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

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

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

Transcription

1 Accountable Care Organizations 101 MultiCare Connected Care October 20 22,

2 Objectives 1. Describe what an ACO is and why we believe developing an ACO is important 2. Describe examples of what integration looks like and how we can work together to meet the challenges of health care reform successfully 3. Articulate the three pillars of our ACO approach 2

3 MHS ACO Strategy & Status Payors Purchasers (Employers) People & Populations Providers 3

4 BACKGROUND 4

5 What is an Accountable Care Organization (ACO)? Group of providers responsible for: Meeting the health care needs of a defined population; Working together while pursuing the goals of improved health; Improving the patient experience; and Controlling medical cost and achieving defined clinical outcomes. 1 Better Care for Individuals Better Health for Populations ACOs are built on the foundation of the Triple Aim. 2 Lower Cost per Capita 1 1 National Committee For Quality Assurance - NCQA.org 2 Berwick, Don M. Workshop on Issues Related to Accountable Care Organizations

6 Goal: Improve Quality via Clinical Integration Communication Patient Experience Medical Management Care Coordination Population Health Technology and Analytics Collaborative communication and data sharing among providers and across the spectrum of care Open communication, active involvement and improved clinical outcomes and access through the use of Patient Centered Medical Homes Chronic Condition and Case Management; frequent ED user and high risk patient management Support to patients across the continuum of care Data management to support clinical outcomes and cost management Integrated technology and data access to patient records, and enhanced continuity of care 6

7 Why are ACOs evolving? Issues Healthcare costs in the US are rising faster than all other goods and services; these increases are unsustainable Quality of care is inconsistent and geographically determined Declining reimbursement Market Responses Businesses are demanding change in continuously rising insurance rates Implementation of the Affordable Care Act Development of integrated systems and Electronic Health Records Consumerism is raising expectations for quality and price transparency 7

8 Current vs. Future State Providers PCP Specialist Surgeon Other Providers Services Lab Radiology Imaging Pathology Other Facilities Outpatient Inpatient Surgery Center Rehab Emergency Services Long Term Care Current State Silos and fragmentation Duplication Independent decision making Patient self-navigates system and coordinates services 8

9 Current vs. Future State Future State Patient-centered and integrated Providers work to coordinate care for patients Designed to meet comprehensive patient needs Utilizes community services and resources 9

10 NATIONAL TRENDS 10

11 National Trends More than 600 ACOs operating across the US at the beginning of ,7 As of the beginning of 2014, it was estimated that 18.2 million American were receiving healthcare through Accountable Care Organizations 6 ACOs are now located in all 50 states and the District of Columbia 6 Quality Performance Comparing commercial ACO results is difficult due to lack of uniformity in measurement and reporting 5 Outcome and financial performance are preliminary and incomplete at this time 5 Exhibit 1: Accountable Care Organizations By State 5 5 Health Affairs May Health Affairs January California HealthCare Foundation,

12 Case Study - Monarch Healthcare ACO OC s Monarch HealthCare ACO Model Gets High Marks for First Year 1 Ranking 2 nd highest performing Pioneer ACO Location and Structure Orange County CA, IPA Size 300 PCPs/50 specialist serving 21,856 members Highest Scores Physician communication, patient satisfaction, care coordination, patient safety metrics Financial Results Cut costs by 5.4% in 2012 Key Drivers for Success Narrowing network with top-performing physicians Giving doctors incentives to perform annual wellness visits Identifying high risk patients using stratification tools and care managers Integrating a 12-month patient history to web interface 1 Physicians Network News.com Posted: Sunday, January 12,

13 Case Study: Anthem Blue Cross PPO/ACO Anthem Blue Cross and HealthCare Partners Save $4.7 Million In Six Months While Improving Quality of Care Provided 1 Location and Structure Southern California, Commercial ACO, Healthcare Partners PPO Size 6300 PCP s and Specialists Key Metrics Reduced incidence of hospital visits and outpatient visits, including ED by 4% Members reported 4% fewer lab and radiology visits; slightly better results in managing cholesterol and blood sugar levels Key Drivers for Success Anthem (insurer) paid management fee and provided rich-data set of information identifying out-of-network utilization which incentivized Partners to reach out to those patients Synergies established between healthplan and providers through data sharing 1 HealthLeadersMedia.com June

14 ROADMAP TO SUCCESS 14

15 Requisites for Successful ACOs Strategic and Cultural Capabilities 8 Shared strategic vision that identifies long term goals within the context of community health needs, provider capabilities and state/federal policy Respectful relationships and clear channels of communication between ACO participants Operational and Infrastructural Capabilities 8 1. Use of care model principles that support the clinical and organizational infrastructure, including care coordination, IT, and financial systems 2. Governance and organizational structure that support ACO strategy through shared hospital-physician leadership, transparent decision making and clarity surrounding participants roles 3. Provider financial incentives and management that address cost, access, quality, and choice and are consistent the ACOs strategic goals 4. Analytics and population management for health analysis and tracking of care model impact on quality of care and cost management 8 8 California Health Care Foundation 15

16 Provider Leadership and Legal Structures Provider Leadership Majority of ACOs are physician led (51%) or jointly led with hospitals (33%) 3 Legal Requirements Defined management functions and leadership team capable of achieving ACO goals Governing body (Board of Directors) to provide management/operations oversight Bylaws applicable to state and federal requirements Adherence to anti-kickback, anti-trust and other regulatory rules Shared governance between hospitals and physicians Processes in place to ensure ACO participants have meaningful participation 3 Health Affairs June

17 Financial Incentives and Management Fee-For-Service Payment Unit based payment rewarding high volume Value/Outcomes-Based Payment Risk/gain sharing Percent of Premium Bundled payments Pay for Performance (P4P) Full Risk The most successful ACOs to date are those that implement proper financial incentives and closely monitor and manage financial performance. Other necessary capabilities include: Financial investments to develop, utilize and provide ongoing support for payment systems Analytics to monitor cost/quality metrics Sufficient capital and clinical/financial capabilities to support risk assumptions Strategy for transition from lower to higher risk models 17

18 MULTICARE CONNECTED CARE 18

19 Antitrust Law and Regulation Sherman Antitrust Act Federal Trade Commission Act Clayton Act Antitrust laws prohibit physicians, hospitals and other providers from collaborating to the extent that allows too much control over the market. Agreements among providers to fix prices are per se illegal. Networks that are clinically or financially integrated can be an exception to the rule, as long as the benefits to the consumer outweigh any anticompetitive effects. Networks must have a high degree of interdependence and cooperation among physicians to control cost and ensure quality. MultiCare is committed to stringently comply with these laws and has developed the infrastructure necessary to meet the clinical integration requirements for Connected Care. 19

20 Three Pillars for Success Accountable Care Organization (ACO) The Legal Entity Clinically Integrated Network (CIN) The Providers Clinical Collaboratives The Engine Achieving the Triple Aim: Improved Quality, Service and Cost 20

21 MultiCare Connected Care, LLC MultiCare Connected Care (MCC) is an affiliated entity of MultiCare Health System. MCC is wholly owned by MultiCare who will invest in developing the required care management, population health management and quality improvement programs supported by financial and clinical analytic platforms. MultiCare will fund the start up operations and team. The Governing Board structure and composition is shown here. 21

22 MultiCare Connected Care Network Substantive clinical integration is the foundation of MultiCare s CIN Detailed, documented clinical integration roadmap Supported by clinical and financial analytics; EMR data exchange Target size: 1,700 providers; all MultiCare facilities Single signature responsibility for payer/plan sponsor agreements, subject to approval of the governing board. 22

23 Clinical Collaboratives Pediatrics Obesity Appendectomy Medicine COPD Pneumonia Critical Care Sepsis Respiratory Failure Surgery Total Joint Colon Surgery Women s Health OB (e.g. elective C-Sxn rate reduction) GYN (e.g. hysterectomy) Cardiovascular CHF AMI Atrial Fibrillation 23

24 Paradigm Shifts FROM Sick care Episodic Care Silos & Fragmented Care Exclusively Fee-For-Service Duplication Bricks & Mortar Care Single EHR WIIFM TO Wellness and disease management Seamless comprehensive care across the continuum Patient-Centered & Integrated Total Cost of Care Coordinated Providers Continuum of Care Single Source of Information WIIFU* *What s in it for Us include patients, providers, payers, purchasers = populations 24

25 MultiCare ACO Closing Thoughts Purchaser activity in the local market is high. MultiCare currently has ACO agreements with a number of commercial payers and is working on pre-launch activities with UW for Boeing. Additionally, MultiCare has responded to the State of Washington ACO RFI. These agreements currently cover approximately 60,000 lives. Reimbursement today is fee-for-service with quality incentive bonus opportunity; gain share and risk share. It is our intent, as our CIN achieves network adequacy in terms of geographic and specialty coverage, to move these arrangements from the MHS owned/employed network to the ACO CIN. We will execute future ACO arrangements under the ACO with the CIN. We believe Accountable Care products, with narrow networks, will become very important in defending and increasing market share. Through Accountable Care products and arrangements, we will provide greater value to our patients and the community by managing the cost of care while ensuring quality and service. 25

26 Objectives 1. Describe what an ACO is and why we believe developing an ACO is important 2. Describe examples of what integration looks like and how we can work together to meet the challenges of health care reform successfully 3. Articulate the three pillars of our ACO approach 26

27 OTHER QUESTIONS? 27

28 Upcoming Educational Sessions We plan to offer additional interactive sessions on ACO over the next several months. Topics include: Population Health Management Physician role in care coordination and case management Understanding value-based reimbursement approaches Ensuring financial success for the ACO participants. Thank you for attending this evening! 28

Clinical Integration Network (CIN)

Clinical Integration Network (CIN) Clinical Integration Network (CIN) Frequently Asked Questions Q: What is clinical integration? A: Clinical integration is a structured collaboration between community and employed physicians and hospitals

More information

Clinical Integration in Practice Case Study Allina Health

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

More information

Accountable Care Organizations 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

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

PHOTO HERE. Monarch Pioneer ACO: Designing and Implementing a Successful Shared Risk Model

PHOTO HERE. Monarch Pioneer ACO: Designing and Implementing a Successful Shared Risk Model PHOTO HERE Monarch Pioneer ACO: Designing and Implementing a Successful Shared Risk Model March 2014 Agenda About Monarch HealthCare Monarch s Pioneer ACO Experience Monarch s Evolving ACO Strategy Future

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

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

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

More information

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 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

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

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

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

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

More information

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

Accountable Care Organization

Accountable Care Organization Accountable Care Organization April 13, 2011 The Indianapolis Association of Health Underwriters Drivers of Payment Reform Increased attention to regional variation in costs and quality Payment for care

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

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

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

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

IU Health Quality Partners

IU Health Quality Partners 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

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

Accountable care payment

Accountable care payment Accountable care payment Jack Ashby For the Honolulu Subarea Health Planning Council of the Hawaii SHPDA March 1, 2011 Agenda for the presentation Describe major forms of accountable care payment Identify

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 Understanding What They Are and How to Structure Them

Accountable Care Organizations Understanding What They Are and How to Structure Them 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

More information

LARGE SCALE NETWORKS NEXT WAVE OF CLINICAL INTEGRATION

LARGE SCALE NETWORKS NEXT WAVE OF CLINICAL INTEGRATION CENTER FOR INDUSTRY TRANSFORMATION MAY 2015 LARGE SCALE NETWORKS NEXT WAVE OF CLINICAL INTEGRATION Authors Michael Strilesky Principal, DHG Healthcare michael.strilesky@dhgllp.com DHG HEALTHCARE CENTER

More information

PCMH and Care Management: Where do we start?

PCMH and Care Management: Where do we start? PCMH and Care Management: Where do we start? Patricia Bohs, RN, BSN Quality Assurance Manager Kelly McCloughan QA Data Manager Wayne Memorial Community Health Centers Honesdale, PA Wayne Memorial Community

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

Payor Perspectives on Provider Realignment and ACOs

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

More information

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

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

Get Plugged in: Defining Your Connectivity Strategy. CHIME College Live 17 April 2013

Get Plugged in: Defining Your Connectivity Strategy. CHIME College Live 17 April 2013 Get Plugged in: Defining Your Connectivity Strategy CHIME College Live 17 April 2013 Topics Introductions Drivers Strategies Imperatives Discussion Page 2 Copyright Kurt Salmon 2013 All Rights Reserved

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

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

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

More information

Nuts and Bolts Accountable Care Organizations: A New Care Delivery Model for New Expectations

Nuts and Bolts Accountable Care Organizations: A New Care Delivery Model for New Expectations Nuts and Bolts Accountable Care Organizations: A New Care Delivery Model for New Expectations Presented to The American College of Cardiology October 27, 2012 1 Franciscan Alliance Overview Franciscan

More information

The Impact of the Affordable Care Act

The Impact of the Affordable Care Act The Impact of the Affordable Care Act on UC Irvine Health 2013 BUSINESS OFFICER INSTITUTE October 22, 2013 Terry A. Belmont Chief Executive Officer Associate Vice Chancellor for Medical Center Affairs

More information

Improving Quality And Bending the Cost Curve: Strategies That Work

Improving Quality And Bending the Cost Curve: Strategies That Work Improving Quality And Bending the Cost Curve: Strategies That Work Lewis G. Sandy MD SVP, Clinical Advancement, UnitedHealth Group UnitedHealth Center for Health Reform and Modernization AcademyHealth

More information

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

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

Accelerating Clinical Integration

Accelerating Clinical Integration Accelerating Clinical Integration A collaborative white paper written by: Kenneth H. Cohn, MD, MBA, FACS, CEO of Healthcare Collaboration Peter A. Pavarini, J.D., partner at Squire Sanders (US) LLP, Executive

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

PIONEER ACO A REVIEW OF THE GRAND EXPERIMENT. Norris Vivatrat, MD Associate Medical Director Monarch HealthCare

PIONEER ACO A REVIEW OF THE GRAND EXPERIMENT. Norris Vivatrat, MD Associate Medical Director Monarch HealthCare PIONEER ACO A REVIEW OF THE GRAND EXPERIMENT Norris Vivatrat, MD Associate Medical Director Monarch HealthCare 2 Agenda Pioneer ACO basics, performance and challenges Monarch HealthCare Post-acute network

More information

PIONEER ACO A REVIEW OF THE GRAND EXPERIMENT

PIONEER ACO A REVIEW OF THE GRAND EXPERIMENT PIONEER ACO A REVIEW OF THE GRAND EXPERIMENT Norris Vivatrat, MD Associate Medical Director Monarch HealthCare 2 Agenda Pioneer ACO basics, performance and challenges Monarch HealthCare Post-acute network

More information

1/31/2012. St. Joseph Heritage Healthcare & Blue Shield of California ACO Collaborative Leveraging An IDS For Patients! Overview of Presentation

1/31/2012. St. Joseph Heritage Healthcare & Blue Shield of California ACO Collaborative Leveraging An IDS For Patients! Overview of Presentation & Blue Shield of California ACO Collaborative Leveraging An IDS For Patients! February 1 st, 2012 HASC Conference on Blurring the Lines C.R. Burke President/CEO cr.burke@stjoe.org Overview of Presentation

More information

Accountable Care Organizations: Legal and Organizational Structures; Governance

Accountable Care Organizations: Legal and Organizational Structures; Governance 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

More information

Better Clinical Quality Through Physician Alignment. John Mark Fones Senior Vice President Managed Care Commonwealth Health Corporation

Better Clinical Quality Through Physician Alignment. John Mark Fones Senior Vice President Managed Care Commonwealth Health Corporation Better Clinical Quality Through Physician Alignment John Mark Fones Senior Vice President Managed Care Commonwealth Health Corporation When It Comes to Healthcare Reform Pack Your Own Chute Today s Presentation

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 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

BAY AREA ACCOUNTABLE CARE NETWORK

BAY AREA ACCOUNTABLE CARE NETWORK BAY AREA ACCOUNTABLE CARE NETWORK CHIEF EECUTIVE OFFICER Bay Area, California Position Specification Prepared by: Michael Meyer Ryan Hubbs Meyer Consulting 5900 N. Granite Reef Road, Suite 100, Scottsdale,

More information

Build a Clinically Integrated Network

Build a Clinically Integrated Network Build a Clinically Integrated Network Create a Sustainable Future For your PHO/IPA April 25, 2013 Our Speaker Lori Fox Ward, SVP Clinical Integration has worked with Valence Health since 1996. Lori oversees

More information

ANALYTIC-DRIVEN QUALITY KEYS SUCCESS IN RISK-BASED CONTRACTS DATE APRIL 27, 2016

ANALYTIC-DRIVEN QUALITY KEYS SUCCESS IN RISK-BASED CONTRACTS DATE APRIL 27, 2016 ANALYTIC-DRIVEN QUALITY KEYS SUCCESS IN RISK-BASED CONTRACTS DATE APRIL 27, 2016 Ross Gustafson, Vice President Allina Performance Resources, Health Catalyst Brian Rice, Vice President Network/ACO Integration,

More information

6/12/2015. Dignity Health Population Health Management and Compliance Programs. Moving Towards Accountable Care. Dignity Health Poised for Innovation

6/12/2015. Dignity Health Population Health Management and Compliance Programs. Moving Towards Accountable Care. Dignity Health Poised for Innovation Dignity Health Population Health Management and Compliance Programs Julie Bietsch, VP Population Health Management Dawnese Kindelt, Senior Compliance Director, Clinical Integration June 8, 2015 Moving

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

MERCY-CR/UI HEALTH CARE ACCOUNTABLE CARE ORGANIZATION Dan Fick, M.D. Timothy Quinn, M.D.

MERCY-CR/UI HEALTH CARE ACCOUNTABLE CARE ORGANIZATION Dan Fick, M.D. Timothy Quinn, M.D. MERCY-CR/UI HEALTH CARE ACCOUNTABLE CARE ORGANIZATION Dan Fick, M.D. Timothy Quinn, M.D. November, 2012 Accountable Care Organization An ACO is a group of health care providers who agree to take on a shared

More information

Most healthcare leaders would agree that the industry is in

Most healthcare leaders would agree that the industry is in Hospital Solutions White Paper Series In cooperation with: August 2014 About Community Hospital 100 Community Hospital 100 Leadership & Strategy Conference October 19 to 21, 2014 Park Hyatt Aviara Carlsbad,

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

PHI IN THE ACO. Risk Management, Mitigation and Data Collection Issues. Online Tech Webinar May 20, 2014. Tatiana Melnik, Attorney Melnik Legal PLLC

PHI IN THE ACO. Risk Management, Mitigation and Data Collection Issues. Online Tech Webinar May 20, 2014. Tatiana Melnik, Attorney Melnik Legal PLLC PHI IN THE ACO Risk Management, Mitigation and Data Collection Issues Online Tech Webinar May 20, 2014 Tatiana Melnik, Attorney Melnik Legal PLLC Carrie Nixon, Attorney, CEO Nixon Law Group Healthcare

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

Pay for Performance and Accountable Care

Pay for Performance and Accountable Care Pay for Performance and Accountable Care Mark McClellan, MD, PhD Director, Engelberg Center for Health Care Reform Senior Fellow, Economic Studies Leonard D. Schaeffer Chair in Health Policy Studies Brookings

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

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

ESSENTIA HEALTH AS AN ACO (ACCOUNTABLE CARE ORGANIZATION)

ESSENTIA HEALTH AS AN ACO (ACCOUNTABLE CARE ORGANIZATION) ESSENTIA HEALTH AS AN ACO (ACCOUNTABLE CARE ORGANIZATION) Hello and welcome. Thank you for taking part in this presentation entitled "Essentia Health as an ACO or Accountable Care Organization -- What

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

Analytic-Driven Quality Keys Success in Risk-Based Contracts. Ross Gustafson, Vice President Allina Performance Resources, Health Catalyst

Analytic-Driven Quality Keys Success in Risk-Based Contracts. Ross Gustafson, Vice President Allina Performance Resources, Health Catalyst Analytic-Driven Quality Keys Success in Risk-Based Contracts March 2 nd, 2016 Ross Gustafson, Vice President Allina Performance Resources, Health Catalyst Brian Rice, Vice President Network/ACO Integration,

More information

Cigna Collaborative Accountable Care

Cigna Collaborative Accountable Care Cigna Collaborative Accountable Care Health Industry Forum 10-22-12 Dick Salmon, MD, PhD National Medical Director Copyright 2012 by Cigna. NETWORK STRATEGY Achieve the triple aim = better quality, better

More information

Driving Value Through Clinical Integration

Driving Value Through Clinical Integration 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

More information

Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual

Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual 2016 This document is a guide to the 2016 Arkansas Blue Cross and Blue Shield Patient-Centered Medical Home program (Arkansas

More information

Accountable Care Platform

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

More information

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

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

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

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

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

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

DMHC and Regulatory Oversight of the Accountable Care Model

DMHC and Regulatory Oversight of the Accountable Care Model DMHC and Regulatory Oversight of the Accountable Care Model Jay J Cohen, MD, MBA Chairman of the Board and President Monarch HealthCare, a Medical Group, Inc. November 3, 2010 ACO Payment Methodologies

More information

The. for DUKE MEDICINE. Duke University Health System. Strategic Goals

The. for DUKE MEDICINE. Duke University Health System. Strategic Goals The for DUKE MEDICINE The (DUHS) was created by action of the Duke University Board of Trustees as a controlled affiliate corporation in 1998. Its purpose is to enable and enhance the mission of Duke University

More information

Utilizing Clinical Integration to Align Physicians and Increase Market Share

Utilizing Clinical Integration to Align Physicians and Increase Market Share Utilizing Clinical Integration to Align Physicians and Increase Market Share Timothy J. Quinn, MD & Daniel J. Marino DISCLAIMER: The views and opinions expressed in this presentation are those of the author

More information

Clinical Integration as an Effective Physician Alignment Strategy. First Illinois Chapter HFMA Fall Summit 2013

Clinical Integration as an Effective Physician Alignment Strategy. First Illinois Chapter HFMA Fall Summit 2013 Clinical Integration as an Effective Physician Alignment Strategy First Illinois Chapter HFMA Fall Summit 2013 Presented by: Ben Fisk, AVP Business Services, NorthShore University HealthSystem Jim Watson,

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

Delivery System Innovation

Delivery System Innovation Healthcare Transformation Concepts and Definitions Our healthcare transformation process is invigorated by many stakeholders with differing backgrounds. To help them with new terms and all of us to use

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

Best Practices and Lessons Learned about EHR Adoption. Anthony Rodgers Deputy Administrator, Center for Strategic Planning

Best Practices and Lessons Learned about EHR Adoption. Anthony Rodgers Deputy Administrator, Center for Strategic Planning Best Practices and Lessons Learned about EHR Adoption Anthony Rodgers Deputy Administrator, Center for Strategic Planning Presentation Topics Value proposition for EHR adoption Medicaid Strategic Health

More information

The Impact Of Employer Contribution Policy On Premium Rate Setting. Group-Specific Experience: Financial And Utilization Performance

The Impact Of Employer Contribution Policy On Premium Rate Setting. Group-Specific Experience: Financial And Utilization Performance Premiums: HMO Premium Rate Calculations Setting Group Renewal Premium Rates The Impact Of Employer Contribution Policy On Premium Rate Setting Group-Specific Experience: Financial And Utilization Performance

More information

THE FUTURE OF QUALITY HEALTHCARE: ACO S?????

THE FUTURE OF QUALITY HEALTHCARE: ACO S????? THE FUTURE OF QUALITY HEALTHCARE: ACO S????? ARKANSAS LEADERSHIP FORUM Lance W. Keilers, MBA, CAPPM September 15, 2015 Learning Objectives Recognize current changes in rural hospital delivery systems Identify

More information

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

1 HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

1 HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Comments on Framework for Reform of Sustainable Growth Rate To House Energy & Commerce Committee And House Ways & Means Committee By National Committee for Quality Assurance Chairman Upton, Chairman Camp,

More information

Welcome to the First Edition!

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

More information

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

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

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

Legal Challenges and Concerns with Clinical Integration

Legal Challenges and Concerns with Clinical Integration Legal Challenges and Concerns with Clinical Integration By Edward Matto and Claire Turcotte, Bricker & Eckler LLP A clear goal of health reform is to foster greater integration and collaboration among

More information

Advisory Panel for Health Care Advancing the Academic Health System for the Future: Profiles in Academic Health System Leadership.

Advisory Panel for Health Care Advancing the Academic Health System for the Future: Profiles in Academic Health System Leadership. Advisory Panel for Health Care Advancing the Academic Health System for the Future: Profiles in Academic Health System Leadership November, 2013 Project Focus and Methodology Project Focus This project

More information

CLINICAL INTEGRATION: A PHYSICIAN-LED PATH TO VALUE JUNE 7, 2016 WILLIAM J. MAYER, M.D., M.P.H., PRESIDENT AND CEO FEDERATION CARE NETWORK

CLINICAL INTEGRATION: A PHYSICIAN-LED PATH TO VALUE JUNE 7, 2016 WILLIAM J. MAYER, M.D., M.P.H., PRESIDENT AND CEO FEDERATION CARE NETWORK CLINICAL INTEGRATION: A PHYSICIAN-LED PATH TO VALUE JUNE 7, 2016 WILLIAM J. MAYER, M.D., M.P.H., PRESIDENT AND CEO FEDERATION CARE NETWORK OBJECTIVES UNDERSTAND CLINICALLY INTEGRATED NETWORK (CIN) APPROACH

More information

Cornerstone Health Care s ACO Playbook. Grace E. Terrell, MD January 17, 2012

Cornerstone Health Care s ACO Playbook. Grace E. Terrell, MD January 17, 2012 Cornerstone Health Care s ACO Playbook Grace E. Terrell, MD January 17, 2012 Mission: To be your medical home Vision: To be the model for physician-led health care in America Values: As a physician owned

More information

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

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 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

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

Pediatric Alliance: A New Solution Built on Familiar Values. Empowering physicians with an innovative pediatric Accountable Care Organization

Pediatric Alliance: A New Solution Built on Familiar Values. Empowering physicians with an innovative pediatric Accountable Care Organization Pediatric Alliance: A New Solution Built on Familiar Values Empowering physicians with an innovative pediatric Accountable Care Organization BEYOND THE TRADITIONAL MODEL OF CARE Children s Health SM Pediatric

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

Early Lessons learned from strong revenue cycle performers

Early Lessons learned from strong revenue cycle performers Healthcare Informatics June 2012 Accountable Care Organizations Early Lessons learned from strong revenue cycle performers Healthcare Informatics Accountable Care Organizations Early Lessons learned from

More information

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