innovative approaches to accountable care · aco report overview this report and accompanying aco...

Innovative Approaches to Accountable Care Health Policy News: Report Overview and Discussion

November 14, 2019

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Agenda

Introduction…………………….......3

ACO Report Overview…..........….4

Innovative State ACO Approach…….............................…5

State and Federal Regulatory Efforts….........................................7

Discussion………………...…...….10

Q&A…………………………………12

Contact Information……………..14

2

www.publicconsultinggroup.com

Margot Thistle

Senior Consultant

mthistle@pcgus.com

3

Senior Advisor

lkaplanhowe@pcgus.com

Lisa Kaplan Howe

Health Policy News Team

Please feel free to send us questions during the

webinar and we will do our best to answer them

during the Q&A.

The discussion portion of the

webinar will feature a member

of our Delivery System and

ACO Evaluation Team -

Michael Joseph, Senior

Consultant

Introduction

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ACO Report Overview

This report and accompanying ACO Tracking Tool were developed for state policy leaders in both the

commercial and public insurance spheres who are looking for insights into the program design

approaches and implementation of accountable care delivery in other states.

4

The report and tracking tool are

posted on the Health Policy

news blog.

The presentation and discussion will touch on

some of the states we featured in the report but

focus more on ongoing efforts to improve

existing ACO programs, including…

• Integration of behavioral health

• Regulatory efforts to ensure a positive

consumer experience

• Quality improvements and measurement

• Value-based payment and other financial

incentives for providers

Innovative State ACO Approaches

5

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Select State ACO Programs

6

Vermont Accountable Care Organizations (ACOs)

Key Features:

• Behavioral Health Integration including technical assistance to MH/SUD providers

• $15.7M in savings in the first two years of its shared savings program.

Active Medicaid ACO Program

Developing/Studying

Medicaid ACO Program*

Maine Accountable

Communities (ACs)

Key Features:

• Behavioral health services

included in TCOC calculations

• ACs realize a 3.1%

cost savings increase,

netting $4.56M for the

Medicaid program.

*as of the end of 2018

Minnesota Integrated Health

Partnerships (IHPs)

Key Features:

• Behavioral health services included

in TCOC calculations

• Realized $213 million in savings,

reduced hospital readmissions 14%, and

ED visits by 7% over 4-year period

State and Federal Regulatory Efforts

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Innovative State Regulatory Approaches

Certification

• Massachusetts, New York and Vermont all

have mechanisms for certifying ACOs.

• Certification is mandatory for certain ACOs.

• Certification in NY allows ACOs to be excluded from

certain legal provisions.

Internal and External Review

• Massachusetts is leading the way on addressing

consumer protection concerns related to ACOs.

• ACOs and other risk-bearing organizations must create

an internal appeals process and patients also have

access to binding external review.

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Federal Regulatory Context and NCQA Approaches

Federal Regulations

• Federal regulations dictate

the development, structure and operation of

ACOs that operate within Medicare ACO

programs:➢ Medicare Shared Savings Program➢ ACO Investment Model➢ Next Generation ACO Model➢ Comprehensive ESRD Care Model

• These programs may serve as models in the development of state programs and regulatory approaches.

• Underlying federal laws may also apply to and impact the development and operation of ACOs.

NCQA Approaches

• Certification of ACOs is available at the

national level through NCQA.

• This accreditation is voluntary but could

be made mandatory by states and is a

signal of ACOs following defined best

practices.

9

Discussion

“” “Evaluations of recent ACO

programs show quality improvements

among all participating organizations and

financial savings for many. This is not a

surprise. The Institute of Medicine has

been reporting for more than a decade

that a third or more of medical spending

could be eliminated while increasing

patient health. The only surprise is how

fast the system has moved in this

direction.”

-David Cutler, PhD, Professor of Economics at

Harvard University

Q & A

“” "Accountable Care

Organizations are

implementing interventions to

achieve triple-aim objectives of

improved quality and

experience of care while

maintaining costs"

-Center for Disease Control*

*Davis MM, Gunn R, Pham R, Wiser A, Lich KH, Wheeler SB, et al. Key Collaborative Factors When Medicaid Accountable Care Organizations Work With Primary Care Clinics to Improve Colorectal Cancer Screening: Relationships, Data, and Quality Improvement Infrastructure. Prev Chronic Dis 2019;16:180395. DOI: http://dx.doi.org/10.5888/pcd16.180395

www.publicconsultinggroup.com

Margot Thistle

Senior Consultant

mthistle@pcgus.com

14

Senior Advisor

lkaplanhowe@pcgus.com

Michael Joseph

Contact Information

Lisa Kaplan Howe

Senior Consultant

mjoseph@pcgus.com

Be sure to check

pcghealthpolicy.com

regularly for breaking

news and coverage of

the latest trends in

health policy!

TM