1 INTEGRATION STRATEGIES FOR A NEW HEALTH CARE ECONOMY Thomas William Baker Baker Donelson Bearman Caldwell & Berkowitz, P.C. Atlanta, Georgia (404) Prepared for East Georgia Physicians Group October 13, 2010
2 TO BE OR NOT TO BE: THAT IS THE QUESTION Focus on Survival Do you want to control your own destiny?
3 WHAT MANNER OF OUTRAGEOUS FORTUNE CONFRONTS US? RESPONDING TO MARKET FORCES. Patient Protection and Affordable Care Act of 2010 PPO/Private Market Insurance Consolidation Medical Tourism Downward Pressure on Payment Rates Regulatory Compliance Under Stark and the Anti- Kickback Statute Fraud and Abuse Initiatives Like RAC Audits
4 OVERVIEW OF THE HEALTH CARE ECONOMY Two Broad Categories: Governmental Reimbursement Programs Private Insurance Coverage.
5 GOVERNMENT REIMBURSEMENT PROGRAMS Steadily Grown since 1965 Account For Over 50% of Health Care Spending PPACA Gives Federal Coverage Up To 133% of the Federal Poverty Income (FPI) in Medicaid and Premium Subsidies For People Earning Up To 400% of the FPI. Traditional Medicare is Last Bastion of Indemnity Insurance
6 COMPETING IN THE PRESENT PRIVATE INSURANCE MARKET Covers Approximately 42% of Health Care Expenses PPOs Cover Approximately 193 Million Americans in a Consolidated Market BLUCAS Represent 80% to 90% in Many Markets Threat to Continuing Existence of PPOs Will Cause Them to Flex Influence on Washington Decision Making PPOs Are Expected to Offer Competing Models of Clinical Integration, Improved Quality, and Cost Containment
7 THE DEMISE OF THE FEE FOR SERVICE ECONOMY Fee For Service is Unsustainable in Both the Medicare and Private Payor Markets System Change Will Be Required To Create the Proper Balance Among Health Care Payors, Health Care Providers, and Patients For Cost-effective Delivery of Quality Health Care Services.
8 IF NOT FEE FOR SERVICE, THEN WHAT? PROVIDER SYSTEMS THAT REQUIRE: An Increase In Shared Risk Consolidations Into New Care Delivery Systems New Organizational Structures New Quality Measurement Approaches New Health Information Technology Systems
9 HOW WILL WE BE PAID? THERE IS NOTHING NEW UNDER THE SUN. Pay-For-Performance Hospital-Physician Bundling For Specific Diagnosis- Related Group (DRG) Codes Bundling Based On Episodes of Care Shared-Savings Capitation
10 EVOLUTION OF PAYMENT MODELS Pay For Reporting Model: Payment For Reporting Quality Criteria Pay For Performance Rewards Reporting Quality Measures and Outcome Goals, Which Will Likely Include Cost Reduction Or Efficiency Measures The Flip Side of Pay For Performance Is a No-Pay For Non-Performance CMS No-Pay List For Never Events Like Wrong- Site, Wrong-Procedure, and Wrong-Patient Surgeries Trend Toward Transparency
11 CONTROLLING COSTS THROUGH COORDINATED CARE Better Management of Individual Patient Health and Wellness As a Means For Controlling Overall Cost. Medical Home Demonstration Project. Purposes: Increase Preventive Care, Early Intervention, Coordinate Care Site Transitions, Decrease Specialist Utilization, Expand Disease Management, and Ensure Home Follow-Up Allows Integration of Services Over an Entire Episode of Care Accountable Care Organizations
12 COORDINATED CARE PAYMENT METHODS: PMPM / CAPITATION Generally On a Per-Member, Per-Month Basis Compensates For Care Coordination and Care Management and Account For the Infrastructure (Such As Electronic Health Records) Necessary To Maintain a Medical Home. Open Season On High End Specialty Practices That Rely On Performance of Expensive Procedures, Such As Cardiovascular Surgery and Interventional Cardiology, Medical Oncology, and Orthopedics. Over Time, It Also Means That There Will Be Fewer Procedures Performed In Hospitals. "Baby Boomers" Should Provide Adequate Hospital Volume, With Financial Success Dependent on ACO's, Bundling Payment Collaboratives and Other Integration Models.
13 COORDINATED CARE PAYMENT METHODS: EPISODES OF CARE A Bundled Or Episodic Payment Structure Will Be Piloted Soon, As Required by the PPACA. A Group of Providers Are Paid a Set Amount For Care Provided To a Medicare Beneficiary With One of Eight Specified Conditions That Is Intended To Cover All Care By All Providers During the Episode. "Episode" Includes a Period From Three Days Before a Hospitalization, Through the Hospitalization, and Thirty Days of Post-acute Care, Which Might Include Skilled Nursing, Home Health, Or Even Long Term Care Inpatient Hospital Services. To Participate, a Provider Entity Will Need To Be Comprised of At Least a Hospital, a Physician Group, a Skilled Nursing Facility, and a Home Health Agency
14 PPACA BUNDLED PAYMENT PILOT PROGRAM PPACA Also Included a National Pilot Program On Payment Bundling. An Episode Would Generally Be Three Days Prior To Admission To a Hospital For the Applicable Condition, During the Hospital Stay, and Thirty Days Following Discharge. A Participating Entity Would Need To Include a Hospital, a Physician Group, a Skilled Nursing Facility, and a Home Health Agency. The ACO Organizational Model Is Effective For Participation In That Pilot Program.
15 CORDINATED CARE PAYMENT METHODS: SHARED SAVINGS THROUGH ACCOUNTABLE CARE ORGANIZATIONS The Most Radical Payment Reform Structure Being Proposed Is Clinical Integration Of Providers Through Accountable Care Organizations (ACOs) Increase Quality and Efficiency of Care Through Mutual Accountability to Peers. May Be a Viable Method of Driving down Costs and Improving Quality
16 MOVEMENT TOWARD ACOs In a Report to Congress in 2009, Medicare Payment Advisory Commission (MedPac) Identified Clinically Integrated ACOs As A Way To Divert The Medicare Program Away From the Unsustainable Spending of the Traditional Medicare Fee-For-Service Program. The American Hospital Association (AHA) has Published Proposed Guidance On Establishing Clinical Integration Programs, Which Includes ACOs.
17 EFFECT OF THE PPACA ON ACOs PPACA Includes a Voluntary Pilot Program For ACOs Called the Shared Savings Program Allows Submission of Medicare Claims For Payment On Normal Fee Schedule With Distribution of a Certain Percentage of Calculated Cost Savings and No Downside Risk Requires the ACO To Have a Formal Legal Structure That Receives and Distributes Shared Savings Payments; Enter Into Three Year Participation Agreement; Comply With Reporting Requirements; and Meet Quality of Care, Patient Satisfaction, Utilization and Other Standards That Will Be Mostly Fleshed Out In Forthcoming Regulations Beneficiaries Assigned To an ACO Based On Their Utilization of Primary Care Services Minimum of 5,000 Beneficiaries Required To Qualify For the Pilot Program
18 ACO COMPENSATION MODELS ACO Will Need To Develop a Compensation Model That Will Align the Incentives of Productivity, Quality, Outcomes and Cost Reduction. Physicians Will Need To Be Engaged In the Organization and Have an Active Role In the Organizations Leadership.
19 CORRECTING MARKET INEFFICIENCY Inefficient Markets Consolidate Health Care Services is an Inefficient Market Federal Trade Commission (FTC) and Rulings and DOJ Antitrust Law Enforcement Discourage Unintegrated Networks From Collectively Negotiating Fee Schedules and Effectively Negotiating With Payors
20 INTEGRATION STRATEGIES ARE THE KEY TO ECONOMIC SURVIVAL Horizontal Integration Vertical Integration Financial Integration Clinical Integration
21 TECHNOLOGY WILL LEAD THE WAY TO REQUIRED INTEGRATION Integrated Health Care Organizations Will Leverage Their Size and Capital To Acquire and Implement Systems (Including Clinical Protocols and Electronic Health Records) The Systems Will Meet the Changing Demands of the Health Care Industry and Ensure That Their Reported Quality Measures Accurately Reflect Their Goals and Values.
22 ANTITRUST LAW REQUIREMENTS FOR INTEGRATION Antitrust laws allow integrated networks that produce significant efficiencies that benefit consumers to create price agreements which, absent such integration, might otherwise be illegal. The price agreement must be integral to the significant efficiencies that the integration is meant to achieve. In the absence of such financial or clinical integration, collective negotiation by physicians is an agreement between competitors on prices, which is per se illegal under the antitrust laws. For non-integrated independent physician associations (IPAs) and physician-hospital organizations (PHOs), any evidence of collective negotiation might result in antitrust law liability.
23 INTEGRATION STRATEGIES To Compete In a Changing Market, Health Care Providers Will Need To Participate In New, Emerging Payment Structures That Can Engage In Collective Negotiation of Fees and Manage Funds That Are Intended To Cover All of the Patient s Health, Wellness, and Medical Needs. Virtually All Providers and Health Systems Must Implement an Integration Strategy. There Are Two Primary Kinds of Integration: Financial Integration and Clinical Integration.
24 FINANCIAL INTEGRATION THROUGH ACQUISITION AND MERGERS Financial Integration Through Health System Acquisition of Medical Practices Profitability Challenges Limitations on Available Health System Capital Medical Practices May Also Engage in Horizontal Mergers to Gain Market Power and Achieve Operating Efficiencies
25 OTHER FINANCIAL INTEGRATION STRATEGIES Financial Integration Through Fiancial Risk Sharing In A Provider Network Capitated Rates: Predetermined Percentage Of Premium Or Revenue From The Plan; Payment By Episode Of Care For A Fixed, Pre-determined Payment, When The Cost Of That Course Of Treatment For Any Individual Patient Can Vary Greatly Due To The Individual Patient s Condition, The Choice, Complexity, Or Length Of Treatment Or Other Factors; Other Significant Financial Incentives For Its Physician Participants, As A Group, To Achieve Specified, Cost-containment Goals. Risk Withholding Programs And Rewards Programs Key: You Need An Organized Network To Participate.
26 CLINICAL INTEGRATION STRATEGIES Purpose Must Be To Achieve Significant Market Efficiencies and Promote Competition. Such Integration May Be Evidenced Through an Active and Ongoing Program To Evaluate and Modify Practice Patterns By the Network s Physician Participants and Create a High Degree of Interdependence and Cooperation Among the Physicians To Control Costs and Ensure Quality. Like Financial Integration, the Agreement and Use of a Set Fee Schedule Must Be Reasonably Necessary To Realize the Intended Efficiencies. Motivated By Consolidating PPO and Health Insurance Markets, and the Push From Government Payors To Move Toward a Pay For Performance Model.
27 CLINICAL INTEGRATION AS A VIABLE ALTERNATIVE Clinical Integration Is a Viable Response Because It Combines Independent Physicians With Hospital Systems and Their Employed Physicians Without Necessarily Requiring Direct Employee Relationships. Changes To the Medicare Program Will Provide Health Care Delivery Systems With the Critical Mass of Patients Required To Provide Incentives For Physicians To Work Within a Clinically Integrated Structure.
28 EXAMPLE OF SUCCESSFUL CLINICAL INTEGRATION MODEL: TRISTATE HEALTH PARTNERS FTC Approved Clinical Integration Program. Network Included Both Independent and Employed Physicians Non-exclusive: Payors Were Free To Contract Directly With Any Member A Core Part of the Program Was Implementation of a Webbased Health Information Technology System As Well As the More Traditional Physician Performance Targets, Utilization and Disease Management, Clinical Protocols, and Quality of Care Standards.
29 FTC CONCLUSIONS FROM TRISTATE DETERMINATION The Program Has the Potential To Create Substantial Integration Among Its Participants, Which Creates Efficiencies Leading To Improved Quality of Care As Well As Cost Effective Care; The Joint Contracting Is Related To the Goal of Delivering the Coordinated Care and Achieving the Quality and Cost Efficiency Goals; and Since the Network Is Non-exclusive, There Is Still Open Competition.
30 FTC AND DOJ CRITERIA FOR ANALYZING CLINICAL INTEGRATION STRATEGIES What Do the Physicians Plan To Do From a Clinical Standpoint? How Are These Activities Designed To Improve Quality of Care, Reduce the Cost of Care, Or Produce Other Efficiencies? How Is the Program Designed To Provide Interdependence Among Physician Participants? How Will the Physicians Be Collectively Motivated To Achieve Those Goals and Efficiencies? How Significant Will the Physicians' Investment (Both Monetary and In Human Capital Form) Be? How Will Performance Be Monitored and Measured? What Are the Consequences of Physician Non-performance Or Sub-par Performance? Why Is Joint Price Negotiation Reasonably Necessary To Achieve the Intended Benefits of the Program? What Are the Likely Competitive Effects of Physicians' Joint Negotiations?
31 ESSENTIAL ELEMENTS OF CLINICALLY INTEGRATED ACO Monitoring Utilization. Establishing Mechanisms To Monitor and Control Utilization of Health Care Services That Are Designed To Control Costs and Assure Quality of Care. Measuring Quality. Clinical Protocols Must Be Established To Reward Provisions of Best Practices, Evidence Based Medicine. Selecting Efficient Providers. Selectively Choosing Network Physicians Who Are Likely To Further These Efficiency Objectives. This Is, In Essence, Pay For Performance. Investment of Capital. The Significant Investment of Capital, Both Monetary and Human, In the Necessary Infrastructure and Capability To Realize the Claimed Efficiencies.
32 FORMATION OF AN ACO An ACO is a Network Web Based Technology Is a Fundamental Requirement. Need Capital, Human Resources, and Organizational Structure Equity Versus Non-equity Models Use of an Existing PHO
33 POTENTIAL OBSTACLES TO DEVELOPMENT OF AN ACO Need Adequate Number of Primary Care Providers To Serve 5,000 Medicare Beneficiaries Effective ACOs Will Require Close Communication and Integration of a Large Group of Providers With Differing Practice Areas, Experiences, and Beliefs That Are Committed To Delivery of High-quality Health Care Delivery Through Cooperation and Risk Sharing. Rural Areas Will Be Difficult To Serve Unless There Is a Telemedicine Component Members of the ACO Will Need To Agree To a Method of Distributing Any Realized Savings Among the Group. Wide Disparity of Physician Incomes and Political Power, and a Deep Distrust Between Some Physicians and Their Community Hospitals. Absence of Incentive To Decrease Utilization For the Benefit of the ACO When the Provider Is Paid Based On Fee For Service.
34 ANTITRUST COMPLIANCE IN ACO DEVELOPMENT The Following Topics Should Be Strictly Avoided In Any Communication Between Competitors: 1. Prices and pricing policies. 2. Terms or conditions of sale. 3. Credit terms and billing practices. 4. Suppliers terms and conditions of sale. 5. Costs. 6. Profits or profit margins. 7. Advertising and marketing plans and practices. 8. Bids, including your intent to bid or not to bid for a particular contract or program, and the timing or amount of your bid. 9. Allocation of territories or customers. 10. Refusals to deal with a supplier or customer.
35 THE MANAGEMENT ALTERNATIVE Combine Providers Under an MSO Achieve Economies of Scale While Collectively Negotiating Still Need to Follow Clinical Integration Rules
36 HOW DO YOU WANT TO TAKE ARMS AGAINST THIS SEA OF TROUBLES AND BY OPPOSING END THEM? Financial Integration? Clinical Integration?
Thirteen Things Health Care Providers Should Know About Accountable Care Organizations and Health Reform Thomas E. Bartrum, 615.726.5641, email@example.com With passage of the Patient Protection
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
CLINICALLY INTEGRATED NETWORKS: BUSINESS AND LEGAL CONSIDERATIONS Claire Turcotte, Esquire, Bricker & Eckler LLP Jim Yanci, MS MT (ASCP), Dixon Hughes Goodman Agenda BUSINESS CONSIDERATIONS How Fast are
Accountable Care Organizations Understanding What They Are and How to Structure Them Maria T. Currier HOLLAND & KNIGHT LLP Miami Chamber of Commerce Healthcare Subcommittee December 7, 2010 Copyright 2010
White Paper Post-Acute/Long- Term Care Planning for Accountable Care Organizations SCORE A Model for Using Incremental Strategic Positioning as a Planning Tool for Participation in Future Healthcare Integrated
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
PROPOSED MEDICARE SHARED SAVINGS (ACO) PROGRAM RULES The Centers for Medicare and Medicaid Services (CMS) and other affected agencies released their notice of proposed rulemaking/request for comment for
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
Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program I. Introduction The Patient Protection and Affordable Care
Accountable Care Organizations The Future Integrated Health Care Delivery Model? Maria T. Currier Randy Fenninger Holland & Knight LLP Adventist Health System Annual Legal Retreat October 25, 2010 Orlando,
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
White Paper Strategy and Options for Alignment and Steps to Create an ACO A Suggested Strategy James M. Daniel, Jr., JD, MBA Hancock, Daniel, Johnson & Nagle, P.C. (866) 967-9604 firstname.lastname@example.org www.hdjn.com
Healthcare Reform Update Conference Call VI Sponsored by the Healthcare Reform Educational Task Force October 9, 2009 2:00-2:45 2:45 pm Eastern Healthcare Delivery System Reform Provisions in America s
Accountable Care Organization Refinement Brief The participants in the Medicare Shared Savings Program (MSSP), the Physician Group Practice Transition Demonstration (PGP-TD), and the Pioneer Accountable
December 2010 Using Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare CONTENTS Background... 2 Problems with the Shared Savings Model... 2 How
The Role of Accountable Care Organizations in the New World of Federal and State Health Care Reform May 5, 2010 Daniel T. Roble Ropes & Gray LLP email@example.com 617.951.7476 Michele M. Garvin
FREQUENTLY ASKED QUESTIONS 1) What is IU Health Quality Partners? It is a clinically integrated provider group; it is not a contracted health insurance plan network where physicians receive a set fee for
CMS RELEASES PROPOSED ACCOUNTABLE CARE ORGANIZATION REGULATIONS By: Kathleen L. DeBruhl, Esq. and Lindsey E. Surratt, Esq. On March 31, 2011, the Centers for Medicare and Medicaid Services ( CMS ) issued
FEDERAL TRADE COMMISSION / DEPARTMENT OF JUSTICE Federal Trade Commission ( FTC ) Antitrust Division of the Department of Justice ( DOJ ) Statement of Antitrust Enforcement Policy Regarding Accountable
MARCH 2010 EXECUTIVE SUMMARY BUSINESS LAW AND GOVERNANCE PRACTICE GROUP The Affiliation of Swedish Medical Center and Minor & James Medical: A New Approach to Physician-Hospital Affiliations Brent R. Eller,
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
CPI Antitrust Chronicle May 2011 (1) ACOs And Antitrust Enforcement: Familiar Rules Raise New Concerns Jane E. Willis, Mark S. Popofsky & Daniel J. Bachner Ropes & Gray LLP www.competitionpolicyinternational.com
The Regulations Are Out: Is An ACO Right For You? Moderator David Pursell 816.983.8190 firstname.lastname@example.org Today s Discussion Overview of the ACO Regulations Alternatives to a Medicare ACO
Source: Health Law Reporter: News Archive > 2010 > 04/15/2010 > BNA Insights > Provider Participation in ACOs May Hinge on HHS Regulations Provider Participation in ACOs May Hinge on HHS Regulations 19
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.
E-ALERT Health Care April 15, 2011 ACCOUNTABLE CARE ORGANIZATION BASICS The Affordable Care Act establishes the Medicare Shared Savings Program ( Program ), which provides for the development of accountable
Antitrust and Accountable Care Organizations Arthur N. Lerner American Health Lawyers Association The Nuts and Bolts of Accountable Care: ACOs and Beyond March 29, 2011 Clinical Integration Defined Clinical
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
Accountable Care Organizations and You E. Christopher Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences CEO, OSU Faculty Group Practice Chair, Department of Surgery Ohio State University
Managing and Coordinating Non-Acute Care in an ACO Environment By Glen Roebuck, Vice President of Business Development, Health Dimensions Group Hospital and health care systems across the country are engaging
PL 111-148 and Amendments: Impact on Post-Acute Care for Health Care Systems By Kathleen M. Griffin, PhD. There are three key provisions of the law that will have direct impact on post-acute care needs
Accountable Care Organizations and Market Power Issues October, 2010 Introduction Accountable care organizations (ACOs) have received significant attention since passage of the Patient Protection and Affordable
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
PPACA: IMPACT ON MEDICAL PRACTICES AND CARE DELIVERY ROSA FINI, M.D. APRIL 2013 1 A SYSTEMS ORGANIZATION CHANGE COMPREHENSIVE SYSTEM REFORM IMPACTS: REIMBURSEMENT MECHANISMS MEDICAL CARE DELIVERY MODEL
& 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
Post-care Networks and LTACs: Finding Your Place in an ACO Model Accountable Care Organizations (ACOs) are more than just a fad. Post-care providers and LTACS in particular, will need to give careful thought
NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS Briefing Paper on the Proposed Medicare Shared Savings Program The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule to implement
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
Bob Perna, FACMPE, Director, WSMA Practice Resource Center Bob Perna, FACMPE Director, WSMA Practice Resource Center E-mail: email@example.com Phone: 206.441.9762 1.800.552.0612 2 DISCLAIMER Disclaimer: This
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
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
: 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
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
Healthcare Reform: The Road Ahead Kevin Lyles, Esq. Partner, Jones Day firstname.lastname@example.org (614) 281-3821 Frank E. Sheeder, Esq. Partner, DLA Piper email@example.com (214) 743-4560 Diane Meyer
Accountable Care Organizations: Proposed Regulations and the Local Landscape May 26, 2011 John Clark, MD, JD Isaac M. Willett Medical Director, Clinical i l Informatics Attorney Indiana University Health
Accountable Care Organizations: Legal and Organizational Structures; Governance The National Accountable Care Organization Congress October 25-27, 2010 Los Angeles, CA Dennis S. Diaz, Esq. Davis Wright
Large Urology Group Practice Association Accountable Care Organizations November 6, 2010 J. Phillip O Brien 312.902.5630 firstname.lastname@example.org Basic Premise for ACOs Facilitate medical care coordination
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
The Impact of Accountable Care Organizations on the Healthcare Industry Dale Maxwell Senior Vice President & CFO Presbyterian Healthcare Services Agenda The Case for Change A New Idea, The ACO Characteristics
DRIVING VALUE IN HEALTHCARE: PERSPECTIVES FROM TWO ACO EXECUTIVES, PART I A firm understanding of the key components and drivers of healthcare reform is increasingly important within the pharmaceutical,
Accountable Care Organization (ACO) 101 Brief Course Neil Kirschner, Ph.D. Director, Regulatory and Insurer Affairs What is an ACO? ACO refers to a legal entity composed of a group of providers that assume
February 28, 2014 Re: Request for Information on the Evolution of ACO Initiatives at CMS AMGA represents multi specialty medical groups and other organized systems of care, including some of the nation
The 4 Pillars of Clinical Integration: A Flexible Model for Hospital- Physician Collaboration Written by Daniel J. Marino, President & CEO, Health Directions November 14, 2012 Originally published by Becker
What Providers Need To Know Before Adopting Bundling Payments Dan Mirakhor Master of Health Administration University of Southern California Dan Mirakhor is a Master of Health Administration student at
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
April 2015 COMMENTARY HHS Announces Next Generation ACO Model of Payment and Care Delivery On March 10, 2015, the U.S. Department of Health and Human Services ( HHS ) announced the Next Generation Accountable
Fraud and Abuse Considerations for Accountable Care Organizations (ACOs) By: Chris Rossman, Foley & Lardner LLP, Detroit, Michigan 1. The Centers for Medicare and Medicaid Services ( CMS ) and the Office
Newsletter Health Care January 2014 North Carolina Accountable Care Organization Update This Bulletin provides an update on the development of Accountable Care Organizations (ACOs) in North Carolina through
C h a p t e r7 Post-acute care providers: Shortcomings in Medicare s fee-for-service highlight the need for broad reforms C H A P T E R 7 Post-acute care providers: Shortcomings in Medicare s fee-for-service
Clinical Integration and the Baptist Physician Alliance Physicians at Baptist Health System will soon have the opportunity to decide whether to participate in the development of a clinically integrated
The New Healthcare Marketplace: Hospital Physician Business Models and Healthcare Reform Legislation October 19, 2010 Today s Webinar Presenters Lars Enstrom Managing Director Alvarez & Marsal Healthcare
Client Advisory Health Care November 10, 2011 CMS Issues Final ACO Regulations After receiving more than 1,300 public comments on its Proposed Rule for Accountable Care Organizations (ACOs) under the Medicare
AMGA Annual Meeting March 24, 2015 Health Care Mergers and Acquisitions The Legal Perspective Presented by Joseph N. Wolfe, Esq. Hall, Render, Killian, Heath & Lyman, P.C. 1 Today s Agenda Introductory
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
Page 1 of 10 Key Features of the Affordable Care Act, By Year On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place comprehensive health insurance reforms that will roll
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
Accountable Care Organizations 101 MultiCare Connected Care October 20 22, 2014 1 Objectives 1. Describe what an ACO is and why we believe developing an ACO is important 2. Describe examples of what integration
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
Population Health: Tales from the Front Integrated Design and Case Study from Northwest Arkansas Objectives 1 2 3 4 Discuss current Population Health trends and approaches in the market Determine the strategies
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.
Timeline: Key Feature Implementations of the Affordable Care Act The Affordable Care Act, signed on March 23, 2010, puts in place health insurance reforms that will roll out incrementally over the next
Statement of the Association of American Medical Colleges on Legal Issues Related to Accountable Care Organizations and Healthcare Innovation Zones Public Workshop hosted by the FTC, CMS, HHS OIG October
Clinically Integrated Networks and Accountable Care Organizations 1 Do Nothing 2 Become Someone s Employee 3 Join a Network Provider The wake up call is for POPULATION health management managing clinical
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
A quick guide to 3M s unique solution for value-based health care Part 2: The era of and Current trends industry changes Volume-based health care Value-based health care ICD-9 ICD-10 Inpatient care Outpatient
Legal & Policy Issues Related to ACO Formation by Independent Physician Groups Troy Barsky Arthur Lerner Crowell & Moring LLP America s Health Insurance Plans ACO Summit May 15, 2013 Background Government
June 6, 2011 Submitted Electronically: http://www.regulations.gov Attention: CMS-1345-P Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G Hubert H. Humphrey Building
What is Healthcare Reform? Get a view of the future health care system in the US; learn about primary resources and tools for the healthcare administrator, and what are the success factors for healthcare
NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS Briefing Paper on the Proposed Medicare Shared Savings Program The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule to implement
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
Reforming and restructuring the health care delivery system Are Accountable Care Organizations and bundling the solution? Prepared by: Dan Head, Principal, RSM US LLP email@example.com, +1 703 336 6536
Building a Healthy ACO Compliance Program HCCA 2014 Compliance Institute Mary C. Malone, Esq. Hancock, Daniel, Johnson & Nagle, P.C. Disclaimer: The content of this presentation does not constitute legal
Federal Health Care Reform: Implications for Hospital and Physician partnerships Walter Kopp Medical Management Services Outline Overview of federal health reform legislation Implications for Care delivery
Transitioning to Accountable Care Harold D. Miller ABOUT THE AUTHOR Harold D. Miller is the Executive Director of the Center for Healthcare Quality and Payment Reform and the President and CEO of the Network
By Jacob Lazarovic, MD, FAAFP Senior Vice President and Chief Medical Officer Broadspire Accountable Care and Workers Compensation: Are They Compatible? First let s review the acronym glossary. Accountable
The Accountable Care Organization Kim Harvey Looney kim.looney@ 615-850-8722 3968555 1 ACOs: Will I Know One When I See One? Relatively New Concept Derived from Various Demonstration Programs No Set Structure
Hospital and Independent Physician Alignment: Structural Options, Business and Compliance Considerations By Bruce A. Johnson and Janice Anderson I. Introduction Numerous policy initiatives are now being