1. Dr. Daniel Berman DBA/HCA,MSN,RN,FACHE,FACATA,LHCRM
Healthcare Thought Leader
Clinical Benefits and Decision Making in the Creation of the Coordinated Care Organizations

2. Important Trends in the Locus of Care
By 2018, Acute Care Beds in Community Hospitals with present Bed Level at 300 will have 50% less Acute Care Beds.
60% of all Hospital Admissions will be ICU admissions only.
70% of all surgical procedures will be outpatient procedures.
90% of all care will no longer be financed as fee for service but rather under a capitated dollar.

3. Present Attitudes of the Consumers
Recent Wall Street Journal Poll of 250,000 healthcare consumers showed that the top seven priorities for healthcare relied more on cost not quality:
1) Co-Payments
2) Cost of Drugs
3) Cost of Hospitalization
4) Big Drop
5) Then quality
6) Liking Physician
7) Patient Outcomes

4. Questions and Contact Dr. Daniel Berman

5. Coordinated Care Organizations
Healthcare Systems are Consolidating at rapid rate
Study was done of the Coordinated Care System in Summitt, NJ area
Found:
There was a 20% drop in the cost of care per episode versus not in a coordinate care organizations
There was a 556Billion dollar saving in Healthcare for a five year period before coordinated organizations in place
(Fiscal Times, June 2012)

6. Advantages to Coordinated Care
Kathleen Sebelius, Secretary of Public Health

7. Advantages to Coordianted Care
Patient Care experiences
Care Coordination
Patient Safety
Prevention
Population Health

8. Economic Advantage to Coordinated Care
Medical Cost Offset-
Is the cost of a Costly Coordinate Delivery System with Intensive Monitoring and Case Management
Less Costly then the cost of Care and without this
In , at the Aids Healthcare Foundation we found that the cost of an intensive monitoring program of the patients with cost outliers to recognize cost savings of over 60% when intensive program used.

9. Program Included Intensive Patient Education
Intensive Telephonic Monitoring
Intensive monitoring of patients following protocols and assigned patient care services
Intensive home health visits
Psychological Counseling

10. Development of Clinical Services in ACO
Using Fiscal Costs of Diseases determine the tops three most costly diseases in the geographic area to be covered. These might change based upon region of the US. They are typically
A) Cardiac
B) Respiratory
C) Diabetes
D) HIV and Cancer

11. Development of Programs
What Clinical Services are needed both pre-hospital, acute care, rehabilitation, and outpatient care
What management systems including management and IT need to be in place
What Capital needs to be in place to carry out this care
What Outcomes Management and Evaluation Systems
What Care and Care Systems Protocols
(These need to be answered for all services covered)
(That is why Medical Cost Offset data is important)

12. Development of Services
The clinical services is less than the revenue generated
Each Disease state has its own unique cost of the disease and cost of the care.
A mistake that ACO make is to use the average cost and not the cost per disease in their calculations of cost and delivery of care

13. Development of Services
Each Disease must have its own clinical protocols and clinical pathways and have a cost of the disease and cost of care with protocols be outlined

14. Success of the Clinical Integration of the Coordinated Care System Need to be based
On importance and Risk Pool of insurance coverage:
Geographic Determinants
Social Determinants
Racial and Cultural Composition of the insured
Epidemiological Results of the population

15. Success of Clinical Integration
Each Disease must have its own complete clinical care system with ot without the same providers.
A common mistake it to often have as same as every thing to meet economies of scale.
Presently before a contract is bidded on the executives and fiscal experts gather data and costs and then bid the contract
The future is going to be in reverse

16. Future of Coordinated Care
No longer is Care going to be provided by one system just because they have history or providing services
Proposed Steps
A) An Epidemiological and Social Epidemilogical assessment of geographic area that health system is operating in
B) A Community Needs Assessment
C) A Community Health Asset Analysis of the area of operation
D) An economic analysis of the cost of disease in the area

17. Future of Coordinated Care
E) An economic analysis of each disease state wanting an ACO for
F) An Economic Analysis of the cost of care for that disease
Pre-hospital
Hospital
Rehab
Outpatient

18. Future of Coordinated Care
G) A description of all the services and systems affixed with that disease and affixed cost.
H) Only after doing all these steps can you decide whether it is cost effective and or profitable to develop a Coordinate Care System