Bellin-ThedaCare Healthcare Partners a Pioneer Accountable Care Organization. George Kerwin President/CEO Bellin Health

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Bellin-ThedaCare Healthcare Partners a Pioneer Accountable Care Organization. George Kerwin President/CEO Bellin Health"

Transcription

1 Bellin-ThedaCare Healthcare Partners a Pioneer Accountable Care Organization George Kerwin President/CEO Bellin Health

2 Objectives Describe the characteristics of Bellin-ThedaCare Healthcare Partners and the market we serve Provide an overview of the Pioneer Accountable Care Organization opportunity Review our analysis of CMS data relating to our Pioneer population Share our keys to success 2

3 SYSTEM RESOURCES 697 Physicians 57 Primary Care Locations 3 Tertiary Hospitals 4 Critical Access Hospitals 1 Psychiatric Hospital with fullservice Behavioral Health Clinic Hospice & Palliative Care Services Skilled Nursing Facilities (1 systemowned) POPULATION SEGMENTS Employees, Children & Families 540,000 people Medicare160,000 people Medicaid 180,000 people Uninsured 120,000 people Total Population 1,000,000 people 3

4 Bellin Health-ThedaCare Relationship Characteristics Contiguous markets with similar demographics and economic base Early adoptors of process improvement theory Similar governance Common competitors Operated a joint venture, provider-based health plan for 10 years ( ) Share an enterprise-wide medical record based on Epic software In 2006, established a clinically integrated delivery system, known today as Bellin- ThedaCare Healthcare Partners 4

5 Business Case High Coordination -$ $$ Low Risk TODAY -$ High Risk Low Coordination 5

6 Payer Segments by % of Net Revenue Commercial Self-Funded Fully-Funded Individual Medicare Medicare Advantage Fee-for-Service Medicaid Other 44% of Theda/Bellin Business 12% of Theda/Bellin Business 27% of Theda/Bellin Business 10% of Theda/Bellin Business 7% of Theda/Bellin Business 6

7 Pioneer Summary What is it? Impacts the Medicare Fee-for-Service Population CMS initiative to test designs of new care that will reduce cost while improving the health of the Medicare population Administered by Center for Medicare/Medicaid Innovation (CMMI) Through better coordination of care and redesign of care delivery desired outcome is improved quality results measured by 33 quality measures and at the same time a reduction in overall cost for the Medicare population 7

8 Pioneer How it works? Participating organizations will take accountability for the quality outcomes and overall cost of care for the population assigned to them Payment will be the normal fee for service amount plus a share of savings if they can provide total cost of care below the national trend Downside risk is assumed by the participating organization and a payment back to CMS will occur if total cost of care is above the national trend Initial term is 3 years with an option to extend for an additional 2 years. There is a 60 day out clause for any reason. Goal of CMS is to save $1.1 billion over the life of the program from all 32 participating organizations 8

9 Medicare Fee for Service (FFS) vs. Medicare Advantage Charges & Total Medicare Payments (in dollars) Theda/Bellin Medicare Charges 800,000, ,000, ,000, ,000,000 - Medicare Fee For Service Medicare Advantage 203,024, ,342,144 Medicare Fee For Service 416,844, ,992,782 Medicare Advantage Fiscal Percent Percent Total Medicare Payments - Theda/Bellin 2011 of Total of Charge Medicare Payments - Medicare Advantage 78,545,969 30% 39% Medicare Payments - FFS 187,171,428 70% 40% Total Medicare Payments 265,717, % 40% 9 9

10 Healthcare Partners Pioneer ACO (Annual Savings Per Beneficiary) 10,500 10,000 9,500 National Trend 9,000 8,500 8,000 7,500 7,000 6,500 Base NEWHVN Trend $345 $444 $ Baseline National HC Partners Target Savings 10

11 Bellin-ThedaCare Healthcare Partners Pioneer ACO Summary Financial Analysis Measurement Measurement Measurement Total Over Year 1 Year 2 Year 3 3 Years Shared Savings Population Benchmark (2) $ 7,290 $ 7,964 $ 8,523 Performance Year Expenditure (3) 6,945 7,515 8,079 Savings (loss) (2)-(3) $ 345 $ 449 $ 444 Number of FFS Beneficiaries - aligned 19,226 20,670 21,935 If Yes, multiply aligned beneficiaries by savings (4)*(5) $ 6,632,970 $ 9,280,830 $ 9,739,140 Shared savings to Healthcare Partners - 70%, 75% (6)*.70 $ 4,643,079 (6)*.75 $ 6,960,623 (6)*.75 $ 7,304,355 $ 18,908,057 Percentage savings (loss) (4)/(3) 4.97% 5.97% 5.50% Is 13 greater than 1% Yes Yes Yes Did you meet all Quality Performance Standards Yes Yes Yes 11

12 Pioneer ACO Program Costs Category 2012 Cost of Capital Letter of Credit $50,000 Administration Quality Reporting 154,000 Consulting Services 150,000 Patient Satisfaction Surveys 50,000 Compliance Costs 50,000 Legal 100,000 Learning Collaborative 25,000 Partial Cap Administration Beneficiary Opt-out Mailings 30,000 Personnel Costs Medical Director 100,000 Pioneer ACO Coordinator 85,000 Care Coordination Team 500,000 Care Coordination Team PLUS Total $1,294,

13 Pioneer ACO Keys to Success 1. Work together around common aims 2. Improve care delivery across the entire patient experience 3. Use information and data resources effectively 4. Learn how to assume accountability for a population 13

14 Pioneer Participants Broad diversification across the country Geographic concentration in Minnesota Different types of organizations in the initiative

15 15

16 16

17 17

Medicare accountable care organization (ACO) update

Medicare accountable care organization (ACO) update Medicare accountable care organization (ACO) update April 4, 2013 David Glass and Jeff Stensland Today s presentation Background Description of ACO models in Medicare Strengths and weaknesses of ACOs vs.

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

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

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

Participating Accountable Care Organizations (ACOs) that meet quality performance standards will be eligible to receive payments for shared savings.

Participating Accountable Care Organizations (ACOs) that meet quality performance standards will be eligible to receive payments for shared savings. Background Sec. 3022 of the Patient Protection and Affordable Care Act (PPACA) requires the Secretary to establish the Medicare Shared Savings Program by Jan. 1, 2012 Program goals: Promote accountability

More information

Accountable Care Organizations

Accountable Care Organizations Accountable Care Organizations Diane Caradeuc CMS Liaison This special regional educational effort is supported by funding provided by the California HealthCare Foundation and The California Wellness Foundation

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

Risk Adjustment in the Medicare ACO Shared Savings Program

Risk Adjustment in the Medicare ACO Shared Savings Program Risk Adjustment in the Medicare ACO Shared Savings Program Presented by: John Kautter Presented at: AcademyHealth Conference Baltimore, MD June 23-25, 2013 RTI International is a trade name of Research

More information

Medicare Shared Savings Program Final Rule

Medicare Shared Savings Program Final Rule Healthcare Committee Medicare Shared Savings Program Final Rule On June 9, 2015, the Centers for Medicare & Medicaid Services ( CMS ) published a final rule that, according to the agency, will update and

More information

Mar. 31, 2011 (202) 690-6145. Summary of proposed rule provisions for Accountable Care Organizations under the Medicare Shared Savings Program

Mar. 31, 2011 (202) 690-6145. Summary of proposed rule provisions for Accountable Care Organizations under the Medicare Shared Savings Program DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 Office of Media Affairs MEDICARE FACT SHEET FOR IMMEDIATE RELEASE

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 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

Prescription drugs are a critical component of health care. Because of the role of drugs in treating conditions, it is important that Medicare ensures that its beneficiaries have access to appropriate

More information

The Affordable Care Act

The Affordable Care Act The Affordable Care Act What does it mean for internists? Joshua Becker MD 10/14/2015 VII. 2015 Reforms and Beyond Payment Penalties under Medicare s Pay-for-Reporting Program Value-Based Payment Modifier

More information

Using Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare

Using Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare December 2010 Using Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare CONTENTS Background... 2 Problems with the Shared Savings Model... 2 How

More information

The Medicare Shared Savings Program

The Medicare Shared Savings Program The Medicare Shared Savings Program Centers for Medicare & Medicaid Services Jonathan Blum, Deputy Administrator & Director, Center for Medicare May 20, 2011 Overview CMS s vision of its ACO program Summary

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

Gold Coast Health IT Resource Center. Accountable Care Organization (ACO)

Gold Coast Health IT Resource Center. Accountable Care Organization (ACO) Gold Coast Health IT Resource Center Accountable Care Organization (ACO) August 27, 2013 Copyright 2013 Gold Coast HIT 1 Agenda Upcoming Webinars ACO s Copyright 2013 Gold Coast HIT 2 Upcoming Webinars

More information

The Medicare Shared Savings Program and the Pioneer Accountable Care Organizations

The Medicare Shared Savings Program and the Pioneer Accountable Care Organizations The Medicare Shared Savings Program and the Accountable Care Organizations Promoting and evaluating accountable care organizations Victoria Boyarsky, FSA, MAAA Rob Parke, FIA, ASA, MAAA Peer reviewed by

More information

Accountable Care Organization Final Rule Briefing. November 7, 2011

Accountable Care Organization Final Rule Briefing. November 7, 2011 Accountable Care Organization Final Rule Briefing November 7, 2011 Health Care Reform: Health Care Delivery Reforms GOALS: Controlling Cost Growth Improving Quality/Outcomes Changing Incentives Coordinating

More information

OUR ACCOUNTABLE CARE ORGANIZATION (ACO) STRATEGY. Meredith Marsh Director Health Choice Care, LLC

OUR ACCOUNTABLE CARE ORGANIZATION (ACO) STRATEGY. Meredith Marsh Director Health Choice Care, LLC OUR ACCOUNTABLE CARE ORGANIZATION (ACO) STRATEGY Meredith Marsh Director Health Choice Care, LLC HEALTH REFORM The Affordable Care Act (ACA) strives to achieve the Triple AIM: Improving the experience

More information

Payment Models Workgroup July 13, 2015

Payment Models Workgroup July 13, 2015 Payment Models Workgroup July 13, 2015 Alternative Payment Models: WHAT Are Other SIM States Doing? 2 State Innovation Models (SIM) Initiative Evaluation - Model Test CMS contracted with RTI to develop

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

Care Transformation and the Journey to Population Health Management

Care Transformation and the Journey to Population Health Management Care Transformation and the Journey to Population Health Management Richard A Bankowitz, MD MBA FACP Chief Medical Officer, Premier healthcare alliance AMGA Institute for Quality September 26, 2013 Premier:

More information

Atrius Health Pioneer ACO: First Year Accomplishments, Results and Insights

Atrius Health Pioneer ACO: First Year Accomplishments, Results and Insights Atrius Health Pioneer ACO: First Year Accomplishments, Results and Insights Emily Brower Executive Director Accountable Care Programs Emily_Brower@AtriusHealth.org November 2013 1 Contents Overview of

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

Medicare Final Accountable Care Organization (ACO) Regulations Effective January 1, 2012 Median Savings of $470 Million over 4 Years

Medicare Final Accountable Care Organization (ACO) Regulations Effective January 1, 2012 Median Savings of $470 Million over 4 Years October 20, 2011 CIT Healthcare, John M. Cousins, SVP Healthcare Intelligence john.cousins@cit.com Tel: 850-668-2907 Cell: 716-867-9965 Medicare Final Accountable Care Organization (ACO) Regulations Effective

More information

ACO Type Initiatives

ACO Type Initiatives If you proposed an ACO initiative, please fill our this Comparison of Elements for Participation in Medicare Shared Savings Program (MSSP) to State SIM ACO Test Proposal From Funding Opportunity Announcement:

More information

Accountable Care Organization Provisions in the Patient Protection and Affordable Care Act

Accountable Care Organization Provisions in the Patient Protection and Affordable Care Act Accountable Care Organization Provisions in the Patient Protection and Affordable Care Act The consolidated Patient Protection and Affordable Care Act 1 is 974 pages long. Text related to Accountable Care

More information

April 17, 2014. Re: Evolution of ACO initiatives at CMS. Dear Dr. Conway:

April 17, 2014. Re: Evolution of ACO initiatives at CMS. Dear Dr. Conway: Patrick Conway, M.D. Acting Director of the Innovation Center Centers for Medicare & Medicaid Services Hubert H. Humphrey Building 200 Independence Avenue, S.W. Room 445-G Washington, DC 20201 Re: Evolution

More information

INTRO TO THE MICHIGAN PIONEER ACO 101: THE BASICS. Karen Unholz, RN, BSN

INTRO TO THE MICHIGAN PIONEER ACO 101: THE BASICS. Karen Unholz, RN, BSN INTRO TO THE MICHIGAN PIONEER ACO 101: THE BASICS Karen Unholz, RN, BSN Origins of the Accountable Care Organization ACOs originated from the Patient Protection and Affordable Care Act (Healthcare Reform)

More information

Accelerating Innovation in Health Care Payment and Delivery: The CMS Innovation Center

Accelerating Innovation in Health Care Payment and Delivery: The CMS Innovation Center Accelerating Innovation in Health Care Payment and Delivery: The CMS Innovation Center William J. Kassler, MD, MPH Chief Medical Officer, New England Region Center for Medicare & Medicaid Innovation We

More information

Accountable Care Organizations (ACOs) Work Group. March 6, 2014

Accountable Care Organizations (ACOs) Work Group. March 6, 2014 Accountable Care Organizations (ACOs) Work Group March 6, 2014 Agenda Welcome Introductions Agency Presentation Statutory Authorization for ACOs Work Group Charge Insurance Law Background Overview of Draft

More information

Synchronizing Medicare policy across payment models

Synchronizing Medicare policy across payment models Synchronizing Medicare policy across payment models C h a p t e r1 C H A P T E R 1 Synchronizing Medicare policy across payment models Chapter summary In this chapter Historically, Medicare has had two

More information

Advancing Risk Capability in 2015: Medicare Shared Savings Program

Advancing Risk Capability in 2015: Medicare Shared Savings Program Advancing Risk Capability in 2015: Medicare Shared Savings Program Educational Slides for 2016 Class DHG is the firm that BPA has used to help determine the distribution methodologies for our previous

More information

Panorama Rooms Thursday 5 March, 2015 14:00. Mr David Abernethy. Health Policy & Government Relations Consultant, Washington, DC

Panorama Rooms Thursday 5 March, 2015 14:00. Mr David Abernethy. Health Policy & Government Relations Consultant, Washington, DC Panorama Rooms Thursday 5 March, 2015 14:00 Mr David Abernethy Health Policy & Government Relations Consultant, Washington, DC U.S. Private Insurance Solutions in the US Social Insurance System for the

More information

Center for Medicare and Medicaid Services. Shari M Ling, MD CMS Deputy Chief Medical Officer. September 11, 2014

Center for Medicare and Medicaid Services. Shari M Ling, MD CMS Deputy Chief Medical Officer. September 11, 2014 Center for Medicare and Medicaid Services Shari M Ling, MD CMS Deputy Chief Medical Officer September 11, 2014 Shaping the future of Aging in Place An understanding of factors that allow people to remain

More information

RE: Medicare Program; Request for Information Regarding Accountable Care Organizations and the Medicare Shared Saving Program

RE: Medicare Program; Request for Information Regarding Accountable Care Organizations and the Medicare Shared Saving Program Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS 1345 NC P.O. Box 8013 Baltimore, MD 21244 8013 RE: Medicare Program; Request for Information Regarding Accountable

More information

Accountable Care Organizations: What Providers Need to Know

Accountable Care Organizations: What Providers Need to Know DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Accountable Care Organizations: FACT SHEET Overview http://www.cms.gov/sharedsavingsprogram On October 20, 2011, the Centers

More information

DETAILED SUMMARY--MEDCIARE SHARED SAVINGS/ACCOUNTABLE CARE ORGANIZATION (ACO) PROGRAM

DETAILED SUMMARY--MEDCIARE SHARED SAVINGS/ACCOUNTABLE CARE ORGANIZATION (ACO) PROGRAM 1 DETAILED SUMMARY--MEDCIARE SHARED SAVINGS/ACCOUNTABLE CARE ORGANIZATION (ACO) PROGRAM Definition of ACO General Concept An ACO refers to a group of physician and other healthcare providers and suppliers

More information

Montefiore s Population Health Management Services. October 23, 2015

Montefiore s Population Health Management Services. October 23, 2015 Montefiore s Population Health Management Services October 23, 2015 Integrated Delivery System Our Locations 3,092 Acute Beds Across 10 Hospitals Including 132 beds at the Children s Hospital at Montefiore

More information

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

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

More information

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

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

More information

Pioneer Accountable Care Organization Model: General Fact Sheet Updated: September 12, 2012

Pioneer Accountable Care Organization Model: General Fact Sheet Updated: September 12, 2012 Pioneer Accountable Care Organization Model: General Fact Sheet Updated: September 12, 2012 The Pioneer ACO Model is a CMS Innovation Center initiative designed to support organizations with experience

More information

Sharp HealthCare ACO. Pioneer Introduction to the FSSB November 8, 2012

Sharp HealthCare ACO. Pioneer Introduction to the FSSB November 8, 2012 Sharp HealthCare ACO Pioneer Introduction to the FSSB November 8, 2012 Sharp HealthCare Not-for-profit serving 3.1 million residents of San Diego County Grew from one hospital in 1955 to an integrated

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

What is an Accountable Care Organization & Why is it Important to Your Home Infusion Company?

What is an Accountable Care Organization & Why is it Important to Your Home Infusion Company? What is an Accountable Care Organization & Why is it Important to Your Home Infusion Company? Lisa Harvey McPherson RN, MBA, MPPM EMHS Vice President Continuum of Care & Chief Advocacy Officer Disclosures

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

Brief Course. Neil Kirschner, Ph.D. Director, Regulatory and Insurer Affairs

Brief Course. Neil Kirschner, Ph.D. Director, Regulatory and Insurer Affairs Accountable Care Organization (ACO) 101 Brief Course Neil Kirschner, Ph.D. Director, Regulatory and Insurer Affairs What is an ACO? ACO refers to a legal entity composed of a group of providers that assume

More information

DRAFT. Background About Shared Savings Program Design Features: Patient Attribution, Cost Target Calculation, and Payment Calculation and Distribution

DRAFT. Background About Shared Savings Program Design Features: Patient Attribution, Cost Target Calculation, and Payment Calculation and Distribution Background About Shared Savings Program Design Features: Patient Attribution, Cost Target Calculation, and Payment Calculation and Distribution Excerpted from Draft Narratives Developed in the CT SIM Equity

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

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

Program Description and FAQ s 2016 Medicare Shared Savings Program Year

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

More information

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

Medicare Accountable Care Organizations: What it s about

Medicare Accountable Care Organizations: What it s about Medicare Accountable Care Organizations: What it s about Gail Albertson, MD Associate Professor of Medicine Chief Operating Officer, UPI Medicare Accountable Care Under the Medicare Shared Savings Program

More information

Atrius Health ACO Initiative. Agenda

Atrius Health ACO Initiative. Agenda Atrius Health ACO Initiative November 9, 2012 Mark Yurkofsky MD Mark_yurkofsky@vmed.org 11/13/2012 1 Agenda Why the interest in the Pioneer ACO? What actually is Pioneer ACO anyway? What is Atrius Health?

More information

What is an Accountable Care Organization & Why is it Important to Your Home Infusion Company? Disclosures. Overview 3/10/2015

What is an Accountable Care Organization & Why is it Important to Your Home Infusion Company? Disclosures. Overview 3/10/2015 What is an Accountable Care Organization & Why is it Important to Your Home Infusion Company? Lisa Harvey McPherson RN, MBA, MPPM EMHS Vice President Continuum of Care & Chief Advocacy Officer Disclosures

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

Accountable Care Organizations: Medicare MSSP & Pioneer Options

Accountable Care Organizations: Medicare MSSP & Pioneer Options Accountable Care Organizations: Medicare MSSP & Pioneer Options Presented by Bill O Brien, FSA, MAAA Consulting Actuary Milliman Houston, TX (713) 658-3008 bill.obrien@milliman.com SEAC/ACSW Annual Meeting

More information

ACOs may elect Track 2 without completing a prior agreement period under a one-sided model

ACOs may elect Track 2 without completing a prior agreement period under a one-sided model Financial and Regulatory Parameters for MSSP Risk Tracks in ACO Learning Network Comments and the blue box indicates LN different from ; red text indicates change from and/or LN on Transition to Two-Sided

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

Anatomy of an ACO. Through the Eyes of a Physician-owned IPA. Genesis Accountable Care Organization

Anatomy of an ACO. Through the Eyes of a Physician-owned IPA. Genesis Accountable Care Organization Anatomy of an ACO Through the Eyes of a Physician-owned IPA Genesis: IPA by the Numbers 1,400 Physicians PCPs 500 900 SCPs 700 Practices 400 Square miles in North Texas Genesis: Challenges for Change Pressure

More information

Issue Brief. CMS Finalizes Rules for Medicare Shared Savings Program (ACOs) KEY POINTS COMMENT

Issue Brief. CMS Finalizes Rules for Medicare Shared Savings Program (ACOs) KEY POINTS COMMENT Issue Brief 4712 Country Club Drive Jefferson City, MO 65109 P.O. Box 60 Jefferson City, MO 65102 573/893-3700 www.mhanet.com FEDERAL ISSUE BRIEF June 5, 2015 KEY POINTS z More than 400 accountable care

More information

Medicare Value Partners

Medicare Value Partners Medicare Value Partners Medicare Shared Savings ACO Program Frequently Asked Questions (FAQ) Q: What exactly is a Medicare Shared Savings Program ACO? A: Medicare Shared Savings Program accountable care

More information

Medicare Advantage: The overlooked cornerstone of healthcare reform

Medicare Advantage: The overlooked cornerstone of healthcare reform Medicare Advantage: The overlooked cornerstone of healthcare reform June 8, 2013 Grace-Marie Turner Galen Institute Medicare: Still basically the 1965 model A social insurance program to help pay for hospital

More information

Accountable Care Organizations: The Final Rule

Accountable Care Organizations: The Final Rule Accountable Care Organizations: The Final Rule October 27, 2011 2011 Akin Gump Strauss Hauer & Feld LLP 10.27.11 101799002 v4 Overview Background Final Rule Highlights Structure and Formation of ACOs Quality

More information

BUNDLING ARE INPATIENT REHABILITATION FACILITIES PREPARED FOR THIS PAYMENT REFORM?

BUNDLING ARE INPATIENT REHABILITATION FACILITIES PREPARED FOR THIS PAYMENT REFORM? BUNDLING ARE INPATIENT REHABILITATION FACILITIES PREPARED FOR THIS PAYMENT REFORM? Uniform Data System for Medical Rehabilitation Annual Conference August 10, 2012 Presented by: Donna Cameron Rich Bajner

More information

Center for Medicare & Medicaid Innovation Request for Information on Health Plan Innovation Initiatives at CMS

Center for Medicare & Medicaid Innovation Request for Information on Health Plan Innovation Initiatives at CMS Center for Medicare & Medicaid Innovation Request for Information on Health Plan Innovation Initiatives at CMS Agency/Office: Type of Notice: Department of Health and Human Services Centers for Medicare

More information

Characteristics of Accountable and Community Care Organizations (ACOs and CCOs)

Characteristics of Accountable and Community Care Organizations (ACOs and CCOs) ACO Definition Organization of providers that shares responsibility for providing care to patients and is accountable for the care of beneficiaries assigned to it. Major Specifically addressed in the Differences

More information

Accountable Care Organizations and Coordinated Care Organizations

Accountable Care Organizations and Coordinated Care Organizations ACO Definition Organization of providers that shares responsibility for providing care to patients and is accountable for the care of beneficiaries assigned to it. Major Specifically addressed in the Differences

More information

Be Careful What You Ask For A Predictive Model That Really Works

Be Careful What You Ask For A Predictive Model That Really Works Be Careful What You Ask For A Predictive Model That Really Works Rod Christensen, MD President, Allina Health Clinics Cheryl Hermann, RN, MBA Vice President, Clinic Operations & Patient Care Services Karen

More information

MAKING THE TRANSITION TO POPULATION HEALTH MANAGEMENT

MAKING THE TRANSITION TO POPULATION HEALTH MANAGEMENT MAKING THE TRANSITION TO POPULATION HEALTH MANAGEMENT H O W T O E F F E C T I V E L Y N E G O T I A T E V A L U E - B A S E D C O N T R A C T S I N T H E N E W R E T A I L M A R K E T P I O N E E R I N

More information

Pioneer Accountable Care Organization (ACO) Model Request for Application

Pioneer Accountable Care Organization (ACO) Model Request for Application DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 Center for Medicare and Medicaid Innovation I. Background Pioneer

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

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

Center for Medicare and Medicaid Innovation Request for Information on Advanced Primary Care Model Concepts

Center for Medicare and Medicaid Innovation Request for Information on Advanced Primary Care Model Concepts Center for Medicare and Medicaid Innovation Request for Information on Advanced Primary Care Model Concepts AGENCY: ACTION: Centers for Medicare & Medicaid Services (CMS), HHS. Request for Information

More information

Care Coordination and Contracting Entities: The CHC Perspective on IPAs and ACOs. Today s Discussion

Care Coordination and Contracting Entities: The CHC Perspective on IPAs and ACOs. Today s Discussion Care Coordination and Contracting Entities: The CHC Perspective on IPAs and ACOs Ohio Association of Community Health Centers June 2014 Contact Us Andrew Principe PO Box 410221, Cambridge, MA 02141 P.

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

Update on Medicare accountable care organizations (ACOs): September 11, 2014 David Glass, Jeff Stensland

Update on Medicare accountable care organizations (ACOs): September 11, 2014 David Glass, Jeff Stensland Update on Medicare accountable care organizations (ACOs): September 11, 2014 David Glass, Jeff Stensland Today s presentation Background Medicare shared savings program (MSSP): status, 1 st year performance

More information

Medicaid Accountable Care Organizations in Other States

Medicaid Accountable Care Organizations in Other States Joint Legislative Oversight Committee on Health and Human Services Medicaid Accountable Care Organizations in Other States David Rice Fiscal Research Division February 11, 2014 Accountable Care Organizations

More information

ACO Definition Cont d 11/15/15. What is an Accountable Care Organization (ACO) Michelle S. McOmber, MBA, CAE CEO, Utah Medical Association

ACO Definition Cont d 11/15/15. What is an Accountable Care Organization (ACO) Michelle S. McOmber, MBA, CAE CEO, Utah Medical Association Michelle S. McOmber, MBA, CAE CEO, Utah Medical Association What is an Accountable Care Organization (ACO) Accountable Care Organizations were created through the Affordable Care Act. Definition: An ACO

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

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

Health System Transformation Post Affordable Care Act

Health System Transformation Post Affordable Care Act Health System Transformation Post Affordable Care Act Patrick Conway, MD, MSc Acting Principal Deputy Administrator and Chief Medical Officer, CMS Deputy Administrator for Innovation and Quality Director,

More information

3/28/2014. Spencer Berthelsen, M.D. Texas Club of Internists

3/28/2014. Spencer Berthelsen, M.D. Texas Club of Internists Spencer Berthelsen, M.D. Texas Club of Internists April 4, 2014 Cost The US spends twice as much per capita as the average of other industrialized nations Institute of Medicine 30% of healthcare dollars

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

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

Critical Access Hospitals and

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

More information

Medical Care Advisory Committee. Andy Vasquez, Deputy Director, Medicaid/CHIP Vendor Drug Program Health and Human Services Commission

Medical Care Advisory Committee. Andy Vasquez, Deputy Director, Medicaid/CHIP Vendor Drug Program Health and Human Services Commission TO: Medical Care Advisory Committee DATE: November 8, 2013 FROM: Andy Vasquez, Deputy Director, Medicaid/CHIP Vendor Drug Program Health and Human Services Commission Agenda Item No.: 7 SUBJECT: Fee-for-Service

More information

Accountable Care Organizations: Principles and Implications for Hospital Administrators

Accountable Care Organizations: Principles and Implications for Hospital Administrators S T U D E N T E S S A Y Accountable Care Organizations: Principles and Implications for Hospital Administrators Andrew Russell Bennett, James Madison University E X E C U T I V E S U M M A R Y With the

More information

Quality Improvement and Payment Reform

Quality Improvement and Payment Reform Quality Improvement and Payment Reform Mark McClellan, MD, PhD Senior Fellow and Director, Initiative on Value and Innovation in Health Care Brookings Institution Mark McClellan. All rights reserved. No

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

CMS Initiatives Involving Patient Experience Surveying FAQs

CMS Initiatives Involving Patient Experience Surveying FAQs CMS Initiatives Involving Patient Experience Surveying FAQs Updated October 2013 Prepared by: DSS Research CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). The

More information

See page 16. Thomas A. Vallas

See page 16. Thomas A. Vallas Compliance TODAY July 2014 a publication of the health care compliance association www.hcca-info.org What s the key to successfully merging two large hospital systems? an interview with Michael R. Holper

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

Health Law Bulletin. provided by: ACOs AND SHARED SAVINGS IN A NUTSHELL Applications to Participate Available Now

Health Law Bulletin. provided by: ACOs AND SHARED SAVINGS IN A NUTSHELL Applications to Participate Available Now Health Law Bulletin provided by: ACOs AND SHARED SAVINGS IN A NUTSHELL Applications to Participate Available Now Earlier this month, the Center for Medicare and Medicaid Services (CMS) published the final

More information

Health Care Reform Update January 2012 MG76120 0212 LILLY USA, LLC. ALL RIGHTS RESERVED

Health Care Reform Update January 2012 MG76120 0212 LILLY USA, LLC. ALL RIGHTS RESERVED Health Care Reform Update January 2012 Disclaimer This presentation is for educational purposes only. It is not a complete analysis of the material contained herein. Before taking any action on the issues

More information

Health System Transformation Post Affordable Care Act

Health System Transformation Post Affordable Care Act Health System Transformation Post Affordable Care Act Patrick Conway, MD, MSc Acting Principal Deputy Administrator and Chief Medical Officer, CMS Deputy Administrator for Innovation and Quality October

More information

New York Presbyterian Innovations in Health Care Reform at Academic Medical Centers

New York Presbyterian Innovations in Health Care Reform at Academic Medical Centers New York Presbyterian Innovations in Health Care Reform at Academic Medical Centers October 28, 2011 Timothy G Ferris, MD, MPH Mass General Physicians Organization, Medical Director Associate Professor,

More information