Harmony Healthcare International, Inc.
|
|
- Darren Booker
- 6 years ago
- Views:
Transcription
1 ACOs: Where Are We At? HARMONY UNIVERSITY The Provider Unit of Harmony Healthcare International, Inc. (HHI) Presented by: Kris Mastrangelo, OTR/L, MBA, NHA President & CEO Harmony Healthcare International, Inc. 1 Objectives The learner will be able to summarize goals of ACOs The learner will be able to identify and articulate examples of the ACO process The learner will be able to identify strategies for interdisciplinary management of ACOs Harmony Healthcare International, Inc. 2 Accountable Care Organizations Voluntary groups of physicians, hospitals, and other health care providers that are willing to assume responsibility for the care of a clearly defined population of Medicare beneficiaries attributed to them on the basis of patients use of primary care services. If an ACO succeeds in both delivering high-quality care or improving care and reducing the cost of that care below what would otherwise have been expected, it will share in the savings it achieves for Medicare. The New England Journal of Medicine (NEJM), October 20, 2011 Making Good on ACOs Promise The Final Rule for the Donald M. Berwick MD, Administrator, CMS Harmony Healthcare International, Inc. 3 1
2 Team Medicine First building blocks of integrated team medicine: Model, data and leadership Create a care team that maximizes impact for patients Build a physician culture of multidisciplinary practice Harmony Healthcare International, Inc. 4 Team Medicine 1. An integrated, flexible physician model Multispecialty group medical practice maximized physicians abilities to care for patients through doctor-to-doctor consultation, through the training and mentoring of young physicians, and through the inherent quality controls built into the group Harmony Healthcare International, Inc. 5 Team Medicine 2. Physician-Friendly Data Yields evidence-based medicine Harmony Healthcare International, Inc. 6 2
3 Team Medicine 3. Rethink physician leadership We recruit physicians with a sense that we re a group practice. We stand for quality. We measure quality and results. We think it s important that we tell patients we re going to give them the kind of quality they deserve. You then orient, evaluate, and promote people based on the same set of values and expectations. Eventually you end up with a culture that is very comfortable with a focus on quality, measurement, comparison, and improvement. Jack Cochran, MD Harmony Healthcare International, Inc. 7 Healthy Bones: Tests and Prescriptions to Prevent Problem: In 2010, osteoporosis was the ninth most costly major illness among the top 5% highest cost Medicare beneficiaries In 2005, 2 million fractures cost the United States $17 billion for both acute and long-term care. By 2025, the annual fracture rate is expected to increase by 50% to about 3 million at a cost of $25 billion per year. On average, 24% of patients presenting with a osteoperosisrelated fracture die within one year, and the mortality rate of men exceeds women Only 21% of women age 67 or older who have had an osteoporosis-related fracture had a bone mineral density test or a drug prescription to treat or prevent osteoporosis in the six months after the fracture * Information provided by Kaiser Permanente Harmony Healthcare International, Inc. 8 Healthy Bones Solution: Care managers, primary care physicians, and surgeons use daily reports generated from the electronic health record to identify members at risk for osteoporosis and fractures Care managers coordinate care for these patients to close care gaps Working together, the team provides patients with education, screening, treatments, and monitoring as needed. The multidisciplinary team includes: Orthopedic surgeons, endocrinologists, gerontologists, family practitioners, internists, rheumatologists, gynecologists, physical therapists, disease/care managers, radiologists and member education Harmony Healthcare International, Inc. 9 3
4 Healthy Bones Impact: Annual bone density screening rates increased by 474% from 2002 to 2009 People on anti-osteoporosis medications increased by 214% from 2002 to 2009 Over 45% reduction in rate of hip fractures (preventing >1400 hip fractures) by 2010 If the Healthy Bones approach were adopted in the United States, the country could achieve a 25% reduction in the rate of hip fractures, preventing 75,000 hip fractures per year Harmony Healthcare International, Inc. 10 Improvement Standard As the New York Times reported on its front page Tuesday, Reuters (10/24, Morgan) reports that the Obama Administration has proposed a settlement to a class-action lawsuit, promising to broaden current Medicare regulations to allow coverage to "maintain the patient's current condition or... prevent or slow further deterioration." Previously, beneficiaries had to demonstrate improvement to continue to receive coverage, the change will likely benefit thousands of Americans with degenerative conditions like multiple sclerosis, Parkinson's, and cerebral palsy. An HHS spokeswoman said the settlement merely "clarifies" current policy, and continued, "We expect no changes in access to services or costs." Harmony Healthcare International, Inc. 11 Improvement Standard The case, Jimmo v. Sebelius, resulted in a focus on skilled service delivery in the context of maintenance programs Historically, patients with chronic conditions and anticipated functional deterioration were considered skilled for the establishment of a maintenance program This settlement now allows for coverage of the actual delivery of maintenance therapy by licensed nurses and therapy professionals Harmony Healthcare International, Inc. 12 4
5 Improvement Standard Current Medicare skilled guidelines state: The services must be provided with the expectation, based on the assessment made by the physician of the patient s restoration potential, that the condition of the patient will improve materially in a reasonable and generally predictable period of time, Or the services must be necessary for the establishment of a safe and effective maintenance program Harmony Healthcare International, Inc. 13 Improvement Standard The Proposed Settlement: Instead, providers, contactors, and adjudicators must recognize maintenance coverage and a beneficiary s need for skilled care that is performed or supervised by professional nurses and therapists. The manual revisions will clarify that, under the Skilled Nursing Facility, Home Health, and Outpatient Therapy maintenance coverage standards, skilled therapy services are covered when an individualized assessment of the patient s clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist ( skilled care ) are necessary for the performance of a safe and effective maintenance program Such a maintenance program to maintain the patient s current condition or to prevent or slow further deterioration is covered so long as the beneficiary requires skilled care for the safe and effective performance of the program Harmony Healthcare International, Inc. 14 Improvement Standard Quality Care is our number one objective Harmony embraces the OBRA 87 regulations which require facilities to provide services to meet the highest practicable physical, medical and psychological well-being of every resident This practice has been our standard since its inception. This new Improvement Standard, further supports our core values as providers of specialized services to the post acute care population. Harmony Healthcare International, Inc. 15 5
6 Continuum of Care Post Discharge When the asthma attack is done, the patient goes home, and the game s over. No one is accountable for any of the follow-up care. George Halvorson, Chairman & CEO Kaiser Permanente Harmony Healthcare International, Inc. 16 Integrated Follow-up Call patient to make sure they are taking their meds Call patient to make sure they are avoiding any allergic trigger Harmony Healthcare International, Inc. 17 Prevention Problem: One in eight women develops breast cancer, and nearly 40,000 die from it every year Regular mammograms which can identify breast cancer early, when it is most treatable can reduce breast cancer deaths by more than 30 percent The United States Preventive Services Task Force recommends screenings every one to two years for women aged years. However, current screening rates fall short of these guidelines, and they have been steadily declining Harmony Healthcare International, Inc. 18 6
7 Prevention Through the Proactive Office Encounter program, the health care team identifies and targets patients with care gaps (including whether a patient is due for a mammography) or chronic medical conditions and encourages them to actively participate in own care Harmony Healthcare International, Inc. 19 Proactive Office Encounter and Mammography The program engages all members of the clinical care team in a coordinated and collaborative effort to encourage and support patient health Automated creation of care checklists for all patients whose records indicate gaps in care At every point of contact with patients, clinical care teams review checklists and help patients get the care they need Based on identified gaps in care, medical assistants during office visits discuss with patients the need for preventive screenings and routine care, such as cancer screenings and tests for abnormal blood sugar or cholesterol levels, and schedule appointments on the spot Harmony Healthcare International, Inc. 20 Proactive Office Encounter Also Helps: Along with other concurrent improvement initiatives, the Proactive Office Encounter has contributed to: 30% increase in colon cancer screening 11% increase in breast cancer screening 5% increase in cervical cancer screening 13% improvement in cholesterol control Harmony Healthcare International, Inc. 21 7
8 Data, Data, Data You cannot make bricks without clay. ~Sherlock Holmes Harmony Healthcare International, Inc. 22 Better Patient Management Using Evidence-Based Medicine Patient Registry and Concurrent Tracking System Identifies all members in the population Risk stratifies population for targeting interventions and resources Tracks and monitors each patient for key indicators (lab, pharmacy, encounters, clinical indicators) Easy access (web-based) Harmony Healthcare International, Inc. 23 Better Patient Management Using Evidence-Based Medicine Care Management Systems Flags/alerts Supports telephone management and documentation Identifies all members in the population Supports Automated Clinical Decision Support and Practice Tools In-reach/outreach Health Education and Self-Care Support Harmony Healthcare International, Inc. 24 8
9 Evidence-based Medicine/Prevention Proactive care instead of reactive care Patients who have the largest gaps in recommended care do not routinely visit their primary care physicians Specialty clinics must play a role to achieve optimal results. Fewer than 40% of patients needing a mammogram or testing for diabetes visited their primary care physician. Appointments can be made on the spot or referrals generated so gaps can be readily addressed Harmony Healthcare International, Inc. 25 Beyond the Patient: Widen Your Gaze Focus on primary care and prevention, and addressing chronic disease requires looking at larger communitywide issues Behavioral factors are as important as specific treatments: better diet, promoting physical activity, and reducing smoking Community education for adults and children in recognizing bad health habits and taking action to create a better health outlook Harmony Healthcare International, Inc. 26 What is an Accountable Care Organization? Healthcare organization with a coordinated set of providers Provider mix dependent on whether federal or commercial ACO structure Who share responsibility for the continuum of care Clinical accountability Quality of care Financial responsibility Cost of care By providing the highest possible value of care Increase quality Decrease costs Harmony Healthcare International, Inc. 27 9
10 What is an Accountable Care Organization? For financial incentives or shared savings Value-based payments Reimbursement for achieving cost and quality goals From participating payors Public payors (e.g., Medicare, Medicaid) Commercial payors (e.g., BCBS of MA) Harmony Healthcare International, Inc. 28 Key Principles and Elements of ACOs Local accountability Ability to provide and manage continuum of care Responsible and accountable for quality and cost of care Incentivize providers for quality not quantity Shared Savings Legal entity and governance structure that allows receiving/distributing shared savings payments Invest shared savings in delivery system improvements Capable of financial and resource planning AC0 Model Principles, The Accountable Care Organization Learning Network, (Accessed 09/16/2011) Harmony Healthcare International, Inc. 29 Key Principles and Elements of ACOs Performance Measurement Ongoing metrics to obtain evidence of meaningful outcome improvements and cost impacts Measurements must be transparent and accessible Essential cost savings are result of meaningful improvements AC0 Model Principles, The Accountable Care Organization Learning Network, (Accessed 09/16/2011) Harmony Healthcare International, Inc
11 Why Accountable Care? National Health Expenditures per Capita, Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at (see Historical; NHE summary including share of GDP, CY ; file nhegdp09.zip). Harmony Healthcare International, Inc. 31 Why Accountable Care? Dental Services and Other Professionals 7% Rx Drugs 10% Government Administration & Net Cost of Health Insurance 7% Investment 1 Nursing Care Facilities & 6% Continuing Care Retirement Communities 6% Other 14% Note: Sum of pieces may not equal 100% due to rounding. Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group. Physicians & Clinics 20% Hospital Care 31 % Other Health, Residential, and Personal Care 2 5% Home Health Care 3% Government Public Health Activities 3% Other Medical Products 3 3% 1. Includes Research (2%) and Structures and Equipment (4%) 2. Includes expenditures for residential care facilities, ambulance providers, medical care delivered in non-traditional settings (such as community centers, senior citizens centers, schools, and military field stations, and expenditures for Home and Community programs under Medicaid 3. Includes Durable (1%) and Non-durable (2%) goods Harmony Healthcare International, Inc. 32 ACOs by Sponsoring Entity 99 Hospital Systems 27 Health Plans 60% 16% 38 Physicians Groups 23% Note: Percentages don t total 100% due to rounding. Source: Leavitt Partners Harmony Healthcare International, Inc
12 Perspective: Final Rule for Medicare Shared Savings Program We believe that today s ACO rule is the next step in our shared commitment to a better, more lasting health care system. We look forward to being a trusted partner in our nation s journey toward patient-centered, coordinated care. Donald M. Berwick MD, Administrator, CMS The New England Journal of Medicine (NEJM) October 20, 2011 Making Good on ACOs Promise The Final Rule for the Harmony Healthcare International, Inc. 34 ACO Requirements Legal Entity Formal legal structure established To receive and distribute any shared savings Proposed rule modified to allow participation of entities organized under Federal or tribal law Sufficient Size Sufficient number of primary care physicians To provide care for at least 5,000 beneficiaries Medicare Program; : Accountable Care Organizations; Final Rule Federal Register, Vol. 76, No. 212 (November 2, 2011), p , , , 67825, 67827, 67829, 67891, Harmony Healthcare International, Inc. 35 ACO Requirements 3-Year Commitment Must commit to participate in the program for at least three years Must provide CMS with 60 days advance notice if terminating agreement Participating ACO will not share in any savings in the performance year for which it notifies CMS of termination Medicare Program; : Accountable Care Organizations; Final Rule Federal Register, Vol. 76, No. 212 (November 2, 2011), p , , , 67825, 67827, 67829, 67891, Harmony Healthcare International, Inc
13 ACO Requirements Leadership & Governance Must have a mechanism for shared governance and responsibility Management structure must include both clinical and administrative systems ACO participants must hold at least 75% control of the ACO s governing body Where ACO comprises multiple, otherwise independent entities not under common control, governing body must be separate and unique to the ACO Must provide for beneficiary representation on governing body Medicare Program; : Accountable Care Organizations; Final Rule Federal Register, Vol. 76, No. 212 (November 2, 2011), p , , , 67825, 67827, 67829, 67891, Harmony Healthcare International, Inc. 37 ACO Requirements Leadership & Governance (Cont.) If governing body does not meet requirements, ACO must describe why it seeks to differ from requirements and how it will involve ACO participants in governance in innovative ways and/or provide for meaningful governance participation by Medicare beneficiaries ACO s operations must be managed by an executive, officer, manager, or general partner, whose appointment and removal are under the control of the governing body Clinical management and oversight must be managed by a seniorlevel medical director who is one of the ACO s physicians, is physically present in an established ACO location on a regular basis, and is board-certified and licensed in one of the states in which the ACO operates Medicare Program; : Accountable Care Organizations; Final Rule Federal Register, Vol. 76, No. 212 (November 2, 2011), p , , , 67825, 67827, 67829, 67891, Harmony Healthcare International, Inc. 38 ACO Requirements Performance Measurement Must define, establish, implement, and periodically update processes to promote evidence-based medicine Guidelines must cover those diagnoses with significant potential for achieving quality improvements, while taking into account individual beneficiaries circumstances Must define, establish, implement, and periodically update processes and infrastructure for ACO participants and providers/suppliers to internally report on quality and cost measures Must report data on 33 quality measures for each year of performance agreement Medicare Program; : Accountable Care Organizations; Final Rule Federal Register, Vol. 76, No. 212 (November 2, 2011), p , , , 67825, 67827, 67829, 67891, Harmony Healthcare International, Inc
14 ACO Requirements Patient-Centered Must adopt a focus on patient-centered care that is promoted by the governing body and integrated into practice by leadership and management Medicare Program; : Accountable Care Organizations; Final Rule Federal Register, Vol. 76, No. 212 (November 2, 2011), p , , , 67825, 67827, 67829, 67891, Harmony Healthcare International, Inc. 40 Eligible Entities Final Rule Designation ACO professionals in group practices Networks of individual practices of ACO professionals Partnerships or joint venture arrangements between hospitals and ACO professionals Hospitals employing ACO professionals Potential Provider Organizations Primary Care Physician Practices Independent Practice Associations (IPA) Multispecialty Physician Groups (MSPG) Integrated Delivery Networks (IDN) Clinical Integrated Networks (CIN) Hospital Medical Staff Organizations (MSO) Physician Hospital Organizations (PHO) Extended Hospital Medical Staff Critical Access Hospitals Such other groups of providers of services and suppliers as the Secretary determines Medicare Program; : Accountable Care Organizations; Final Rule Federal Register, Vol. 76, No. 212 (November 2, 2011), p ; Accountable Care Organizations: A Roadmap for Success: Guidance on First Steps By Bruce Flareau and Joe Bohn, 1st ed., Virginia Beach, VA: Convergent Publishing, LLC, 2911, pg. 45. Harmony Healthcare International, Inc. 41 Quality Reporting Requirements 33 quality reporting criteria across 4 domains include: Domain CMS Criteria 1. Patient/Caregiver Experience Measures Care coordination/patient Safety Measures Preventive Health Measures At-Risk Population Measures Medicare Program; : Accountable Care Organizations; Final Rule Federal Register, Vol. 76, No. 212 (November 2, 2011), p , Harmony Healthcare International, Inc
15 Quality Reporting Requirements Patient/Caregiver Experience (1-7): Getting Timely Care, Appointments, and Information How Well Your Doctors Communicate Patients Rating of Doctor Access to Specialists Health Promotion and Education Shared Decision Making Health Status/Functional Status Harmony Healthcare International, Inc. 43 Quality Reporting Requirements Care coordination/patient Safety (8-13): Risk-Standardized, All Condition Readmission: The rate of readmissions within 30 days of discharge from an acute care hospital for assigned ACO beneficiary population. Ambulatory Sensitive Conditions Admissions: Chronic Obstructive Pulmonary Disease [AHRQ Prevention Quality Indicator (PQI) #5] Ambulatory Sensitive Conditions Admissions: Congestive Heart Failure [AHRQ Prevention Quality Indicator (PQI) #8] Percent of PCPs who successfully qualify for an EHR incentive program payment Medication Reconciliation: Reconciliation After Discharge from an Inpatient Facility Falls: Screening for Fall Risk Harmony Healthcare International, Inc. 44 Quality Reporting Requirements Preventive Health (14-21): Influenza Immunization Pneumococcal Vaccination Adult Weight Screening and Follow-up Tobacco Use Assessment and Tobacco Cessation Intervention Depression Screening Colorectal Cancer Screening Mammography Screening Portion of Adults 18+ who have had their Blood Pressure measured within the preceding two years Harmony Healthcare International, Inc
16 Quality Reporting Requirements At-Risk Population (22-33): Diabetes Composite (All or Nothing Scoring): Hemoglobin A1c Control (<8%) Diabetes Composite (All or Nothing Scoring): Low Density Lipoprotein (LDL) (<100) Diabetes Composite (All or Nothing Scoring): Blood Pressure > 140/90 mmhg Diabetes Composite (All or Nothing Scoring): Tobacco Non Use Diabetes Composite (All or Nothing Scoring): Aspirin Use: Daily Aspirin use for patients with Diabetes and Cardiovascular Disease Diabetes Mellitus: Hemoglobin A1c Poor Control (>9%) Harmony Healthcare International, Inc. 46 Quality Reporting Requirements At-Risk Population (Cont.) Hypertension (HTN): Blood Pressure Control: Percentage of patient visits for patients aged 18 years and older with a diagnosis of HTN with either systolic blood pressure 140 mmhg or diastolic blood pressure 90 mmhg with documented plan of care for hypertension Ischemic Vascular Disease (IVD): Complete Lipid Profile and LDL Control <100mg/dl Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Harmony Healthcare International, Inc. 47 Quality Reporting Requirements At-Risk Population (Cont.) Coronary Artery Disease (CAD) Composite (All or Nothing Scoring): Drug Therapy for Lowering LDL-Cholesterol Coronary Artery Disease (CAD) Composite (All or Nothing Scoring): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Patients with CAD and Diabetes and/or Left Ventricular stolic Dysfunction (LVSD). Percentage of patients aged 18 years and older with a diagnosis of CAD who also have Diabetes Mellitus and/or LVSD (LVEF <40%) who were prescribed ACE inhibitor or ARB Harmony Healthcare International, Inc
17 Payment Mechanism Shared Savings ACOs to receive payment for shared Medicare savings provided it Meets the quality performance requirements Demonstrates that it has achieved savings against benchmark of expected average per capita Medicare FFS expenditures An ACO shall be eligible for payment of shared savings [O]nly if the estimated average per capita Medicare expenditures under the ACO for Medicare FFS beneficiaries for Parts A and B services is at least the percent specified by the Secretary below the applicable benchmark. Medicare Program; : Accountable Care Organizations; Final Rule Federal Register, Vol. 76, No. 212 (November 2, 2011), p , Harmony Healthcare International, Inc. 49 Payment Mechanism Shared Savings ACOs receive bonuses for achieving resource use and quality targets over the course of a year ACOs face penalties for failing to meet these requirements The final rule sets out two risk models with various incentives for ACOs to receive shared savings payments Medicare Program; : Accountable Care Organizations; Final Rule Federal Register, Vol. 76, No. 212 (November 2, 2011), p , Harmony Healthcare International, Inc. 50 Regulatory Considerations Federal Anti-Kickback Statute (AKS) Federal Physician Self-Referral Law (Stark Law) Federal Civil Monetary Penalty (CMP) Federal Antitrust Law Federal Tax Law State Regulations Antitrust Fraud and Abuse False Claims Corporate Practice of Medicine Insurance Law Harmony Healthcare International, Inc
18 Regulatory Considerations Federal Anti-Kickback Statute Definition ACO Implication Prohibition against soliciting, receiving, or paying remuneration in exchange for the referral healthcare service billed to Medicare, Medicaid, or any other federal healthcare program. Current safe harbors to potentially shield ACOs from possible violations Direct employment Co-management arrangements Gainsharing Medicare Program; : Accountable Care Organizations and Medicare Program: Waiver Designs in Connection With the and the Innovation Center; Proposed Rule and Notice Federal Register, Vol. 76, No. 67 (April 7, 2011). Harmony Healthcare International, Inc. 52 Regulatory Considerations Federal Stark Law Definition Prohibition against physician referrals to providers of Designated Health Services with whom the referring physician has a financial relationship. ACO Implication Compliance with the AKS and Stark may be waived, as may be necessary, to conduct: Any payment model for ACOs that the Secretary determines will improve the quality and efficiency of items and services furnished under the Medicare program The bundled payment/episode of care pilot Medicare Program; : Accountable Care Organizations and Medicare Program: Waiver Designs in Connection With the and the Innovation Center; Proposed Rule and Notice Federal Register, Vol. 76, No. 67 (April 7, 2011). Harmony Healthcare International, Inc. 53 Regulatory Considerations Federal Civil Monetary Penalties Definition ACO Implication Civil penalties against hospital payments to physicians for Reducing length of stay Reducing readmission rates Other forms of fraud and abuse HHS has provided a waiver similar to those given for Stark Law and the AKS. Medicare Program; : Accountable Care Organizations and Medicare Program: Waiver Designs in Connection With the and the Innovation Center; Proposed Rule and Notice Federal Register, Vol. 76, No. 67 (April 7, 2011). Harmony Healthcare International, Inc
19 Regulatory Considerations Federal Tax Law Definition ACO Implication Integration between providers coordinating care may cause nonprofit, tax exempt providers and for profit, taxable entities, to merge. Tax-exempt participants in ACOs should be able to remain that way as long as ACO furthers charitable purposes. Accountable Care Organizations: Promise of Better Outcomes at Restrained Costs; Can They Meet Their Challenges? By C. Frederick Geilfuss and Renate M. Gray, BNA s Health Law Reporter, Vol. 19, no. 956 (July 8, 2010). Herding Cats? What Health Care Reform Means for Hospital-Physician Alignment and Clinical Integration, By Daniel H. Melvin and Chris Jedrey, McDermott, Will & Emery (October 13, 2010), p.38. Harmony Healthcare International, Inc. 55 Regulatory Considerations Federal Antitrust Definition Sherman Act, Section 1 prohibits contracts, combinations and conspiracies that unreasonably restrain trade Applies to independent, competing providers Does not apply to: Physicians all within the same group A hospital and its full-time, employed physicians A hospital and its controlled subsidiaries ACO Implication FTC and DOJ released proposed rules governing mandatory antitrust monitoring, based on the percentage of market share an ACO has for any specific service line. Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Saving Program 76 FR 75 (April 19, 2011), p Harmony Healthcare International, Inc. 56 Reimbursement Considerations Hospitals Large health systems may be in best position to form ACOs Attract more PCPs Vertical Integration will likely aid in transition to ACO May easily meet quality requirements Greater access to capital and IT requirements Potential Hurdles: May need to lower cost or increase private insurers cost to generate shared savings Investors Not Likely to Provide ACO Funding Under Proposed Rule, Venture Capitalist Says By Sara Hansard, Bureau of National Affairs, Health Law Reporter, Vol. 20, No. 1026, 2011; Quality over Quantity By Bryn Nelson, The Hospitalist (December 2009), (Accessed 2/28/11).; Will Mayo Clinic save money as an ACO? By Christopher Snowbeck and Don McCanne, Physicians for a National Health Program (February 8, 2011), (Accessed 2/28/11). Harmony Healthcare International, Inc
20 Technology Considerations Electronic Medical Records Significant cost Help eliminate silos and increase continuity of care Meaningful use standards The technological impacts on providers choosing to participate in an ACO are rooted in the primary issue of purchasing or updating an EHR system Costly Must meet meaningful use standards to be eligible for savings EHR integration and alignment among ACO participants is critical to ensure benefits of HIT utilization are obtained Technology Fundamentals for Realizing ACO Success, Medicity, September 2010, (Accessed June 30, 2011). Harmony Healthcare International, Inc. 58 Key Principles of Accountable Care Underlying Causes of Poor Performance Lack of clarity about aims, and about whose perspectives are most relevant. Principles of Accountable Care Clear aims: better overall health through higherquality care and lower costs with a focus on patients. Providers are fragmented and unable to coordinate care well; providers accept responsibility only for what they directly control. Establish provider organizations accountable for achieving better results for all of their patients at a lower cost. Payment system drives fragmentation, rewards unnecessary care, and penalizes care coordination and overall efficiency. Align financial, regulatory, and professional incentives with the aims of better health through higher-quality care, lower costs. Inadequate information to support provider and patient confidence about the value of reforms. Valid, meaningful performance measures that support provider accountability for aims and support informed and confident patient care choices. Harmony Healthcare International, Inc. 59 Where The ACOS Are Harmony Healthcare International, Inc
21 32 Pioneer ACOs ACO STATE Banner Health Network Brown & Toland Physicians Healthcare Partners Medical Group Heritage California ACO Monarch Healthcare Primecare Medical Network ACO Sharp Healthcare ACO Physician Health Partners JSA Medical Group TriHealth, Inc. OSF Healthcare System Franciscan Alliance ACO Atrius Health Beth Israel Deaconess Physician Organization Mount Auburn Cambridge Independent Practice Association (MACIPA) Partners Healthcare Steward Health Care System AZ CA CA CA CA CA CA CO FL IA IL IN MA MA MA MA MA Harmony Healthcare International, Inc Pioneer ACOs ACO STATE Eastern Maine Healthcare Systems Genesys Physician Hospital Organization Michigan Pioneer ACO University of Michigan Health System Fairview Health Services Park Nicollet Health Services Allina Hospitals & Clinics Dartmouth-Hitchcock ACO Presbyterian Healthcare Services Central New Mexico Pioneer Accountable Care Organization Healthcare Partners of Nevada Bronx Accountable Healthcare Network (BAHN) Renaissance Medical Management Company North Texas ACO Seton Health Alliance Bellin-Thedacare Healthcare Partners ME MI MI MI MN MN MN/WI NH/VT NM NV NY PA TX TX WI Harmony Healthcare International, Inc Shared Savings Program ACOs ACO STATE Arizona Connected Care, LLC AppleCare Medical ACO, LLC Premier ACO Physician Network Accountable Care Coalition of Coastal Georgia Accountable Care Coalition of the Mississippi Gulf Coast, LLC Florida Physicians Trust, LLC Primary Partners, LLC West Florida ACO, LLC Accountable Care Coalition of Greater Athens Georgia Jackson Purchase Medical Associates, PSC Jordan Community ACO Physicians of Cape Cod ACO Description of Organization Accountable Care Coalition of Caldwell County, LLC Accountable Care Coalition of Eastern North Carolina, LLC Coastal Carolina Quality Care, Inc. AZ CA CA FL FL FL FL FL GA KY MA MA NC NC NC Harmony Healthcare International, Inc
22 27 Shared Savings Program ACOs ACO STATE North Country ACO AHS ACO, LLC Hackensack Physician-Hospital Alliance ACO, LLC Optimus Healthcare Partners, LLC Accountable Care Coalition of Mount Kisco, LLC Accountable Care Coalition of the North Country, LLC Chinese Community Accountable Care Organization CIPA Western New York IPA, doing business as Catholic Medical Partners Crystal Run Healthcare ACO, LLC Accountable Care Coalition of Texas, Inc. RGV ACO Health Providers, LLC Accountable Care Coalition of Southeast Wisconsin, LLC NH NJ NJ NJ NY NY NY NY NY/PA TX TX WI Harmony Healthcare International, Inc Additional ACOs As of July 1, new Accountable Care Organizations (ACOs) began serving 1.2 million people with Medicare in 40 states and Washington, D.C. Brings total number of organizations participating in Medicare shared savings initiatives to 154, including the 32 ACOs Pioneer ACOs and six Physician Group Practice Transition Demonstration organizations that started in January 2011 As of July 1, more than 2.4 million beneficiaries are receiving care from providers participating in Medicare shared savings initiatives Harmony Healthcare International, Inc. 65 The Spread of ACOs Harmony Healthcare International, Inc
23 Impact on SNF Transparency Might as well adjust to the fact that entities, other than surveyors, will be more interested in what SNFs are doing Outcomes Coordinated, efficient, error free transitions of care Length of Stay Functional rehabilitation progress: Service delivery Re-hospitalization rates Patient and Family Satisfaction Harmony Healthcare International, Inc. 67 Impact on SNF Regulatory Level Outcomes Clinical QMs (falls, pressure sores, infection, restraints, pain, psychotropic meds, etc) Pharmacy error rates and Safety Annual and Complaint Survey compliance Harmony Healthcare International, Inc. 68 Depression, PH Q9 The monitoring and prevention in the geriatric population requires closer scrutiny Harmony Healthcare International, Inc
24 Questions/Answers Harmony Healthcare International Harmony Healthcare International, Inc. 70 Harmony Healthcare International Have you Considered a Customized Complimentary HARMONY(HHI) MEDICARE PROGRAM EVALUATION or CASE MIX ANALYSIS for your Facility? Perhaps your facility has potential for additional revenue Benchmark your facility against key indicators and national norms us at for more information RUGS@harmony-healthcare.com Analysis is cost & obligation free Harmony Healthcare International, Inc
Improving Quality of Care for Medicare Patients: Accountable Care Organizations
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Improving Quality of Care for Medicare Patients: FACT SHEET Overview http://www.cms.gov/sharedsavingsprogram On October
More information3/29/2013. Effective ACO Compliance. Objectives THE HEALTH CARE DILEMMA: ARE ACOS THE ANSWER? HCCA Compliance Institute April 21, 2013
Effective ACO Compliance HCCA Compliance Institute April 21, 2013 Margaret Hambleton, MBA, CHC, CHPC Sr. Vice President, Chief Compliance Officer St. Joseph Health System 1 Objectives Understand Accountable
More informationAccountable Care and the Laboratory Value Proposition. Les Duncan Director of Operations Highmark Health - Home and Community Services
Accountable Care and the Laboratory Value Proposition Les Duncan Director of Operations Highmark Health - Home and Community Services Agenda The Goals and Status of Delivery System Reform and Alternative
More informationBenchmark Data Sources
Medicare Shared Savings Program Quality Measure Benchmarks for the 2016 and 2017 Reporting Years Introduction This document describes methods for calculating the quality performance benchmarks for Accountable
More informationPractice Implications for Accountable Care Organizations
Practice Implications for Accountable Care Organizations An Overview following the Final Rule Gregory M. Marsh, MPH, PMP December 14, 2011 Why CCME? Effective EHR/HIE Implementation will: Improve patient
More informationPioneer Accountable Care Organization Model: General Fact Sheet May 22, 2012
Pioneer Accountable Care Organization Model: General Fact Sheet May 22, 2012 The Pioneer ACO Model is a CMS Innovation Center initiative designed to support organizations with experience operating as Accountable
More informationACO Information Required to be Published on ACO Website per CMS Regulations
ACO Name and Location SJFI, LLC dba Oklahoma Health Initiatives St. John Administration 1923 S. Utica Ave Tulsa, OK 74104 ACO Primary Contact Ann Paul, MPH ACO President OKHI@sjmc.org 918.744.2180 Organizational
More informationShared Savings Program ACO Public Reporting Instructions. with Pre-Populated Template
Shared Savings Program ACO Public Reporting Instructions Introduction with Pre-Populated Template The purpose of this document is to provide ACOs participating in the Shared Savings Program with a public
More informationShared Savings Program ACO Public Report
ACO ame and Location Shared Savings Program ACO Public Report University of Health Alliance Accountable Care Organization, LLC 1227 E. Rusholme Street Davenport, 52803 ACO Primary Contact Primary Contact
More informationQuality Measurement Approaches of State Medicaid Accountable Care Organization Programs
TECHNICAL ASSISTANCE TOOL September 2014 Quality Measurement Approaches of State Medicaid Accountable Care Organization Programs S tates interested in using an accountable care organization (ACO) model
More informationImproving Clinical Outcomes
Improving clinical outcomes and reducing health care costs under the Affordable Care Act - are enhanced medication management strategies part of the solution? Sandra L. Baldinger, Pharm.D., M.S. Kenneth
More informationACO Name and Location ACO Primary Contact
ACO ame and Location Chrysalis Medical Services, LLC 4888 Loop Central Drive Suite 700 Houston, Texas 77081 ACO Primary Contact Primary Contact ame Adrienne Opalka Primary Contact Phone umber 914-281-0827
More informationAccelerating the Impact of Performance Measures: Role of Core Measures
Accelerating the Impact of Performance Measures: Role of Core Measures Mark McClellan, MD, PhD Director, Engelberg Center for Health Care Reform Senior Fellow, Economic Studies Leonard D. Schaeffer Chair
More informationQuality Measurement, Population Health and Payment Reform
Quality Measurement, Population Health and Payment Reform The Move from Volume to Value Dale W. Bratzler, DO, MPH, FACOI, FIDSA Professor, Colleges of Medicine and Public Health Associate Dean, College
More informationACO Name and Location. ACO Primary Contact. Organizational Information
ACO ame and Location Ascension Care Management Health Partners Indianapolis, LLC Previous Legal Business Entity ame: MissionPoint Indianapolis, LLC 523 Mainstream Dr ashville, Tennessee 37228-1238 ACO
More informationACO Name and Location. ACO Primary Contact. Organizational Information
ACO ame and Location Ascension Care Management Health Partners Indianapolis, LLC Previous Legal Business Entity ame: MissionPoint Indianapolis, LLC 523 Mainstream Dr ashville, Tennessee 37228-1238 ACO
More informationUnited Medical ACO Participation Criteria
United Medical ACO Participation Criteria Items Requiring Practice Reporting 1) Submission of Reports: Practices must report A,B, and C to UMACO A. Thirty-four ACO Quality Measures -See Appendix A B. Average
More informationACO Name and Location. ACO Primary Contact. Organizational Information
ACO ame and Location Illinois Health Partners ACO, LLC 1100 West 31st Street Suite 300 Downers Grove, Illinois 60515 ACO Primary Contact Primary Contact ame Teri Kaneski Primary Contact Phone umber 630-527-3055
More informationACO Name and Location. ACO Primary Contact. Organizational Information
ACO Name and Location Physician Quality Partners, LLC 1505 Doctors Circle Building B Wilmington, North Carolina 28401 ACO Primary Contact Primary Contact Name Lydia Newman, MPP Primary Contact Phone Number
More informationIMPROVING THE QUALITY OF CARE IN SOUTH CAROLINA S MEDICAID PROGRAM
IMPROVING THE QUALITY OF CARE IN SOUTH CAROLINA S MEDICAID PROGRAM VICE PRESIDENT, PUBLIC POLICY & EXTERNAL RELATIONS October 16, 2008 Who is NCQA? TODAY Why measure quality? What is the state of health
More informationCMS Office of Public Affairs FIRST ACCOUNTABLE CARE ORGANIZATIONS UNDER THE MEDICARE SHARED SAVINGS PROGRAM
For Immediate Release: Tuesday, April 10, 2012 Contact: CMS Office of Public Affairs 202-690-6145 FIRST ACCOUNTABLE CARE ORGANIZATIONS UNDER THE MEDICARE SHARED SAVINGS PROGRAM On April 10, 2012, the Centers
More information=======================================================================
======================================================================= ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary
More informationACO GPRO 2016 Ready to Report Basics GPRO ACO Random Sample Reporting January 17, 2017 to March 17, 2017
ACO GPRO 2016 Ready to Report Basics 2016 GPRO ACO Random Sample Reporting January 17, 2017 to March 17, 2017 ACO GPRO 2016 Ready to Report Basics What is an Accountable Care Organization (ACO)? Which
More informationACO Update. LVHN Scholarly Works. Lehigh Valley Health Network. Lehigh Valley Health Network. Spring 2017
Lehigh Valley Health Network LVHN Scholarly Works ACO Update Newsletters Spring 2017 ACO Update Lehigh Valley Health Network Follow this and additional works at: https://scholarlyworks.lvhn.org/acoupdate
More informationHow Does This Fit into the Provisions of the Affordable Care Act? The goals are aligned
Background April 2012 The Federal Centers for Medicare and Medicaid Services (CMS) approved 3 NJ Accountable Care Organizations (ACOs) to participate in the Medicare Shared Savings Program Accountable
More informationCMS Quality Initiatives: Past, Present, and Future
CMS Quality Initiatives: Past, Present, and Future Jeff Flick Regional Administrator CMS, Region IX June 29, 2007 Slide -1 Learning Objectives Value Driven Health Care CMS Quality Initiatives Premiere
More informationQuality Measurement and Reporting Kickoff
Quality Measurement and Reporting Kickoff All Shared Savings Program ACOs April 11, 2017 Sandra Adams, RN; Rabia Khan, MPH Division of Shared Savings Program Medicare Shared Savings Program DISCLAIMER
More informationMaximizing the Financial Performance of Employed Physicians
Maximizing the Financial Performance of Employed Physicians Presented by: Health Directions, LLC Sabrina Burnett, Vice President HFMA Kentucky Chapter Summer Institute, July 24, 2014 About Health Directions,
More informationPopulation Health or Single-payer The future is in our hands. Robert J. Margolis, MD
Population Health or Single-payer The future is in our hands Robert J. Margolis, MD Today s problems Interim steps Population health Alternatives Conclusions Outline $3,000,000,000,000 $1,000,000,000,000
More informationSt. Vincent s Health Partners
St. Vincent s Health Partners St. Vincent s Health Partners is now working with your doctor to offer: Care Coordination Among All our Healthcare Providers St. Vincent s will work with all your providers
More informationShared Savings Program ACO Public Reporting Instructions. with Pre-Populated Template
Shared Savings Program ACO Public Reporting Instructions Introduction with Pre-Populated Template The purpose of this document is to provide ACOs participating in the Shared Savings Program with a public
More informationMeaningful Use: a Primer
Health Information Technology Extension Center of Los Angeles Meaningful Use: a Primer Mary Mitchell Director of Meaningful Use Defined as: What is Meaningful Use? A. Use of a certified EHR in a meaningful
More informationThe Why and How. Carol L. Henwood, DO, FACOFP dist.
Patient-Centered Medical Home: The Why and How Carol L. Henwood, DO, FACOFP dist. AODME January 14, 2012 The Triple Aim Improved Health Enhanced Patient Experience of Care Reduced Cost [+1: Improved Productivity]
More information1.01 Government Programs: CMS and Pay for Performance: Current Issues. CMS Regional Administrator March 2009
1.01 Government Programs: CMS and Pay for Performance: Current Issues David Saÿen CMS Regional Administrator March 2009 Overview Why value-based purchasing? What demonstrations are underway? Hospital demonstrations
More informationValue based care: A system overhaul
Value based care: A system overhaul Lee A. Fleisher, M.D. Robert D. Dripps Professor and Chair of Anesthesiology Perelman School of Medicine at the University of Pennsylvania Email: lee.fleisher@uphs.upenn.edu
More informationThe long and winding road to Accountable Care
The long and winding road to Accountable Care Elliott Fisher, MD, MPH Director, The Dartmouth Institute John E. Wennberg Distinguished Professor Geisel School of Medicine The long and winding road Past
More informationTable of Contents. Bellin Health Lessons from a Successful Medicare Pioneer ACO
Bellin Health Lessons from a Successful Medicare Pioneer ACO March 31, 2016 Table of Contents I. We Are Doing Some Good Things Rating Agency Actions II. Who We Are Bellin Health s Platform Organizational
More informationACO Name and Location. ACO Primary Contact. Organizational Information. Page 1 of 8
ACO ame and Location Essential Care Partners, LLC 5900 Southwest Parkway Building 3 Austin, Texas 78735 ACO Primary Contact Primary Contact ame Jeff Spight Primary Contact Phone umber 914-597-2073 Primary
More informationMedicare & Medicaid EHR Incentive Program Final Rule. Implementing the American Recovery & Reinvestment Act of 2009
Medicare & Medicaid EHR Incentive Program Final Rule Implementing the American Recovery & Reinvestment Act of 2009 Conceptual Approach to Meaningful Use Improved Data capture and sharing Advanced Clinical
More informationExamining the Differences Between Commercial and Medicare ACO Models
Examining the Differences Between Commercial and Medicare ACO Models Michelle Copenhaver December 10, 2015 Agenda 1 Understanding Accountable Care Organizations 2 Moving to Accountable Care: Enhancing
More informationMedicare & Medicaid. William Kassler, MD Chief Medical Officer Centers for Medicare & Medicaid Services Boston, MA
Medicare & Medicaid EHR Incentive Program William Kassler, MD Chief Medical Officer Centers for Medicare & Medicaid Services Boston, MA Overview Background / Policy Context EHR Incentive Program basics
More informationErin Page
ACO ame and Location Accountable Care Coalition of orth Texas, LLC. 4888 Loop Central Drive, Suite 700 Houston, Texas 77081 ACO Primary Contact Primary Contact ame Primary Contact Phone umber Erin Page
More informationMedicare Physician Group Practice Demonstration
Medicare Physician Group Practice Demonstration Disease Management Colloquium Philadelphia, Pennsylvania June 23, 2005 John Pilotte Senior Research Analyst Medicare Demonstrations Program Group Centers
More informationMeaningful Use Measures: Quick Reference Guide Stage 2 (2014 and Beyond)
Meaningful Use Measures: Quick Reference Guide Stage 2 (2014 and Beyond) Core Measures Required: All 17 objectives Objective: Requirement: Exclusions: Accomplish in Clinical 1. Computerized - Documenting
More informationACOs: California Style
ACOs: California Style ACO Congress John E. Jenrette, M.D. Chief Executive Officer Sharp Community Medical Group November 2, 2011 California Style California Style A CO California Style California Style
More informationSlide 1. Slide 2 Rural Princeton. Slide 3 Agenda Rural ACO RURAL ACOS CAN WORK AND LEAD THE WAY
Slide 1 RURAL ACOS CAN WORK AND LEAD THE WAY Nebraska Rural Health Association September 20, 2017 Slide 2 Rural Princeton Slide 3 Agenda Rural ACO Illinois Rural Community Care Organization (IRCCO)/Statewide
More informationPHCA Webinar January 30, Latsha Davis & McKenna, P.C. Kimber L. Latsha, Esq.
PHCA Webinar January 30, 2014 Latsha Davis & McKenna, P.C. Kimber L. Latsha, Esq. 1 2 Intended to: Encourage the development of ACOs in Medicare Promotes accountability for a patient population and coordinates
More informationHEALTH CARE REFORM IN THE U.S.
HEALTH CARE REFORM IN THE U.S. A LOOK AT THE PAST, PRESENT AND FUTURE Carolyn Belk January 11, 2016 0 HEALTH CARE REFORM BIRTH OF THE AFFORDABLE CARE ACT Health care reform in the U.S. has been an ongoing
More informationRequest for Information Regarding Accountable Care Organizations (ACOs) and Medicare Shared Savings Programs (CMS-1345-NC)
Via Electronic Submission Donald Berwick, MD, MPP Administrator Centers for Medicare & Medicaid Services ATTN: CMS-1345-NC 7500 Security Blvd. Baltimore, MD 21244-8013 Re: Request for Information Regarding
More informationAccountable Care Organizations Under Medicare Shared Savings Program PROPOSED RULE
Accountable Care Organizations Under Medicare Shared Savings Program PROPOSED RULE The information in this document summarizes a proposed rule issued by the Centers for Medicare and Medicaid id Services.
More informationThe Pain or the Gain?
The Pain or the Gain? Comprehensive Care Joint Replacement (CJR) Model DRG 469 (Major joint replacement with major complications) DRG 470 (Major joint without major complications or comorbidities) Actual
More informationExhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013)
Exhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013) 24 percent (52 ACOs) earned shared savings bonus 27 percent (60 ACOs) reduced spending,
More informationForces of Change- Seeing Stepping Stones Not Potholes
May 19, 2014 Forces of Change- Seeing Stepping Stones Not Potholes 2 3 4 Overview Demographics Long Term Care Financing Challenges Broad Health System Challenges Payment Reform Delivery System Reform Where
More informationSession 10: Integrating Data and Analytics into Provider Workflows Improves ACO Quality and Financial Performance
Session 10: Integrating Data and Analytics into Provider Workflows Improves ACO Quality and Financial Performance Joan Valentine, MSA, RN Executive Vice President Visiting Physicians Association David
More informationImproving Care for the Chronically Ill. Linda Magno Director, Medicare Demonstrations
Improving Care for the Chronically Ill Linda Magno Director, Medicare Demonstrations Medicare Spending for Beneficiaries with Chronic Conditions The 20 percent of beneficiaries with 5+ chronic conditions
More informationLong term commitment to a new vision. Medical Director February 9, 2011
ACCOUNTABLE CARE ORGANIZATION (ACO): Long term commitment to a new vision Michael Belman MD Michael Belman MD Medical Director February 9, 2011 Physician Reimbursement There are three ways to pay a physician,
More informationREPORT OF THE BOARD OF TRUSTEES
REPORT OF THE BOARD OF TRUSTEES B of T Report 21-A-17 Subject: Presented by: Risk Adjustment Refinement in Accountable Care Organization (ACO) Settings and Medicare Shared Savings Programs (MSSP) Patrice
More informationAccountable Care Organizations: Organizational and Legal Structures; Governance
Accountable Care Organizations: Organizational and Legal Structures; Governance California Association of Physician Groups (CAPG) May 4, 2011 Palm Desert, CA Dennis S. Diaz, Esq. Davis Wright Tremaine
More informationPatient-Centered Primary Care
Patient-Centered Primary Care Greg Moody, Director Office of Health Transformation July 30, 2014 www.healthtransformation.ohio.gov Agenda 1. Health System Challenges 2. Health System Trends in Primary
More informationFramework for Post-Acute Care: Current and Future Issues for Providers
Framework for Post-Acute Care: Current and Future Issues for Providers Alan G. Rosenbloom Alliance for Quality Nursing Home Care March 2012 Overview of Presentation Post-Acute Care: Background and Trends
More informationAccountable Care Organizations: Process and Applications. Presentation to South Carolina Hospital Association CO CFO Forum.
Accountable Care Organizations: Lessons Learned from the ACO Process and Applications Presentation to South Carolina Hospital Association CO CFO Forum TheSea PinesResort Hilton Head, SC August 28, 2013
More informationThe Accountable Care Organization & Compliance
The Accountable Care Organization & Compliance Joy A. Heim, Compliance Officer Franciscan ACO, Inc. HCCA Regional Conference Indianapolis, Indiana September 30, 2016 1 Creation of Medicare Accountable
More informationThe Accountable Care Organization & Compliance
The Accountable Care Organization & Compliance Joy A. Heim, Compliance Officer Franciscan ACO, Inc. HCCA Regional Conference Indianapolis, Indiana September 30, 2016 1 Creation of Medicare Accountable
More informationSandra Robinson, RN, MSN, ACM, CEN
Developing and Measuring Care Coordination Outcome Goals and Objectives ACMA National Conference April 28, 2015 Cleveland Clinic Care Management Sandra Robinson, RN, MSN, ACM, CEN (robinss12@ccf.org) Joan
More informationProposed CMMI Rural Shared Savings Demonstration Project: Frontier/Rural Community Care Organizations
Proposed CMMI Rural Shared Savings Demonstration Project: Frontier/Rural Community Care Organizations Executive Summary Rural networks across the nation have been working with rural providers to assist
More informationBundled Payments to Align Providers and Increase Value to Patients
Bundled Payments to Align Providers and Increase Value to Patients Stephanie Calcasola, MSN, RN-BC Director of Quality and Medical Management Baystate Health Baystate Medical Center Baystate Health Is
More informationA Practical Approach Toward Accountable Care and Risk-Based Contracting: Design to Implementation
A Practical Approach Toward Accountable Care and Risk-Based Contracting: Design to Implementation Daniel J. Marino, President/CEO, Health Directions Asad Zaman, MD June 19, 2013 Session Objectives Establish
More informationPartners in the Continuum of Care: Hospitals and Post-Acute Care Providers
Partners in the Continuum of Care: Hospitals and Post-Acute Care Providers Presented to the Wisconsin Association for Home Health Care November 3, 2017 By: Laura Rose WHA Vice President, Policy Development
More informationThe Accountable Care Organization Specific Objectives
Accountable Care Organizations and You E. Christopher h Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences CEO, OSU Faculty Group Practice Chair, Department of Surgery Ohio State
More informationPhysician Compensation for Quality Within Groups: Complying with Stark and State of The Art. Traditional Physician Compensation Models
Physician Compensation for Quality Within Groups: Complying with Stark and State of The Art Alice G. Gosfield, Esq. Medicare and Medicaid Institute American Health Lawyers Association March 29, 2012 c.2012,
More informationMEMORANDUM Texas Department of Human Services * Long Term Care/Policy
MEMORANDUM Texas Department of Human Services * Long Term Care/Policy TO: FROM: LTC-R Regional Directors Section/Unit Managers Marc Gold Section Manager Long Term Care Policy State Office MC: W-519 SUBJECT:
More informationComprehensive Care for Joint Replacement (CJR) Readiness Kit
Comprehensive Care for Joint Replacement (CJR) Readiness Kit Contents CMS Announces Shift From Volume To Value...2 Top Things To Know About CJR Final Rule...3 Proposed Timeline For CJR...4 Who Is Impacted?...5
More informationCLINICAL PRACTICE EVALUATION II: CLINICAL SYSTEMS REVIEW
Diplomate: CLINICAL PRACTICE EVALUATION II: CLINICAL SYSTEMS REVIEW A. INFORMATION MANAGEMENT 1. Does your practice currently use an electronic medical record system? Yes No 2. If Yes, how long has the
More informationQuestions and Answers on the CMS Comprehensive Care for Joint Replacement Model
Questions and Answers on the CMS Comprehensive Care for Joint Replacement Model MEGGAN BUSHEE, ESQ. 704.343.2360 mbushee@mcguirewoods.com 201 North Tryon Street, Suite 3000 Charlotte, North Carolina 28202-2146
More informationReforming Health Reform: After the Election, What Happens Now?
2013 CliftonLarsonAllen LLP Reforming Health Reform: After the Election, What Happens Now? cliftonlarsonallen.com LeadingAge Indiana Deb Freeland May 6, 2013 Objectives Update current status of ACA Ongoing
More informationNC TIDE SPRING CONFERENCE April 26, NC Department of Health and Human Services Medicaid Transformation and the 1115 Waiver
NC TIDE SPRING CONFERENCE April 26, 2017 NC Department of Health and Human Services Medicaid Transformation and the 1115 Waiver Agenda Medicaid Landscape NC Medicaid Transformation Supporting Legislation
More informationAHLA. A. All Together Now: Minimizing Antitrust Risk when Creating and Operating ACOs, PHOs, and Other Clinically Integrated Entities
AHLA A. All Together Now: Minimizing Antitrust Risk when Creating and Operating ACOs, PHOs, and Other Clinically Integrated Entities Alpa G. Davis Attorney Federal Trade Commission Washington, DC Ashley
More informationkaiser medicaid and the uninsured commission on O L I C Y
P O L I C Y B R I E F kaiser commission on medicaid and the uninsured 1330 G S T R E E T NW, W A S H I N G T O N, DC 20005 P H O N E: (202) 347-5270, F A X: ( 202) 347-5274 W E B S I T E: W W W. K F F.
More information2015 Annual Convention
2015 Annual Convention Date: Tuesday, October 13, 2015 Time: 8:00 am 9:30 am Location: Gaylord National Harbor Resort and Convention Center, National Harbor 10 Title: Activity Type: Speaker: Opportunities
More informationMission Health Care Network. April 2017
Mission Health Care Network April 2017 WHAT IS MISSION HEALTH CARE NETWORK? Mission Health Care Network is a Clinically Integrated Network including groups of doctors, the hospital and other health care
More information1. The new state-based insurance exchange for small businesses (SHOP) stands for:
Chapter 5 Review Questions 1. The new state-based insurance exchange for small businesses (SHOP) stands for: a. Small Business Health Options Program b. Small Business Health Option Plans c. State Health
More informationCompliance Issues For Multi-Provider Collaborations: How To Spot & Avoid Potential Pitfalls
Compliance Issues For Multi-Provider Collaborations: How To Spot & Avoid Potential Pitfalls LeadingAge New York s Financial Managers Annual Conference Wednesday, August 31, 2016 Saratoga Hilton, Saratoga
More informationPhysician Only ACOs: An Opportunity to Consider * Elias N. Matsakis, Esq.
Physician Only ACOs: An Opportunity to Consider * Elias N. Matsakis, Esq. The Affordable Care Act authorized the Center for Medicare and Medicaid Services (CMS) to establish the Medicare Shared Savings
More informationGetting Ready for the Maryland Primary Care Program
Getting Ready for the Maryland Primary Care Program Presentation to Maryland Academy of Nutrition and Dietetics March 19, 2018 Maryland Department of Health All-Payer Model: Performance to Date Performance
More informationHealth Care Reform Provisions Affecting Older Adults and Persons with Special Needs 3/30/10
Health Care Reform Provisions Affecting Older Adults and Persons with Special Needs 3/30/10 On March 23, 2010, President Obama signed a comprehensive health care reform bill (H.R. 3590) into law. On March
More informationTransitioning Care to Reduce Admissions and Readmissions. Sven T. Berg, MD, MPH Julie Mobayed RN, BSN, MPH
Transitioning Care to Reduce Admissions and Readmissions Sven T. Berg, MD, MPH Julie Mobayed RN, BSN, MPH Disclaimer: Potential for Error Type One Error Rejecting the null hypothesis when it is true
More information3/16/2016. Swapping, Kickbacks, Fair Market Value: Risks for a Post-Acute Provider. AKS designed to prevent improper referrals, which can lead to:
Swapping, Kickbacks, Fair Market Value: Risks for a Post-Acute Provider Alan Schabes, Partner Benesch, Friedlander, Coplan & Aronoff LLP Shannon Drake, VP, Associate General Counsel Kindred at Home Amanda
More informationAccountable Care and Governance Challenges Under the Affordable Care Act
Accountable Care and Governance Challenges Under the Affordable Care Act The First National Congress on Healthcare Clinical Innovations, Quality Improvement and Cost Containment October 26, 2011 Doug Hastings
More informationUnitedHealth Center for Health Reform & Modernization September 2014
Health Reform & Modernization September 2014 2014 UnitedHealth Group. Any use, copying or distribution without written permission from UnitedHealth Group is prohibited. Overview Why Focus on Primary Care?
More informationThe Evolving Landscape of Healthcare Payment: Incentive Programs and ACO Model Optimization. Quality Forum August 19, 2015
The Evolving Landscape of Healthcare Payment: Incentive Programs and ACO Model Optimization Quality Forum August 19, 2015 Ross Manson rmanson@eidebailly.com 701.239.8634 Barb Pritchard bpritchard@eidebailly.com
More informationSwapping, Kickbacks, Fair Market Value: Risks for a Post-Acute Provider
Swapping, Kickbacks, Fair Market Value: Risks for a Post-Acute Provider Alan Schabes, Partner Benesch, Friedlander, Coplan & Aronoff LLP Shannon Drake, VP, Associate General Counsel Kindred at Home Amanda
More informationACOs the Medicare Shared Savings Program And Other Healthcare Reform Payment Methods
A unique vision for an ever-changing healthcare environment ACOs the Medicare Shared Savings Program And Other Healthcare Reform Payment Methods Presented by Joe Laden, President, ORVA, LLC The Environment
More informationMBQIP Quality Measure Trends, Data Summary Report #20 November 2016
MBQIP Quality Measure Trends, 2011-2016 Data Summary Report #20 November 2016 Tami Swenson, PhD Michelle Casey, MS University of Minnesota Rural Health Research Center ABOUT This project was supported
More informationTotal Cost of Care Technical Appendix April 2015
Total Cost of Care Technical Appendix April 2015 This technical appendix supplements the Spring 2015 adult and pediatric Clinic Comparison Reports released by the Oregon Health Care Quality Corporation
More informationMedicare Physician Payment Reform:
Medicare Physician Payment Reform: Implications and Options for Physicians and Hospitals Background The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law on April 14, 2015.
More informationThe influx of newly insured Californians through
January 2016 Managing Cost of Care: Lessons from Successful Organizations Issue Brief The influx of newly insured Californians through the public exchange and Medicaid expansion has renewed efforts by
More informationGateway to Practitioner Excellence GPE 2017 Medicaid & Medicare
Gateway to Practitioner Excellence GPE 2017 Medicaid & Medicare Recognizing and Rewarding Excellent Practices Improving the Health of Gateway Members PRACTICE ELIGIBILITY (see PCMH slide #27 for separate
More informationMedicare & Medicaid EHR Incentive Program Final Rule. Implementing the American Recovery & Reinvestment Act of 2009
Medicare & Medicaid EHR Incentive Program Final Rule Implementing the American Recovery & Reinvestment Act of 2009 Purpose of this Presentation To give an overview of the CMS final rule on the EHR Incentive
More informationRural-Relevant Quality Measures for Critical Access Hospitals
Rural-Relevant Quality Measures for Critical Access Hospitals Ira Moscovice PhD Michelle Casey MS University of Minnesota Rural Health Research Center Minnesota Rural Health Conference Duluth, Minnesota
More informationWhat Have we Learned from the Pioneer ACO Model?
What Have we Learned from the Pioneer ACO Model? Sherly Binu, CMMI December 7, 2016 Disclaimers 2 This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose
More information