Keith J. Mueller, Ph.D. Director, RUPRI Center for Rural Health Policy Analysis Head, Department of Health Management and Policy College of Public
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1 Presentation to the National Organization of State Offices of Rural Health August 29, 2012 Chicago, Illinois Keith J. Mueller, Ph.D. Director, RUPRI Center for Rural Health Policy Analysis Head, Department of Health Management and Policy College of Public Health University of Iowa
2 Increasingly intensive focus on cost New models rolling out ambulatory System expansion/growth Mergers, acquisitions, affiliations
3 A rural community focus What is needed? What do we have? How do we play in a way that sustains essential local services?
4 Value Patient-centered Choice Savings
5 Accepting insurance risk Focus on population health Trimming organization costs Using the data being captured (e.g., electronic health records) Health care as retail business
6 Transitions have to be managed First do no harm Relationships among strange bedfellows (urban and rural, systems and independents, institutions and community-based providers) Value, value, value proposition is critical Flexibility in business plans means flexibility in policy models
7 Not just a buzz word Is a new model, built on use of data systems and management strategies Provider systems focused on health
8 Private started before Medicare Medicare Pioneer, MSSP, Advanced Payment Almost daily stories on more being formed And they are in rural places (the first 59 Medicare ACOs)
9 Accountable Care Organizations Pioneer and Shared Savings ACOs, Western Census Region Metropolitan county Non-metropolitan county ACO coverage area
10 Accountable Care Organizations Pioneer and Shared Savings ACOs with rural coverage, Western Census Region Metropolitan county Non-metropolitan county ACO coverage area
11 Accountable Care Organizations Pioneer and Shared Savings ACOs Midwest Census Region Metropolitan county Non-metropolitan county ACO coverage area
12 Accountable Care Organizations Pioneer and Shared Savings ACOs with rural coverage, Midwest Census Region Metropolitan county Non-metropolitan county ACO coverage area
13 Accountable Care Organizations Pioneer and Shared Savings ACOs South Census Region Metropolitan county Non-metropolitan county ACO coverage area
14 Accountable Care Organizations Pioneer and Shared Savings ACOs with rural coverage, South Census Region Metropolitan county Non-metropolitan county ACO coverage area
15 Accountable Care Organizations Pioneer and Shared Savings ACOs Northeast Census Region Metropolitan county Non-metropolitan county ACO coverage area
16 Accountable Care Organizations Pioneer and Shared Savings ACOs with rural coverage, Northeast Census Region Metropolitan county Non-metropolitan county ACO coverage area
17 32 Pioneer ACOs 116 MSSP ACOs are Advanced Payment 221 private sector ACOs
18 ACO DISTRIBUTION BY STATE Source: David Muhlestein, Andrew Croshaw, Tom Merrill, Cristian Pena. Growth and Dispersion of Accountable Care Organizations: June 2012 Update. Leavitt Partners. Accessed August 20, 2012 from LeavittPartners.com 18
19 ACO DISTRIBUTION BY HOSPITAL REFERRAL REGION Source: David Muhlestein, Andrew Croshaw, Tom Merrill, Cristian Pena. Growth and Dispersion of Accountable Care Organizations: June 2012 Update. Leavitt Partners. Accessed August 20, 2012 from LeavittPartners.com 19
20 Data from D Mulestein, A Croshow, T Merrill, and C Pena, Growth and Dispersion of Accountable Care Organizations: June 2012 Update. Leavitt Partners. Accessed August 20, LeavittPartners.com IN: 2 Hospital System, 1 Insurer KS: 1 Insurer WI: 7 Hospital System, 2 Physician Group, 1 Insurer IA: 3 Hospital System, 2 Insurer
21 IL: 2 Hospital System, 1 Physician Group, 1 Insurer NE: 2 Hospital System MI: 8 Hospital System, 3 Physician Group, 1 Insurer MN: 4 Hospital System, 2 Physician Group OH: 8 Hospital System, 1 Insurer MO: 3 Hospital System, 1 Insurer
22 Colorado Accountable Care Collaborative: began pilot in 2011 New Jersey Medicaid ACO Demonstration: authorizing legislation passed in 2011 Oklahoma Accountable Care Organization for Dual Eligibles: PCCM program, contemplating Medicare ACO
23 Oregon Coordinated Care Organization Plan: authorizing legislation enacted in early 2012; implementation underway Utah Accountable Care Organization Program: Pending CMS waiver approval Source: Kaiser Commission Issue Paper, Emerging Medicaid Accountable Care Organizations: The role of Managed Care. May, 2012.
24 From Journal of Rural Health article by MacKinney, Mueller and McBride, Winter 2011 Preserving rural autonomy Adapting rural practice design Adapting to low rural volumes Baseline against historical rural efficiency
25 Meeting urban motivations in regional design Addressing urban provider cost structure Overcoming legal and regulatory barriers Accelerating learning curves for rural leaders
26 Developing networks: exclusively rural, regional collaboratives, rural participation in large systems best positioning for rural providers Understanding motivations of parties to negotiations: rural-urban, urban-rural, publicprivate, private-public Adopting best practices in patient care and clinic management Developing performance measures
27 Provider readiness/support Flexibility in design Effects on payment and revenue Part of the move to pay for value
28 For Further Information The RUPRI Center for Rural Health Policy Analysis The RUPRI Health Panel
29 Dr. Keith J. Mueller Department of Health Management and Policy College of Public Health 105 River Street, N232A, CPHB Iowa City, IA
Presentation to the State Offices for Rural Health - Region D Meeting San Diego, CA May 1, 2013
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Keith J. Mueller, PhD Director, RUPRI Center for Rural Health Policy Analysis Head, Department of Health Management and Policy University of Iowa
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