1 Robert Margolis, M.D. CEO, HealthCare Partners February 25, 2010 The Future Design of Accountable, Coordinated Care Organizations.

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Presentation transcript:

1 Robert Margolis, M.D. CEO, HealthCare Partners February 25, 2010 The Future Design of Accountable, Coordinated Care Organizations

2 Health Care Reform Insurance Reform Delivery System Reform – Today’s Topic

3

4 HealthCare Partners HealthCare Partners and its physician networks nationally serves over 1,000,000 patients including over 140,000 Medicare Advantage and 600,000 commercially insured members primarily through global capitation. The pre-eminent physician-owned, professionally managed, patient-centered coordinated care system in the nation and an important delivery system in the many communities we serve.

5 Accountable Care Organizations Providers capable of full continuum of care Physician / hospital networks  Contracted / financial alignment / PHO Legal structure allows distribution of performance bonuses Quality metrics, transparency HIT adoption

6 One Model of ACO Development NCQA tiered criteria for Medical Home Parallel track – financial solvency and capability to assume financial risk  Shared savings  Shared risk  Full risk

7

8 Within an ACO Medical Home Bundled Payments Shared Decision Making Care Management – Hospital and Ambulatory Hospitalists Data / Data / Data Information

9 Current SystemFuture State Current SystemFuture State - FFS – Volume Incentives- Integration - More vs. Better- Coordination - Adversarial Relationships- Cooperation - Fragmentation- Team Care - Aligned Incentives - Payment and Profitability tied to quality, access and efficiency

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