Paying Through the Nose: New Payment Models for Physician Reimbursement March 16, AAO-HNS Leadership Forum Arlington, Virginia.

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Paying Through the Nose: New Payment Models for Physician Reimbursement March 16, 2015. AAO-HNS Leadership Forum Arlington, Virginia. www.ober."

Transcription

1 Paying Through the Nose: New Payment Models for Physician Reimbursement March 16, 2015 AAO-HNS Leadership Forum Arlington, Virginia Kristin Carter Principal Ober Kaler Christopher Dean Principal Ober Kaler

2 Today s Discussion Changing payment landscape Shift from volume to value Alternative payment models ACOs Value-based purchasing Bundled payments Patient-Centered Medical Homes

3 Health Care Market Tension Politics: Left vs. right Who is covered? What is covered? What cost? Zero sum game? Payor vs. provider Quality & cost Independent judgment & patient choice

4 Physician Market Tensions Fragmented market Specialty v. primary care Emergency medicine vs. radiology vs. pathology vs. specialist vs. anesthesia vs. hospitalist vs. primary care Primary care vs. specialist vs. anesthesia Geography-driven Less consolidation

5 Size of the Market U.S. Health Care - $2.9 trillion Medicare Expenditures In $4.9 billion In $224.4 billion In $499.7 billion In $525.0 billion In $585.7 billion Source: National Health Expenditure Accounts

6 Medicare Expenditures by Group Hospitals $220.3 billion in 2009 $242.7 billion in 2013 Physicians $109.4 billion in 2009 $130.3 billion in /5 of Medicare $ to hospitals and physicians

7 Medicare: Pay for Quality and Value? 85% of Medicare payments in % of Medicare payments in % through alternative payment models by 2016 ACO BPCI Value based purchasing

8 Reimbursement Methodology Good habit today Better reimbursement Future bad habit Less reimbursement EHR Incentive Physician Quality Reporting System

9 Alternative Models Bundled care Accountable Care Organizations (ACOs) Bundled Payments for Care Improvement (BPCI) Shifting risk and cost From carrier / insurer To hospital / provider / physician level

10 Medicare ACOs: Basics of the Program Legal entities under state law main purpose includes: Receiving and distributing Medicare shared savings Repaying shared losses or other monies owed to CMS Establishing, reporting and ensuring provider compliance with health care quality criteria ACO Participants work together to manage and coordinate care for Medicare beneficiaries Triple Aim: better care for individuals, better health for populations, and lower growth in expenditures

11 Trajectory of Medicare ACO Program April 2012 October 2012 January 2013 January 2014 January 2015 CMS Innovation Center 27 ACOs 106 ACOs 250+ ACOs 366 ACOs 405 ACOs 32 ACOs in Pioneer ACO model when it began, 19 remain

12 What is an ACO? Eligible participants 5,000 Beneficiaries TIN Legal entity Shared savings/losses Quality measures

13 Pros and Cons of ACOs Pros Opportunity to increase Medicare reimbursement if targets met May provide a vehicle for negotiating with private payers Fraud and abuse waiver

14 Pros and Cons of ACOs Cons Becoming an ACO is a large and complicated undertaking Primary care focused-would require enlisting primary care physicians with at least 5,000 covered lives as well as acute care hospitals Expensive to establish

15 Pros and Cons of ACOs Cons No guarantee that savings benchmarks would be achieved Most of any savings would likely have to be shared with the PCPs and acute care hospitals The fraud and abuse waiver is not unlimited

16 ACO Performance Mixed Results (Year 1 MSSP) Net Savings$383 million ½ of participants reduced spending ¼ of participants received shared savings One ACO in Track 2 overspent target by $10 million, and owed shared losses of $4 million (Source: CMS, Medicare ACOs continue to succeed in improving care, lowering cost growth (Nov. 2014))

17 Bundled Payments for Care Improvement Medicare pays for a bundle of care based on pre-identified DRGs Acute care and post-acute care redesign = $$ savings or risk? Share savings or risk with physicians Administrative requirements Does it work? - Too early to tell

18 Alternative Payment Models Patient-Centered Medical Homes (PCMH) Care coordination through patient s primary care physician Medicare Reimbursement Transitional Care Management (TCM) Chronic Care Management (CCM)

19 Value Based Payment Model Do you report PQRS? No: 2-4% decrease How large is your group? 10 or more 1-9 physicians Quality Cost

20 Over the Horizon. but not too far Health Care Transformation Task Force Private payors and health care systems 75% of all payments tied to value in 2020 Health Care Payment and Learning Action Network (HCPLAN?) CMS-led Payors, Medicaid, employers

21 Over the Horizon. but not too far Old language Budget neutrality SGR "New language" Category neutrality Quality value based modifier Alternative payment ACO, BPCI Population based model Fee for service category less attention

22 Takeaways? Data and quality are key Larger groups = bigger Medicare impact Early adopters - mixed results Currently voluntary, but movement toward value across system Federal and private payors may work together Patients will still need physicians Medicare will still need physicians

23 Innovative Programs

24 Questions Kristin Carter Ober Kaler Christopher Dean Ober Kaler

Accountable Care Organizations and Provider Integration Under Health Care Reform. Sarah Swank 202.326.5003 seswank@ober.com

Accountable Care Organizations and Provider Integration Under Health Care Reform. Sarah Swank 202.326.5003 seswank@ober.com Accountable Care Organizations and Provider Integration Under Health Care Reform Sarah Swank 202.326.5003 seswank@ober.com February 26, 2014 Overview Affordable Care Act and ACOs Trends in Integration

More information

NAVIGATING ALTERNATIVE PAYMENT MODELS

NAVIGATING ALTERNATIVE PAYMENT MODELS NAVIGATING ALTERNATIVE PAYMENT MODELS 2016 Annual Meeting Kansas Grown: Strong, Healthy & Caring Overland Park, KS Learning Objectives Aledade will be presenting on how partnering with our company helps

More information

Merit-Based Incentive Payment System November 17, 2015

Merit-Based Incentive Payment System November 17, 2015 Merit-Based Incentive Payment System November 17, 2015 Today s presenters: Thomas Bennett, Client Services Relationship Manager Elisabeth Renczkowski, Content Specialist Agenda Current Health IT Landscape

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

MACRA: Looking Ahead - Implications Across the Care Continuum. May 16, 2016/ 12:00-1:00 PM EST

MACRA: Looking Ahead - Implications Across the Care Continuum. May 16, 2016/ 12:00-1:00 PM EST MACRA: Looking Ahead - Implications Across the Care Continuum May 16, 2016/ 12:00-1:00 PM EST 1 Today s Presenter Melinda Hancock Partner, DHG Healthcare Leads a team in developing DHG Healthcare s next

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

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

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

Alternative Payment Models Impacting Care Delivery Across the Care Continuum

Alternative Payment Models Impacting Care Delivery Across the Care Continuum Alternative Payment Models Impacting Care Delivery Across the Care Continuum AT A GLANCE Contributing Tenant Partners The recent announcement by HHS and CMS accelerates the movement away from FFS and provides

More information

Clinical Integration: A Road Map to Accountable Care

Clinical Integration: A Road Map to Accountable Care Clinical Integration: A Road Map to Accountable Care Jacqueline Matthews, RN, MS Senior Healthcare Transformation Director IBM Watson Health May 12, 2016 Housekeeping 1. Using the control panel - Use the

More information

The Changing Face of Healthcare: Challenges & Solutions. Mark Stauder, President/COO

The Changing Face of Healthcare: Challenges & Solutions. Mark Stauder, President/COO The Changing Face of Healthcare: Challenges & Solutions Mark Stauder, President/COO Disclosure of Relevant Financial Relationship with Commercial Companies/Organizations Mark Stauder has disclosed financial

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

A Glimpse at MACRA August 16, 2016

A Glimpse at MACRA August 16, 2016 A Glimpse at MACRA August 16, 2016 Medicare Payment Prior to MACRA Fee-for-service (FFS) payment system, where clinicians are paid based on volume of services, not value. The Sustainable Growth Rate (SGR)

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

Population Health Management: Banner Health Network s Perspective. Neta Faynboym, Medical Director Banner Health Network

Population Health Management: Banner Health Network s Perspective. Neta Faynboym, Medical Director Banner Health Network Population Health Management: Banner Health Network s Perspective Neta Faynboym, Medical Director Banner Health Network 29 Acute Care Hospitals BANNER AT A GLANCE Banner Health Network with 400K lives

More information

Understanding MACRA and Impact on Providers

Understanding MACRA and Impact on Providers Health Policy Understanding MACRA and Impact on Providers Prepared for National Accountable Care Congress November 16, 2015 Trusted Advisor to America s Leading Health Systems Three Decades of Experience

More information

Engage Connect Influence

Engage Connect Influence Engage Connect Influence 2013 CAP Policy Meeting Pathology s Experience with Care Coordination Blair Childs Premier Healthcare Alliance Blair Childs SVP, Public Affairs THE NATION S LARGEST HEALTHCARE

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

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

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

CPCA California Primary Care Association

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

More information

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

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

Meaningful Use: The Next Chapter January 13, 2016

Meaningful Use: The Next Chapter January 13, 2016 Meaningful Use: The Next Chapter January 13, 2016 In collaboration with: Today s presenter: Al Wroblewski, Client Services Relationship Manager Agenda Expanded Role of Health IT Drives Change Payment Reform

More information

Mount Sinai Care: A Medicare Shared Savings Program Primer. Brett Bernstein, MD, AGAF, FASGE Medical Director, Provider Partners of Mount Sinai IPA

Mount Sinai Care: A Medicare Shared Savings Program Primer. Brett Bernstein, MD, AGAF, FASGE Medical Director, Provider Partners of Mount Sinai IPA Mount Sinai Care: A Medicare Shared Savings Program Primer Brett Bernstein, MD, AGAF, FASGE Medical Director, Provider Partners of Mount Sinai IPA Mount Sinai Health System Network Mount Sinai Health System

More information

Accountable Care Communities 101. Jennifer M. Flynn, Esq. Senior Director, State Affairs Premier healthcare alliance January 30, 2014

Accountable Care Communities 101. Jennifer M. Flynn, Esq. Senior Director, State Affairs Premier healthcare alliance January 30, 2014 Accountable Care Communities 101 Jennifer M. Flynn, Esq. Senior Director, State Affairs Premier healthcare alliance January 30, 2014 Premier is the largest healthcare alliance in the U.S. Our Mission:

More information

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

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

More information

MACRA: Medicare's Shift to Value-based Delivery & Payment Models. Presented by Amy Mullins, MD, CPE, FAAFP

MACRA: Medicare's Shift to Value-based Delivery & Payment Models. Presented by Amy Mullins, MD, CPE, FAAFP MACRA: Medicare's Shift to Value-based Delivery & Payment Models Presented by Amy Mullins, MD, CPE, FAAFP Current State Over Utilization Volume over Value Fee for Service Silos of Care 2 Push Toward Value

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

How to Prepare for CMS Bundled Payments

How to Prepare for CMS Bundled Payments How to Prepare for CMS Bundled Payments Mandatory bundled payments for joint replacement will serve as many hospitals first pilot program for value-based reimbursement in 2016. Combined with the five-star

More information

CMS/CMMI Pioneer ACO Model AAMC Contacts: Karen Fisher, J.D. Jane Eilbacher 202-862-6140 202-828-0896 kfisher@aamc.org jeilbacher@aamc.

CMS/CMMI Pioneer ACO Model AAMC Contacts: Karen Fisher, J.D. Jane Eilbacher 202-862-6140 202-828-0896 kfisher@aamc.org jeilbacher@aamc. CMS/CMMI Pioneer ACO Model AAMC Contacts: Karen Fisher, J.D. Jane Eilbacher 202-862-6140 202-828-0896 kfisher@aamc.org jeilbacher@aamc.org Updated 6/16/11 CMS Objective for Pioneer ACOs To design an ACO

More information

Medicare ACO Road Map

Medicare ACO Road Map PYALeadership Briefing Medicare ACO Road Map January, 2013 Medicare ACO Road Map The Centers for Medicare & Medicaid Services ( CMS ) has announced 106 new accountable care organizations ( ACOs ) have

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

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

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

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

More information

Accountable Care Organizations: 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

Concurrent Session 2.3. Building an ACO Framework: Opportunities and Challenges for Providers and Hospitals. Dr. Edward G.

Concurrent Session 2.3. Building an ACO Framework: Opportunities and Challenges for Providers and Hospitals. Dr. Edward G. Concurrent Session 2.3 Building an ACO Framework: Opportunities and Challenges for Providers and Hospitals Dr. Edward G. Murphy Chairman Amin Neghabat SVP, Business Development 1 Introduction Sound Physicians,

More information

AIM: A Medicare ACO for Rural Providers. Federal Office of Rural Health Policy April 2, ACO Investment Model

AIM: A Medicare ACO for Rural Providers. Federal Office of Rural Health Policy April 2, ACO Investment Model AIM: A Medicare ACO for Rural Providers Federal Office of Rural Health Policy April 2, 2015 ACO Investment Model Stephen Jenkins, Model Lead April 2 nd, 2015 1 Opportunity The business case for an ACO

More information

CMS ACO Proposed Regulations

CMS ACO Proposed Regulations CMS ACO Proposed Regulations May 2011 Proposed CMS ACO Regulations Proposed Regulations issued March 31, 2011 Comments due back June 6, 2011 Requires 3 year binding commitment Formal Legal Structure Required

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

OHIO HOSPITAL ASSOCIATION 2015 Annual Meeting. Accountable Care Organizations Comprehensive Integration Strategy

OHIO HOSPITAL ASSOCIATION 2015 Annual Meeting. Accountable Care Organizations Comprehensive Integration Strategy OHIO HOSPITAL ASSOCIATION 2015 Annual Meeting Accountable Care Organizations Comprehensive Integration Strategy ACO Development Market Conditions Increasing Economic pressures Consumerism Regulatory scrutiny

More information

Medicare Shared Savings Program

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

More information

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

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

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

What is an Accountable Care Organization. Amit Rastogi, MD President/CEO PriMed What is an Accountable Care Organization Amit Rastogi, MD President/CEO PriMed Goals Why is U.S. healthcare undergoing dramatic change How reimbursement structures are likely to change What is the timeline

More information

U.S. HOUSE OF REPRESENTATIVES COMMITTEE ON ENERGY AND COMMERCE

U.S. HOUSE OF REPRESENTATIVES COMMITTEE ON ENERGY AND COMMERCE U.S. HOUSE OF REPRESENTATIVES COMMITTEE ON ENERGY AND COMMERCE April 15, 2016 TO: FROM: Members, Subcommittee on Health Committee Majority Staff RE: Hearing entitled Medicare Access and CHIP Reauthorization

More information

Webinar: Next Generation ACO Implications: Impact of the New CMS ACO Model

Webinar: Next Generation ACO Implications: Impact of the New CMS ACO Model Webinar: Next Generation ACO Implications: Impact of the New CMS ACO Model a HealthcareWebSummit Event, 1PM Eastern, Wednesday, April 22nd, 2015 Individual Registration Fee: $195. Post-Event Materials:

More information

Advanced Payment Models in Medicare and Medicaid Draft May 1, 2015

Advanced Payment Models in Medicare and Medicaid Draft May 1, 2015 Advanced Payment Models in Medicare and Medicaid Draft May 1, 2015 Secretary of Health and Human Services (HHS) Burwell recently announced a goal for Medicare of having 30% of fee-for-service (FFS) payments

More information

Harriet L. Hall, Ph.D., President and CEO Jefferson Center for Mental Health

Harriet L. Hall, Ph.D., President and CEO Jefferson Center for Mental Health Harriet L. Hall, Ph.D., President and CEO Jefferson Center for Mental Health Medicaid expansion state State-run health insurance exchange Colorado Office of Behavioral Health renamed in 2010 to reflect

More information

SGR Repeal and Medicare Provider Payment Modernization Act of 2015: Timeline of Implementation

SGR Repeal and Medicare Provider Payment Modernization Act of 2015: Timeline of Implementation SGR Repeal and Medicare Provider Payment Modernization Act of 2015: Timeline of Implementation 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026+ Base Update Jan Jun: 0 July- Dec: 0.5 0.5% 0.5%

More information

National Trends in Medicare Alternative Payment Models. James Michel Senior Director, Medicare Reimbursement & Policy AHCA

National Trends in Medicare Alternative Payment Models. James Michel Senior Director, Medicare Reimbursement & Policy AHCA National Trends in Medicare Alternative Payment Models James Michel Senior Director, Medicare Reimbursement & Policy AHCA Discussion Review of CMS priorities and goals related to shifting Medicare spending

More information

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

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

More information

MACRA MIPS and CME. Working Group 3/17/16

MACRA MIPS and CME. Working Group 3/17/16 MACRA MIPS and CME Working Group 3/17/16 MACRA, MIPS and CME Enacted in April 2015 Eliminates SGR; Requires EHR interoperability by 2018 Creates Two New Payment Paths for Medicare Eligible Provider Reimbursement

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

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

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

PHOTO HERE. Monarch Pioneer ACO. Current State and Future Outlook January 12, 2015

PHOTO HERE. Monarch Pioneer ACO. Current State and Future Outlook January 12, 2015 PHOTO HERE Monarch Pioneer ACO Current State and Future Outlook January 12, 2015 Questions 1. Are ACOs meeting their full potential? 2. What changes should be made to achieve the Triple Aim? 2 Monarch

More information

Clinically Integrated Networks and Accountable Care Organizations

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

More information

Value-Based Payment and Health System Transformation

Value-Based Payment and Health System Transformation Value-Based Payment and Health System Transformation National Health Policy Forum Patrick Conway, M.D., MSc CMS Chief Medical Officer Deputy Administrator for Innovation and Quality Director, Center for

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

MACRA & APMs: More than Acronyms June 2, 2016

MACRA & APMs: More than Acronyms June 2, 2016 MACRA & APMs: More than Acronyms June 2, 2016 Agenda 1. Framework 2. CMS Quality Initiatives 3. MACRA - MIPS or APM? 4. Alternative Payment Models 5. Case Study 2 Alternative Payment Models Transitioning

More information

Accountable Care and Value Based Payments 101: Government Programs Update

Accountable Care and Value Based Payments 101: Government Programs Update 1 Accountable Care and Value Based Payments 101: Government Programs Update June 24 th, 2014 Dave Neiman, FSA, MAAA Senior Consulting Actuary DaveN@Wakely.com (720) 226-9806 2 Caveats Opinions expressed

More information

Using the MSSP ACO Model as a Pathway Towards Risk Contracting

Using the MSSP ACO Model as a Pathway Towards Risk Contracting Using the MSSP ACO Model as a Pathway Towards Risk Contracting Hymin Zucker MD, CMO & Amy Holm, MHA Triple Aim Development Group November 12 th 13 th 2015 Extinction/Volume Evolution/Value 1 Disclaimer:

More information

Accountable Care Organizations

Accountable Care Organizations Accountable Care Organizations Myth, Reality, Facts Why =System Failure Low Quality - IOM report High Cost Quality Cost disconnect Low Value Problems Disconnect between Quality and Cost Care is fragmented

More information

Newsroom. The quality measures are organized into four domains:

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

More information

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

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

Accountable Care Organization Overview

Accountable Care Organization Overview Accountable Care Organization Overview Presented by: Bill Wachs & Kai Tsai April 28, 2015 This webinar is brought to you by the American Hospital Association s Center for Healthcare Governance. Backed

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

Proposed Rule: Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations (CMS-1461-P)

Proposed Rule: Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations (CMS-1461-P) Via online submission to http://www.regulations.gov February 6, 2015 Sylvia M. Burwell Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS 1461

More information

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

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

More information

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

Accountable Care Organization Refinement Brief

Accountable Care Organization Refinement Brief 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

More information

SGR Repeal: What Are the Implications to Academic Medicine? Len Marquez Mary Wheatley April 17, 2015

SGR Repeal: What Are the Implications to Academic Medicine? Len Marquez Mary Wheatley April 17, 2015 SGR Repeal: What Are the Implications to Academic Medicine? Len Marquez Mary Wheatley April 17, 2015 Agenda SGR Eulogy High Level Issues in HR2 Important to Academic Medicine Overview of the SGR Replacement

More information

Survey of Connecticut Accountable Care Organizations

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

More information

5/19/2016 MIPS AND MACRA: MAKING SENSE OF THE NEW REGULATIONS AND PAYMENT SYSTEMS. No Disclosures AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS

5/19/2016 MIPS AND MACRA: MAKING SENSE OF THE NEW REGULATIONS AND PAYMENT SYSTEMS. No Disclosures AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS MIPS AND MACRA: MAKING SENSE OF THE NEW REGULATIONS AND PAYMENT SYSTEMS 1 No Disclosures 2 1 To Better Understand the Future.. We must remember the past regarding physician payment. 3 THE SGR SGR=Sustainable

More information

Pioneer ACO Model: Overview

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

More information

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

NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS. Briefing Paper on the Proposed Medicare Shared Savings Program

NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS. Briefing Paper on the Proposed Medicare Shared Savings Program 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

More information

An Overview of Clinical Integration, ACOs and Risk Contracting

An Overview of Clinical Integration, ACOs and Risk Contracting An Overview of Clinical Integration, ACOs and Risk Contracting November 9, 2012 Todd Fitz Vice President Strategic Advisory Services Agenda Review factors driving evolution toward value-based care Outline

More information

Health Care and Political Polarization. Northeast Business Group on Health April 2012

Health Care and Political Polarization. Northeast Business Group on Health April 2012 Health Care and Political Polarization Northeast Business Group on Health April 2012 Peter R. Orszag Citigroup, Council on Foreign Relations, and Bloomberg What is driving the recent deceleration in health

More information

ASQ s Healthcare Update: published in collaboration with the ASQ Healthcare Division

ASQ s Healthcare Update: published in collaboration with the ASQ Healthcare Division Guest Essays Opportunities for Quality Professionals in the Accountable Care World by Donald E. Lighter, M.D., corporate medical director for healthcare quality and safety, Shriners Hospitals for Children

More information

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

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

More information

CLINICALLY INTEGRATED NETWORKS: BUSINESS AND LEGAL CONSIDERATIONS

CLINICALLY INTEGRATED NETWORKS: BUSINESS AND LEGAL CONSIDERATIONS 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

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

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

ACO Valuation Issues and Economic Challenges in light of the Regulatory Guidance

ACO Valuation Issues and Economic Challenges in light of the Regulatory Guidance ACO Valuation Issues and Economic Challenges in light of the Regulatory Guidance AHLA Fraud and Compliance Forum October 1-2, 2012 Presented by: Thomas Bartrum, Esq., Baker Donelson et al. Albert Chip

More information

Medicare Shared Savings Program

Medicare Shared Savings Program Medicare Shared Savings Program Eastern Michigan Chapter of HFMA Insurance and Reimbursement Committee April 30, 2015 Presenter: Kenneth B. Lipan, FHFMA Director of Finance: Clinical Integration, Unified

More information

Accountable Care Organizations An Operational Overview

Accountable Care Organizations An Operational Overview Accountable Care Organizations An Operational Overview Chris Champ Principal cchamp@eidebailly.com 701-239-8620 1 Medicare Spending 2 1 CMS Goal Transition of Risk 60 50 40 30 20 10 0 2015 2016 2018 Percentage

More information

The true meaning of ACO is Awesome Consulting Opportunities. - The Weekly Standard, 04/12/11. Consultants

The true meaning of ACO is Awesome Consulting Opportunities. - The Weekly Standard, 04/12/11. Consultants 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

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

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

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

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

More information

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

Physician Integration Models: ACOs as the Latest and Greatest? David T. Lewis david.lewis@lpnt.net LifePoint Hospitals, Inc.

Physician Integration Models: ACOs as the Latest and Greatest? David T. Lewis david.lewis@lpnt.net LifePoint Hospitals, Inc. Physician Integration Models: ACOs as the Latest and Greatest? David T. Lewis david.lewis@lpnt.net LifePoint Hospitals, Inc. Brentwood, TN Kim Harvey Looney kim.looney@wallerlaw.com Waller Lansden Dortch

More information

A MACRA Overview. A web discussion with guests Ivy Baer, Gayle Lee, and Tanvi Mehta of AAMC

A MACRA Overview. A web discussion with guests Ivy Baer, Gayle Lee, and Tanvi Mehta of AAMC A MACRA Overview A web discussion with guests Ivy Baer, Gayle Lee, and Tanvi Mehta of AAMC An Affinity Group Brought to you by HFMA and Vizient Sponsored by Kaufman Hall June 6, 2016 Meeting Notes Plan

More information

Steven E. Ramsland, Ed.D., Senior Associate, OPEN MINDS The 2015 OPEN MINDS Performance Management Institute February 13, 2015 10:15am 11:30am

Steven E. Ramsland, Ed.D., Senior Associate, OPEN MINDS The 2015 OPEN MINDS Performance Management Institute February 13, 2015 10:15am 11:30am Steven E. Ramsland, Ed.D., Senior Associate, OPEN MINDS The 2015 OPEN MINDS Performance Management Institute February 13, 2015 10:15am 11:30am The execution or accomplishment of work, acts, or feats The

More information

Adding Value to. Provider Compensation. June 13, 2016. Healthcare Strategy Group OHA Presentation 2016. Adding Value to. Physician Compensation

Adding Value to. Provider Compensation. June 13, 2016. Healthcare Strategy Group OHA Presentation 2016. Adding Value to. Physician Compensation Provider Compensation June 13, 2016 1 Who are We? About (HSG) Hospital-physician integration specialists since 1999 Strategic, best practice approach to employed physician networks and independent physician

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

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