innovative approaches to accountable care · aco report overview this report and accompanying aco...
TRANSCRIPT
Innovative Approaches to Accountable Care Health Policy News: Report Overview and Discussion
November 14, 2019
www.publicconsultinggroup.com
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
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www.publicconsultinggroup.com
Margot Thistle
Senior Consultant
3
Senior Advisor
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.
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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
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Select State ACO Programs
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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.
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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
14
Senior Advisor
Michael Joseph
Contact Information
Lisa Kaplan Howe
Senior Consultant
Be sure to check
pcghealthpolicy.com
regularly for breaking
news and coverage of
the latest trends in
health policy!
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