Safiah Mamoon HTM 520

INTRODUCTION U.S. healthcare sector– very large with fragmented care High spending for poor outcomes Care not coordinated Providers reimbursed for services regardless of quality According to the IOM, care needs to be: Safe Effective Efficient Equitable Timely Patient-centered

ACOs can be the solution

WHAT IS AN ACO ? Set of providers jointly held accountable for achieving measured quality improvements reductions in the rate of spending growth Provides coordinated, patient-centric services across continuum of care in designated population Comprised of primary care physicians Specialists hospitals post-acute care facilities health insurance plans Other

ACA and ACO ACA of 2010 required Medicare to start utilizing ACOs by 2012 To participate in the Medicare Shared Savings Program (MSSP), ACO must Enroll 5000 Medicare beneficiaries Participate in the MSSP for a minimum of 3 years Share in any cost savings that arise from quality improvements and enhanced efficiency

ACO and Meaningful Use (MU) ACO need to show improved performance on 65 clinical measures in 3-year period 26 of 65 requirements also MU Criteria captured by certified EHR system Strong alignment between EHR incentive program and MSSP MU and HIEs will help ACO meet many of its objectives

ACO AND MU MU Improve quality, safety, efficiency, and reduce health disparities Engage patients and families Improve care coordination Ensure adequate privacy and security protections for personal health information Improve population and public health. MU goals

ACOs and Quantifiable Data Demonstrate evidence-based medical practice Demonstrate patient engagement Report on quality and cost measures Demonstrate improved outcomes Demonstrate cost-savings Value-based reimbursement Financial incentives

ACOs AND HIT

Organizations AHIC

BENEFITS OF ACOs

Barriers and Challenges Financial Business HIE-related Standards and Certification Privacy and Security Cultural Legal

ACO MAP

FUTURE TRENDS December, 2013—500 ACOs Expected to double by end of 2014 Commercial plans with ACOs Aetna, Blue Cross Blue Shield, Cigna and Anthem/Wellpoint EXPECTED TO GROW

Remember What is an ACO Joint accountability measured quality improvements cost reduction patient-centric coordinated services Across continuum of care Financial incentives ACA and ACO Organizations and Standards Benefits Barriers Future Trends