1 / 7

Accountable Care Organizations: Healthcare reform provision

Accountable Care Organizations: Healthcare reform provision. Broad range of providers able to initiate ACOs Accountability for total cost, quality and care of beneficiaries 3-year participation commitment Legal structure to receive and distribute savings

chun
Download Presentation

Accountable Care Organizations: Healthcare reform provision

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Accountable Care Organizations:Healthcare reform provision Broad range of providers able to initiate ACOs Accountability for total cost, quality and care of beneficiaries 3-year participation commitment Legal structure to receive and distribute savings Primary care physicians to cover a minimum of 5,000 Medicare beneficiaries Defined processes for evidence-based medicine and patient engagement, quality and cost measures reporting and telehealth, remote patient monitoring, etc. Patient-centeredness No participation in other government-based shared savings demonstration projects Allows CMS to join existing ACOs with payment models beyond fee-for-service CMS may give preference to ACOs already contracting with private market Saves $4.9 B over 10 years Allows pediatric providers to form ACOs through state Medicaid programs (2012) Accountable Care Organizations - Providers meeting criteria can be recognized as ACOs and can qualify for incentives bonus. (no later than 2012-01-01) 2017 2010 2011 2012 2013 2014 2015 2016

  2. ACO Participation Requirements:Healthcare Reform Provisions • Providers eligible to participate in ACOs: • Hospitals employing ACO professionals • ACO professionals in group practice arrangements • Networks of individual practices of ACO professionals • Partnerships or joint venture arrangements between hospitals and ACO professionals • Other groups of providers that the Secretary deems appropriate • ACOs must meet certain quality thresholds: • Clinical processes and outcomes • Patient and caregiver perspectives on care • Utilization and costs

  3. Washington Developments • 6/24, 1st CMS listening session • 9/8, Group CMS listening session • 9/13, MedPAC meeting on ACOs • 10/5, FTC/OIG/CMS workshop • 11/13, CMS request for information • Fall/winter 2010, regulation expected

  4. Key design issues • Beneficiary attribution, opt-out, transparency and inducements • Timely access to A, B & D claims data and beneficiary list • Encourage & coordinate with other payers (Medicaid, private) • Legal (anti-trust, anti-kickback…) “safe harbors”/guidance • Models that include broadest group of provider types to maximize impact on communities • Multiple payment models (partial or full capitation) from the start of the program • Shared savings design for small patient populations

  5. Physician Group Practice (PGP) - CMS Demo • Test bed for demonstrating ACO models • Creates incentives for physician groups to coordinate the overall care delivered to Medicare beneficiaries • Shared savings based on improved quality and cost efficiency • Enables collaboration among providers to benefit Medicare beneficiaries • Demo goals (5 year demonstration): • Coordination of Part A and Part B services • Promote cost efficiency and effectiveness through investment in care management programs, process redesign, and tools for physicians and their clinical care teams • Reward physicians for improving health outcomes (32 quality measures) by sharing in financial savings

  6. PGP Participants • PGP participants include 5,000 physicians and 220,000 Medicare fee-for-service beneficiaries: • Billings Clinic, Billings, Montana • Dartmouth-Hitchcock Clinic, Bedford, New Hampshire • The Everett Clinic, Everett, Washington • Forsyth Medical Group, Winston-Salem, North Carolina • Geisinger Health System, Danville, Pennsylvania • Marshfield Clinic, Marshfield, Wisconsin • Middlesex Health System, Middletown, Connecticut • Park Nicollet Health Services, St. Louis Park, Minnesota • St. John’s Health System, Springfield, Missouri • University of Michigan Faculty Group Practice, Ann Arbor, Michigan

  7. PGP Outcomes… So far (as of 8/2009) • Three-year average quality-improvement results: • 10 percentage points on the diabetes, • 11 percentage points on the congestive heart failure measures, • 6 percentage points on the coronary artery disease measures, • 10 percentage points on the cancer screening measures, and • 1 percentage point on the hypertension measures. • Five participants earned $25.3 million in performance payments for improving quality and achieving savings of $32.3 million: • Dartmouth-Hitchcock Clinic • Geisinger Clinic • Marshfield Clinic • St. John’s Health System, and • The University of Michigan Faculty Group Practice

More Related