ACOs the Medicare Shared Savings Program And Other Healthcare Reform Payment Methods

Size: px
Start display at page:

Download "ACOs the Medicare Shared Savings Program And Other Healthcare Reform Payment Methods"

Transcription

1 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

2 The Environment Patient Protection and Affordable Care Act PPACA (Obamacare) Healthcare 18% of GDP Healthcare Reform U.S Budget Crisis 2012 Election The country has run out of money

3 Possible Healthcare Solutions Cut Provider Fees Price Controls Rationing Universal Healthcare Medicare/Medicaid for All Capitation Reinstitute HMOs Bundled Pricing Physician Extenders (replacements)

4 ACO to the Rescue Accountable Care Organization Medicare 47.5 million beneficiaries 15.5% of populstion 35%-45% of medical practice Non-Medicare

5 ACO General Definition A partnership among health care providers to coordinate and deliver efficient care Assumes joint accountability for improving quality and slowing cost growth

6 ACO Definition Organization Legal Entity Provider Owned Hospital, Physician Healthcare Delivery Payment System Local

7 ACO Definition Care Coordinated Quality Primary Care Based

8 ACO Definition Accountable for... Assigned Base of patients Continuum of Care Cost Total per Capita Quality

9 ACO Characteristics Based on Idea That More Integration Equals Less Cost as Observed in Mayo Clinic and Kaiser Models

10 ACO Origin Physician Groups 5 Year Demonstration Kaiser Permanante HealthCare Partners Medical Group Brookings/Dartmouth 5 Group Pilot with Humana, UHC & Anthem

11

12 The Medicare ACO Authorized by section 3020 of the Patient Protection and Affordable Care Act (ACA) CMS Directed to establish a Shared Savings Program Facilitate Coordination Among Providers Solve Problem of FFS with No Coordination

13 ACO Participants ACO professionals (i.e., practitioners meeting the statutory definition) in Group practice arrangements, Networks of individual practices of ACO professionals, Partnerships or joint ventures arrangements between hospitals and ACO professionals, Hospitals employing ACO professionals, or

14

15 ASO Start and Application Dates

16 How Does Medicare ACO Work? Patients Assigned to ACO by CMS Assignment Based on Primary Care MD Specialists w/ Primary Care Considered Patients not Restricted to ACO ACO Knows Probable Patients Historical 3 Year Beneficiary Cost Known Providers Paid Normal FFS Rates Providers Need Not be in ACO Patients Can Leave ACO

17 How Does Medicare ACO Work? Must commit to three years At End of Year Costs to Medicare Calculated for Assigned Patients Costs Compared to Historical If Costs Are Lower, ACO receives portion of savings (Shared Savings)

18 How Does Medicare ACO Work? Minimum Savings Rate (MSR) will be established below which no savings will be shared Minimum Loss Rate (MLR) above which the ACO will share losses ACO can request claim data on its patients

19 But Wait!!! Savings mean the ACO providers received less fees than they would have if there had been no ACO for the Medicare patient assigned. And, the ACO entity, not the providers receive the shared savings reward from Medicare

20 One Sided Model Shared savings for first period with no losses. This model will have smaller populations and more possible variation Sharing rate up to 50% of savings based on performance measures

21 One Sided Model Maximum % of Shared Savings 50% Minimum Savings rate 2% to 3.9% depending on number of beneficiaries Shared Savings Cap 10% No Shared Losses Cap

22 Two Sided Model Shared savings for first period with losses possible if Minimum Loss Ratio is exceeded. Quality Metrics taken into account Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) inclusion will increase potential shared savings

23 Two Sided Model Maximum % of Shared Savings 60% Minimum Savings rate 2% Shared Savings Cap 15% Shared Losses Cap 5% in year 1 7.5% in year 2 10% in year 3

24 Example 2 Sided Historical cost per beneficiary = $10,000 Minimum Savings Rate 2% = $200 Shared savings cap 15% = $1,500 Shared losses cap 7.5% = $750 ($10,750) Shared savings 60% > 2% Assume ACO saves $450 per beneficiary Shared savings = 60% of ($450-$200) =$150

25 Example 2 Sided Assume ACO has 10,000 Medicare Beneficiaries Total shared savings = $1.5 million Risk - $750 per beneficiary = $7.5 million

26 How Can Savings Be Achieved? - I Primary Care Extends Hours, Reducing ER Visits. Care Is Coordinated via Improved Communications and EMR Eliminate Duplicate Services Eliminate Unnecessary/Marginal Test and Treatments Prescribe Lower Cost Drugs

27 How Can Savings Be Achieved? - II Communicate With Patients via Telephone, & Web Portal Rather Than FFS Visits Increase Use of Physician Extenders Increase Use of ARNPs and PAs House Calls and Nursing Home Calls by non-physicians to Check on Care Publish and Follow Clinical Pathways and Best Practices

28 How Can Savings Be Achieved? - III Use Care Coordinators and Nurse Managers to Closely Manage Chronic Conditions and Expensive Episodes of Care ($35pmpm, $1.1M for 5K patients) Use MD Specialty Services Sparingly Telemedicine Remote Monitoring Evaluation of Skilled Nursing Facilites MD Involvement with Rehab Facilities

29 Categories of Quality Patient Experience Care Coordination Patient Safety Preventative Health At Risk Population/Frail Elderly Health Will be aligned with EHR/PQRS

30 What Happens to HBPs Less Surgery for Anesthesiologists Fewer Imaging Services for Radiologists ER Visits Reduced Fewer Pathology Studies Fewer Patients in Hospital for Hospitalists

31 Will There Be an Impact on HBPs? There may be no Medicare ACO in the area. Only a fraction of Medicare patients will be in an ACO. How much surgery and other services will realistically be eliminated? Medicare is a very poor physician payer, it may be helpful to let patients go to another hospital.

32 How Will Savings Be Shared? Hospital Owned ACO Employed MDs Non-employed MDs Primary Care Owned ACO Primary Care Owners Outside Specialists Hospitals, ASC, Nursing Homes, etc.

33 Problems with Hospitals Sharing Sharing with doctors may run afoul of anti-trust and Stark Laws Entities not a part of the ACO may not have an incentive to cooperate

34 Potential ACO Problems - I Large financial losses probable in initial years Participation may be low due to the large upfront investment necessary ACOs may try to shift Medicare losses to private payers Entitles not a part of the ACO may not have an incentive to cooperate

35 Potential ACO Problems - II ACO must have EMR implemented system wide A comprehensive IT structure is needed for quality and other reporting Uncertain rewards, concept unproven Less than half of demo ACO achieved more than 2% savings after 5 years

36 Potential ACO Problems - III Each year s savings is next year s benchmark for minimum savings Referral patterns will be disrupted Patients are not personally involved in helping save costs

37 Hospital ACOs and HBPs Will the Hospital Share with HBPs? Did the HBPs Help Produce Savings? Hospitals Already Contract With HBPs If Hospitals Expect Overall Services to Be Reduced, Will Hospitals Want to Reduce Stipends to HPBs?

38 Primary Care ACOs and HBPs Would They Share With HPBs? Would They Share with Hospitals and Other Facilities?

39 Pioneer ACO Started January ACOs Selected 18 States 860,000 Patients Assigned 1.1 Billion to be saved over 5 Years Represents 1% of Medicare Budget Closest: Franciscan of Indianapolis

40 Pioneer ACO Must have a least 15,000 beneficiaries First two years higher level of risk and shared savings Year three can transition to population based and full risk Required to negotiate outcomes-based arrangements with non-medicare payers

41 Pioneer ACO Franciscan Alliance 8 Area Hospitals 22,000 Medicare Patients 700 MDs 180 Employed Agreements with Non-employed MDs Alliance with WellPoint (Anthem) 11 Other Hospitals May be added Pledged to Expand Outside Medicare

42 Advanced Payment ACO CMS Response to Medical Groups Designed to help small entities start up Three types of advance payment Must have no inpatient facilities Must be under $50 million in revenue May be a low volume rural hospital May enter only in April or July 2012

43 Payments Advanced Payment ACO Upfront Fixed Upfront variable based on number of beneficiaries Monthly payment per beneficiary Advance payments will be recouped from shared savings but not beyond savings, if any

44 Could Specialists Form An ACO? A Few Million in Startup Costs Need Contracts With Primary Care To Handle At Least 5,000 Medicare Patients ACO Owners Would be Rewarded with Savings from Hospitals and Specialists Outside the ACO

45 The Fallout From Threat of ACOs Hospitals Rushing to Employ Primary Care MDs, If Not Already Employed Formation Of Integrated Networks Multiple Hospitals and Large Medical Groups Implementation of EMRs by Hospitals and primary Care

46 The Fallout From Threat of ACOs Hospital Systems Merging Hospital Systems Forming Alliances Hospital Systems Adding Hospitals, ASC, Home Health, DME, Nursing Homes Hospitals Branching Out Geographically

47 Why Are ACOs a Threat to Hospitals? Shows the Government is Serious About Reducing Costs The Lion s Share of the Healthcare Dollar Goes to Hospitals Hospitals Have Huge, Expensive Infrastructure That Will Be Hard to Dismantle as Reinbursement Declines

48 Why Are ACOs a Threat to Hospitals? ACOs Are Only One Part of Government Healthcare Reform That Will Reduce Hospital Reimbursement Competitors May Establish an ACO First Non-Government ACOs May Be a Larger Threat than Medicare ACOs CMS May Eventually Convert all FFS to Capitated ACOs

49 ACOs Can Be Opportunity for Hospitals Hospital-Based ACO Can Profit From Reduction In Services of Providers Outside the ACO (HBPs, other facilities) Hospitals Can Gain Market Share By Capturing Medicare Beneficiaries via Well-run ACO

50 ACOs Can Be Opportunity for Hospitals Hospitals Can Use ACO Fear as a Method to Acquire Physician Practices with No Acquisition Cost. Hospitals Can Use ACO Fear as a Method to Acquire Weak Hospitals and ASCs. Hospitals can Establish non-medicare, Private ACOs (and have already done so)

51

52 Bundled Payments for Care Applicant specifies episode definition and pricing Retrospective Payment Bundling Discount off FFS Savings under the target can be shared Physicians and hospital can arrange for gain sharing

53 Bundled Payments for Care Test over 5 years Payment for episode of care Fixed payment target set for episode Providers received agreed upon discounted fee for service CMS pays bonus if under target Compensation between physician and hospital fair market value

54 Bundled Payments for Care Retrospective Payment Bundling Model 1 Inpatient Stay Only Model 2 Inpatient stay and post acute care Model 3 Post acute care only

55 Bundled Payments for Care Prospective Payment Bundling Inpatient care only Minimum discount of 3% Bundled payment paid to hospital only Hospital may share with physicians

56 Bundled Payments for Care-Positive Encourages communication about patient progress No incentive for unnecessary care Does not penalize providers that treat severely ill patients because all services are included in initial pricing

57 Bundled Payments for Care-Negative Risk that costs are not contained May reduce incentive to withhold care Problems splitting payments and rewards between hospital and MDs Payment division problems may be both legal and practical

58 Where is all this headed? Death of Fee for Service ACO-type entities control care Hospital systems and integrated provider and insurer systems dominate Mass health system employment of MDs Rationing Employers exit health coverage Shift from physician to non-physician providers

59 Discussion How will the ACO, Capitation and Bundled Payments Fit in Your Future?

The Center for Medicare & Medicaid Innovations: Programs & Initiatives

The Center for Medicare & Medicaid Innovations: Programs & Initiatives The Center for Medicare & Medicaid Innovations: Programs & Initiatives Rob Stone, Esq. American Health Lawyers Association Institute on Medicare & Medicaid Payment Issues March 30-April 1, 2012 CMMI Mission

More information

PHCA Webinar January 30, Latsha Davis & McKenna, P.C. Kimber L. Latsha, Esq.

PHCA 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 information

Physician Compensation in an Era of New Reimbursement Models

Physician Compensation in an Era of New Reimbursement Models 2014 IHA Annual Membership Meeting Physician Compensation in an Era of New Reimbursement Models Taryn E. Stone Ice Miller LLP (317) 236-5872 taryn.stone@ Agenda Background New Reimbursement Models Trends

More information

Succeeding in a New Era of Health Care Delivery

Succeeding in a New Era of Health Care Delivery March 14, 2012 Succeeding in a New Era of Health Care Delivery Building Value-Based Partnerships LeadingAge Pennsylvania Kathleen Griffin, PhD, National Director Post-Acute and Senior Services 1 Your Presenter

More information

Connected Care Partners

Connected Care Partners Connected Care Partners Our Discussion Today Introducing the Connected Care Partners CIN What is a Clinically Integrated Network (CIN) and why is the time right to join the Connected Care Partners CIN?

More information

The Accountable Care Organization Specific Objectives

The 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 information

Physician Engagement

Physician Engagement Pathways for Successful Accountable Care Organizations: Physician Engagement Thomas Kloos, MD Jim Barr, MD Atlantic ACO & Optimus Healthcare Partners ACO Helping providers Care Better for their patients.

More information

Workhorse or Unicorn: Incentive Realignment and Health Improvement After One Year of ACOs. Objectives

Workhorse or Unicorn: Incentive Realignment and Health Improvement After One Year of ACOs. Objectives Session L23 These presenters have nothing to disclose Workhorse or Unicorn: Incentive Realignment and Health Improvement After One Year of ACOs By James E. Orlikoff and Len Nichols Sunday, December 9,

More information

ACOs: California Style

ACOs: 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 information

HEALTH CARE REFORM IN THE U.S.

HEALTH 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 information

Health Care Evolution

Health Care Evolution Health Care Evolution Patient-Centered Medical Home to Clinical Integration & Accountable Care Ken Bertka, MD bertka@mindspring.com 419-346-8719 Agenda Top 3 Challenges of Health Care Reform PCMH & ACO

More information

Value-Based Care Contracting and Legal Issues

Value-Based Care Contracting and Legal Issues Session 4b Value-Based Care Contracting and Legal Issues Presented by: Janet Walker Farrer General Counsel and Insurance Legal Department Chair Ascension Health Leah Stewart Associate Vice President for

More information

Thought Leadership Series White Paper The Journey to Population Health and Risk

Thought Leadership Series White Paper The Journey to Population Health and Risk AMGA Consulting Thought Leadership Series White Paper The Journey to Population Health and Risk The Journey to Population Health and Risk Howard B. Graman, M.D., FACP White Paper, January 2016 While the

More information

The Cost of Care: Understanding the Next Generation of Payment Models

The Cost of Care: Understanding the Next Generation of Payment Models The Cost of Care: Understanding the Next Generation of Payment Models Presented by: Debbie Welle Powell, MPA, Vice President Sisters of Charity Health System and Exempla Healthcare September 27 th, 2012

More information

Long term commitment to a new vision. Medical Director February 9, 2011

Long 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 information

Laying the Foundation for Successful Clinical Integration

Laying the Foundation for Successful Clinical Integration The Governance Institute Laying the Foundation for Successful Clinical Integration Webinar November 29, 2011, 2:00pm ET/11:00am PT Daniel M. Grauman President & CEO DGA Partners, Bala Cynwyd, PA dgrauman@dgapartners.com

More information

Accountable Care Organizations

Accountable Care Organizations Accountable Care Organizations Randy Wexler, MD, MPH, FAAFP Associate Professor Vice Chair, Clinical Services Department of Family Medicine The Ohio State University Wexner Medical Center Objectives To

More information

DRIVING VALUE-BASED POST-ACUTE COLLABORATIVE SOLUTIONS. Amy Hancock, CEO Presented to: CPERI April 16, 2018

DRIVING VALUE-BASED POST-ACUTE COLLABORATIVE SOLUTIONS. Amy Hancock, CEO Presented to: CPERI April 16, 2018 DRIVING VALUE-BASED POST-ACUTE COLLABORATIVE SOLUTIONS Amy Hancock, CEO Presented to: CPERI April 16, 2018 Cross-Continuum Road-Mapping Post-acute partners are beginning to utilize tools to identify new

More information

1. Current Reimbursement and Care Delivery Structures

1. Current Reimbursement and Care Delivery Structures ACOs A New Reimbursement Strategy? During the past few months we heard a few representatives of medical device companies, claim that their new and innovative devices would be sold directly to Accountable

More information

Redesigning Post-Acute Care: Value Based Payment Models

Redesigning Post-Acute Care: Value Based Payment Models Redesigning Post-Acute Care: Value Based Payment Models Liz Almeida-Sanborn, MS, PT President Preferred Therapy Solutions This session will address: Discussion of the emergence of voluntary and mandatory

More information

Forces of Change- Seeing Stepping Stones Not Potholes

Forces 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 information

MACRA & Implications for Telemedicine. June 20, 2016

MACRA & Implications for Telemedicine. June 20, 2016 MACRA & Implications for Telemedicine June 20, 2016 Presentation Overview Introductions Deep Dive Into MACRA Implications for Telemedicine Questions Growth in Value-Based Care Over Next Two Years Growth

More information

Payment and Delivery System Reform in Vermont: 2016 and Beyond

Payment and Delivery System Reform in Vermont: 2016 and Beyond Payment and Delivery System Reform in Vermont: 2016 and Beyond Richard Slusky, Director of Reform Green Mountain Care Board Presentation to GMCB August 13, 2015 Transition Year 2016 1. Medicare Waiver

More information

Value based care: A system overhaul

Value 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 information

What s Wrong with Healthcare?

What s Wrong with Healthcare? What s Wrong with Healthcare? Dan Murrey, MD, MPP Chief Executive Officer Agenda What s wrong with healthcare in the US? What would make it better? How can you help? What s wrong with US healthcare? What

More information

The Accountable Care Organization & Compliance

The 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 information

The Accountable Care Organization & Compliance

The 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 information

Primary Care 101: A Glossary for Prevention Practitioners

Primary Care 101: A Glossary for Prevention Practitioners PREVENTION COLLABORATION IN ACTION Engaging the Right Partners Primary Care 101: A Glossary for Prevention Practitioners As the U.S. healthcare landscape continues to change under the Affordable Care Act

More information

Getting Started in a Medicare Shared Savings Program Accountable Care Organization

Getting Started in a Medicare Shared Savings Program Accountable Care Organization 1 Getting Started in a Medicare Shared Savings Program Accountable Care Organization Tuesday, September 16 th Pam Maxwell, Chief Growth Officer What is an ACO? Accountable Care Organizations (ACOs) are

More information

Accountable Care Organizations American Osteopathic Association Health Policy Day September 23, 2011

Accountable Care Organizations American Osteopathic Association Health Policy Day September 23, 2011 Accountable Care Organizations American Osteopathic Association Health Policy Day September 23, 2011 Cary Sennett MD PhD Cary Sennett, MD, PhD Managing Director, Engelberg Center for Health Care Reform

More information

Value-Based Reimbursements are Here: Are you Ready?

Value-Based Reimbursements are Here: Are you Ready? Value-Based Reimbursements are Here: Are you Ready? White Paper ELLIS MAC KNIGHT, MD Senior Vice President/CMO Published by Becker s Hospital Review April 2016 White Paper Value-Based Reimbursements are

More information

Rural Health Clinics

Rural Health Clinics Rural Health Clinics * An Issue Paper of the National Rural Health Association originally issued in February 1997 This paper summarizes the history of the development and current status of Rural Health

More information

Exhibit 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) 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 information

Accountable Care Organizations: Organizational and Legal Structures; Governance

Accountable 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 information

Telehealth: Overcoming the challenges of implementing innovative health care solutions

Telehealth: Overcoming the challenges of implementing innovative health care solutions Telehealth: Overcoming the challenges of implementing innovative health care solutions NRTRC 5 TH ANNUAL CONFERENCE MARCH 22, 2016 ROKI CHAUHAN, MD, FAAFP Disclaimer 2 The material presented here is being

More information

Medicaid Payment Reform at Scale: The New York State Roadmap

Medicaid Payment Reform at Scale: The New York State Roadmap Medicaid Payment Reform at Scale: The New York State Roadmap ASTHO Technical Assistance Call June 22 nd 2015 Greg Allen Policy Director New York State Medicaid Overview Background and Brief History Delivery

More information

Complex Patient Care Redesign: ThedaCare Innovation. Gregory Long, MD Chief Medical Officer

Complex Patient Care Redesign: ThedaCare Innovation. Gregory Long, MD Chief Medical Officer Complex Patient Care Redesign: ThedaCare Innovation Gregory Long, MD Chief Medical Officer ThedaCare Northeastern Wisconsin An Integrated Community Health System; >7000 employees Primary service area of

More information

1. The new state-based insurance exchange for small businesses (SHOP) stands for:

1. 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 information

Patient-Centered Medical Home 101: General Overview

Patient-Centered Medical Home 101: General Overview Patient-Centered Medical Home 101: General Overview Publicly Available Slide Deck Last Updated: January 2015 Suggested Citation: PCPCC Map Tools. (2015). Patient-Centered Medical Home 101: General Overview.

More information

MEDICARE COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL (CCJR) Preparing for Risk-Based Outcomes of Bundled Care 8/12/2015.

MEDICARE COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL (CCJR) Preparing for Risk-Based Outcomes of Bundled Care 8/12/2015. MEDICARE COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL (CCJR) Preparing for Risk-Based Outcomes of Bundled Care August 13, 2015 Eric M. Rogers MEd RT(R) Managing Consultant erogers@bkd.com Jeff Bond President

More information

HOME DIALYSIS REIMBURSEMENT AND POLICY. Tonya L. Saffer, MPH Senior Health Policy Director National Kidney Foundation

HOME DIALYSIS REIMBURSEMENT AND POLICY. Tonya L. Saffer, MPH Senior Health Policy Director National Kidney Foundation HOME DIALYSIS REIMBURSEMENT AND POLICY Tonya L. Saffer, MPH Senior Health Policy Director National Kidney Foundation Objectives Understand the changing dynamics of use of home dialysis Know the different

More information

State Policy Report #47. October Health Center Payment Reform: State Initiatives to Meet the Triple Aim. Introduction

State Policy Report #47. October Health Center Payment Reform: State Initiatives to Meet the Triple Aim. Introduction Health Center Payment Reform: State Initiatives to Meet the Triple Aim State Policy Report #47 October 2013 Introduction Policymakers at both the federal and state levels are focusing on how best to structure

More information

Moving the Dial on Quality

Moving the Dial on Quality Moving the Dial on Quality Washington State Medical Oncology Society November 1, 2013 Nancy L. Fisher, MD, MPH CMO, Region X Centers for Medicare and Medicaid Serving Alaska, Idaho, Oregon, Washington

More information

Improving Care and Managing Costs: Team-Based Care for the Chronically Ill

Improving Care and Managing Costs: Team-Based Care for the Chronically Ill Improving Care and Managing Costs: Team-Based Care for the Chronically Ill Cathy Schoen Senior Vice President The Commonwealth Fund www.commonwealthfund.org cs@cmwf.org High Cost Beneficiaries: What Can

More information

Cathy Schoen. The Commonwealth Fund Grantmakers In Health Webinar October 3, 2012

Cathy Schoen. The Commonwealth Fund  Grantmakers In Health Webinar October 3, 2012 Innovating Care for Chronically Ill Patients Cathy Schoen Senior Vice President The Commonwealth Fund www.commonwealthfund.org cs@cmwf.org Grantmakers In Health Webinar October 3, 2012 Chronically Ill:

More information

MassMedic Healthcare and Payment Reform: Impact on Value Demonstration

MassMedic Healthcare and Payment Reform: Impact on Value Demonstration MassMedic Healthcare and Payment Reform: Impact on Value Demonstration November 2, 2012 David Martin, Senior Director, Health Policy COVIDIEN, COVIDIEN with logo, Covidien logo and positive results for

More information

Emerging Models of Care Delivery Christy Mokrohisky Ex. Dir. of PI & Emerging Models

Emerging Models of Care Delivery Christy Mokrohisky Ex. Dir. of PI & Emerging Models Emerging Models of Care Delivery Christy Mokrohisky Ex. Dir. of PI & Emerging Models 1 Sacred Encounters Perfect Care Healthiest Communities St. Joseph Heritage Healthcare Founded in 1994 Manage 7 Medical

More information

Succeeding with Accountable Care Organizations

Succeeding with Accountable Care Organizations Succeeding with Accountable Care Organizations The Point B Webinar Series October 25, 2011 Today s Discussion Key ACO trends and emerging models Critical success factors for building an ACO Developing

More information

ACCOUNTABLE CARE ORGANIZATION & ALTERNATIVE PAYMENT MODEL SUMMIT

ACCOUNTABLE CARE ORGANIZATION & ALTERNATIVE PAYMENT MODEL SUMMIT ACCOUNTABLE CARE ORGANIZATION & ALTERNATIVE PAYMENT MODEL SUMMIT The Centers for Medicare and Medicaid Services Kate Goodrich, MD MHS Director, Clinical Standards & Quality Chief Medical Officer 1 DISCLAIMERS

More information

ADDING VALUE TO PHYSICIAN COMPENSATION A COMPREHENSIVE GUIDE TO ALIGNING PROVIDER COMPENSATION WITH VALUE-BASED REIMBURSEMENT

ADDING VALUE TO PHYSICIAN COMPENSATION A COMPREHENSIVE GUIDE TO ALIGNING PROVIDER COMPENSATION WITH VALUE-BASED REIMBURSEMENT ADDING VALUE TO PHYSICIAN COMPENSATION A COMPREHENSIVE GUIDE TO ALIGNING PROVIDER COMPENSATION WITH VALUE-BASED REIMBURSEMENT 1 INTRODUCTION The evolving physician compensation landscape Recently, HSG

More information

Physician Alignment Strategies and Options. June 1, 2011

Physician Alignment Strategies and Options. June 1, 2011 Physician Alignment Strategies and Options June 1, 2011 1 Today s Discussion Review physician-hospital alignment objectives Understand the changing paradigm Evaluate alignment strategies for a new delivery

More information

The Pain or the Gain?

The 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 information

Brave New World: The Effects of Health Reform Legislation on Hospitals. HFMA Annual National Meeting, Las Vegas, Nevada

Brave New World: The Effects of Health Reform Legislation on Hospitals. HFMA Annual National Meeting, Las Vegas, Nevada Brave New World: The Effects of Health Reform Legislation on Hospitals HFMA Annual National Meeting, Las Vegas, Nevada Highlights of PPACA Requires most Americans to have health insurance Expands coverage

More information

Transitioning 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 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 information

Physician-Hospital Integration 2012 How Health Care Reform Is Reshaping California s Delivery System

Physician-Hospital Integration 2012 How Health Care Reform Is Reshaping California s Delivery System C A LIFORNIA HEALTHCARE FOUNDATION Physician-Hospital Integration 2012 How Health Care Reform Is Reshaping California s Delivery System Prepared for California HealthCare Foundation By Cleo Burtley, MBA

More information

Reinventing Health Care: Health System Transformation

Reinventing Health Care: Health System Transformation Reinventing Health Care: Health System Transformation Aspen Institute Patrick Conway, M.D., MSc CMS Chief Medical Officer Director, Center for Clinical Standards and Quality Acting Director, Center for

More information

New Jersey Medicaid Medical Home Demonstration Project Report to the Legislature

New Jersey Medicaid Medical Home Demonstration Project Report to the Legislature New Jersey Medicaid Medical Home Demonstration Project Report to the Legislature November 2012 Division of Medical Assistance and Health Services NJ Department of Human Services Introduction In September,

More information

The Affordable Care Act

The Affordable Care Act The Affordable Care Act Medical City, Dallas, TX October 26, 2012 Presented by Cheryl West, MPH Director, Government Affairs, AARC Affordable Care Act (ACA) 2 What I m Not Going to Talk About 3 What I

More information

Basic Utilization and Case Management

Basic Utilization and Case Management & CHAPTER 7 Basic Utilization and Case Management I Bartlett CHAPTER Learning, STUDY LLC REVIEW 1. Goal of utilization management is to see that each member receives the appropriate level of care at an

More information

What s Next for CMS Innovation Center?

What s Next for CMS Innovation Center? What s Next for CMS Innovation Center? A Guide to Building Successful Value-Based Payment Models Given CMMI s New Focus on Voluntary, Home-Grown Initiatives W W W. H E A L T H M A N A G E M E N T. C O

More information

ACO REVIVAL. Medicare Shared Savings Program Final Regulation Overview. Blue & Co., LLC Healthcare Reform Symposium Thursday, November 3, 2011

ACO REVIVAL. Medicare Shared Savings Program Final Regulation Overview. Blue & Co., LLC Healthcare Reform Symposium Thursday, November 3, 2011 ACO REVIVAL Medicare Shared Savings Program Final Regulation Overview Blue & Co., LLC Healthcare Reform Symposium Thursday, November 3, 2011 11/03/2011 1 Introductions John Redding, MD, MBA Manager Healthcare

More information

Bundled Payments. AMGA September 25, 2013 AGENDA. Who Are We. Our Business Challenge. Episode Process. Experience

Bundled Payments. AMGA September 25, 2013 AGENDA. Who Are We. Our Business Challenge. Episode Process. Experience Bundled Payments AMGA September 25, 2013 Who Are We AGENDA Our Business Challenge Episode Process Experience 1 Cleveland Clinic is transforming Fee for service Fee for value 3 Fast Facts 41,200 employees

More information

Austin Regional Clinic Seton Health Alliance

Austin Regional Clinic Seton Health Alliance Austin Regional Clinic Seton Health Alliance Clinical Integration Through the Eyes of an Independent Multispecialty Physician Group AMGA Annual Conference March 14, 2013 Norman H. Chenven, M.D. Founder

More information

7/7/17. Value and Quality in Health Care. Kevin Shah, MD MBA. Overview of Quality. Define. Measure. Improve

7/7/17. Value and Quality in Health Care. Kevin Shah, MD MBA. Overview of Quality. Define. Measure. Improve Value and Quality in Health Care Kevin Shah, MD MBA 1 Overview of Quality Define Measure 2 1 Define Health care reform is transitioning financing from volume to value based reimbursement Today Fee for

More information

Care Redesign: An Essential Feature of Bundled Payment

Care Redesign: An Essential Feature of Bundled Payment Issue Brief No. 11 September 2013 Care Redesign: An Essential Feature of Bundled Payment Jett Stansbury Director, New Payment Strategies, Integrated Healthcare Association Gabrielle White, RN, CASC Executive

More information

Innovative Business Activities in Health Care with Commercial Partners

Innovative Business Activities in Health Care with Commercial Partners Innovative Business Activities in Health Care with Commercial Partners Steve Witman, CPA, MBA Vice President of Business Development / Financial and Capital Planning LifeBridge Health March 4, 2014 Business

More information

WHITE PAPER #2: CASE STUDY ON FRONTIER TELEHEALTH

WHITE PAPER #2: CASE STUDY ON FRONTIER TELEHEALTH WHITE PAPER #2: CASE STUDY ON FRONTIER TELEHEALTH I. CURRENT LEGISLATION AND REGULATIONS Telehealth technology has the potential to improve access to a broader range of health care services in rural and

More information

A 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 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 information

2017/2018. KPN Health, Inc. Quality Payment Program Solutions Guide. KPN Health, Inc. A CMS Qualified Clinical Data Registry (QCDR) KPN Health, Inc.

2017/2018. KPN Health, Inc. Quality Payment Program Solutions Guide. KPN Health, Inc. A CMS Qualified Clinical Data Registry (QCDR) KPN Health, Inc. 2017/2018 KPN Health, Inc. Quality Payment Program Solutions Guide KPN Health, Inc. A CMS Qualified Clinical Data Registry (QCDR) KPN Health, Inc. 214-591-6990 info@kpnhealth.com www.kpnhealth.com 2017/2018

More information

4/9/2016. The changing health care market THE CHANGING HEALTH CARE MARKET. CPAs & ADVISORS

4/9/2016. The changing health care market THE CHANGING HEALTH CARE MARKET. CPAs & ADVISORS CPAs & ADVISORS experience support // ADVANCED PAYMENT MODELS: CJR Eric. M. Rogers MEd. RT(R) Managing Consultant The changing health care market THE CHANGING HEALTH CARE MARKET HHS goal of 30% of traditional

More information

Accountable Care Organizations Under Medicare Shared Savings Program PROPOSED RULE

Accountable 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 information

Rural and Independent Primary Care.

Rural and Independent Primary Care. Rural and Independent Primary Care www.caravanhealth.com Agenda 2015 Results from Rural ACO Participants Fundamental population health programs. Overview of additional rural value-based payments Opportunities

More information

Department of Radiology Massachusetts General Hospital Alumni Reunion October 16 th, 2010 James H Thrall MD Radiologist-in-Chief Massachusetts

Department of Radiology Massachusetts General Hospital Alumni Reunion October 16 th, 2010 James H Thrall MD Radiologist-in-Chief Massachusetts Department of Radiology Massachusetts General Hospital Alumni Reunion October 16 th, 2010 James H Thrall MD Radiologist-in-Chief Massachusetts General Hospital Juan M Taveras Professor of radiology Harvard

More information

ESSENTIAL STRATEGIES IN MEDI-CAL PAYMENT REFORM. Richard Popper, Director, Medicaid & Duals Strategy August 3, 2017

ESSENTIAL STRATEGIES IN MEDI-CAL PAYMENT REFORM. Richard Popper, Director, Medicaid & Duals Strategy August 3, 2017 ESSENTIAL STRATEGIES IN MEDI-CAL PAYMENT REFORM Richard Popper, Director, Medicaid & Duals Strategy August 3, 2017 1 DISCLAIMER The enclosed materials are highly sensitive, proprietary and confidential.

More information

PAYMENT INNOVATION: Real Examples of Client Implementation. Craig Tolbert & Michael Wolford

PAYMENT INNOVATION: Real Examples of Client Implementation. Craig Tolbert & Michael Wolford PAYMENT INNOVATION: Real Examples of Client Implementation Craig Tolbert & Michael Wolford 2 PINNACLE SPEAKER PROFILE CRAIG TOLBERT Principal DHG Healthcare Birmingham, AL PINNACLE SPEAKER PROFILE MICHAEL

More information

Health Reform and IRFs

Health Reform and IRFs American Medical Rehabilitation Providers Association 8 th Annual AMRPA Educational Conference New Orleans, LA Health Reform and IRFs Planning Today for Success Tomorrow October 14, 2010 Agenda Introduce

More information

Updates from CMS: Value-Based Purchasing, ACOs, and Other Initiatives The Seventh National Pay for Performance Summit March 20, 2012

Updates from CMS: Value-Based Purchasing, ACOs, and Other Initiatives The Seventh National Pay for Performance Summit March 20, 2012 Updates from CMS: Value-Based Purchasing, ACOs, and Other Initiatives The Seventh National Pay for Performance Summit March 20, 2012 Presenters David Sayen, CMS Regional Administrator Betsy L. Thompson,

More information

CPAs & ADVISORS. experience support // ADVANCED PAYMENT MODELS: CJR

CPAs & ADVISORS. experience support // ADVANCED PAYMENT MODELS: CJR CPAs & ADVISORS experience support // ADVANCED PAYMENT MODELS: CJR Andy M. Williams Partner BKD Eric M. Rogers Managing Consultant BKD Will McLeod VP of Patient Services McLeod Health Emily Adams Associate

More information

UnitedHealth Center for Health Reform & Modernization September 2014

UnitedHealth 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 information

Seeing the Value and Transparency of Medicare Part B: Four Case Studies of Medicare Successes

Seeing the Value and Transparency of Medicare Part B: Four Case Studies of Medicare Successes Seeing the Value and Transparency of Medicare Part B: Four Case Studies of Medicare Successes As the largest payer of healthcare services in the United States, the Centers for Medicare & Medicaid Services

More information

Post-Acute Care. December 6, 2017 Webinar Louise Bryde and Doug Johnson

Post-Acute Care. December 6, 2017 Webinar Louise Bryde and Doug Johnson Post-Acute Care December 6, 2017 Webinar Louise Bryde and Doug Johnson Topics for Discussion Background What Is Post Acute Care? Lexicon Levels of Care Why Focus on Post Acute Care? Emerging PAC Trends

More information

Value Based Care Emergent Care Services

Value Based Care Emergent Care Services Value Based Care Emergent Care Services If this is an emergency, dial 911 or go to the Emergency Room About the Speakers Cliff Frank cliff.frank@partnerapartners.com Co founder of Partnera, specializes

More information

Policies for Controlling Volume January 9, 2014

Policies for Controlling Volume January 9, 2014 Policies for Controlling Volume January 9, 2014 The Maryland Hospital Association Policies for controlling volume Introduction Under the proposed demonstration model, the HSCRC will move from a regulatory

More information

Reforming Health Care with Savings to Pay for Better Health

Reforming Health Care with Savings to Pay for Better Health Reforming Health Care with Savings to Pay for Better Health Mark McClellan, MD PhD Director, Initiative on Health Care Value and Innovation Senior Fellow, Economic Studies October 2014 National Forum on

More information

Value-Based Care Emergent Care Services. Presented by Cliff Frank Partnera Partners LLC

Value-Based Care Emergent Care Services. Presented by Cliff Frank Partnera Partners LLC Value-Based Care Emergent Care Services Presented by Cliff Frank Partnera Partners LLC Problem Un-doctored consumers are driving $575 billion inappropriate emergent care Fee-for-service ER visits add another

More information

Recovery Homes: Recovery and Health Homes under Health Care Reform

Recovery Homes: Recovery and Health Homes under Health Care Reform Recovery Homes: Recovery and Health Homes under Health Care Reform 4/27/11 Richard H. Dougherty, Ph.D. DMA Health Strategies Challenges of health reform Increasing coverage Reducing costs of coverage Reducing

More information

THE REIMBURSEMENT SHIFT: PREPARING YOUR PRACTICE FOR PATIENT-CENTERED PAYMENT REFORM. November 20, 2015

THE REIMBURSEMENT SHIFT: PREPARING YOUR PRACTICE FOR PATIENT-CENTERED PAYMENT REFORM. November 20, 2015 THE REIMBURSEMENT SHIFT: PREPARING YOUR PRACTICE FOR PATIENT-CENTERED PAYMENT REFORM November 20, 2015 TODAYS PRESENTERS Kavon Kaboli Consultant Galen Healthcare Solutions Cece Teague Consultant Galen

More information

Person-Centered Accountable Care

Person-Centered Accountable Care Person-Centered Accountable Care Nelly Ganesan, MPH, Senior Director, Avalere s Evidence, Translation and Implementation Practice October 12, 2017 avalere.com @NGanesanAvalere @avalerehealth Despite Potential

More information

UNITED STATES HEALTH CARE REFORM: EARLY LESSONS FROM ACCOUNTABLE CARE ORGANIZATIONS

UNITED STATES HEALTH CARE REFORM: EARLY LESSONS FROM ACCOUNTABLE CARE ORGANIZATIONS UNITED STATES HEALTH CARE REFORM: EARLY LESSONS FROM ACCOUNTABLE CARE ORGANIZATIONS Stephen M. Shortell, Ph.D., M.P.H, M.B.A. Blue Cross of California Distinguished Professor of Health Policy and Management

More information

CLINICAL INTEGRATION DRIVERS, IMPACT, AND OPTIONS JOBY KOLSUN, D.O. MEDICAL DIRECTOR CLINICAL INTEGRATION LEE PHO

CLINICAL INTEGRATION DRIVERS, IMPACT, AND OPTIONS JOBY KOLSUN, D.O. MEDICAL DIRECTOR CLINICAL INTEGRATION LEE PHO CLINICAL INTEGRATION DRIVERS, IMPACT, AND OPTIONS JOBY KOLSUN, D.O. MEDICAL DIRECTOR CLINICAL INTEGRATION LEE PHO Disclaimers My current position I am not offering advice on clinical integration Items

More information

National ACO Summit. Third Annual. June 6 8, Follow us on Twitter and use #ACOsummit.

National ACO Summit. Third Annual. June 6 8, Follow us on Twitter and use #ACOsummit. Third Annual National ACO Summit June 6 8, 2012 Follow us on Twitter at @ACO_LN and use #ACOsummit. Opening Plenary Session Welcome and Overview Mark McClellan, MD, PhD Director, Engelberg Center for Health

More information

AGENDA. QUANTIFYING THE THREATS & OPPORTUNITIES UNDER HEALTHCARE REFORM NAHC Annual Meeting Phoenix AZ October 21, /21/2014

AGENDA. QUANTIFYING THE THREATS & OPPORTUNITIES UNDER HEALTHCARE REFORM NAHC Annual Meeting Phoenix AZ October 21, /21/2014 QUANTIFYING THE THREATS & OPPORTUNITIES UNDER HEALTHCARE REFORM NAHC Annual Meeting Phoenix AZ October 21, 2014 04 AGENDA Speaker Background Re Admissions Home Health Hospice Economic Incentivized Situations

More information

The 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 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 information

Medicare, Managed Care & Emerging Trends

Medicare, Managed Care & Emerging Trends Medicare, Managed Care & Emerging Trends LeadingAge Michigan 2015 Annual Leadership Institute August 12, 2015 Jon Lanczak, Manager Beth Sullivan, Senior Manager Plante Moran, PLLC Overall Theme Healthcare

More information

Healthcare Financial Management Association October 13 th, 2016 Introduction to Accountable Care Organizations and Clinically Integrated Networks

Healthcare Financial Management Association October 13 th, 2016 Introduction to Accountable Care Organizations and Clinically Integrated Networks Healthcare Financial Management Association October 13 th, 2016 Introduction to Accountable Care Organizations and Clinically Integrated Networks Agenda Define ACO, CIN, and Coordinated Care Review ACO/CIN

More information

Healthcare Reimbursement Change VBP -The Future is Now

Healthcare Reimbursement Change VBP -The Future is Now Healthcare Reimbursement Change VBP -The Future is Now 1 On the Move Volume/ Fee-for-Service Fee-for-service reimbursement High quality not rewarded No shared financial risk Stand-alone systems can thrive

More information

Making the Business Case

Making the Business Case Making the Business Case for Payment and Delivery Reform Harold D. Miller Center for Healthcare Quality and Payment Reform To learn more about RWJFsupported payment reform activities, visit RWJF s Payment

More information

Transitioning to a Value-Based Accountable Health System Preparing for the New Business Model. The New Accountable Care Business Model

Transitioning to a Value-Based Accountable Health System Preparing for the New Business Model. The New Accountable Care Business Model Transitioning to a Value-Based Accountable Health System Preparing for the New Business Model Michael C. Tobin, D.O., M.B.A. Interim Chief medical Officer Health Networks February 12, 2011 2011 North Iowa

More information

The Evolution of ASC Joint Ventures: Key Trends for Value-Based Care

The Evolution of ASC Joint Ventures: Key Trends for Value-Based Care The Evolution of ASC Joint Ventures: Key Trends for Value-Based Care The Evolution of ASC Joint Ventures: Key Trends for Value-Based Care By Laura Dyrda As healthcare moves toward value-based care and

More information

Partnering with hospitals to create an accountable care organization Elias N. Matsakis, Esq.

Partnering with hospitals to create an accountable care organization Elias N. Matsakis, Esq. Partnering with hospitals to create an accountable care organization Elias N. Matsakis, Esq. There are many opportunities for physicians and hospitals to affiliate and clinically integrate so as to enable

More information