ACOs and PCMHs: Health Care Transformation or More Alphabet Soup?

Size: px
Start display at page:

Download "ACOs and PCMHs: Health Care Transformation or More Alphabet Soup?"

Transcription

1 Florida Blue Center for Health Policy ACOs and PCMHs: Health Care Transformation or More Alphabet Soup? Carl Patten, JD, MPH Introduction The challenges facing the American health care system are clear. Tens of millions of people have difficulty paying for health care because they are uninsured or underinsured. The introduction of health insurance subsidies in 2014 under the Affordable Care Act (ACA) should substantially mitigate this issue. However, the challenge of access will remain formidable due to the choice of many states, including Florida, not to expand Medicaid eligibility. There are numerous opportunities to improve health care quality and, by extension, people s overall health. Also, many agree that the upward trend of health care costs is unsustainable. The United States spends approximately 80 percent more per person on health care than Norway, the second country in this category. This is driven, in large part, by a fee-for-service payment structure, provider consolidation and medical technology. Braving the tempest; changing our path While there is broad agreement regarding the problems, the hard part is identifying and implementing discrete, adequate solutions. This is difficult for two reasons. First, the challenges facing health care in this country are entangled, complex and require comprehensive solutions. For example, it is clear that more money is not the answer to better quality. Improved quality requires a combination of coordinated efforts among all providers, utilizing technology and treatment methods appropriately, and educated and involved patients and families. Many of these issues depend on people having financial and actual access to health care. This in turn is directly related to the cost of health care that manifests itself in the form of insurance premiums, out of pocket costs to consumers and additional tax dollars dedicated to health care programs. Second, health care issues are politically sensitive and emotionally charged. Health care policy impacts public and individual finances, individual rights ranging from access to health care, to privacy, to debates over states versus federal realms of power. Last, but not least, health care is eventually, and literally, a life or death issue for nearly everyone. Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association. Calming the storm The Patient-Centered Medical Home (PCMH) and Accountable Care Organization (ACO) concepts have been prominently presented as potential solutions to mitigate the ills of the health care system. The ACA has brought much attention to these models; however, their genesis and the interest of the private sector pre-date the ACA. This is especially true for the PCMH. While there are overlapping elements between these two concepts, they have distinct and complementary KEY TAKEAWAYS 1. PCMHs are rooted in primary care and the chronic care model and are strongly based on evidence. The model incorporates elements that address many of the significant drivers of high health care costs and suboptimal quality. 2. ACOs serve as catalysts for the proliferation of PCMH principles throughout the health care system. The ACO model utilizes legal and financial arrangements designed to respond to incentives that encourage activities that support the PCMH concept. 3. Although there are many questions about how these models should be implemented, PCMHs and ACOs have taken hold in the public and private sectors and have shown promise. 4. We are in the learning stages of discovering the potential of PCMHs and ACOs. Public policy must encourage broad participation and a variety of approaches to these models. Robust research and evaluation is needed to identify best practices of translating evidence into practice; organizational adaptation to change; financial and legal structures; and balancing the need for providers to take on risk while protecting consumers. 5. Research and evaluation must be coordinated and build upon efforts to identify core metrics for useful comparisons to inform future implementation efforts. Florida Blue Center Issue for Health Brief 1, Policy July 20131

2 roles. Essentially, the PCMH model captures the best thinking of the role of patients, providers and payers in the delivery of high quality health care. An ACO is an ecosystem that pervasively enables and catalyzes the principles of PCMHs. Patient Centered Medical Homes: broad support and comprehensive solutions. Is it enough? The PCMH concept has evolved over the past five decades and is firmly rooted in the culture of primary care. In 1967 the American Academy of Pediatrics (AAP) introduced the medical home concept to describe the coordination role of primary care pediatric practices for the chronically ill and later expanded the definition to refer to primary care that is accessible, continuous, comprehensive, coordinated, familycentered and culturally effective. This definition positions primary care physicians as leaders and coordinators of all of the care received by the patient. During the following three decades the World Health Organization, the Institute of Medicine, the American Academy of Family Physicians (AAFP) and the American College of Physicians (ACP) embraced these elements and began to promote public policy in support of them. In 1996 Dr. Ed Wagner introduced the chronic care model which emphasizes team-based care, patient self-management support and use of health information technology (HIT) to support evidence-based care. These principles were incorporated into the medical home concept. The PCMH model contains multiple elements that are designed to address commonly identified challenges facing the health care system. Although there is some disagreement on the degree, many researchers acknowledge that there is unexplained variation in health care spending. That is, higher spending cannot be supported by medical need or evidence-based medicine. Research has shown that quality is worse in higher spending regions from the perspective of providers and patients. In 2006, a widely cited article reported that Americans receive evidence-based medicine 55 percent of the time. This means where research dictates that providers should do B if A happens, B happens slightly more than half of the time. Nationally, measurable medical errors that harm patients cost an estimated $17.1 billion annually. Finally, Americans do not demonstrate healthy behaviors. For example approximately onethird of children and two-thirds of adults in America are overweight or obese. These numbers are slightly higher in Florida. The elements of PCMH listed in the paragraph above along with an emphasis on patient participation and connection to community resources provides support for addressing these issues. 2 Florida Blue Center for Health Policy The PCMH concept has broad support. In March of 2007, the AAFP, the AAP, the ACP and the American Osteopathic Association created the Joint Principles of the Patient Centered Medical Home (Joint PCMH Principles). The Patient-Centered Primary Care Collaborative (PCPCC -- which included national employers and physician groups), health plans, consumer groups, labor unions and other stakeholders played a critical role in initiating the creation of the Joint PCMH Principles. The Joint PCMH Principles were adopted by the ACA and serve as the definition of PCMHs in the law. Furthermore, these principles led to the development of NCQA PCMH 2011 Standards. While other accreditation bodies have PCMH programs, the National Committee for Quality Assurance (NCQA) is an early leader. For all of its qualities, the PCMH model is not a panacea for several reasons. First, implementation of the PCMH model requires funding. The acquisition and maintenance of HIT and the implementation of processes to support team-based care, population management, enhanced access and continuous quality improvement efforts requires significant financial investment. Second, the PCMH model would require significant workflow redesign and organizational culture changes. In addition to paying for the elements above, buy-in is required to effectively implement them along with establishing relationships with relevant community resources to enable effective patient-centered care. Third, there must be a high level of cooperation among practices to fully realize the intended impact of the PCMH. Thus, the culture change must be within and among practices. Accountable Care Organizations: the how that delivers the what ACOs serve as the legal and financial infrastructure to incentivize improved quality and a more efficient health care system. Policy experts describe ACOs as the medical neighborhood that facilitates the transition of accountability among providers. The model has its roots in previous concepts such as HMOs, pay-forperformance and other approaches to improve the cost-effectiveness of care. They are responsible for a defined population. However the ACO concept, formalized by Dr. Elliott Fisher in 2006, provides more flexibility regarding structure, payment and assumption of risk. The other end of a shared continuum PCMHs and ACOs share several elements. According to the literature, desired elements of ACOs include complete and timely information about patients; population management and care coordination among providers; patient education and self-management

3 support; the ability to measure and report on the quality of care; evidence based medicine; and the ability to effectively implement HIT. These elements strongly overlap with themes advanced in the Joint PCMH Principles and NCQA PCMH 2011 Standards. The literature also reveals that the ACO model primarily focuses on organizational and systemic transformation through governance and financial arrangements. These elements include the ability to manage financial risk; a commitment by the organization s leadership to improving value as a top priority; a system of operational accountability to drive improved performance; the ability to effectively allocate and optimize a workforce to improve quality efficiently; and the ability to effectively negotiate and align with others within the health care system supply chain. This requires a free flow of information among the providers, payers and members facilitated by a robust and highly functional HIT system. Furthermore, creating value for patients requires a holistic approach, different from incentives promoted by most fee-forservice payment models. For instance in order for a ACO to be successful a Hospital may have to provide less services, thus having less direct business. The payment model under which an ACO operates dictates the level of risk it assumes. The Academy of Actuaries identifies five payment models: one-sided shared savings, two-sided shared savings, bundled/ episode payments, partial capitation/global payments and global payments. These models are listed in order of ascending levels of risk allocated to the ACO and are explained in the appendix 1. The shared savings models are built on a fee-for-service platform. Thus, while there may be some potential variation in revenue, and a possibility of it having to refund money, the risk the ACO assumes is less compared to the other models. The bundled and partial capitated payment models shift more risk to the ACO, but there are limitations based on either incidence of risk or which services are paid on a fee-for-service basis versus capitation. Under the global payment model the ACO assumes full risk and is responsible for incidence and severity of their illness and how efficiently it can address that illness while meeting quality standards. It is critical to understand how risk allocation to ACOs impacts the quality and cost of care as well as the overall health care delivery market. Transitioning payment models that allocate more risk to ACOs encourages greater focus on quality outcomes and efficiency. This transition must be purposeful and strategic. Assessing and managing risk is a highly specialized skill, and it is, expectedly, one not typically within the wheelhouse of health care providers. Although obtaining greater value for the care delivered will require providers to engage payment models that allocate more risk to them, this transition must take into account the capacity of provider organizations to manage risk and the impact to the overall market. If an ACO suffers financially, this could result in the elimination or reduction in quality of care delivered to patients. Furthermore, larger organizations are better positioned to assess and manage risk, creating a potential advantage. If not monitored properly, this transition could cause a concentration of economic power in the market that could result in higher prices for consumers without a corresponding increase in quality. The neighbors are restless among others Although major stakeholders of the health care system support the general principles of ACOs, there are some differences among physicians, hospitals and payers. The AMA believes that ACOs must be physician-led. It also supports flexibility in patient referral and antitrust laws to allow physicians to collaborate with hospitals in forming ACOs without being employed by the hospital or the ACO. Hospitals have expressed concerns about overcoming physician attitudes favoring autonomy and individual accountability over coordination. Policy experts also have concerns about the horizontal and vertical integration sparked by the Medicare Shared Savings program under the ACA. The fear is that it could result in the aggregation of excessive market power, especially in smaller markets. This would lead to reduced competition and higher health care costs. There are a number of unanswered questions regarding the implementation of ACOs. These issues are associated with payment, risk and operations. Payment and risk issues include the entrenchment of the current fee-for-service model; the ability of provider-led organizations to assess and assume risk; the ability to assess the risk of populations assigned to ACOs; and how to assign populations to ACOs. As providers bear more risk, there needs to be some consideration about how the financial health of these organizations will be monitored without overburdening them. With respect to population assignment, it is important to adjust for disease severity among populations to ensure that ACOs are not assuming risk for which they are not compensated. A complicating factor is that patients may obtain care outside of the ACO to which they are assigned, potentially limiting the impact of ACOs on the outcomes of its patients. This model also assumes significant patient engagement. Techniques must be identified to maximize the participation of patients and their families. 1 See appendix for more detailed explanation of payment models. Florida Blue Center for Health Policy 3

4 Operational issues include the cultural transition from patient care based on office visits to maintaining the health of a population; transitions to value-based payment models that allocate more risk to ACOs; and the lack of IT capabilities and administrative infrastructure to become a robust ACO. This is especially true among smaller practices that may have fewer resources to implement structural change. A public and private affair There are numerous public sector efforts regarding PCMHs and ACOs. The Federal PCMH Collaborative is a collection of seven federal agencies with initiatives related to PCMH to identify opportunities for collaboration, learn from one another and minimize duplication. According to the National Academy for State Health Policy, 43 states have adopted policies and programs to advance PCMHs. The Community Care of North Carolina, a program that links Medicaid and CHIP enrollees to community-based primary care medical homes, reportedly saved $1 billion over a four year period. Federal ACO programs, particularly the Medicare Shared Savings Program created by the ACA, have garnered a lot of attention. This program was implemented in 2012, and it includes a one-sided or two-sided shared savings reimbursement model, at the option of the ACO. Other federal ACO initiatives include the Pioneer ACO program, which includes six variations of financial incentive designs and the Advance Payment ACO program that provides upfront funding to poorly capitalized organizations to then start an ACO. As of January 2013 more than 250 ACOs cover more than four million Medicare beneficiaries. There are several private sector PCMH and ACO efforts. As of August 2012, 80 organizations were identified as having an ACO contract had only private-payer contracts or both public and private payer contracts. Blue Shield of California rolled out an ACO pilot with 40,000 members of the California Public Employee Retirement System (CalPERS), which saved an estimated $15 million and intends to expand the pilot to other markets. Blue Cross Blue Shield of Massachusetts rolled out the Alternative Quality Contract, which includes a global budget with annual spending growth limits; incentive payments to improve quality based on previously agreed upon measures; and technical support for participating groups and five year contracts with providers. The Brookings- Dartmouth Partnership is providing technical assistance to five pilot ACO sites and will monitor and study results of the pilots to make recommendations on further development of the ACO model. The state of Vermont, national health plans and other Blue plans have implemented or are preparing to implement ACOs. 4 Florida Blue Center for Health Policy Florida Blue has demonstrated leadership in the effort to implement PCMHs and ACOs. Approximately 30 percent of Florida Blue s medical spend is through value based models, including PCMHs and ACOs. With over 2,200 primary care physicians and 240 participating groups, Florida Blue has one of the largest PCMH programs in the nation. Florida Blue also has eight ACO agreements with more in the pipeline. Under Florida Blue s PCMH program, physicians have performed the same or better than non-participating peers in all of the 29 clinical quality metrics. Emergency room visits have dropped by 12 percent, and overall Florida Blue has seen a cost reduction better than four percent during the first year of implementation. The value of evaluation Evaluation is crucial to the ability of PCMHs and ACOs to deliver better quality care that is more efficient. These models are designed to promote and implement concepts that have been identified as solutions to the root causes of quality and cost issues. As we move forward, sound and coordinated research efforts will be essential to maximizing the potential of these concepts. Although there are more data on PCMHs than ACOs, research conducted to-date indicates both of these models are promising and provide direction for improvement. First, the PCMH model is built on evidence-based methods to provide better primary care and chronic care. Second, several PCMH programs, including Florida Blue s, have produced outcomes indicating improved quality, cost savings, and successful care coordination efforts among highrisk/high-need patients. Third, ACOs have been successful in engaging physicians and moving the needle in forming agreements linking payment to quality measures and efficiency. Research has also identified clear opportunities for improvement such as engaging patients in quality improvement efforts, improving quality and reducing unnecessary utilization of care among low-risk patients, patient and provider education, and useful data sharing between payers and providers. There is much more to learn. As we continue to utilize these models it is essential to understand systemic, organizational and stakeholder dynamics. The following list is exemplary, not exhaustive. Systemic issues include how the requirements of public programs interact with private multi-payer programs; the potential impact of these models on the quality of, and access to, care regarding vulnerable populations; and the impact of the contextual environment in which PCMHs and ACOs operate (e.g. population health status, economics, culture, politics

5 and health care infrastructure). Organizational issues include desired leadership characteristics needed for organizational adaptation to change; feasible financing models; allocation of financial and nonfinancial resources; workflow; and the flexibility needed in PCMH models to address diverse populations and settings. Stakeholder dynamics include relationship building within and among organizations and with community representatives; patient and family engagement; and continuous education among all stakeholders regarding best practices and their roles in the implementation and operation of these models. Finally, we must continue to build on current efforts to standardize evaluation measures among PCMHs and ACOs to maximize the usefulness of future research. Informing the journey Two things are clear. First, although some fee-forservice models allow for quality improvement and cost management, we must explore the inclusion of other payment models that provide stronger incentives for alignment among payers, providers and patients as well as better quality and more efficiency. Second, PCMHs and ACOs offer functional and, to a significant extent, politically viable solutions. These models are not silver bullets, and there are many questions to answer. However, the implementation of these concepts has begun to pervade the health care system in the public and private sectors. These efforts must continue with the purpose of continuous improvement toward the goals of consistently improving the quality of health care for all populations and making health care more affordable. Moving forward, it is important to encourage broad participation and a broad variety of structures of PCMHs and ACOs in the public and private sectors. This will allow for the identification of best practices overall and within differing social and economic environments. The public and private sectors should also share information and learn from one another. This requires robust research and evaluation. Resources should be allocated for these purposes in the public sector and the private sector should be encouraged to participate in research efforts through financial incentives (e.g. tax credits) to dedicate resources to the collection and analysis of data with reputable research organizations. There also should be coordination between the two sectors regarding implementation, especially around performance measures and payment incentives. Future efforts must build upon the strong foundation within the PCMH model. The primary care and chronic care models are the foundation of the PCMH concept, and they are backed by strong evidence. As the evidence-based-medicine body of work continues to evolve, PCMHs and ACOs must continue to explore the best way to translate that evidence into practice within organizations and throughout the whole system. How should resources be allocated to use people, technology and other resources to continuously integrate the latest evidence to deliver quality care? And how should organizations coordinate with one another to do it system-wide? Furthermore, research efforts should build off of current efforts to standardize performance metrics of PCMHs and ACOs to enable meaningful comparison. Evaluation of ACOs must move beyond focus on formation to their impact on changing incentives to drive improved quality and efficiency. Specifically, it is important to understand the relationship between the risk presented by various payment models and the ability to improve the quality and efficiency of care. In addition to adapting to providing patientcentered, team-based care, providers will need to migrate towards reimbursement models that transfer risk to them to create the proper incentives. However, this must be done strategically to balance the need to move away from the entrenched fee-for-service model while not moving too fast and putting providers in peril who would otherwise survive under a more gradual, yet purposeful, migration. Also, it is essential to identify providers that are important to maintaining competition and who deliver services to vulnerable populations, but may have fewer resources than others to effectively adapt to the changing environment. These organizations may require assistance to begin their migration. The impact on vulnerable populations, such as low income or high risk/high need populations must be monitored. These incentives must be structured such that providers who address these populations are not penalized because of the needs or constraints of their patients. Finally, as more ACOs take on more risk, regulation must balance the need to protect consumers with the need to minimize burdens that would discourage experimentation and participation or would be too onerous to allow them to thrive. Carl Patten is director of the Florida Blue Center for Health Policy. Acknowledgments: Thanks to Kirk Fischer, vice president of Provider Networks and Operations, and Joseph Furry, public policy research and education consultant, both of Florida Blue, for content review of this article. Florida Blue Center for Health Policy 5

6 Appendix Payment Model One-sided shared savings Two-sided shared savings Bundled/Episode Payments Partial Capitation/Global Payments Global Payments Characteristics Fee-for-service arrangement ACO receives a bonus if it meets quality of care standards at lower than projected costs. ACO assumes no risk for exceeding projected costs. Fee-for-service arrangement ACO receives a bonus if it meets quality of care standards at lower than projected costs. ACO assumes financial risk if projected costs are exceeded. ACO receives a single payment for all services a patient requires for an entire episode of care. ACO assumes risk for the severity risk (i.e. the amount and cost of care required to treat an illness or injury). ACO does not assume risk for the incidence risk (i.e. whether an individual suffers and illness or injury) ACO receives capitated payments for certain categories of services (e.g. specialty care could be paid on a capitated basis while primary care is paid on a fee-for-service basis) ACO assumes risk for only the services paid on a capitated basis. The ACO receives a pre-determined payment for each patient based on a set of criteria. The ACO assumes severity and incidence risk. Source: Academy of Actuaries Issue Brief, An Actuarial Perspective on Accountable Care Organizations, p Florida Blue Center for Health Policy

7 Bibliography American Academy of Actuaries, An Actuarial Perspective on Accountable Care Organizations, American Academy of Actuaries Issue Brief, December org/files/publications/aco_issue_brief.pdf American Hospital Association, Committee on Research, Accountable Care Organizations: AHA Research Synthesis Report, June content/aco-synthesis-report.pdf America s Health Insurance Plans, Accountable Care Organizations and Market Power Issues, October uploads/2011/08/ac-summary pdf American Medical Association, Accountable Care Organization Principles. Massachusetts Medical Society, Nov. 11, Key-Issues/Payment-Reform/AMA-Accountable-Care- Organization-Principles/. Arend, Jonathan, Jenny Tsang-Quinn, and Jenny Levine. The Patient-Centered Medical Home: History, Components, and Review of the Evidence, Mt. Sinai Journal of Medicine, vol. 79, no. 4 (2012): Bachrach, Deborah, William Bernstein, and Anne Karl. High-Performance Health Care for Vulnerable Populations: A Policy Framework for Promoting Accountable Care in Medicaid. The Commonwealth Fund (2012): Bates, David, and Asaf Bitton. The Future of Health Information Technology in the Patient-Centered Medical Home, Health Affairs, vol. 29, no. 4 (2010): Bechtel, Christine and Deborah Ness. If You Build It, Will They Come? Designing Truly Patient-Centered Health Care, Health Affairs, vol. 29, no. 5 (2010): Berenson, Robert, Paul Ginsburg, and Jon Christianson. The Growing Power Of Some Providers To Win Steep Payment Increases From Insurers Suggests Policy Remedies May Be Needed. Health Affairs, vol. 31, no. 5 (2012): Berwick, Donald, Thomas Nolan, and John Whittington. The Triple Aim: Care, Health, and Cost. Health Affairs, vol. 27, no. 3 (2008): Burns, Lawton and Mark Pauly. Accountable Care Organizations May Have Difficulty Avoiding the Failures of Integrated Care Delivery Networks of the 1990s, Health Affairs, vol. 31, no. 11 (2012): Chernew, Robert, Robert Mechanic, and Bruce Landon. Private-Payer Innovation in Massachusetts: The Alternative Quality Contract. Health Affairs, vol. 30, no. 1 (2011): Ciliberto, Federico and David Dranove. The Effect of Physician-Hospital Affiliation on Hospital Prices in California, Journal of Health Economics, vol. 25, no. 1 (2006): Cuellar, Alison Evans, and Paul Gertler. How The Expansion of Hospital Systems Has Affected Consumers, Health Affairs, vol. 24, no. 1 (2005): Dartmouth Institute for Health Policy & Clincial Practice, Accountable Care Organizations, dartmouth.edu/initiatives/accountable-care-organizations/ implementation. Fischer, Elliot, Stephen Shortell, and Sara Kreindler. A Framework for Evaluating the Formation, Implementation, and Performance of Accountable Care Organizations. Health Affairs, vol. 31, no. 11 (2012): Goldsmith, Jeff. Accountable Care Organizations: The Case for Flexible Partnerships between Health Plans and Providers, Health Affairs, vol. 30, no. 1 (2011): Han, Esther, Sarah Hudson Scholle, and Suzanne Morton. Survey Shows that Fewer than a Third of Patient-Centered Medical Home Practices Engage Patients in Quality Improvement, Health Affairs, vol. 32, no. 2 (2013): Harbrecht, Marjie and Lisa Latts. Colorado s Patient- Centered Medical Home Pilot Met Numerous Obstacles, Yet Saw Results Such as Reduced Hospital Admissions, Health Affairs, vol. 31, no. 9 (2012): Healthcare Information Management Systems Society (HIMSS) and National Committee for Quality Assurance (NCQA), Leveraging Health IT to Achieve Ambulatory Quality: The Patient-Centered Medical Home. HIMSS- NCQA PCMH Fact Sheet (2010). Hoff, John. Accountable Care Organizations: Obamacare s Magic Bullet Misfires, Heritage Foundation Backgrounder, no (2011): Homer, Charles and Richard Baron. How to Scale Up Primary Care Transformation: What We Know and What We Need to Know, Journal of General Internal Medicine, vol. 25, no. 6 (2010): Keckley, Paul and Michelle Hoffman. Accountable Care Organizations: A New Model for Sustainable Innovation, Deloitte Center for Health Solutions, (2010): Kroch, Eugene, R. Wesley Champion, and Susan DeVore. Measuring Progress Toward Accountable Care. The Commonweath Fund, (2012): Landon, Bruce, Bruce Gill, and Richard Antonelli. Using Evidence to Informa Policy: Developing a Policy-Relevant Research Agenda for the Patient-Centered Medical Home, Journal of General Internal Medicine, vol. 25, no. 6 (2010): Larson, Bridget, Arrica Van Citters, and Sara Kreindler. Insights From Transformations Under Way at Four Brookings-Dartmouth Accountable Care Organization Pilot Sites, Health Affairs, vol. 31, no. 11 (2012): Florida Blue Center for Health Policy 7

8 Lewis, Valerie, Bridget Larson, and Asha B. McClurg. The Promise and Peril of Accountable Care for Vulnerable Populations: A Framework for Overcoming Obstacles, Health Affairs, vol. 31, no. 8 (2012): Lewis, Valerie, Asha B. McClurg, and Jeremy Smith. Attributing Patients to Accountable Care Organizations: Performance Year Approach Aligns Stakeholders Interests, Health Affairs, vol. 32, no. 3 (2013): Lipsman, Joshua. Accountable Care Organizations and Patient-Centered Medical Homes, Maximus Webinar Series (2010): files/filemanager/maximus_aco_and_pcmh_webinar_ Slides_ pdf Meyers, David, Debbie Peikes, and Janice Genevro. The Roles of Patient-Centered Medical Homes and Accountable Care Organizations in Coordinating Patient Care, Agency for Healthcare Research and Quality, AHRQ Publication No. 11-M005-EF: Miller, Harold. How to Create Accountable Care Organizations. Center for Healthcare Quality and Payment Reform, (2009): National Committee for Quality Assurance (NCQA). Standards and Guidelines for NCQA s Patient-Centered Medical Home (PCMH) National Committee for Quality Assurance, (2011): Nocon, Robert S., Ravi Sharma, and Jonathan M. Birnberg. Association between Patient-Centered Medical Home Rating and Operating Cost at Federally Funded Centers. Journal of the American Medical Association, vol. 308, no. 1 (2012): Numerof, Rita. Why Accountable Care Organizations Won t Deliver Better Health Care - and Market Innovation Will. Heritage Foundation Backgrounder, No (2011): 1-9. Patient-Centered Primary Care Collaborative, (American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Osteopathic Association), Joint Principles of the Patient- Centered Medical Home, February 2007, org/dam/aafp/documents/practice_management/pcmh/ initiatives/pcmhjoint.pdf Rittenhouse, Diane, David Thom, and Julie Schmittdiel. Developing a Policy-Relevant Research Agenda for the Patient-Centered Medical Home: A Focus on Outcomes, Journal of General Internal Medicine, vol. 25, no. 6 (2010): Rittenhouse, Diane, Lawrence Casalino, and Stephen Shortell. Small and Medium-Size Physician Practices Use Few Patient-Centered Medical Home Processes, Health Affairs, vol. 30, no. 8 (2011): Rosenberg, Cynthia Napier, Pamela Peele, and Donna Keyser. Results From a Patient-Centered Medical Home Pilot at UPMC Health Plan Hold Lessons for Broader Adoption of the Model, Health Affairs, vol. 31, no. 11 (2012): Rosenthal, Meredith B., Melinda K. Abrams, and Asaf Bitton. Recommended Core Measures for Evaluating the Patient- Centered Medical Home: Cost, Utilization, and Clinical Quality. Commonwealth Fund Data Brief, no (2012): Sillow-Carroll, Sharon, and Jennifer Edwards. Early Adopters of the Accountable Care Model: A Field Report on Improvements in Health Care Delivery. The Commonwealth Fund (2013): Strange, Kurt C., Paul Nutting, and William Miller. Defining and Measuring the Patient-Centered Medical Home, Journal of General Internal Medicine, vol. 25, no. 6 (2010): Takach, Mary. About Half the States are Implementing Patient-Centered Medical Homes for their Medicaid Populations, Health Affairs, vol. 31, no. 11 (2012): Tallia, Alfred, and Jenna Howard. An Academic Health Center Sees Both Challenges and Enabling Forces as it Creates an Accountable Care Organization, Health Affairs, vol. 31, no. 11 (2012): Wagner, Edward, Katie Coleman, and Robert Reid. The Changes Involved in Patient-Centered Medical Home Transformation. Primary care: Clinics in Office Practice, vol. 39, no. 2 (2012): Patel, Urvashi, Carl Rathjen, Elizabeth Rubin, and et. al.. Horizon s Patient-Centered Medical Home Program Shows Practices Need Much More than Payment Changes to Transform, Health Affairs, vol. 31, no. 9 (2012): Raskas, Ruth, Lisa Latts, and Jill Hummel. Early Results Show WellPoint s Patient-Centered Medical Home Pilots Have Met Some Goals for Costs, Utilization, and Quality, Health Affairs, vol. 31, no. 9 (2012): Rauber, Chris. CalPERS says it saved $15M with ACO pilot program, will likely expand it. San Francisco Business Times, April 12, Florida Blue Center for Health Policy

Value-Based Purchasing Literature Survey August 2012

Value-Based Purchasing Literature Survey August 2012 Value-Based Purchasing Literature Survey August 2012 This document highlights a selection of briefs, reports, and commentaries on value-based purchasing payment reform methods as well as how payment reforms

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

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

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

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

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

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

RE: CMS 1461-P; Medicare Shared Savings Program: Accountable Care Organizations

RE: CMS 1461-P; Medicare Shared Savings Program: Accountable Care Organizations 221 MAIN STREET, SUITE 1500 SAN FRANCISCO, CA 94105 PBGH.ORG OFFICE 415.281.8660 FACSIMILE 415.520.0927 February 6, 2015 Marilyn Tavenner Administrator Centers for Medicare and Medicaid Services 7500 Security

More information

Accountable Care Organizations. Rick Shinto, MD Aveta Health Inc. July 20, 2010

Accountable Care Organizations. Rick Shinto, MD Aveta Health Inc. July 20, 2010 Accountable Care Organizations Rick Shinto, MD Aveta Health Inc. July 20, 2010 1 Health Care Reform- New Models of Care Patient Protection and Affordable care Act (PPACA 2010) controlling costs and improving

More information

Issue Brief. Raising the Bar. Standards for Accountable Care Organizations to Truly Improve Health Care Quality and Affordability in the United States

Issue Brief. Raising the Bar. Standards for Accountable Care Organizations to Truly Improve Health Care Quality and Affordability in the United States Raising the Bar Standards for Accountable Care Organizations to Truly Improve Health Care Quality and Affordability in the United States Issue Brief Introduction Health care costs continue to rise at an

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

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

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

Key Strategic and Tactical Steps to Excel as Community Hospital May 2011

Key Strategic and Tactical Steps to Excel as Community Hospital May 2011 Key Strategic and Tactical Steps to Excel as Community Hospital May 2011 1 2 3 Pillars of Excellence 4 Transformation from Hospital-Centric to Community-Centric with Triple Aim as Framework 5 Objectives

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

Population Health Management: Leveraging Data and Analytics to Achieve Value. White Paper. A Special Report

Population Health Management: Leveraging Data and Analytics to Achieve Value. White Paper. A Special Report Authors Carol Cassell CTG Health Solutions John Kontor, MD Clinovations Lisa Shah, MD, MAPP Clinovations Contributors Marla Roberts, DrPH, RN CTG Health Solutions Katie Stevenson Clinovations : Leveraging

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

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

2014-2016 REQUEST FOR APPLICATIONS FOR TECHNICAL ASSISTANCE

2014-2016 REQUEST FOR APPLICATIONS FOR TECHNICAL ASSISTANCE National Academy for State Health Policy Learning Collaborative: Supporting State Strategies to Design and Deliver Whole-Person Care in Ambulatory Settings 2014-2016 REQUEST FOR APPLICATIONS FOR TECHNICAL

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

Making the Transition into Risk-Based Payment Why Children s Hospitals Need to Accept Value-Based Care Strategies

Making the Transition into Risk-Based Payment Why Children s Hospitals Need to Accept Value-Based Care Strategies Making the Transition into Risk-Based Payment Why Children s Hospitals Need to Accept Value-Based Care Strategies Substantial changes within the Medicaid marketplace are driving U.S. children s hospitals

More 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

Aligning Payers and Practices to Transform Primary Care:

Aligning Payers and Practices to Transform Primary Care: EXECUTIVE SUMMARY Aligning Payers and Practices to Transform Primary Care: A Report from the Multi-State Collaborative by Lisa Dulsky Watkins, MD Since the mid-2000s, a number of states have developed

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

Clinical Integration in Practice Case Study Allina Health

Clinical Integration in Practice Case Study Allina Health Clinical Integration in Practice Case Study Allina ealth The Second of Six Conference Calls for VA, Inc. Leading Constructive Change Boston Cleveland Dallas Denver Miami San Francisco Washington, D.C.

More information

ACCOUNTABLE CARE ORGANIZATIONS

ACCOUNTABLE CARE ORGANIZATIONS ACCOUNTABLE CARE ORGANIZATIONS Implementing Efficient, Value-Based Health Care Programs Prepared by Sara Watson September 2010 Table of Contents Abstract.. pg. 2 Overview.pg. 2-3 Background...pg. 2-3 Introduction...pg.

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

Commonwealth of Kentucky Cabinet for Health and Family Services (CHFS) Office of Health Policy (OHP)

Commonwealth of Kentucky Cabinet for Health and Family Services (CHFS) Office of Health Policy (OHP) Commonwealth of Kentucky Cabinet for Health and Family Services (CHFS) Office of Health Policy (OHP) State Innovation Model (SIM) Model Design June Integrated and Coordinated Care Workgroup June 16, 2015

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

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

Piloting an ACO: A Community Provider Network Which Achieves the Triple Aims

Piloting an ACO: A Community Provider Network Which Achieves the Triple Aims Piloting an ACO: A Community Provider Network Which Achieves the Triple Aims December 1, 2008 Jim Hester PhD Director VT Health Care Reform Commission Outline Pilot goals The context: Vermont Health care

More information

Accountable Care: Implications for Managing Health Information. Quality Healthcare Through Quality Information

Accountable Care: Implications for Managing Health Information. Quality Healthcare Through Quality Information Accountable Care: Implications for Managing Health Information Quality Healthcare Through Quality Information Introduction Healthcare is currently experiencing a critical shift: away from the current the

More information

The Impact of Accountable Care Organizations on Healthcare Delivery, the Primary Care Physician and the Medicare Patient

The Impact of Accountable Care Organizations on Healthcare Delivery, the Primary Care Physician and the Medicare Patient The Impact of Accountable Care Organizations on Healthcare Delivery, the Primary Care Physician and the Medicare Patient Brian A. Kessler, D.O. Health Policy Fellowship Class of 2011 ACOs l November 1,

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

Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed?

Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed? Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed? Accountable Care Organizations: Implications for Consumers October 14, 2010 Washington, DC Sam Nussbaum, M.D. Executive Vice

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

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

Accountable Care Organizations (ACOs): Potential to Foster Quality While Reducing Costs

Accountable Care Organizations (ACOs): Potential to Foster Quality While Reducing Costs Accountable Care Organizations (ACOs): Potential to Foster Quality While Reducing Costs Debra Ness Co-Chair, Consumer-Purchaser Disclosure Project President, National Partnership for Women & Families David

More information

Accountable Care Organization Workgroup Glossary

Accountable Care Organization Workgroup Glossary Accountable Care Organization Workgroup Glossary Accountable care organization (ACO) a group of coordinated health care providers that care for all or some of the health care needs of a defined population.

More information

HEALTH REFORM AND THE PATIENT-CENTERED MEDICAL HOME: Policy Provisions and Expectations of the Patient Protection and Affordable Care Act

HEALTH REFORM AND THE PATIENT-CENTERED MEDICAL HOME: Policy Provisions and Expectations of the Patient Protection and Affordable Care Act Safety Net Medical Home Initiative HEALTH REFORM AND THE PATIENT-CENTERED MEDICAL HOME: Policy Provisions and Expectations of the Patient Protection and Affordable Care Act Policy Brief Issue 2 Introduction

More information

1 of 5 4/9/2014 3:48 PM

1 of 5 4/9/2014 3:48 PM 1 of 5 4/9/2014 3:48 PM This installment of Law and the Public's Health examines accountable care organizations (ACOs), a health-care delivery system 1 centerpiece of the Affordable Care Act (ACA). ACOs

More information

Accountable Care Organizations: Forging Stakeholder Partnerships for Health Care Performance and Efficiency

Accountable Care Organizations: Forging Stakeholder Partnerships for Health Care Performance and Efficiency Accountable Care Organizations: Forging Stakeholder Partnerships for Health Care Performance and Efficiency Julie Lewis Director of Health Policy Dartmouth Institute for Health Policy and Clinical Practice

More information

Leading the Conversation: New Channels for Provider Contracting

Leading the Conversation: New Channels for Provider Contracting WHITE PAPER Leading the Conversation: New Channels for Provider Contracting Author: Cindy Lee On the vanguard of thought. On the front lines of ac on. Leading the Conversation: New Channels for Provider

More information

Health Care Financing: ACC/ ACO s, beyond the hype hope. Brian Seppi, MD, President, Washington State Medical Assn.

Health Care Financing: ACC/ ACO s, beyond the hype hope. Brian Seppi, MD, President, Washington State Medical Assn. : ACC/ ACO s, beyond the hype hope Brian Seppi, MD, President, Washington State Medical Assn. Washington State Medical Association Health Care Financing Our vision Make Washington the best place to practice

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

Medicaid Accountable Care:

Medicaid Accountable Care: Medicaid Accountable Care: Accountable Care Organizations, Medicaid, and Medicaid Health Plans Prepared for the Medicaid Health Plans of America By John Pourciau, JD Sellers Dorsey 230 S. Broad Street,

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

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

Accountability and Innovation in Care Delivery Models

Accountability and Innovation in Care Delivery Models Accountability and Innovation in Care Delivery Models Lisa McDonnel Senior Vice President, Network Strategy & Innovation, United Healthcare November 6, 2015 Today s discussion topics Vision Our strategic

More information

Patient-Centered Medical Home. Transform Your Practice

Patient-Centered Medical Home. Transform Your Practice Patient-Centered Medical Home Transform Your Practice 1 The New York ehealth Collaborative (NYeC) Regional Extension Center (REC) The NYeC Regional Extension Center is the physician s trusted advisor in

More information

ISSUE BRIEF POLICY RESEARCH

ISSUE BRIEF POLICY RESEARCH MATHEMATICA ISSUE BRIEF POLICY RESEARCH T I M E L Y I N F O R M A T I O N F R O M M A T H E M A T I C A Improving public well-being by conducting high quality, objective research and surveys JUNE 2010

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

For Additional Information Maulik S. Joshi, DrPH Senior Vice President of Research, American Hospital Association (312) 422-2622 mjoshi@aha.

For Additional Information Maulik S. Joshi, DrPH Senior Vice President of Research, American Hospital Association (312) 422-2622 mjoshi@aha. 1 Suggested Citation American Hospital Association. 2010 Committee on Research. AHA Research Synthesis Report: Accountable Care Organization. Chicago: American Hospital Association, 2010. For Additional

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

Commonwealth of Kentucky Cabinet for Health and Family Services (CHFS) Office of Health Policy (OHP)

Commonwealth of Kentucky Cabinet for Health and Family Services (CHFS) Office of Health Policy (OHP) Commonwealth of Kentucky Cabinet for Health and Family Services (CHFS) Office of Health Policy (OHP) State Innovation Model (SIM) Model Design Payment Reform Workgroup Kickoff Meeting March 24, 2015 9

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

Payor Perspectives on Provider Realignment and ACOs

Payor Perspectives on Provider Realignment and ACOs Payor Perspectives on Provider Realignment and ACOs Joel L. Michaels March 15, 2011 Overview Issues to be addressed Medicare Shared Savings Program overview ACO organization options Health care reform

More information

The Patient Protection and Affordable. How The Center For Medicare And Medicaid Innovation Should Test Accountable Care Organizations

The Patient Protection and Affordable. How The Center For Medicare And Medicaid Innovation Should Test Accountable Care Organizations By Stephen M. Shortell, Lawrence P. Casalino, and Elliott S. Fisher How The Center For Medicare And Medicaid Innovation Should Test Accountable Care Organizations doi: 10.1377/hlthaff.2010.0453 HEALTH

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

Community Health Centers and Health Reform: Issues and Ideas for States

Community Health Centers and Health Reform: Issues and Ideas for States Community Health Centers and Health Reform: Issues and Ideas for States Ann S. Torregrossa, Esq. Deputy Director & Director of Policy Governor s Office of Health Care Reform Commonwealth of Pennsylvania

More information

Accountable Care Organizations

Accountable Care Organizations Accountable Care Organizations June 10, 2008 Elliott Fisher, MD, MPH The Dartmouth Institute for Health Policy and Clinical Practice How can the best medical care in the world cost twice as much as the

More information

The importance of home and community-based settings in population health management

The importance of home and community-based settings in population health management The importance of home and community-based settings in population health management Nathan Cohen Dieter van de Craen Andrija Stamenovic Charles Lagor Philips Home Monitoring March 2013 Philips Healthcare

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

The Pediatric ACO: When Things Go Bump in the Night

The Pediatric ACO: When Things Go Bump in the Night The Pediatric ACO: When Things Go Bump in the Night Angelo P. Giardino, MD, PhD Chief Medical Officer Texas Children s Health Plan, Houston Chief Quality Officer for Medicine Texas Children s Hospital

More information

Systems in the Act, Trying Out ACOs

Systems in the Act, Trying Out ACOs A L O O K A H E A D Systems in the Act, Trying Out ACOs BY MARK CRAWFORD Catholic health care leaders are experimenting with accountable care organizations (ACOs) as a method of delivering higher quality

More 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

Welcome to the First Edition!

Welcome to the First Edition! Issue #1/Dec. 6, 2010 Welcome to the First Edition! CHCA is pleased to welcome and introduce you to this first edition of the ACO Update newsletter. The newsletter is in response to numerous questions

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

Integrated Health Systems: Promise And Performance

Integrated Health Systems: Promise And Performance Integrated Health Systems: Promise And Performance Stephen M. Shortell, Ph.D. Blue Cross of California Distinguished Professor of Health Policy and Management Professor of Organization Behavior Dean, School

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

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

MaineHealth ACO in. Context W 5

MaineHealth ACO in. Context W 5 MaineHealth ACO in Who? Context W 5 What? Why? When? HoW? 1 Who? 2 The MaineHealth ACO is all of the MaineHealth member hospitals plus St. Mary s Regional Medical Center and all of the physicians in Community

More information

Accountable Care Organizations: What is the Evidence? Julia G. Shaw, MPH Health Care Policy Analyst Vermont Legal Aid Office of Health Care Advocate

Accountable Care Organizations: What is the Evidence? Julia G. Shaw, MPH Health Care Policy Analyst Vermont Legal Aid Office of Health Care Advocate Accountable Care Organizations: What is the Evidence? Julia G. Shaw, MPH Health Care Policy Analyst Vermont Legal Aid Office of Health Care Advocate January 2014 Accountable Care Organizations: What is

More information

A Foundation for Health Care Reform Legislation

A Foundation for Health Care Reform Legislation A Foundation for Health Care Reform Legislation Mayo Clinic s Point of View Mayo Clinic believes that U.S. health care urgently needs reform to ensure access to quality, affordable patient care. Each major

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

State Innovation Model

State Innovation Model State Innovation Model P a t i e n t C e n t e r e d M e d i c a l H o m e W e b i n a r M a y 1 1, 2 0 1 6 1 Agenda SIM Overview & Updates Patient Centered Medical Home Overview Questions 2 1 SIM Overview

More information

1115 Medicaid Waiver Programs Section1115 of the Social Security Act allows CMS the authority to approve state demonstration projects that improve care, increase efficiency, and reduce costs related to

More information

Accountable Care Organizations and Health Reform

Accountable Care Organizations and Health Reform Accountable Care Organizations and Health Reform Country: USA Partner Institute: Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management Survey no: (16)2010 Author(s):

More information

Accountable Care Organizations: Principles and Implications for Hospital Administrators

Accountable Care Organizations: Principles and Implications for Hospital Administrators S T U D E N T E S S A Y Accountable Care Organizations: Principles and Implications for Hospital Administrators Andrew Russell Bennett, James Madison University E X E C U T I V E S U M M A R Y With the

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

Title Slide: Healthcare Reform and Multilevel Interventions and Research: Big Changes Go Hand-in-Hand with Big Science

Title Slide: Healthcare Reform and Multilevel Interventions and Research: Big Changes Go Hand-in-Hand with Big Science Title Slide: Healthcare Reform and Multilevel Interventions and Research: Big Changes Go Hand-in-Hand with Big Science Presented by Kelly J. Devers Prepared for the N C I Conference on Multilevel Interventions

More information

Guidelines for Patient-Centered Medical Home (PCMH) Recognition and Accreditation Programs. February 2011

Guidelines for Patient-Centered Medical Home (PCMH) Recognition and Accreditation Programs. February 2011 American Academy of Family Physicians (AAFP) American Academy of Pediatrics (AAP) American College of Physicians (ACP) American Osteopathic Association (AOA) Guidelines for Patient-Centered Medical Home

More information

The Continued Need for Reform: Building a Sustainable Health Care System

The Continued Need for Reform: Building a Sustainable Health Care System The Continued Need for Reform: Building a Sustainable Health Care System Sustainable reform must address cost and quality, while expanding coverage through a vibrant and functional marketplace As the largest

More information

Why Electronic Health Records are Ill-Suited for Population Health Management An InfoMC White Paper January 2016

Why Electronic Health Records are Ill-Suited for Population Health Management An InfoMC White Paper January 2016 Why Electronic Health Records are Ill-Suited for Population Health Management An InfoMC White Paper January 2016 Many studies have demonstrated that cost of care for patients with chronic illnesses is

More information

ANA ISSUE BRIEF Information and analysis on topics affecting nurses, the profession and health care.

ANA ISSUE BRIEF Information and analysis on topics affecting nurses, the profession and health care. ANA ISSUE BRIEF Information and analysis on topics affecting nurses, the profession and health care. New Care Delivery Models in Health System Reform: Opportunities for Nurses & their Patients Key Points

More information

October 15, 2010. Re: National Health Care Quality Strategy and Plan. Dear Dr. Wilson,

October 15, 2010. Re: National Health Care Quality Strategy and Plan. Dear Dr. Wilson, October 15, 2010 Dr. Nancy Wilson, R.N., M.D., M.P.H. Senior Advisor to the Director Agency for Healthcare Research and Quality (AHRQ) 540 Gaither Road Room 3216 Rockville, MD 20850 Re: National Health

More information

Accountable Care Organizations Strategic Planning & Preparations Bob Perna, FACMPE, Director, WSMA Practice Resource Center

Accountable Care Organizations Strategic Planning & Preparations Bob Perna, FACMPE, Director, WSMA Practice Resource Center Bob Perna, FACMPE, Director, WSMA Practice Resource Center Bob Perna, FACMPE Director, WSMA Practice Resource Center E-mail: rjp@wsma.org Phone: 206.441.9762 1.800.552.0612 2 DISCLAIMER Disclaimer: This

More information

Principles on Health Care Reform

Principles on Health Care Reform American Heart Association Principles on Health Care Reform The American Heart Association has a longstanding commitment to approaching health care reform from the patient s perspective. This focus including

More information

For Additional Information Maulik S. Joshi, DrPH Senior Vice President of Research, American Hospital Association (312) 422-2622 mjoshi@aha.

For Additional Information Maulik S. Joshi, DrPH Senior Vice President of Research, American Hospital Association (312) 422-2622 mjoshi@aha. 1 Suggested Citation American Hospital Association. 2010 Committee on Research. AHA Research Synthesis Report: Patient-Centered Medical Home (PCMH). Chicago: American Hospital Association, 2010. For Additional

More information

One of the major changes occurring, in large part. Accountable Care Organizations The Promise, Perils and Pathway to Value for Plan Sponsors

One of the major changes occurring, in large part. Accountable Care Organizations The Promise, Perils and Pathway to Value for Plan Sponsors Delivery Method Changes Accountable Care Organizations The Promise, Perils and Pathway to Value for Plan Sponsors If the potential of accountable care organizations (ACOs) is realized, they could significantly

More information

Crowe Healthcare Webinar Series

Crowe Healthcare Webinar Series New Payment Models Crowe Healthcare Webinar Series Audit Tax Advisory Risk Performance 2014 Crowe Horwath LLP Agenda Bundled Care for Payment Improvements Payment Models Accountable Care Organizations

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

Integrated Leadership for Hospitals and Health Systems: Principles for Success

Integrated Leadership for Hospitals and Health Systems: Principles for Success Integrated Leadership for Hospitals and Health Systems: Principles for Success In the current healthcare environment, there are many forces, both internal and external, that require some physicians and

More information

Healthcare Information Technology (HIT)

Healthcare Information Technology (HIT) Healthcare Information Technology (HIT) Why State Governments Must Help Create a National Health Information Network Ian C. Bonnet Deloitte Consulting LLP October, 2005 State Leadership in developing a

More information

July 20, 2015. Dear Colleague:

July 20, 2015. Dear Colleague: July 20, 2015 Dear Colleague: On May 29, 2015, the Department of Human Services released a request for information (RFI) to help guide us as we plan for the release of a new procurement for the provision

More information

Primary Care 101: A Glossary for Prevention Practitioners

Primary Care 101: A Glossary for Prevention Practitioners PREVENTION COLLABORATION IN ACTION Engaging the Right Partners Primary Care 101: A Glossary for Prevention Practitioners As the U.S. healthcare landscape continues to change under the Affordable Care Act

More information

Population-based health care: can you get there from here?

Population-based health care: can you get there from here? Population-based health care: can you get there from here? by David Howe SORH Contracted Rural Writer Hospitals and insurance companies are acquiring other hospitals and insurance companies. Other hospitals

More information

Best Practices and Strategies to Engage ACOs, Incentive Programs and Emerging Payment Models JUSTIN T. BARNES

Best Practices and Strategies to Engage ACOs, Incentive Programs and Emerging Payment Models JUSTIN T. BARNES Best Practices and Strategies to Engage ACOs, Incentive Programs and Emerging Payment Models JUSTIN T. BARNES CHAIRMAN EMERITUS, EHR ASSOCIATION CO-CHAIR, ACCOUNTABLE CARE COMMUNITY OF PRACTICE About Justin

More information

Primary Care, ACOs, and Payment Reform

Primary Care, ACOs, and Payment Reform Primary Care, ACOs, and Payment Reform Mark McClellan, MD, PhD Director, Initiatives on Value and Innovation in Health Care Engelberg Center for Healthcare Reform Senior Fellow, Economic Studies The Brookings

More information