Ron Stock MD MA Oregon Rural Health Conference October 24, 2013
|
|
|
- Emery Perry
- 8 years ago
- Views:
Transcription
1 Ron Stock MD MA Oregon Rural Health Conference October 24, 2013
2 Provide a historical context for healthcare reform including the 2010 Patient Protection & Accountable Care Act Connect what is known to improve health outcomes to service delivery policy at the state and national level Outline Oregon healthcare reform activities that will impact Oregonians, including the CCO, primary care medical home, dual eligible beneficiaries and long term care
3
4 1935: New Deal 1948: Truman Fair Deal program fails 1965: Medicare & Medicaid established under Social Security Act; The Great Society 1972: Add- 1)speech, PT, chiropractic; 2) HMO s; 3)Young people w/disabilities; 3) ESRD 1982: Hospice 1997: Balanced Budget Act; Part C Medicare Advantage and PACE program 2003: Medicare Modernization Act - Part D drug
5 Individual mandate, health insurance exchange, and Medicaid expansion Reduced payments to Medicare Advantage and some hospitals/clinicians Created Independent Payment Advisory Board (IPAB) Phasing out the Part D donut hole Fraud and abuse Preventive services: Annual Wellness Exam Center for Medicare and Medicaid Innovation (CMMI)
6 6
7 Chronic Care Model Community Resources and Policies Health System Health Care Organization Self- Management Support Delivery System Design Decision Support Clinical Information Systems Informed, Activated Patient Productive Interactions Prepared, Proactive Practice Team Improved Outcomes
8 1. Improving the individual experience of care; Better care 2. Improving the health of populations; Better health 3. Reducing the per capita costs of care for populations; Lower costs Berwick et al. Health Affairs, 27(1): , 2008
9 Coordinated Care Interventions The Medicare Coordinated Care Demo (MCCD) Patient-centered primary care medical home Transitional Care Interventions Self-Management Education Interventions Chronic Disease Self-management program Shared Decision-Making Healthcare Information Systems -Brown et al. The Promise of Care Coordination, Mathematica Policy Research, March, 2009
10 Key Components of Success: Targeting In-Person Contact Access to Info on Hospital & ED Admits Close interaction between CC s and PCP s Services provided, eg med management, social work support, ADL assistance, transportation, address social isolation Staffing: RN role vs SW role
11 Keys to success to reduce hospitalizations: 1.Focus on high risk patients 2.Face to face contact w/ patients 3.Care Manager face to face contact w/ physicians 4.Patient Education 5.Managing care setting transitions 6.Communication hub role of CM 7.Medication management
12 The Innovation Center was established by section 1115A of the Social Security Act (as added by section 3021 of the Affordable Care Act). Congress created the Innovation Center for the purpose of testing innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care for those individuals who receive Medicare, Medicaid, or Children s Health Insurance Program (CHIP) benefits. Aims: Test new payment and service delivery models; Evaluate results and advance best practice ; Engage a broad range of stakeholders to develop new models
13
14 To support Health System Transformation, the Oregon Health Authority needs to transform itself Partner with Coordinated Care Organizations (CCO)to increase the rate and spread of innovation needed to achieve triple aim. Spread elements of the coordinated care model to other payers
15 Transformation Center will house: Innovator Agents Learning Collaboratives Data & Analytics Technical assistance and infrastructure support Conferences and workshops, communications, outreach and networking Council of Clinical Innovators; Clinical standards & supports Regional Health Equity Coalitions Promotion of patient-centered primary care homes, use of nontraditional health workers and elements of the CCO model
16 Coordinated Care Organizations (CCO) Patient-Centered Primary Care Medical Home State PCPCH PCPCH Institute FQHC Advanced Primary Care Practice Demo Comprehensive Primary Care Initiative Independence at Home Demonstration Community-based Care Transitions Program Grants: TopMed; OPIP; ORPRN; Health Commons; SIM grant
17 An organization of providers that is accountable for the care of the Medicare Beneficiaries assigned to it. ACO s will have a strong emphasis on Primary Care and reducing overall costs. Shared savings model Community based Governance (Board, CAP, CAC) patient centered primary care homes fixed global budgets efficiency and QI to reduce costs for Oregon Medicaid 17 Incentive Measures CCOs align and integrate Oregonians eligible for both Medicare and Medicaid to reduce admin costs. ACO CCO
18 Local health entities that deliver health care and coverage for people eligible for Medicaid (the Oregon Health Plan). Local control One point of accountability Global (single) budget fixed rate of growth Expected health outcomes Health Equity Integrate physical and behavioral health Community health workers Focus on prevention Reduced administrative overhead Electronic health records Patient-Centered Primary Care Homes* *CCOs required to include recognized clinics in their networks of care to the maximum extent feasible 18
19
20 HB 2009 established the PCPCH Program: Create access to patient-centered, high quality care and reduce costs by supporting practice transformation Key PCPCH Program Functions: PCPCH recognition and verification Refinement and evaluation of the PCPCH Standards over time Communication and provider outreach Coordination across OHA divisions, CCO development and health reform initiatives Restructure primary care payment to align with the PCPCH framework Technical assistance development
21 Based on the Oregon Health Policy Board s Action Plan: All OHA covered lives (almost 900, 000) receive care through a Patient-Centered Primary Care Home - Includes Medicaid, public employees, Oregon educators, Oregon high-risk pool, Family Health Insurance Assistance Program, and Healthy Kids 75% of ALL Oregonians have access to quality care through a PCPCH by 2015 Spread to private payers and Qualified Health Plans via the Exchange
22 Tier 3: Advanced Primary Care Home Proactive patient and population management Accountable for quality outcomes Tier 2: Intermediate Primary Care Home Demonstrates performance improvement Additional structure and process improvements Tier 1: Basic Primary Care Home Foundational structures and processes
23 Date # Recognized Tier 1 Tier 2 Tier 3 10/21/ % 23.70% 74.94%
24 24
25 Current minimum criteria to become a PCPCH will remain the same More options available for clinics to achieve PCPCH recognition and higher Tier levels Application renewal cycle expanded from annually to every two years (effective September 3, 2013) - Clinics can reapply every 6 months if they meet a higher tier or score New opportunity for primary care homes to become Tier 3 star performers
26 2014 PCPCH Standards are available on the web CPC practices will be well-positioned to meet many of the additional menu of standards/measures Patient-Centered Primary Care Institute (PCPCI.org) is an additional resource for technical assistance Tools/Webinars/online learning/learning collaboratives for clinics/leaders/ta providers Work with CCOs/Transformation Center to engage/support PCPCHs Continuing to engage payers inside and outside the OHA to support recognized PCPCHs and align initiatives. PEBB/OEBB CoverOregon - Insurance Exchange Aetna PCPCH payment incentive program launched
27 Launched in 2012 Public-private partnership Broad array of technical assistance for practices at all stages of transformation Ongoing mechanism to support practice transformation and quality improvement in Oregon
28 Four year, multi-payer collaboration between CMS and statewide private payers; Redesign of the primary care practice Seven (7) demonstration regions/ markets (AR, CO, NY, OH, KY, NJ, OK, OR) New payment model Monthly per-member-per month (PMPM) management fee In years 2-4, potential to share in savings
29
30 67 Primary Care Practices 552 Providers 5 Payers: CareOregon, TualityHealth, Providence, Regence BC/BS, OHA Estimated 48,000 beneficiaries served
31 Risk-stratified Care Management; Access and Continuity; Planned Care for Chronic Conditions and Preventative Care; Patient and Caregiver Engagement; Coordination of Care Across the Medical Neighborhood.
32 1. Provide care management for high risk patients. 2. Provide 24/7 patient access guided by the medical record. 3. Assess and improve patient experience of care. 4. Use data to guide improvement in care at the provider/care team level. 5. Demonstrate active engagement and care coordination across the medical neighborhood 6. Improve patient shared decision-making capacity.
33 1. Time (finding time; deadlines; length of time provided) 2. My patients (attributing the right ones, risk stratification) 3. My team (staffing, budgeting, transforming) 4. Metrics and measuring success (reports, baseline metrics, harmonization) 5. Competing priorities (other projects, new responsibilities)
34 Subtitle Jan 1, 2014, all CCO s will be required to offer a Medicare Advantage plan Not required to enroll in the CCO Pushing CCO s to be more attractive Improvement initiatives beginning to make it easier to submit claims Better member communication; address grievances
35 LTC carve out Shared Accountability for Long Term Care (LTC) Memorandum of Understanding CMS/LTC/CCO Study Group- An exploratory stakeholder process that will result in a report to the Centers for Medicare/Medicaid Services (CMS) regarding the integration of DHS Medicaid-funded Long-Term Care (LTC) for the aged or people with disabilities into the Coordinated Care Organizations (CCO) global budgets.
36 Care coordination throughout the system Alternative payment methodologies Integration of physical, behavioral, oral health Community-based focus Flexible services Testing, accelerating and spreading innovation
37 Horses out of the barn Beginning to see changes at the practice level What s so different now? Workforce
The 2014 Patient- Centered Primary Care Home (PCPCH) Recognition Criteria
The 2014 Patient- Centered Primary Care Home (PCPCH) Recognition Criteria Deepti Shinde, MPP and E. Dawn Creach, MS Patient-Centered Primary Care Home Program Oregon Health Authority October 2, 2013 Welcome!
Addictions Services Refers to alcohol and other drug treatment and recovery services.
APPENDIX E GLOSSARY: MOU GUIDANCE This Glossary is a communication tool which attempts to provide informal explanations of terms which may be used in discussions regarding the MOU. These terms should not
Metrics for Coordinated Care Organizations: Measuring Health Inequities. Lori Coyner, MA Director of Accountability and Quality
Metrics for Coordinated Care Organizations: Measuring Health Inequities Lori Coyner, MA Director of Accountability and Quality 2 Accountability Plan Addresses the Special Terms and Conditions that were
Strengthening Medicare: Better Health, Better Care, Lower Costs Efforts Will Save Nearly $120 Billion for Medicare Over Five Years.
Strengthening Medicare: Better Health, Better Care, Lower Costs Efforts Will Save Nearly $120 Billion for Medicare Over Five Years Introduction The Centers for Medicare and Medicaid Services (CMS) and
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
CMS Innovation Center: Report to Congress. Centers for Medicare & Medicaid Services. Center for Medicare and Medicaid Innovation REPORT TO CONGRESS
Centers for Medicare & Medicaid Services Center for Medicare and Medicaid Innovation REPORT TO CONGRESS DECEMBER 2014 Table of Contents 1. Executive Summary... 1 2. Introduction... 3 CMS Innovation Center
State Innovation Models Initiative:
Department of Health & Human Services Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 FACT SHEET FOR IMMEDIATE RELEASE Contact: CMS Media Relations
CMS Innovation and Health Care Delivery System Reform
CMS Innovation and Health Care Delivery System Reform Dr. Patrick Conway, M.D., MSc CMS Chief Medical Officer and Deputy Administrator for Innovation and Quality Director, Center for Medicare and Medicaid
IV. PROJECT NARRATIVE Oregon State Innovation Models Testing Assistance Application
IV. PROJECT NARRATIVE Oregon State Innovation Models Testing Assistance Application A. Description of the State Health Care Innovation Plan Testing Strategy A.1. Model Purpose: Oregon has chosen to address
Development of a Vermont Pilot Community Health System To Achieve the Triple Aims
Development of a Vermont Pilot Community Health System To Achieve the Triple Aims Webinar February 23, 2010 Jim Hester PhD Director Vermont Health Care Reform Commission Outline Context: Vermont Health
CMS Innovation and Health Care Delivery System Reform and IOM Future of Nursing Report Recommendations
CMS Innovation and Health Care Delivery System Reform and IOM Future of Nursing Report Recommendations Janet Heinrich, DrPH, RN, FAAN Center for Medicare and Medicaid Innovation May, 2015 The CMS Innovation
A FEDERAL STATE DISCOURSE ON PRIMARY CARE AND BEHAVIORAL HEALTH INTEGRATION. Background Material
A FEDERAL STATE DISCOURSE ON PRIMARY CARE AND BEHAVIORAL HEALTH INTEGRATION Background Material 1 The Need for Primary Care and Behavioral Health Integration Individuals with behavioral health needs often
Oct 5, 2014 John McCarthy Medicaid Director
Ohio Medicaid Overview Oct 5, 2014 John McCarthy Medicaid Director Medicaid Overview Medicaid is Ohio s largest health payer 83,000 active providers, hospitals, nursing homes and other providers care for
Applying ACO Principles to a Pediatric Population UH Rainbow Care Connection: Transforming Pediatric Ambulatory Care with a Physician Extension Team
Applying ACO Principles to a Pediatric Population UH Rainbow Care Connection: Transforming Pediatric Ambulatory Care with a Physician Extension Team Ethan Chernin, MBA Director 1 Objectives Understand
Summary of the Final Medicaid Redesign Team (MRT) Report A Plan to Transform The Empire State s Medicaid Program
Summary of the Final Medicaid Redesign Team (MRT) Report A Plan to Transform The Empire State s Medicaid Program May 2012 This document summarizes the key points contained in the MRT final report, A Plan
Broad Issues in Quality Measurement: the CMS perspective
Broad Issues in Quality Measurement: the CMS perspective Shari M. Ling, MD Deputy Chief Medical Officer Centers for Medicare & Medicaid Services Workshop on Quality Measurement Developing Evidence-Based
Designing Integrated Payment Systems in Medicaid
Designing Integrated Payment Systems in Medicaid Commonwealth of Massachusetts Public Payer Commission May 5, 2014 Tricia McGinnis Director of Delivery System Reform, CHCS Supported by The Massachusetts
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
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
An Update on Payment Reform Activities at CMS and How Data Analytics and Rapid-Cycle Evaluation Support Transformation
An Update on Payment Reform Activities at CMS and How Data Analytics and Rapid-Cycle Evaluation Support Transformation William Shrank, MD MSHS Division of Pharmacoepidemiology and Pharmacoeconomics Harvard
THE ACA TO HEALTHCARE TRANSFORMATION: What's in Store for Hawai i
THE ACA TO HEALTHCARE TRANSFORMATION: What's in Store for Hawai i WHY THE ACA AND TRANSFORMATION? Health Status Getting Worse Despite High Costs Rising rates of obesity and chronic diseases Disparities
CMS Innovation Center Improving Care for Complex Patients
CMS Innovation Center Improving Care for Complex Patients ECRI Institute Dr. Patrick Conway, M.D., MSc CMS Chief Medical Officer and Deputy Administrator for Innovation and Quality Director, Center for
Updates from CMS: Value-Based Purchasing, ACOs, and Other Initiatives The Seventh National Pay for Performance Summit March 19, 2012
Updates from CMS: Value-Based Purchasing, ACOs, and Other Initiatives The Seventh National Pay for Performance Summit March 19, 2012 Presenters David Sayen, CMS Regional Administrator Betsy L. Thompson,
Patient Protection and Affordable Care Act [PL 111-148] with Amendments from 2010 Reconciliation Act [PL 111-152] Direct-Care Workforce
![Patient Protection and Affordable Care Act [PL 111-148] with Amendments from 2010 Reconciliation Act [PL 111-152] Direct-Care Workforce](/thumbs/25/6872632.jpg "Patient Protection and Affordable Care Act [PL 111-148] with Amendments from 2010 Reconciliation Act [PL 111-152] Direct-Care Workforce")
DIRECT-CARE WORKFORCE AND LONG-TERM CARE PROVISIONS AS ENACTED IN PATIENT PROTECTION AND AFFORDABLE CARE ACT AND HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 2010 Key Provisions Direct-Care Workforce
The Health Care Transformation Glossary
The Health Care Transformation Glossary which was compiled using a variety of sources helps to educate your staff, governance and community about the new language associated with transformation. Using
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
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
Opportunities for Home Care Providers in Working with Medical Homes October 2014. EMHS Vice President Continuum of Care Chief Advocacy Officer
How to Establish Partnerships and Opportunities for Home Care Providers in Working with Medical Homes October 2014 Lisa Harvey-McPherson, RN, MBA, MPPM EMHS Vice President Continuum of Care Chief Advocacy
Accelera'ng Care and Payment Innova'on: The CMS Innova'on Center
Accelera'ng Care and Payment Innova'on: The CMS Innova'on Center Healthcare IT Connect Sean Cavanaugh Deputy Director Center for Medicare and Medicaid Innova:on May 21, 2013 The CMS Innovation Center Identify,
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
Value-Based Payment and Health System Transformation
Value-Based Payment and Health System Transformation National Health Policy Forum Patrick Conway, M.D., MSc CMS Chief Medical Officer Deputy Administrator for Innovation and Quality Director, Center for
CMMI Model. Leslie Welsh Flaherty Offices of Enterprise Management. 2013 MES Conference
CMMI Model Leslie Welsh Flaherty Offices of Enterprise Management 2013 MES Conference Center for Medicare and Medicaid Innovation (CMMI) The Innovation Center Purpose: Test innovative payment and service
The Impact of Healthcare Reform on Pharmacy Practice. Disclosure
The Impact of Healthcare Reform on Pharmacy Practice Thomas Buckley, MPH, RPh Assistant Clinical Professor University of Connecticut School of Pharmacy Disclosure Thomas Buckley has nothing to disclose
Health Literacy & Health Reform Opportunities and Challenges
Health Literacy & Health Reform Opportunities and Challenges Frank Funderburk Director, Division of Research Office of Communications Centers for Medicare & Medicaid Services November 10, 2010 CMS Perspective
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
Impact of Health Care Reform on the Future of Nutrition and Dietetics
Impact of Health Care Reform on the Future of Nutrition and Dietetics Understanding the changes to create new nutrition opportunities Pepin Andrew Tuma, JD Director, Regulatory Affairs Academy of Nutrition
AGENCY-SPECIFIC PLAN FOR THE NATIONAL QUALITY STRATEGY
AGENCY-SPECIFIC PLAN FOR THE NATIONAL QUALITY STRATEGY Adult Medicaid Quality Grants Program The Adult Medicaid Quality Grants Program is a 2-year funding opportunity designed to support grantee Medicaid
Dual Eligibles and State Innovations in Care Management
Dual Eligibles and State Innovations in Care Management Ann Kohler, Director of Health Services National Association of State Medicaid Directors American Public Human Services Association Ann.Kohler@aphsa.org
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,
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
Key Design Feature Scope of services Governance Payment Measurement & Evaluation
Figure 2: Domains of State Activity Name of Initiative Key Design Feature Scope of services Governance Payment Measurement & Evaluation Support for Infrastructure Alabama Regional Organizations (RCOs)
How Health Reform Will Affect Health Care Quality and the Delivery of Services
Fact Sheet AARP Public Policy Institute How Health Reform Will Affect Health Care Quality and the Delivery of Services The recently enacted Affordable Care Act contains provisions to improve health care
Affordable Care Act Opportunities for the Aging Network
Affordable Care Act Opportunities for the Aging Network The Affordable Care Act (ACA) offers many opportunities for the Aging Network to be full partners in health system reform. These include demonstration
Building an Accountable Care Organization. Jean Malouin, MD MPH University of Michigan Health System September 21, 2012
Building an Accountable Care Organization Jean Malouin, MD MPH University of Michigan Health System September 21, 2012 Agenda UMHS overview PGP demo ACO precursor Current efforts underway Role of primary
What this means for Idaho?
What this means for Idaho? Why now? The 2011 Idaho Legislature approved the Medicaid Cost Containment and Health Care Improvement Act : The current fee-for-service health care delivery system of payment
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
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
Health Care Homes and Accountable Care Organizations
Health Care Homes and Accountable Care Organizations Testimony to the Health and Human Services Finance Committee of the Minnesota House of Representative Jeff Schiff, MD, MBA Ross Owen, MPA Marie Maes-Voreis,
Accountable Care Organization Refinement Brief
Accountable Care Organization Refinement Brief The participants in the Medicare Shared Savings Program (MSSP), the Physician Group Practice Transition Demonstration (PGP-TD), and the Pioneer Accountable
Workforce Utilization in CMS s New Models of Payment and Care
Workforce Utilization in CMS s New Models of Payment and Care Janet Heinrich, DrPH, RN Tim Day, MSPH 10 th Annual AAMC Workforce Research Conference Center for Medicare and Medicaid Innovation (CMMI) Created
The ACA and Beyond: Public Policy and Marketplace Changes Affecting the Future of Rural Health
The ACA and Beyond: Public Policy and Marketplace Changes Affecting the Future of Rural Health KEITH J. MUELLER, PHD UNIVERSITY OF IOWA COLLEGE OF PUBLIC HEALTH AND RURAL POLICY RESEARCH INSTITUTE CENTER
The Physician s Role in Delivery System Reform
The Physician s Role in Delivery System Reform Dr. Patrick Conway, M.D., MSc Acting Principal Deputy Administrator, CMS Chief Medical Officer and Deputy Administrator for Innovation and Quality Director,
ACOs, CCOs: Challenges & Opportunities. Speakers
ACOs, CCOs: Challenges & Opportunities 2014 Compliance Institute Wednesday, April 2 San Diego, CA Speakers Chris Apgar CEO and President, Apgar and Associates, LLC Dick Sabath Compliance Officer, Trillium
Medicaid Accountable Care Organization Programs: State Profiles
BRIEF OCTOBER 2015 Medicaid Accountable Care Organization Programs: State Profiles By Jim Lloyd, Rob Houston, and Tricia McGinnis, Center for Health Care Strategies S IN BRIEF States are implementing accountable
CMS oral Health Initiative an opportunity for Dental Hygienists April 23 rd 2015 Nancy Gurzick, RDH, BSDH, MA
CMS oral Health Initiative an opportunity for Dental Hygienists April 23 rd 2015 Nancy Gurzick, RDH, BSDH, MA Course objectives Part I Federal and State Oral Health Programs Understanding Medicaid/Federal
1900 K St. NW Washington, DC 20006 c/o McKenna Long
1900 K St. NW Washington, DC 20006 c/o McKenna Long Centers for Medicare & Medicaid Services U. S. Department of Health and Human Services Attention CMS 1345 P P.O. Box 8013, Baltimore, MD 21244 8013 Re:
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.
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
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.
AHLA. Q. Medicaid ACOs: Coming to a Neighborhood Near You. Clifford E. Barnes Epstein Becker & Green PC Washington, DC
AHLA Q. Medicaid ACOs: Coming to a Neighborhood Near You Clifford E. Barnes Epstein Becker & Green PC Washington, DC Jennifer E. Gladieux Senior Health Policy Analyst Health Policy Source, Inc. Alexandria,
Elke Shaw-Tulloch, Administrator Division of Public Health Idaho Department of Health and Welfare
Elke Shaw-Tulloch, Administrator Division of Public Health Idaho Department of Health and Welfare IDAHO STATE HEALTHCARE INNOVATION PLAN HOW DID WE GET HERE? Idaho has been engaged in efforts to redesign
SHIBA. Statewide Health Insurance Benefits Advisors. Medicare, Health Insurance, & the Affordable Care Act Updates for Summer 2013
SHIBA Statewide Health Insurance Benefits Advisors Medicare, Health Insurance, & the Affordable Care Act Updates for Summer 2013 Liz Mercer Regional Trainer Sponsored by the: 8/8/2013 1 Today s overview
Population Health Refocusing Health Care
Population Health Refocusing Health Care The Population, The Payment, The Quality Karen Hacker, MD MPH Director, Allegheny County Health Department The Context of Health Care in the USA: A Time for Alignment
State Innovation Model
State Innovation Model P a t i e n t C e n t e r e d M e d i c a l H o m e W e b i n a r M a y 1 1, 2 0 1 6 1 Agenda SIM Overview & Updates Patient Centered Medical Home Overview Questions 2 1 SIM Overview
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
Strategic Plan for Vermont Health Reform
Strategic Plan for Vermont Health Reform 2012 2014 Released January, 2012; Revised July 2012 by Robin J. Lunge, J.D., Director of Health Care Reform, Agency of Administration, State of Vermont Developed
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
Strengthening Community Health Centers. Provides funds to build new and expand existing community health centers. Effective Fiscal Year 2011.
Implementation Timeline Reflecting the Affordable Care Act 2010 Access to Insurance for Uninsured Americans with a Pre-Existing Condition. Provides uninsured Americans with pre-existing conditions access
Employee Population Health Management:
Employee Population Health Management: a stepping stone for accountable care Richard Boehler, MD, MBA, FACPE President and Chief Executive Officer St. Joseph Hospital, Nashua N.H. Learning to Manage Populations
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
Medicaid ACO Pediatric Quality Measures and Innovative Payment Models
Medicaid ACO Pediatric Quality Measures and Innovative Payment Models Select States Summer, 2015 Introduction Since the Medicaid program was implemented 50 years ago, it has undergone several evolutions
Supreme Court upholds the Affordable Care Act in its entirety:
Supreme Court upholds the Affordable Care Act in its entirety: What does this mean for Seniors? The Supreme Court s decision to uphold the Affordable Care Act (ACA) in its entirety is a huge victory for
Brief environmental scan Ti Triple AIM?...key elements Why the Plus One? How do we get there? What will be the advantage for us?
The Current Environment Requires Progress On All Four Simultaneously! Bruce Bagley, MD President and CEO TransforMED Brief environmental scan Ti Triple AIM?...key elements Why the Plus One? How do we get
National Training Program
National Training Program Module 12 Medicaid and the Children s Health Insurance Program Session Objectives This session will help you Describe eligibility, benefits, and administration of Medicaid Define
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
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.
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
The ACO Model/Capabilities Framework and Collaborative. Wes Champion Senior Vice President Premier Healthcare Alliance
The ACO Model/Capabilities Framework and Collaborative Wes Champion Senior Vice President Premier Healthcare Alliance Roadmaps to Serve as a Bridge from FFS to ACO Current FFS System What are the underpinning
Commonwealth of Kentucky Cabinet for Health and Family Services (CHFS) Office of Health Policy (OHP)
Commonwealth of Kentucky Cabinet for Health and Family Services (CHFS) Office of Health Policy (OHP) State Innovation Model (SIM) Model Design Payment Reform Workgroup Kickoff Meeting March 24, 2015 9
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
Integration of Dental Care into the Accountable Care Organizations the Oregon Model
Integration of Dental Care into the Accountable Care Organizations the Oregon Model Mike Plunkett DDS, MPH Senior Director, Dental Care Delivery, Kaiser Permanente Assistant Prof., Oregon Health and Science
Introduction. Millions of Americans are already benefiting from the health care law's improvements to Medicare:
The Affordable Care Act: Lowering Medicare Costs by Improving Care Efforts Will Save Over $200 Billion for Taxpayers Through 2016, Nearly $60 Billion for Beneficiaries in traditional Medicare Introduction
Nebraska Medicaid Managed Long-Term Services and Supports
Background A significant shift in the management and administration of Medicaid services has taken place over the past several years with the growth of managed care. Full-risk managed care is a health
Geneva Association 10th Health and Aging Conference Insuring the Health of an Aging Population
Geneva Association 10th Health and Aging Conference Insuring the Health of an Aging Population November 18, 2013 Diana Dennett EVP, Global Issues and Counsel America s Health Insurance Plans (AHIP) America
1 Kaiser Commission on Medicaid and the Uninsured, Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2012 and 2013, October
Managed Care in Oregon This profile reflects state managed care program information as of August 2014, and only includes information on active federal operating authorities, and as such, the program start
Managed Long Term Care: Options for New York and Examples From Other States
Managed Long Term Care: Options for New York and Examples From Other States Prepared by James M. Verdier Mathematica Policy Research, Inc. for the Medicaid Redesign Team Managed Long Term Care Implementation
Oregon Health Care Innovation Plan Oregon Health Authority. Submitted to Centers for Medicare & Medicaid Innovation September 21, 2012
Oregon Health Care Innovation Plan Oregon Health Authority Submitted to Centers for Medicare & Medicaid Innovation September 21, 2012 Table of Contents I. Vision of Oregon s Health Care Innovation Plan...
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
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
Concept Paper: Texas Nursing Facility Transformation Program
QAPI Version Concept Paper: Texas Nursing Facility Transformation Program Introduction This concept paper presents a proposal to establish a Nursing Facility (NF) Transformation Program beginning in DY
Testimony to the Senate Committee on Veterans Affairs and Health S. B. 739. February 27, 2014. What is an Accountable Care Organization or ACO?
Testimony to the Senate Committee on Veterans Affairs and Health S. B. 739 Professor Sidney D. Watson Center for Health Law Studies Saint Louis University School of Law February 27, 2014 My name is Sidney
Moving Toward Accountable Care Organizations in the States
Moving Toward Accountable Care Organizations in the States Delivering on the Promise Medicaid Health Plans of America 2012 Annual Meeting Presented by Joyce Dubow October 24, 2012 Presentation overview
How To Improve Health Care For All
TIMELINE FOR IMPLEMENTATION OF THE AFFORDABLE CARE ACT 2010: NEW CONSUMER PROTECTIONS Eliminated pre-existing coverage exclusions for children: under age 19. Prohibited insurers from dropping coverage:
OHIO CONSUMERS FOR HEALTH COVERAGE POLICY PRIORITIES FY 2012-13. Medicaid Make Improvements to Improve Care and Lower Costs
OHIO CONSUMERS FOR HEALTH COVERAGE POLICY PRIORITIES FY 2012-13 Ohio Consumers for Health Coverage supports robust implementation of the Patient Protection and Affordable Care Act (ACA) in Ohio, making
Are We There Yet? Evaluating Care Coordination Systems
Are We There Yet? Evaluating Care Coordination Systems Dianne Hasselman, Senior Director, Strategic Programs NAMD Annual Meeting November 4, 2014 Arlington, VA Network for Regional Healthcare Improvement
Medical Home Overview May 6, 2014 Noon-1:00pm EST
Medical Home Overview May 6, 2014 Noon-1:00pm EST Paul Klintworth, Medical Home Lead Office of the National Coordinator for IT U.S. Department of & Human Services Meaningful Use as a Building Block Office
HIV Services, Ryan White Programs and the Affordable Care Act: What do we know now?
HIV Services, Ryan White Programs and the Affordable Care Act: What do we know now? Thursday April 10, 2014 Presented by Carole Treston, RN, MPH Chief Nursing Officer Association of Nurses in AIDS Care
The Affordable Care Act: Its Impact on People with Serious Chronic Diseases
The Affordable Care Act: Its Impact on People with Serious Chronic Diseases PSC Partners Annual Conference Victoria Veltri, JD, LLM State Healthcare Advocate April 26, 2013 Discussion Areas What is the
Pushing the Boundaries of Population Health Management: How University Hospitals Launched Three ACOs July 26, 2013 American Hospital Association
Pushing the Boundaries of Population Health Management: How University Hospitals Launched Three ACOs July 26, 2013 American Hospital Association Eric J. Bieber, M.D. Chief Medical Officer, University Hospitals
Care Coordination among DSRIP Partners
Care Coordination among DSRIP Partners John F. Skip Williams, Jr., MD, EdD, MPH Maureen Fahey, RN, MBA Thursday, June 25, 2015 3:00-3:30 pm OVERVIEW OF PRESENTATION New York State DSRIP Overview Brooklyn