1. KAREN POSTAL PH.D., ABPP-CN CHAIR OF PRACTICE, AMERICAN ACADEMY OF CLINICAL NEUROPSYCHOLOGY KATHERINE NORDAL, PH.D. EXECUTIVE DIRECTOR APA PRACTICE ORGANIZATION Healthcare Reform Are neuropsychologists at the Table?

2. Medicare & Medicaid Private Insurance Thought experiment: change in our practices Timeline of Changes:

3. Medicare is Changing PRIOR: PAY PER PROCEDURE NOW: INCENTIVE LESS CARE/ QUALITY

4. Now.

5. Timeline PPACA Pioneer Pilot ACOs begin 1/1/12 33 across the country; 5 in Eastern MA Cost saving sharing 1/1/12Medicare ACO share “profit” Global payment pilots 1/1/13First bundled payment pilot Expansion of Medicaid 1/1/14Additional 16 Million covered Exchanges must be established 1/1/1424 Million more covered Global Payments 1/1/15

7. The supreme court decision is not stopping that train.

8. $ Highest percentage of GPA Worse global health outcomes Payment reform is a bipartisan issue U.S Healthcare system

9. Private Insurance is Changing PRIOR: PAY PER PROCEDURE NOW: INCENTIVE LESS CARE/ QUALITY

10. Private insurers are rapidly moving towards global payments and ACOs Massachusetts BCBS HMO 75% of patients currently in AQCs

11. Why do private insurers love Global Payments? Providers Authorization gate keeping Financial risk

13. REIMBURSEMENTS ARE TIED TO REDUCTIONS IN THE TOTAL COST OF CARE FOR A POPULATION OF PATIENTS. (AS LONG AS QUALITY MARKERS ARE MET) accountable care organizations (ACOs)

14. Medicare ACO Quality Measures

16. MEDICARE PROFESSIONALS MD DO PA NP CNS OTHER ENTITIES MAY JOIN THE GROUPS AS “PARTICIPANTS” Who shares in the incentives?

17. THE ACO KNOWS EXACTLY WHAT EACH DOCTOR IS BILLING ACOs Tools to Control Costs Transparency

18. Thought Experiment

19. Current common referral patterns Institutional setting neurology Primary care Other specialists Private practice Word of mouth neurology Primary care

21. PCP refers to neurologist Neurologist refers to: You. $ of You+ neurologist+ ___PCP___ ACO $ $ $

22. PCP refers to another neurologist Neurologist refers to: neurologist+ ___PCP___ ACO $

23. PCP refers to: Only $ of __PCP__ ACO

24. Your contribution Reducing Costs Improving quality measures

25. What is the diagnosis? How can cognitive & psych data be used to improve health and reduce cost? Fundamental shift in our professional identity

26. PATIENTS HEALTH AND HEALTHCARE COSTS. This means neuropsychologists have to own

27. TREAT MEDICATION NON-COMPLIANCE AS A CRISIS? UTILIZE PSYCHOLOGICAL AND COGNITIVE DATA TO DEVELOP AN ACTION PLAN TO ADDRESS THEIR MAJOR HEALTH ISSUES? Diabetes action plan: blood monitoring and diet Heart disease action plan: exercise Asthma management (often family systems intervention) How many neuropsychologists

28. PCP refers to: Neuro- psychology PCP+ Neuropsych Cost saving

29. IDENTIFY AND DEVELOP A RELATIONSHIP WITH LOCAL ACO(S) EFFECTIVELY COMMUNICATE HOW NEUROPSYCH ASSESSMENTS WILL HELP THEM LOWER COSTS/ IMPROVE QUALITY SUPPORT APA PRACTICE ORGANIZATION/ ADVOCACY FOR MORE FAVORABLE RULES Who will succeed? Neuropsychologists who: