNOLOGY BEFORE THE UNITED STATES SENATE COMMITTEE ON HEALTH, EDUCATION, LABOR & PENSIONS STATEMENT OF PATRICK CONWAY, MD, MSc ACTING PRINCIPAL DEPUTY ADMINISTRATOR, DEPUTY ADMINISTRATOR FOR INNOVATION AND QUALITY, AND CHIEF MEDICAL OFFICER, CENTERS FOR MEDICARE & MEDICAID SERVICES ON ACHIEVING

More information

Accelera'ng Care and Payment Innova'on: The CMS Innova'on Center

Accelera'ng Care and Payment Innova'on: The CMS Innova'on Center Accelera'ng Care and Payment Innova'on: The CMS Innova'on Center Healthcare IT Connect Sean Cavanaugh Deputy Director Center for Medicare and Medicaid Innova:on May 21, 2013 The CMS Innovation Center Identify,

More information

Exploring the Impact of the RAC Program on Hospitals Nationwide

Exploring the Impact of the RAC Program on Hospitals Nationwide Exploring the Impact of the RAC Program on Hospitals Nationwide Overview of AHA RACTrac Survey Results, 4 th Quarter 2010 For complete report go to: http://www.aha.org/aha/issues/rac/ractrac.html Agenda

More information

Medical Industry Leadership Institute. Carlson School of Management. What Changes will Health Reform Bring to Medicare Advantage

Medical Industry Leadership Institute. Carlson School of Management. What Changes will Health Reform Bring to Medicare Advantage Medical Industry Leadership Institute Carlson School of Management What Changes will Health Reform Bring to Medicare Advantage Plan Benefits and Enrollment? WORKING PAPER SERIES Robert A. Book Senior Research

More information