Accuntable Care Organizatins Presentatin t NCSL Fall Frum Dec. 10, 2010 Barbara Yndrf, NCSL Cnsultant Yndrf & Assciates ---- Phenix, Ariz. Overview f Presentatin 2010-11 11 NCSL health prject fresh lk at state ptins fr cntaining csts Accuntable care rganizatins - vehicle fr cst cntainment 2
Cntaining Health Csts, Realizing Efficiencies Series f briefs n strategies t: Reduce expenditures Slw expenditure grwth Get better value Eliminate waste, excessive payments Fcus: state examples, laws Emphasis: dcumented savings, efficiencies 3 State Cst Cntainment Strategies Examples Payment refrm Glbal prvider payments Episde-f-care payments All-payer claims databases Prvider perfrmance-based payments All-payer rate setting Purchasing strategies Rx vlume purchasing Generic drugs, brand-name discunts Pling public emplyee health care
State Cst Cntainment Strategies (p. 2) Examples (cnt d) Delivery system refrms, preventin Accuntable care rganizatins Medical hmes Public health prmting healthy habits Emplyer wellness prgrams Other Administrative simplificatin Fraud and abuse cntrl (See handut fr cmplete list) Accuntable Care Organizatins (ACOs) Elements: Lcal, prvider-led entity Wide range f cllabrating prviders Care mnitred acrss prviders (physician practices, clinics, hspitals, etc.) Accuntable t payers fr verall cst, quality fr a defined ppulatin 6
Accuntable Care Organizatin Specialists Physician practices (medical hmes) Hspital(s) If yu ve seen ne ACO, yu ve seen ne ACO Relatively new cncept Exact definitin varies Nnetheless, frming quickly DMC dctrs jin march tward accuntable care CIGNA Piedmnt Physicians Grup Launch ACO Pilt Prgram in Atlanta fr Better Care Crdinatin
Types f ACOs Level 1 Prviders Included Multiple primary care practices Pssible Cst Savings Preventin, early diagnsis, care management, fewer ER visits Level 2 + Majr specialties + Mre efficient specialist use Level 3 + Hspitals + Imprved cmplex patient care management Level 4 + Safety net clinics, public health + Crdinated health, scial service supprts
Cst Cntainment Target Lack f accuntability ab fr ttal cst, quality f patient care Estimated ptential Medicare savings: $5.3 billin between 2010 and 2019 frm reduced service vlume and intensity. Cngressinal Budget Office 11 Adherence t Quality Guidelines Breast Cancer Prenatal Care Crnary Artery Disease Hypertensin COPD Hyperlipidemia Diabetes Mellitus 75.7 73 68 64.7 58 48.6 45.4 Adults receive abut Half recmmended d care 54.9% = Overall care 54.9% = Preventive care 53.5% = Acute care 56.1% = Chrnic care Alchl Dependence 10.5 0 25 50 75 100 % f Recmmended Care Received
Uncrdinated Care My specialist did nt receive basic medical infrmatin frm my primary care dctr My primary care dctr did nt receive a reprt back frm a specialist Test results/medical recrds were nt available at time f appintment Dctrs didn't give ther prviders imprtant medical infrmatin I think shuld have it I was nt cntacted r had t call repeatedly t get test results Any f the abve 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Surce: Cmmnwealth Fund Survey f Public Views in the U.S. Health Care System, 2008. State Examples MA Cmmissin: set risk rules t accept glbal payments OR Cmmittee: establish accuntable care districts WA 2 multi-payer pilts integrated and nn-integrated VT natinal pilt participatin Medicaid, CHIP shared savings cntracts Anti-trust prvisins Medicaid prgrams (ACO-like) Cmmunity Care f Nrth Carlina Clrad Reginal Care Crdinatin Organizatins
Federal Health Refrm Pilts Medicaid/SCHIP pediatric ACOs demnstratin (2012-2016) Medicare ACO shared savings prgram Savings, Quality Evidence Insufficient i evidence New cncept, nt fully tested Any prjectins f savings frm the frmatin f ACOs are subject t a high degree f uncertainly. Medicare Payment Advisry Cmmissin
Savings, Quality Evidence (p. 2) Integrated health systems mre efficient care Kaiser Geisinger Grup Health Cperative Private Minnesta Patient Chice prgram savings, quality imprvement Medicare Grup Practice Demnstratin unclear 1990s risk-bearing prvider grups prblems Pssible State Rles Authrize creatin License, certify Authrize Medicaid, CHIP cntracts Address anti-trust issues Address rural issues Fund enhanced payments, crdinatin fees Handle prvider, cnsumer cmplaints Cllect, analyze data Evaluate
Anti-Trust Issue Dctrs Hspitals. Imprved Outcmes Lwer Csts ± Higher Prices Imprved Outcmes Thanks