1. CCOs in Oregon Moderated by: John McGraw, MD

2. Presenters David SchlactusCEO, Hope Orthopaedics David SchlactusCEO, Hope Orthopaedics Robert Orfaly, MDOAO President/OR BOC Robert Orfaly, MDOAO President/OR BOC Timothy Keenen, MDOAO President-Elect Timothy Keenen, MDOAO President-Elect John Tongue, MDAAOS President John Tongue, MDAAOS President

3. Introduction to the Issue Using Oregon as a case study Using Oregon as a case study Ideas on adjusting to expanded coordinated care Ideas on adjusting to expanded coordinated care OAO response OAO response At least 8 other states are developing similar models At least 8 other states are developing similar models Nearly 30 states have considered legislation to study expanding ACOs Nearly 30 states have considered legislation to study expanding ACOs

4. States Implementing ACOs for Medicaid

5. States with Medicaid/State Payer ACOs Colorado Colorado Oregon Oregon Maine Maine Massachusetts Massachusetts Minnesota Minnesota New Jersey New Jersey Texas Texas Utah Utah Vermont Vermont

6. Colorado First Medicaid ACO model First Medicaid ACO model Pre-dated federal ACOs Pre-dated federal ACOs Transitioning 1/3 of children and 2/3 of adults to ACOs Transitioning 1/3 of children and 2/3 of adults to ACOs Specialty care requires referral from a primary care provider Specialty care requires referral from a primary care provider Per Member Per Month fees, plus incentives for achieved savings Per Member Per Month fees, plus incentives for achieved savings

7. Massachusetts No physician is required to become part of an ACO No physician is required to become part of an ACO Providers of freestanding services may appeal if an ACO declines to contract with them Providers of freestanding services may appeal if an ACO declines to contract with them Provider groups whose spending exceeds state-set spending targets may be required to file a performance improvement plan Provider groups whose spending exceeds state-set spending targets may be required to file a performance improvement plan Provider groups who carry downside financial risk must register with the state Provider groups who carry downside financial risk must register with the state Exempts groups without financial risk who have fewer than 15,000 patients or less than $25 million in net patient service revenue. Exempts groups without financial risk who have fewer than 15,000 patients or less than $25 million in net patient service revenue.

8. Massachusetts State collects and publicly reports cost and quality data provided by provider group State collects and publicly reports cost and quality data provided by provider group Physicians must report their cost and quality information to the state annually Physicians must report their cost and quality information to the state annually State will certify groups that carry downside financial risk to determine if they are likely to meet their financial obligations State will certify groups that carry downside financial risk to determine if they are likely to meet their financial obligations

9. Oregon AAOS Health Policy Action Fund grant helped to fund legislative event AAOS Health Policy Action Fund grant helped to fund legislative event Included three Health Committee leaders Included three Health Committee leaders Educated state policymakers about orthopaedic position Educated state policymakers about orthopaedic position Health policy leaders educated physicians about health system transformation Health policy leaders educated physicians about health system transformation