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Accountable Care Organizations, Bundled Payments, and the
Future of Health Care
David Harlow JD MPHTHE HARLOW GROUP LLC
blog • healthblawg.comtwitter • @healthblawg October 27, 2011
Interactive Housekeeping . . .
• Questions and comments– Webinar chat window– Livetweeting the webinar, and a real-time
tweetchat -- #ACOchat -- http://j.mp/ACOchat
• Links to all government ACO issuances from October 20 – http://j.mp/ACOfinal
We are challenged by shifting sands
High-performing health care providers can be integrated into
high-performing health care systems
What are the federales trying to
accomplish?
The “Triple Aim”
Better careBetter health Lower costs
ACO: Getting more elegant
ACO is one tool to get providers to manage a population of
patients
How? Financial incentives.
$0
$2,000,000
$4,000,000
$6,000,000
$8,000,000
$10,000,000
$12,000,000
$14,000,000
$16,000,000
$18,000,000
BillingsDartmouth Everett Forsyth
GeisingerMarshfield
Middlesex Park Nicollet St. John's
Michigan
Yr 1 Yr 2
Yr 3 Yr 4
Yr 5
Graphic courtesy Jaan Sidorov, Disease Management Care Blog
Whatisan
ACO?
ACO BasicsSingle entityThree-year commitmentOne-way or two-way risk-sharingPCPs and broader network 5000 patient minimum
33 performance measuresPatient engagementPatient-centerednessStark/AKSIRSAntitrust
ACO regulations coordinate
across numerous Federal
agencies
All in all, ACO risk/reward ratio seems skewed
IT infrastructure cost estimate >$1.5m
More details from the ACO rules, and traps for the unwary
Rolling start dates due to lateness in finalizing rules
Over 60% of health care provider executives said earlier this year
they intend to form an ACO
Culture of Collaboration
Opportunities for physician-led ACOs
Even if an ACO is not in your immediate future, these principles
will affect you
Bundled Payments
Commercial ACOs
Pay for Performance
Other Innovations
MSSP is just one arrow in the quiver
•Medicare Shared Savings Program – “Traditional” ACO•Advance Payment Initiative•Pioneer ACO•Other CMS Innovation Center Initiatives
CMS Bundled Payment Initiative
Bundled Payments
ACO “lite”MS-DRG-specificGainsharing
. . . Bundled Payment Pilot - 2013
Care Coordination Initiatives
Commercial plans are non-standardized
Jeff Goldsmith: Suggests 3 commercial ACO payment systems
for 3 different types of providers
• Risk-adjusted capitation
Primary
• Fee-for-service
Emergency
• Bundled payments
Specialty
What can you do now to prepare for the future?
Physicians are central to
the development
of an accountable
care organization
You cannot manage what you do not measure
Opportunity for all providers: Be the go-to (cost-effective) guys (or gals)
.
for contact info txt dharlow to 50500or scan the QR code
harlowgroup.nethealthblawg.com
twitter.com/healthblawgdavid@harlowgroup.net
Thank You David Harlow JD MPHTHE HARLOW GROUP LLC
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