![Dale Jarvis, CPA MCPP Healthcare Consulting [email_address] ,[object Object]](https://image.slidesharecdn.com/nclive5-14-10updatedpresentation-100603164332-phpapp01/85/Healthcare-Reform-Implementation-ACOs-1-320.jpg)
![The Situation ,[object Object],As much as 30% of health care costs (over $700 billion per year) could be eliminated without reducing quality $2.3 - $5.2 Trillion](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Healthcare Reform Implementation: ACOs
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Editor's Notes
- Fee-For-Service, Non-Integrated Model: All the wrong incentives and disincentives Federal Healthcare reform will trigger dramatic changes in how health and behavioral health services are organized and funded These changes will create a tipping point in how the healthcare needs of persons with serious mental illness and the behavioral healthcare needs of all Americans are addressed Which will change the way Community Behavioral Healthcare Organizations are funded and fit into the new healthcare ecosystem
- Specialists: High performing Retire Decide to become PCPs Less opportunities available as med students think about their specialties PCPs More NPs & PAs Specialist conversions More med students going into primary care
- Group Health Cooperative 2002-2006: Move towards Medical Home Email PCP Online Medical Records Same Day/Next Day Appointment (Increased patient access but also saw provider burn-out and decline in HEDIS scores) 2007: More robust Healthcare Home Pilot / Added more staff (15% more docs; 44% more mid-levels; 17% more RNs; 18% more MAs/LPNs; 72% more pharmacists) // Shifted to 30 minute PCP slots // (Reduced burnout, increased HEDIS scores, no difference in overall costs)
- Payment mechanisms will be tied to these measures in a variety of ways. Bundled payments that only pay for part of potentially avoidable complications (PACs) will penalize providers that have higher error rates. CBHOs that don’t have structures and staffing to provide effective prevention and early intervention services and manage chronic health conditions will not be eligible for case rates and capacity-based payments to fund that work. CBHOs that don’t hit performance measure targets will not earn their bonuses. A related issue from above is whether existing carve-out plans that have worked closely with CBHOs to develop innovative payment mechanisms such as sub-capitation, case rates, risk corridors with bonuses, etc. will still be in business in the near future. Should CBHO groups and existing behavioral health carve-outs look to align/merge with health plans such as members of the Association for Community Affiliated Plans? What other strategies could be used to ensure their survival?
- Payment mechanisms will be tied to these measures in a variety of ways. Bundled payments that only pay for part of potentially avoidable complications (PACs) will penalize providers that have higher error rates. CBHOs that don’t have structures and staffing to provide effective prevention and early intervention services and manage chronic health conditions will not be eligible for case rates and capacity-based payments to fund that work. CBHOs that don’t hit performance measure targets will not earn their bonuses. A related issue from above is whether existing carve-out plans that have worked closely with CBHOs to develop innovative payment mechanisms such as sub-capitation, case rates, risk corridors with bonuses, etc. will still be in business in the near future. Should CBHO groups and existing behavioral health carve-outs look to align/merge with health plans such as members of the Association for Community Affiliated Plans? What other strategies could be used to ensure their survival?
- Payment mechanisms will be tied to these measures in a variety of ways. Bundled payments that only pay for part of potentially avoidable complications (PACs) will penalize providers that have higher error rates. CBHOs that don’t have structures and staffing to provide effective prevention and early intervention services and manage chronic health conditions will not be eligible for case rates and capacity-based payments to fund that work. CBHOs that don’t hit performance measure targets will not earn their bonuses. A related issue from above is whether existing carve-out plans that have worked closely with CBHOs to develop innovative payment mechanisms such as sub-capitation, case rates, risk corridors with bonuses, etc. will still be in business in the near future. Should CBHO groups and existing behavioral health carve-outs look to align/merge with health plans such as members of the Association for Community Affiliated Plans? What other strategies could be used to ensure their survival?