The federal government is trying to reinvent the health care system through a variety of programs. One of them is the Accountable Care Organization program for Medicare. Another is a series of initiatives from the CMS Center for Innovation, including bundled payment initiatives. Commercial insurance companies have already deployed ACO-like approaches to contracting with their provider networks, stepping away from traditional fee-for-service payment and towards pay for performance. These changes in reimbursement will drive changes in care delivery systems, and physicians need to prepare themselves to be integrated into these new systems. This presentation examines the current landscape -- including the final ACO regs -- and future opportunities for providers. David Harlow consults to provider organizations on matters including physician-hospital collaboration, and has prepared successful demonstration project applications for CMS gainsharing (PHCD) and ACE demonstrations. He can educate your organization and facilitate the conversations that need to happen among hospitals, physicians and other providers in order to find a way forward together in a rapidly-changing health care environment. Engage David Harlow as a keynote speaker or consultant to your organization: http://healthblawg.com One recent review: '@healthblawg is so good I just tend to listen vs tweet' To access a webcast of this webinar with audio, go to: http://j.mp/tgvGBH.

1. Accountable Care Organizations,
Bundled Payments, and the
Future of Health Care
David Harlow JD MPH
THE HARLOW GROUP LLC
blog • healthblawg.com
October 27, 2011 twitter • @healthblawg

2. Interactive Housekeeping . . .
• Questions and comments
– Webinar chat window
– Livetweeting the webinar, and a real-time
tweetchat -- #ACOchat -- http://j.mp/ACOchat
• Links to all government ACO issuances from
October 20
– http://j.mp/ACOfinal

3. We are challenged by shifting sands

4. High-performing health care providers
can be integrated into
high-performing health care systems

5. What are the
federales trying to
accomplish?
The “Triple Aim”
Better care
Better health
Lower costs

6. ACO: Getting more elegant

7. ACO is one tool to get providers
to manage a population of
patients

8. How? Financial incentives.
$18,000,000
$16,000,000
$14,000,000 Yr 1 Yr 2
$12,000,000 Yr 3 Yr 4
$10,000,000
Yr 5
$8,000,000
$6,000,000
$4,000,000
$2,000,000
$0
Billings
Dartmouth
Everett
Forsyth
Geisinger
Marshfield
Middlesex
Park
Nicollet St. John's
Michigan
Graphic courtesy Jaan Sidorov, Disease Management Care Blog

9. What
is
an
ACO?

10. ACO Basics
Single entity 33 performance measures
Three-year commitment Patient engagement
One-way or two-way risk-sharing Patient-centeredness
PCPs and broader network Stark/AKS
5000 patient minimum IRS
Antitrust

11. Proposed Rule versus Final Rule
http://j.mp/ACOchart

12. Final ACO quality measures
http://j.mp/ACOqualitymeasures

13. ACO
regulations
coordinate
across
numerous
Federal
agencies

14. All in all, ACO risk/reward ratio
seems skewed

15. IT infrastructure cost estimate
>$1.5m

16. More details from the ACO
rules, and traps for the unwary

17. Rolling start dates due to lateness
in finalizing rules

18. Over 60% of health care provider
executives said earlier this year
they intend to form an ACO

19. Culture of Collaboration

20. Opportunities for
physician-led ACOs

21. Even if an ACO is not in your
immediate future, these principles
will affect you
Bundled Commercial
Payments ACOs
Pay for Other
Performance Innovations

22. MSSP is just one arrow in the quiver
•Medicare Shared Savings Program – “Traditional” ACO
•Advance Payment Initiative
•Pioneer ACO
•Other CMS Innovation Center Initiatives

23. CMS Bundled Payment Initiative
Bundled
Payments
ACO “lite”
MS-DRG-specific
Gainsharing
. . . Bundled Payment Pilot - 2013

24. Care Coordination Initiatives

25. Commercial plans are
non-standardized

26. Jeff Goldsmith: Suggests 3
commercial ACO payment systems
for 3 different types of providers
Primary
• Risk-adjusted
capitation
Emergency
• Fee-for-
service
Specialty
• Bundled
payments

27. What can you do now to prepare
for the future?

28. Physicians
are central to
the
development
of an
accountable
care
organization

29. You cannot manage what you do
not measure

30. Opportunity for all providers: Be the
go-to (cost-effective) guys (or gals)

32. .

34. David Harlow JD MPH
Thank You THE HARLOW GROUP LLC
for contact info
txt dharlow to 50500
or scan the QR code
harlowgroup.net
healthblawg.com
twitter.com/healthblawg
david@harlowgroup.net