![Page 1: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/1.jpg)
Accountable Care OrganizationsThe Camel’s Nose Is In The Tent
David Harlow JD MPHTHE HARLOW GROUP
LLCblog • healthblawg.com
twitter • @healthblawg
November 8, 2012 Baton Rouge, LA
23rd AnnualLouisiana Society of Hospital Attorneys
Health Law Symposium
![Page 2: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/2.jpg)
We are challenged by shifting sands
![Page 3: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/3.jpg)
High-performing health care providers can be integrated into
high-performing health care systems
![Page 4: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/4.jpg)
What are the federales trying to
accomplish?
The “Triple Aim”
Better careBetter health Lower costs
![Page 5: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/5.jpg)
ACO: Getting more elegant?
![Page 6: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/6.jpg)
ACO: Drop in the bucket?
![Page 7: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/7.jpg)
ACO: Getting more elegant?
![Page 8: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/8.jpg)
Value-Based Payment
![Page 9: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/9.jpg)
ACO is one tool to get providers to manage a population of
patients
![Page 10: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/10.jpg)
How? Financial incentives.
BillingsDartmouth
EverettForsyth
GeisingerMarshfield
MiddlesexPark Nicollet
St. John'sMichigan
$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
Yr 1 Yr 2
Yr 3 Yr 4
Yr 5
Graphic courtesy Jaan Sidorov, Disease Management Care Blog
![Page 11: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/11.jpg)
What is an
ACO?
![Page 12: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/12.jpg)
ACO BasicsSingle entityThree-year commitmentOne-way or two-way risk-sharingPCPs and broader network 5000 patient minimum
33 performance measures Patient engagement Patient-centeredness Stark/AKS IRS Antitrust
![Page 15: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/15.jpg)
ACO regulations coordinate
across numerous Federal
agencies
![Page 16: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/16.jpg)
All in all, ACO risk/reward ratio seems skewed
![Page 17: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/17.jpg)
IT infrastructure cost estimate >$1.5m
![Page 18: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/18.jpg)
Success requires both:Conversion of health systemdata to actionable intelligence
Clinical Integration
&
![Page 19: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/19.jpg)
More details from the ACO rules, and traps for the unwary
![Page 20: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/20.jpg)
Over 60% of health care provider executives said they intend to form an ACO before the rules were out
![Page 21: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/21.jpg)
Culture of Collaboration
![Page 22: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/22.jpg)
Opportunities for physician-led ACOs
![Page 23: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/23.jpg)
Even if an ACO is not in your immediate future, these principles
will affect you
Bundled Payments
Commercial ACOs
Pay for Performance
Other Innovations
![Page 24: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/24.jpg)
Commercial plans are non-standardized
![Page 25: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/25.jpg)
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
![Page 26: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/26.jpg)
MSSP is just one arrow in the quiver
•Medicare Shared Savings Program – “Traditional” ACO•Advance Payment Initiative•Pioneer ACO•Other CMS Innovation Center Initiatives
Bundled PaymentsComprehensive Primary Care InitiativeFinancial Alignment InitiativeFQHC Advanced Primary Practice DemoGraduate Nurse Education DemoHealth Care Innovation AwardsIndependence At Home DemoInitiative to Reduce Avoidable Hospitalizations Among Nursing Facility ResidentsInnovation Advisors ProgramMedicaid Emergency Psychiatric DemoMedicaid Incentives for the Prevention of Chronic DiseasesMillion HeartsPartnership for PatientsCommunity-based Care Transitions ProgramState Innovation Models InitiativeStrong Start for Mothers and NewbornsFor details, see: innovations.cms.gov/initiatives/
![Page 27: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/27.jpg)
CMS Bundled Payment Initiative
Bundled Payments
ACO “lite”MS-DRG-specificGainsharing
. . . Bundled Payment Pilot - 2013
![Page 28: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/28.jpg)
Medicare FFS Reimbursement
Discount incorporated
into target price
Potential shared savings
Actual cost of providing bundle of services
Bundled Payments
CMS payment
![Page 29: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/29.jpg)
Care Coordination Initiatives
![Page 30: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/30.jpg)
What can you do now to prepare for the future?
![Page 31: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/31.jpg)
Physicians are central to
the development
of an accountable
care organization
![Page 32: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/32.jpg)
You cannot manage what you do not measure
![Page 33: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/33.jpg)
Opportunity for all providers: Be the go-to (cost-effective) guys (or gals)
![Page 34: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/34.jpg)
![Page 35: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/35.jpg)
.
![Page 36: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/36.jpg)
![Page 37: Accountable Care Organizations - The Camel's Nose Is In the Tent](https://reader031.vdocument.in/reader031/viewer/2022020715/554ea1ebb4c9055f7b8b47b7/html5/thumbnails/37.jpg)
for contact info txt dharlow to 50500or scan the QR code
harlowgroup.nethealthblawg.com
twitter.com/[email protected]
Thank YouDavid Harlow JD MPHTHE HARLOW GROUP
LLC