Driving Value Through Clinical Integration

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Driving Value Through Clinical Integration"

Transcription

1 Driving Value Through Clinical Integration How Independent Physician Groups and Independent Practice Associations (IPAs) can remain independent and profitable in a changing healthcare reimbursement environment November Lippincott Drive Marlton, NJ

2 The challenge to remain independent under the ACA Although the passage of the Affordable Care Act (ACA) in 2010 has resulted in more insured Americans about 10 million to date it has also created new challenges for independent physician groups and IPAs. Under the current Fee-for-Service (FFS) model, payors created volume-based provider economics, where providers were paid each time they delivered a service. The new approach is accountable care, a model that places the focus on value over volume. Payment is tied to patient outcomes and appropriate use of healthcare resources. Value-based (VB) payment can take many forms: pay-for-performance (P4P), for example, or bundled payments. FUTURE STATE Projected Mix of Payment Models within Organization Among payors who are other than 100% FFS only FFS 56% 42% 32% 18% 19% Capitation 17% 14% 18% P4P Episode of Care/Bundled Global Payment Other (e.g. Shared Savings) 10% 8% 6% 3% 12% 8% 5% 14% 10% 7% Today *Source: McKesson Health Solutions, years from now 5 years from now 1

3 Doctors in small and large groups or traditional IPAs are not only subject to declining reimbursements and a reduction in FFS patients, they face increasing financial and time burdens, as they struggle to adopt new tools of medical practice, such as electronic health records (EHR). Because of the need for infrastructure investment, physicians may feel pressured to accept hospital employment as networks become more narrow. And with the increasing need for documentation for virtually every aspect of care, many doctors are frustrated and overwhelmed. As Dr. Fred Pelzman stated in a Medpage Today blog post about the new healthcare environment, Those of us who have been doing this for a long time worry that this is going to become just another version of some monitor looking over our shoulders at what we are spending while we care for patients, and telling us what we can and cannot do to take care of them. 1 While we recognize that ultimately there is a business side to healthcare...many of us fear that linking our practice of medicine to the sometimes unavoidable and messy nature of healthcare delivery, with the ultimate goal of saving money, creates a paradigm in which the practitioner may be pressured to avoid providing care they 1 think is necessary and appropriate. But whether physicians are ready or not, the ACA is driving change across the entire healthcare landscape. At the heart of health care improvement is the so-called 2 Triple Aim : improved experience of care for the patient, improved overall health for the community and lower overall costs, with a network of collaborating physicians at the core of care delivery. Although providers bear a greater portion of clinical risk under the new model, they are better positioned than payors to make proactive clinical decisions and appropriate tradeoffs. For the first time, providers have the opportunity to benefit from more cost-effective health outcomes, and many physician groups and IPAs have already been dipping their toes in the Accountable Care waters. In July 2012, a significant number of Medicare Accountable Care Organizations (ACOs) were new entities formed of independent physicians (with or without 3 hospitals) coming together through some type of virtual aggregation. Today in 2014, according to the New England Journal of Medicine, there are 361 ACOs contracting with Medicare and hundreds of ACO-like contracts in the private sector. 4 1 Pelzman FN. The Promise and Perils of ACOs blog Building the Patient-Centered Medical Home MedPage today October 14, The Institute for Healthcare Improvement descibes the"triple Aim" as an approach to optimizing health system performance through the pursuit of three dimensions - improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care. 3 Oliver Wyman, 2012 The ACO Surprise, p2 4 Casalino LP, Accountable Care Organizations The Risk of Failure and the Risks of Success. 2014, N Eng J Med. 371;18: Or we can go back to the primary reference cited: McClellan M, White R, Kocot L, Mostashari F. How to improve the Medicare accountable care organization (ACO) program. Washington, DC: Brookings Institution, June

4 The move to value is changing the treatment paradigm patient populations at a fixed reimbursement rate, reflecting historical costs and adjusted for population-specific risk. If a medical group is able to deliver that care for less than the target reimbursement, they share in the savings, either as part of a risk-sharing program or pay-for-performance. Providers have always viewed high quality care as an imperative, but traditional feefor-service contracts were never designed to support proactive care and disease management. Today, physicians need to think differently about their medical practice, learning how to help their patients manage their chronic illnesses to avoid acute episodes, for example, or identifying which patients in their practice are By focusing on the value of the health care given and the well-being of the patient instead of the volume of services provided, value-based contracts can improve quality, reduce overall costs, and improve providers financial performance but only if they are able to work together and coordinate care. 5 Recent data show that this approach appears to be working. A report from the Congressional Budget Office (CBO) in late August showed that 10-year Medicare cost projections have declined every year for the last six years in a row, with a difference of about $95 billion between the most recent projection of Medicare s 2019 budget and the one four years ago. Part of this reduction is attributed to a change in behavior by health care providers. According to a New York Times article, Medicare beneficiaries are using fewer high-cost health care services than in the past taking fewer brand-name drugs, for example, or spending less time in the hospital. These changes have dominated the downward estimate revisions since NIHCM Foundation, The Concentration of Health Care Spending, NIHCM Foundation Data Brief, July NY Times August 27, Medicare: Not such a Budget-Buster Anymore. 3

5 An analysis of the results of the effect of global budgets (that is value-based rather than traditional fee-for-service) in Massachusetts compared with traditional plans seems to bear this out. 7 Compared with similar populations in other states, claims spending under global budgets was slower over the four-year period between 2009 and 2012, mostly driven by cost savings in the outpatient setting, and explained by both lower fee schedules and reduced utilization. In addition, improvement in process and outcome quality was better than those seen in the control group (non-accountable care) and also compared with the Healthcare Effectiveness Data and Information Set (HEDIS). 7 Song Z, Rose S, Safran DG, et al. Changes in health care spending and quality 4 years into global payment. N Engl J Med 2014; 371:

6 Outcome Quality in the 2009 AQC Cohort Information Set (HEDIS), * * Outcome quality consisted of the following five measures: control of the glycated hemoglobin level ( 9%), control of the low-density lipoprotein (LDL) cholesterol level (<100 mg per deciliter [2.6 mmol per liter]), and blood-pressure control (<140/80 mm Hg) in patients with diabetes; the same level of control of LDL cholesterol in patients with coronary artery disease; and a blood-pressure control level of 140/90 mm Hg in patients with hypertension Although this news is a reassuring proof of concept it is not a slam-dunk for value-based arrangements. Sadly, many physician groups and IPAs are underequipped to manage proactive care and total cost performance, and lack the strategic partnerships with ambulatory, acute, and post-acute care providers. Moreover some groups lack the strong development strategy needed to achieve the information competencies required for effective population management, and to learn how to benefit clinically and financially by managing clinical risk. To do this, providers need extensive patient information. Without it, the group will find it almost impossible to understand patient stratification what segments live inside the total population or how to manage them. And without an information dashboard, integration tools, and actionable insights proactively delivered at the point of care, a multidisciplinary care team will have little chance of shifting the cost/quality/value equation. 5

7 Today s healthcare environment impacts traditional IPA members in several ways: Declining reimbursements Increasing financial and time burdens Pressure to accept hospital employment Lack of funding for infrastructure investment Threat of exclusion from emerging narrow networks Inability to capitalize on value-based reimbursement opportunities The opportunity for Independent Providers Clinical Integration well-being and clinical 6

8 With the right implementation, Clinical Integration comprises the organizational attributes necessary to catalyze the transformation of health care delivery, including governance structure, leadership, and comprehensive physician-hospital alignment, while allowing to continue to benefit from existing FFS opportunities. Why Clinical integration makes sense Strengthens relationships among all providers (physicians, hospitals, etc.) Makes providers more attractive network participants to payors Focuses efforts on keeping people well rather than treating acute events Lowers cost of care Creates momentum for additional quality initiatives to improve the health of the patient population, while improving the financial health of the practice Although shifting to a value-based payment environment may be daunting for providers accustomed to working in traditional silos, the benefits of either creating or joining a Clinical Integration arrangement can mean survival to physicians who want to maintain their independence. More than survival, the value to a Clinically Integrated physician group or IPA can be a return to the values that drove physicians to become doctors in the first place the practice of quality patient care and being a successful and financially solvent part of a healthy community. 7

9 402 Lippincott Drive Marlton, NJ Phone: Fax:

Program Description and FAQ s 2016 Medicare Shared Savings Program Year

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

More information

Program Description and FAQ s 2016 Medicare Shared Savings Program Year

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

More information

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

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

The ABCs of Population Health Management Jennifer Houlihan, MSP Director of CIN Strategy, Integration and Population Health

The ABCs of Population Health Management Jennifer Houlihan, MSP Director of CIN Strategy, Integration and Population Health The ABCs of Population Health Management Jennifer Houlihan, MSP Director of CIN Strategy, Integration and Population Health A view from the marketplace Employers seek Other health Systems for Clinically

More information

Population Health: Tales from the Front

Population Health: Tales from the Front Population Health: Tales from the Front Integrated Design and Case Study from Northwest Arkansas Objectives 1 2 3 4 Discuss current Population Health trends and approaches in the market Determine the strategies

More information

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

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

More information

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

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

More information

The 4 Pillars of Clinical Integration: A Flexible Model for Hospital- Physician Collaboration

The 4 Pillars of Clinical Integration: A Flexible Model for Hospital- Physician Collaboration The 4 Pillars of Clinical Integration: A Flexible Model for Hospital- Physician Collaboration Written by Daniel J. Marino, President & CEO, Health Directions November 14, 2012 Originally published by Becker

More information

Accountable Care Organizations 101. MultiCare Connected Care October 20 22, 2014

Accountable Care Organizations 101. MultiCare Connected Care October 20 22, 2014 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

More information

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

THE ACCOUNTABLE CARE ORGANIZATION (ACO) TRAIN IS LEAVING THE STATION: ARE YOU ON BOARD? UNDER THE MICROSCOPE NOVEMBER 5, 2013 THE ACCOUNTABLE CARE ORGANIZATION (ACO) TRAIN IS LEAVING THE STATION: ARE YOU ON BOARD? ISSUE. A 2006 Institute of Medicine report ( Performance measurement: Accelerating

More information

Population health management:

Population health management: GE Healthcare Population health management: Navigating successfully from volume to value In the new world of value-based care and risk-sharing compensation, success will depend on how well provider organizations

More information

Banner Health Network Pioneer ACO - Physician Toolkit

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

More information

Achieving Quality and Value in Chronic Care Management

Achieving Quality and Value in Chronic Care Management The Burden of Chronic Disease One of the greatest burdens on the US healthcare system is the rapidly growing rate of chronic disease. These statistics illustrate the scope of the problem: Nearly half of

More information

Electronic Health Records and Quality Metrics Using the right expertise to make full and meaningful use of your EHR investment

Electronic Health Records and Quality Metrics Using the right expertise to make full and meaningful use of your EHR investment Electronic Health Records and Quality Metrics Using the right expertise to make full and meaningful use of your EHR investment October 2014 402 Lippincott Drive Marlton, NJ 08053 856.782.3300 www.challc.net

More information

Chapter Three Accountable Care Organizations

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

More information

Advancing Accountable Care

Advancing Accountable Care Advancing Accountable Care April 19, 2012 S. Lawrence Kocot, JD, LLM, MPA Deputy Director, Engelberg Center for Health Care Reform; Senior Counsel, SNR Denton Sean McBride Project Manager, Engelberg Center

More information

Helping You Achieve Better Clinical and Financial Health

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

More information

MetroCare/HealthChoice Trilogy Clinically Integrated Network FAQs

MetroCare/HealthChoice Trilogy Clinically Integrated Network FAQs MetroCare/HealthChoice Trilogy Clinically Integrated Network FAQs 1. What is clinical integration? Clinical integration is a new model for healthcare delivery that promotes collaboration among a community

More information

ISSUE BRIEF Accountable Care Organizations March 2009

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

More information

Chapter Seven Value-based Purchasing

Chapter Seven Value-based Purchasing Chapter Seven Value-based Purchasing Value-based purchasing (VBP) is a pay-for-performance program that affects a significant and growing percentage of Medicare reimbursement for medical providers. It

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

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

Running Head: COST-CONTROLLING MEASURES OF THE A.C.A. 1. Lesser Politicized Cost-Controlling Measures of the Affordable Care Act: Literature Review

Running Head: COST-CONTROLLING MEASURES OF THE A.C.A. 1. Lesser Politicized Cost-Controlling Measures of the Affordable Care Act: Literature Review Running Head: COST-CONTROLLING MEASURES OF THE A.C.A. 1 Lesser Politicized Cost-Controlling Measures of the Affordable Care Act: Literature Review Robin Persun Excelsior College COST-CONTROLLING MEASURES

More information

Transitioning to a Sub-Capitation (At Risk) Model

Transitioning to a Sub-Capitation (At Risk) Model Transitioning to a Sub-Capitation (At Risk) Model Presentation Overview Understanding the Changing Environment Understanding Changing Payment Models Network Management Keys For Success Shifting Mindsets

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

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

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

More information

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

Health Care Reform. Jim Smith American Continental Group 900 19 th Street, NW, #800 Washington, DC 20006 202-327-8100

Health Care Reform. Jim Smith American Continental Group 900 19 th Street, NW, #800 Washington, DC 20006 202-327-8100 Health Care Reform Jim Smith American Continental Group 900 19 th Street, NW, #800 Washington, DC 20006 202-327-8100 *Tobacco-related disease *Poor diet *Lack of exercise *Excessive use of alcohol *American

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

Lowering Costs and Improving Outcomes. Patient Engagement Issues. Nancy Davenport-Ennis President & CEO. September 8 th, 2009

Lowering Costs and Improving Outcomes. Patient Engagement Issues. Nancy Davenport-Ennis President & CEO. September 8 th, 2009 The Healthcare Imperative: Lowering Costs and Improving Outcomes Patient Engagement Issues Nancy Davenport-Ennis President & CEO National Patient Advocate Foundation September 8 th, 2009 Institute of Medicine

More information

Plenary Session 1. Health Dimensions Group. 2010 Health Dimensions Group

Plenary Session 1. Health Dimensions Group. 2010 Health Dimensions Group Plenary Session 1 Kathleen M. Griffin, PhD Health Dimensions Group March 31, 2011 Hospital, Post Acute and Long-Term Care Collaboration in Health Care Reform: Critical Success Factors National Summit:

More information

Our Changing & Challenging Health Care Landscape: A Brief Overview

Our Changing & Challenging Health Care Landscape: A Brief Overview Welcome! Our Changing & Challenging Health Care Landscape: A Brief Overview Sheryl Slonim, DNP, RN-BC, NEA-BC Executive Vice President, Patient Care Svcs/CNO Welcome! Our Changing & Challenging Health

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

Advancing Accountable Care

Advancing Accountable Care Advancing Accountable Care Sean McBride Project Manager, Engelberg Center for Health Care Reform; Project Manager, ACO Learning Network Agenda 2. 4. Overview of national ACO Implementation: growing private

More information

Analytics for ACOs Integrated patient views

Analytics for ACOs Integrated patient views Analytics for ACOs Integrated patient views What s at stake? Level-setting Overview The healthcare environment is changing and healthcare organizations have challenging decisions to make. With the dramatic

More information

Premier ACO Collaboratives Driving to a Patient-Centered Health System

Premier ACO Collaboratives Driving to a Patient-Centered Health System Premier ACO Collaboratives Driving to a Patient-Centered Health System As a nation we all must work to rein in spiraling U.S. healthcare costs, expand access, promote wellness and improve the consistency

More information

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

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

More information

Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION

Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION At the end of this session, you will be able to: Identify ways RT skills can be utilized for

More information

New Business and Investment Opportunities Emerging from Population Health Management (PHM)

New Business and Investment Opportunities Emerging from Population Health Management (PHM) Stax s Perspective on Changes Driven by PHM New Business and Investment Opportunities Emerging from Population Health Management (PHM) By Natalie De Fazio, Director, Stax Inc. November 2014 New Business

More information

TRENDS IN DIABETES QUALITY MEASUREMENT. Manage patients entire healthcare experience with a more comprehensive approach

TRENDS IN DIABETES QUALITY MEASUREMENT. Manage patients entire healthcare experience with a more comprehensive approach TRENDS IN DIABETES QUALITY MEASUREMENT Manage patients entire healthcare experience with a more comprehensive approach Type 2 diabetes is a complex disease that requires a multifaceted treatment approach

More information

Use Facility Image if available How to Select the Right Pop Health Vendor for Your Organization

Use Facility Image if available How to Select the Right Pop Health Vendor for Your Organization Use Facility Image if available How to Select the Right Pop Health Vendor for Your Organization May 19, 2016 Agenda I. Case Study: Illinois Partnership for Heath (IPH) II. Population Health Management

More information

ACCOUNTABLE CARE ORGANIZATION (ACO): SUPPLYING DATA AND ANALYTICS TO DRIVE CARE COORDINATION, ACCOUNTABILITY AND CONSUMER ENGAGEMENT

ACCOUNTABLE CARE ORGANIZATION (ACO): SUPPLYING DATA AND ANALYTICS TO DRIVE CARE COORDINATION, ACCOUNTABILITY AND CONSUMER ENGAGEMENT ACCOUNTABLE CARE ORGANIZATION (ACO): SUPPLYING DATA AND ANALYTICS TO DRIVE CARE COORDINATION, ACCOUNTABILITY AND CONSUMER ENGAGEMENT MESC 2013 STEPHEN B. WALKER, M.D. CHIEF MEDICAL OFFICER METRICS-DRIVEN

More information

Performance Measurement in CMS Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS

Performance Measurement in CMS Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS Performance Measurement in CMS Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS Mind the Gap: Improving Quality Measures in Accountable Care Systems October

More information

ACOs ECONOMIC CREDENTIALING BUNDLING OF PAYMENTS

ACOs ECONOMIC CREDENTIALING BUNDLING OF PAYMENTS ACOs ECONOMIC CREDENTIALING BUNDLING OF PAYMENTS There are a number of medical economic issues Headache Medicine Physicians should be familiar with as we enter a new era of healthcare reform. Although

More information

DRAFT NCMS POLICY (v. 7) Accountable Care Organizations

DRAFT NCMS POLICY (v. 7) Accountable Care Organizations DRAFT NCMS POLICY (v. 7) Accountable Care Organizations Background: Accountable Care Organizations (ACOs) are an emerging health care delivery model comprised of groups of providers that join together

More information

Leveraging your PHO in a Value Based Environment

Leveraging your PHO in a Value Based Environment Leveraging your PHO in a Value Based Environment May 1, 2014 1 Today s discussion Aurora Mitchell Aurora Branum Mitchell is a healthcare executive with over 20 years of hospital, medical, managed care

More information

Managing Population Health: Equity through Person- Centered Care

Managing Population Health: Equity through Person- Centered Care Managing Population Health: Equity through Person- Centered Care Linda Alexander, RN, MBA, CCM Total Health Care Chief Clinical Officer Plante Moran Healthcare Consulting Detroit Medical Center - Clinical

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

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

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

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

What is an ACO? What forms of organizations may become an ACO? IAMSS 30 th Annual Education Conference Pearls of Wisdom

What is an ACO? What forms of organizations may become an ACO? IAMSS 30 th Annual Education Conference Pearls of Wisdom IAMSS 30 th Annual Education Conference Pearls of Wisdom The Impact of Accountable Care Organizations (ACOs) and Health Care Reform on Credentialing, Privileging and Peer Review April 28-29, 2011 Michael

More information

Enterprise Analytics Strategic Planning

Enterprise Analytics Strategic Planning Enterprise Analytics Strategic Planning June 5, 2013 1 "The first question a data driven organization needs to ask itself is not "what do we think?" but rather "what do we know? Big Data: The Management

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

Are ACOs the Fix? The Latest Addition to the AHS Coding Corner

Are ACOs the Fix? The Latest Addition to the AHS Coding Corner Are ACOs the Fix? The Latest Addition to the AHS Coding Corner It has been some time since I have added to the seven contributions already on the AHS website Coding Corner. The reason is because there

More information

CPAs & ADVISORS PHYSICIAN ALIGNMENT STRATEGIES. experience clarity // Moving Forward in the Health Reform Era

CPAs & ADVISORS PHYSICIAN ALIGNMENT STRATEGIES. experience clarity // Moving Forward in the Health Reform Era CPAs & ADVISORS experience clarity // PHYSICIAN ALIGNMENT STRATEGIES Moving Forward in the Health Reform Era OVERVIEW Physician alignment is a key in achieving Triple Aim -type outcomes Alignment opportunities

More information

ACOs & ESCOs. Interdisciplinary Nephrology Conference. October 25, 2013

ACOs & ESCOs. Interdisciplinary Nephrology Conference. October 25, 2013 ACOs & ESCOs National Kidney Foundation of Illinois Interdisciplinary Nephrology Conference October 25, 2013 About Me Dan Viaches VP Corp. Development - DaVita 6 Years with DaVita - 5 Years center operations

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

How Health Plans Are Using Advanced Analytics to Improve Medical Costs and Quality

How Health Plans Are Using Advanced Analytics to Improve Medical Costs and Quality geneia Case Study How Health Plans Are Using Advanced Analytics to Improve Medical Costs and Quality Background: [Our health plan] is investing in innovative solutions and delivering powerful analytics

More information

THE EVOLUTION OF CMS PAYMENT MODELS

THE EVOLUTION OF CMS PAYMENT MODELS THE EVOLUTION OF CMS PAYMENT MODELS December 3, 2015 Dayton Benway, Principal AGENDA Legislative Background Payment Model Categories Life Cycle The Models LEGISLATIVE BACKGROUND Medicare Modernization

More information

Future of Health Care: How Do You Fit In? Physician Leadership Institute February 28, 2015 Brian M. McCook, CPA

Future of Health Care: How Do You Fit In? Physician Leadership Institute February 28, 2015 Brian M. McCook, CPA Future of Health Care: How Do You Fit In? Physician Leadership Institute February 28, 2015 Brian M. McCook, CPA Learning Objectives Industry Transitions Challenges and Changes ACO s Look at the Future

More information

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

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

More information

Accountable Care Organizations New Healthcare Opportunities for Employers

Accountable Care Organizations New Healthcare Opportunities for Employers Accountable Care Organizations New Healthcare Opportunities for Employers The ACO and Employer Opportunities Since the passage of the Patient Protection and Affordable Care Act (PPACA) in 2009, the marketplace

More information

CPR-PBGH Toolkit for Purchasers on Accountable Care Organizations. June 26, 2014

CPR-PBGH Toolkit for Purchasers on Accountable Care Organizations. June 26, 2014 CPR-PBGH Toolkit for Purchasers on Accountable Care Organizations June 26, 2014 Overview Introductions The Current ACO Landscape ACO Options Available to Employers Today Features of the Ideal ACO CPR-PBGH

More information

THE LANDSCAPE OF MEDICAID ALTERNATIVE PAYMENT MODELS

THE LANDSCAPE OF MEDICAID ALTERNATIVE PAYMENT MODELS POLICY BRIEF September 2014 THE LANDSCAPE OF MEDICAID ALTERNATIVE PAYMENT MODELS Authored by: America s Essential Hospitals staff KEY FINDINGS States have increasingly sought to establish alternative payment

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

SMD# 13-001 ACA #23. Re: Health Home Core Quality Measures. January 15, 2013. Dear State Medicaid Director:

SMD# 13-001 ACA #23. Re: Health Home Core Quality Measures. January 15, 2013. Dear State Medicaid Director: DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850 SMD# 13-001 ACA #23 Re: Health Home Core Quality

More information

Broad Issues in Quality Measurement: the CMS perspective

Broad Issues in Quality Measurement: the CMS perspective Broad Issues in Quality Measurement: the CMS perspective Shari M. Ling, MD Deputy Chief Medical Officer Centers for Medicare & Medicaid Services Workshop on Quality Measurement Developing Evidence-Based

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

Five things your company needs to do to prepare for the influence of Accountable Care Organizations

Five things your company needs to do to prepare for the influence of Accountable Care Organizations Five things your company needs to do to prepare for the influence of Accountable Care Organizations An extract from Pricing & Market Access Outlook 2013 Edition Five things your company needs to do to

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

POPULATION HEALTH ANALYTICS

POPULATION HEALTH ANALYTICS POPULATION HEALTH ANALYTICS ANALYTICALLY-DRIVEN INSIGHTS FOR POPULATION HEALTH LAURIE ROSE, PRINCIPAL CONSULTANT HEALTH CARE GLOBAL PRACTICE DISCUSSION TOPICS Population Health: What & Why Now? Population

More information

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

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

More information

VALUE BASED PURCHASING

VALUE BASED PURCHASING HEALTH WEALTH CAREER VALUE BASED PURCHASING EMPLOYEE BENEFITS PLANNING ASSOCIATION MARY KAY O NEILL, MD, MBA FEBRUARY 25, 2016 WHAT ARE THE GOALS OF ACOS AND VBCS? A fundamental shift in how health care

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

Value Based Care and Healthcare Reform

Value Based Care and Healthcare Reform Value Based Care and Healthcare Reform Dimensions in Cardiac Care November, 2014 Jacqueline Matthews, RN, MS Senior Director, Quality Reporting & Reform Quality and Patient Safety Institute Cleveland Clinic

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

Population Health Management Primer

Population Health Management Primer Population Health Management Primer A White Paper October 2014 Impact Advisors LLC 400 E. Diehl Road Suite 190 Naperville IL 60563 1-800- 680-7570 Impact- Advisors.com Table of Contents What Is Population

More information

Critical Access Hospitals and

Critical Access Hospitals and Critical Access Hospitals and Health Care Reform What s in it for you? Patient Protection and Affordable Care Act (ACA) Fundamental changes Moving Medicare from payment for services to payment for outcomes

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

How CDI is Revolutionizing the Transition to Value-Based Care

How CDI is Revolutionizing the Transition to Value-Based Care How CDI is Revolutionizing the Transition to Value-Based Care How CDI is Revolutionizing the Transition to Value-Based Care Creating a state-of-the-art clinical documentation improvement (CDI) program

More information

What you need to know to realize value-based revenue

What you need to know to realize value-based revenue The Definitive Guide to Value-Based Care What you need to know to realize value-based revenue 1 Making sense of value-based care 5 How meaningful is Meaningful Use? 2 Why the change to P4P is needed 6

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

Population Health Management A Key Addition to Your Electronic Health Record

Population Health Management A Key Addition to Your Electronic Health Record Population Health Management A Key Addition to Your Electronic Health Record Rosemarie Nelson, MS Principal Consultant, MGMA Sponsored by: 1 Contents Introduction... 3 Managing Populations of Patients...

More information

Overview and Legal Context

Overview and Legal Context Impact of ACOs on Physician/Provider Membership Decisions 0 Overview and Legal Context Michael R. Callahan Katten Muchin Rosenman LLP Vice Chair, Medical Staff Credentialing and Peer Review Practice Group

More information

Supplementary Appendix

Supplementary Appendix Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Song Z, Rose S, Safran DG, Landon BE, Day MP, Chernew ME. Changes

More information

Transition Sleep Practice to Respond to ACO Challenges DUANE JOHNSON PHD KATHRYN HANSEN, BS, CPC REEGT SLEEP CENTER MANAGEMENT INSTITUTE

Transition Sleep Practice to Respond to ACO Challenges DUANE JOHNSON PHD KATHRYN HANSEN, BS, CPC REEGT SLEEP CENTER MANAGEMENT INSTITUTE Transition Sleep Practice to Respond to ACO Challenges DUANE JOHNSON PHD KATHRYN HANSEN, BS, CPC REEGT SLEEP CENTER MANAGEMENT INSTITUTE ACCOUNTABLE CARE ORGANIZATION (ACO) CARE INTEGRATION AND QUALITY

More information

Medicare Physician Group Practice Demonstration Overview & Lessons Learned

Medicare Physician Group Practice Demonstration Overview & Lessons Learned Medicare Physician Group Practice Demonstration Overview & Lessons Learned John Pilotte Director, Division of Payment Policy Demonstrations Office of Research, Development and Information Centers for Medicare

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

CMS Innovation and Health Care Delivery System Reform

CMS Innovation and Health Care Delivery System Reform CMS Innovation and Health Care Delivery System Reform Dr. Patrick Conway, M.D., MSc CMS Chief Medical Officer and Deputy Administrator for Innovation and Quality Director, Center for Medicare and Medicaid

More information

Population Health Solution

Population Health Solution Population Health Solution Transform healthcare data into actionable clinical intelligence to deliver near real-time insights and facilitate effective and timely care collaboration. Introduction Population

More information

Incorporating New Payment Models Into a Managed Care Environment

Incorporating New Payment Models Into a Managed Care Environment Incorporating New Payment Models Into a Managed Care Environment Association of Community Affiliated Health Plans CEO Summit, Washington DC, July 13, 2011 Topics for our conversation today An experience

More information

The Impact of Accountable Care Organizations on the Healthcare Industry. Dale Maxwell Senior Vice President & CFO Presbyterian Healthcare Services

The Impact of Accountable Care Organizations on the Healthcare Industry. Dale Maxwell Senior Vice President & CFO Presbyterian Healthcare Services The Impact of Accountable Care Organizations on the Healthcare Industry Dale Maxwell Senior Vice President & CFO Presbyterian Healthcare Services Agenda The Case for Change A New Idea, The ACO Characteristics

More information

ACO Project Overview and Key Elements. Presented to FSSA September 3, 2013. 2013 Franciscan Alliance, Inc.

ACO Project Overview and Key Elements. Presented to FSSA September 3, 2013. 2013 Franciscan Alliance, Inc. ACO Project Overview and Key Elements Presented to FSSA September 3, 2013 2013 Franciscan Alliance, Inc. Background of Presentation House Enrolled Act 1328 requires the Indiana Family and Social Services

More information

Quality Accountable Care Population Health: The Journey Continues

Quality Accountable Care Population Health: The Journey Continues Quality Accountable Care Population Health: The Journey Continues Health Insights April 10, 2014 Doug Hastings 2001 Institute of Medicine 2 An Agenda For Crossing The Chasm Between the health care we have

More information

Accountable Care: 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

Accountable Care Organizations and Future Healthcare Delivery

Accountable Care Organizations and Future Healthcare Delivery Accountable Care Organizations and Future Healthcare Delivery Introduction Accountable care organizations (ACOs) are a key component of healthcare reform. This module covers the establishment of accountable

More information

Use Facility Image if available

Use Facility Image if available Use Facility Image if available Payor/Provider Date Trends HealthTechNet June 17, 2016 Agenda I. Introduction II. Reimbursement Trends III. Payor/Provider Collaborations IV. Narrow Networks V. Questions

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