What to look for in an Accountable Care Organization

 In 2000, Congress via legislative mandates directs the Centers of Medicare and Medicaid Services to test models of care that share savings with physicians.  The Innovation Center was established by section 1115A of the Social Security Act(as added by section 3021 of the Affordable Care Act)  In 2006, researcher, Elliot Fisher of Dartmouth introduced the concept of “extended hospital medical staff”.  In 2002, the Physician Group Practice Demonstration Design Report was submitted to CMS  Physician Group Practice Demonstration implemented from

 Passage in April 2010  CMS issues the final rule for the ACO concept October 2011  Pioneer ACO’s awarded in January 2012  The Supreme Court upholds the constitutionality of the now infamous “Obamacare Act” July

 Increasing numbers of uninsured or underinsured Americans  Medical bills a leading driver of personal bankruptcies  Skyrocketing cost: with cost rising at the present rate medical cost will be 19.3% of GDP by

5 As the cost of health care continues to rise, averaging $20, per American family, and as the cost consumes more of the GDP Payers (Commercial and Public) are looking for more value for each dollar spent.

 The World Health Organization ranks the United States of America 37 th among industrialized countries  5% of the patients drive 44% of the healthcare expenditure 6

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8 Access to Care Cost Containment Quality of Care Value

 Groups of Physicians, hospitals, SNF, Providers/Suppliers, etc. who agree to work together to achieve improved individual health, improved population health, reduced expenditures for health care in an Evidence- based approach  Legal Entity  Governing Body with 75% Physician Representation  Willing and able to distribute Shared Savings 9

 Qualified legal entity  3 year contract with CMS for a minimum of 5,000 Medicare A&B and dual eligible recipients  Achieve the triple goal of better care, better health, and lower cost  Pioneer ACO’s, Advance Payment Model, Shared Savings (one-sided or two-sided model) 10

 Fee for Service continues to decline with physicians trying their best to keep up by volume business.  Bundled Payments  Chronic Disease Management or Intensivist Carve-Outs  Shared Savings Arrangement (Medicare and Commercial) 11

12 PayrollStaffing Office Overhead EHR Billing and Management MeaningfulUse ChronicDiseaseManagement CareCoordination

13 CVCHiP Health IT Health Analytics Population Management Care Coordination Business Development CMS Liaison Outreach MD SNFMD HOSPITAL MD Provider Supplier RNNPPA STAFF

 Governance (will you have a seat at the table?)  Mission  Policy and design input  IT, Quality Improvement, and Reporting support  Shared Savings 14

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18 ACO’s Provide the Cover for Urban Practices Health IT Care Coordination Population Management Health Analytics

 Centers for Medicare and Medicaid Services website  Medicare Shared Savings: A Practical Path to Accountable Care, sponsored by Medical Economics whitepaper  Commonwealth Fund 2010, Exhibit ES-1. Overall Ranking  Health Affairs, Volume 31 No.11, November

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