1. Accountable Care Organizations
The Camel’s Nose Is In The Tent
David Harlow JD MPH
THE HARLOW GROUP LLC
23rd Annual
Louisiana Society of Hospital Attorneys blog • healthblawg.com
Health Law Symposium twitter • @healthblawg
November 8, 2012
Baton Rouge, LA

2. We are challenged by shifting sands

3. High-performing health care providers
can be integrated into
high-performing health care systems

4. What are the
federales trying to
accomplish?
The “Triple Aim”
Better care
Better health
Lower costs

5. ACO: Getting more elegant?

6. ACO: Drop in the bucket?

7. ACO: Getting more elegant?

8. Value-Based
Payment

9. ACO is one tool to get providers
to manage a population of
patients

10. How? Financial incentives.
$18,000,000
$16,000,000
$14,000,000 Yr 1 Yr 2
$12,000,000 Yr 3 Yr 4
$10,000,000
Yr 5
$8,000,000
$6,000,000
$4,000,000
$2,000,000
$0
Billings
Dartmouth
Everett
Forsyth
Geisinger
Marshfield
Middlesex
Park
Nicollet St. John's
Michigan
Graphic courtesy Jaan Sidorov, Disease Management Care Blog

11. What
is
an
ACO?

12. ACO Basics
Single entity 33 performance measures
Three-year commitment Patient engagement
One-way or two-way risk-sharing Patient-centeredness
PCPs and broader network Stark/AKS
5000 patient minimum IRS
Antitrust

13. Proposed Rule versus Final Rule
http://j.mp/ACOchart

14. Final ACO quality measures
http://j.mp/ACOqualitymeasures

15. ACO
regulations
coordinate
across
numerous
Federal
agencies

16. All in all, ACO risk/reward ratio
seems skewed

17. IT infrastructure cost estimate
>$1.5m

18. Success requires both:
Conversion of
health system
data to actionable
intelligence
&
Clinical
Integration

19. More details from the ACO
rules, and traps for the unwary

20. Over 60% of health care provider
executives said they intend to form
an ACO before the rules were out

21. Culture of Collaboration

22. Opportunities for
physician-led ACOs

23. Even if an ACO is not in your
immediate future, these principles
will affect you
Bundled Commercial
Payments ACOs
Pay for Other
Performance Innovations

24. Commercial plans are
non-standardized

25. Jeff Goldsmith: Suggests 3
commercial ACO payment systems
for 3 different types of providers
Primary
• Risk-adjusted
capitation
Emergency
• Fee-for-
service
Specialty
• Bundled
payments

26. Bundled Payments
MSSP is just one arrow Comprehensive Primary Care
Initiative
Financial Alignment Initiative
in the quiver FQHC Advanced Primary Practice
Demo
•Medicare Shared Savings Program Graduate Nurse Education Demo
– “Traditional” ACO Health Care Innovation Awards
Independence At Home Demo
•Advance Payment Initiative Initiative to Reduce Avoidable
•Pioneer ACO Hospitalizations Among Nursing
•Other CMS Innovation Center Initiatives Facility Residents
Innovation Advisors Program
Medicaid Emergency Psychiatric
Demo
Medicaid Incentives for the
Prevention of Chronic Diseases
Million Hearts
Partnership for
PatientsCommunity-based Care
Transitions Program
State Innovation Models Initiative
Strong Start for Mothers and
For details, see: innovations.cms.gov/initiatives/ Newborns

27. CMS Bundled Payment Initiative
Bundled
Payments
ACO “lite”
MS-DRG-specific
Gainsharing
. . . Bundled Payment Pilot - 2013

28. Bundled
Payments Medicare FFS Reimbursement
CMS payment
Actual cost of providing bundle of services Discount
incorporated
Potential shared savings into target
price

29. Care Coordination Initiatives

30. What can you do now to prepare
for the future?

31. Physicians
are central to
the
development
of an
accountable
care
organization

32. You cannot manage what you do
not measure

33. Opportunity for all providers: Be the
go-to (cost-effective) guys (or gals)

35. .

37. David Harlow JD MPH
Thank You THE HARLOW GROUP LLC
for contact info
txt dharlow to 50500
or scan the QR code
harlowgroup.net
healthblawg.com
twitter.com/healthblawg
david@harlowgroup.net