The State of Accountable Care: Evidence to Date and Next Steps October 20, 2014 l The Brookings Institution
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1 The State of Accountable Care: Evidence to Date and Next Steps October 20, 2014 l The Brookings Institution #ACOFuture l aco@brookings.edu
2 Agenda 9:00 a.m. Welcome and ACO Overview 9:15 a.m. The MSSP Proposed Rule: Looking Ahead 9:45 a.m. What We Know About ACOs So Far 10:30 a.m. Break 10:45 a.m. Big Issues for ACOs Going Forward 11:30 a.m. ACO Policy Issues and Solutions on the Horizon 12:15 p.m. Closing 12:20 p.m. Adjournment
3 ACO Overview Mark McClellan, MD, PhD Director, Health Care Innovation and Value Initiative Senior Fellow, Economic Studies The Brookings Institution
4 Growth of ACOs Over Time: Medicare vs. Non-Medicare # of ACOs Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Medicare Non-Medicare Total
5 Growing (Preliminary) Evidence on ACOs Medicare ACOs Commercial ACOs Medicaid ACOs 5.6 million beneficiaries million beneficiaries (over 280 plans) Over 40 ACO contracts in 19 states First year results: Higher measured quality Approx. one-quarter beat cost benchmark 1-2% overall savings vs benchmarks Second year results: 11/23 Pioneers earned shared savings ~1% overall savings vs benchmarks Substantial improvement on quality measures Typically larger payment and benefit reforms than Medicare ACOs Early results (not consistently analyzed): Improvement in measured quality Variable reported savings, 2-12% Limited results so far, but promising impacts on quality of care
6 Number of MSSP ACOs in Each Overall Quality Performance Percentile Number of ACOs Below 30th 30th 40th 50th 60th 70th 80th 90th
7 PY1 Quality Performance Score (% Total Points) By Organization Type 90% 80% 70% 60% 50% 40% 30% Academic Medical Center (n=1) FQHC (n=1) Hospital-Led (n=6) Integrated Delivery System (n=71) Other (n=17) Physician-Hospital Organization (n=11) Physician-Led (n=113)
8 Pioneer ACOs in Each Quality Percentile Performance Year 1 and Performance Year Number of ACOs 6 4 PY1 PY th 50th 60th 70th 80th 90th Quality Score Percentile
9 Pioneer ACO PY2 Quality Scores vs. Gross Savings/Losses Gross Savings/Losses ($ Million) % 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%
10 ACO Learning Network A member-driven network of providers, payers, associations, consulting firms, pharmaceutical and device manufacturers, and other related industries provides participating organizations with the tools and knowledge necessary to successfully implement accountable care delivers national guidance on practical policy steps for advancing health care reform through accountable fosters the critical exchange of implementation strategies and thought leadership to move member organizations forward in their accountable care efforts helps ACOs overcome the implementation and policy challenges highlighted today
11 Keynote Address Sean Cavanaugh Deputy Administrator & Director of the Center for Medicare, CMS
12 The State of Accountable Care: Evidence to Date and Next Steps October 20, 2014 l The Brookings Institution #ACOFuture l aco@brookings.edu
13 What We Know About ACOs So Far Panelists Michael Randall, Vice President of Clinical Innovation, Advocate Physician Partners Marcus Zachary, Senior Medical Director, Brown and Toland Medical Group J. Michael McWilliams, Associate Professor of Health Care Policy, Department of Health Care Policy, Harvard Medical School David Muhlestein, Director of Research, Leavitt Partners
14 The State of Accountable Care: Evidence to Date and Next Steps October 20, 2014 l The Brookings Institution #ACOFuture l aco@brookings.edu
15 Big Issues for ACOs Going Forward Panelists Kelly Taylor, Director of Care Management and Quality, Mercy Clinics Jennifer Sweeney, Vice President, National Partnership for Women & Families Morey Menacker, President and Chief Executive Officer, Hackensack Alliance Accountable Care Organization
16 Big Issues for Accountable Care Organizations Engaging Beneficiaries Payment Formulas: Benchmarks for Quality and Cost Bearing Financial Risk: Shared Savings, Partial Risk, and Insurance Risk Managing Startup Costs Improving Data and Performance Measures Combining ACO Reforms with Other Payment Reforms Identifying Best Practices for Clinical Transformation McClellan et al. Issue Brief: How to Improve the Medicare Accountable Care Organization (ACO) Program. The Brookings Institution, June 2014
17 Big Issues for ACOs Going Forward Panelists Kelly Taylor, Director of Care Management and Quality, Mercy Clinics Jennifer Sweeney, Vice President, National Partnership for Women & Families Morey Menacker, President and Chief Executive Officer, Hackensack Alliance Accountable Care Organization
18 The State of Accountable Care: Evidence to Date and Next Steps October 20, 2014 l The Brookings Institution #ACOFuture l aco@brookings.edu
19 ACO Policy Issues and Solutions on the Horizon Panelists Mark Wagar, President, Heritage Medical Systems Joe Damore, Vice President, Population Health Management, Premier Healthcare Alliance Mark Miller, Executive Director, MedPAC Paul B. Ginsburg, Norman Topping Chair in Medicine and Public Policy, USC Schaeffer Center for Health Policy and Economics
20 Potential Policy and Regulatory Changes for Medicare ACO Program Technical Adjustments to Benchmarks and Payments Transition to More Person-Based Payments: More Significant Financial Risk Increased Beneficiary Engagement Enhanced and Better-Aligned Performance Measures Better, More Consistent Supporting Data Link ACO Implementation to Reinforcing Payment Reforms Bonus Payment and Other Incentives to Overcome Startup Costs Best Practices for Clinical Transformation McClellan et al. Issue Brief: How to Improve the Medicare Accountable Care Organization (ACO) Program. The Brookings Institution, June 2014
21 ACO Policy Issues and Solutions on the Horizon Panelists Mark Wagar, President, Heritage Medical Systems Joe Damore, Vice President, Population Health Management, Premier Healthcare Alliance Mark Miller, Executive Director, MedPAC Paul B. Ginsburg, Norman Topping Chair in Medicine and Public Policy, USC Schaeffer Center for Health Policy and Economics
22 Closing and Next Steps Mark McClellan, MD, PhD Director, Health Care Innovation and Value Initiative Senior Fellow, Economic Studies The Brookings Institution
23 Interested in Joining the ACO Learning Network? Contact Us Today!
24 ACO Learning Network A member-driven network of providers, payers, associations, consulting firms, pharmaceutical and device manufacturers, and other related industries provides participating organizations with the tools and knowledge necessary to successfully implement accountable care delivers national guidance on practical policy steps for advancing health care reform through accountable fosters the critical exchange of implementation strategies and thought leadership to move member organizations forward in their accountable care efforts helps ACOs overcome the implementation and policy challenges highlighted today
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26 Thank You! #ACOFuture l aco@brookings.edu
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