With an increased focus on improving patient outcomes and satisfaction through integrated care delivery, Accountable Care Organizations (ACO) continue to increase in numbers and evolve in maturity. While ACO operational models will differ based on the healthcare needs of local communities, there are common competencies that every ACO must address. Focusing on 4 key priorities – People, Process, Technology and Financials – will help every ACO achieve sustained success. Our experts explain how to: - Create a roadmap for success in every stage in the ACO lifecycle - Develop strategies to improve operations in the 4 key areas: People, Process, Technology and Financials - Build a successful ACO with lessons learned from Dennis Horrigan, President and CEO at Catholic Medical Partner (CMP) Dennis Horrigan, President and CEO of CMP, shares his experience contributing to CMP’s ACO success. CMP became a successful, top-performing ACO in the Medicare Shared Saving Program (MSSP). ACO expert Doris Stein with Optimity Advisors discusses core competencies within the framework of the ACO lifecycle. Whether you’re in the early planning stages or have shared in savings, this webinar will help you prioritize your efforts in 4 core operational areas - People, Process, Technology and Financials.

1. 4 Key Priorities for ACO Success
People, Process, Technology and Financials

2. Doris Stein
Healthcare Partner
Optimity Advisors
Doris, with over 20 years of consulting and industry experience,
leads the government programs practice for Optimity Advisors and
is a frequent industry speaker about ACOs. Most recently, she
presented at the European Health Conference and the ACO
Southeast Regional Conference.
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Dennis R. Horrigan
President and Chief Executive Officer
Catholic Medical Partners
Dennis and his management team at Catholic Medical Partners are
managing over $1 billion in healthcare expenditures using a
population health/business model. CMP was one of the top
performing Shared Saving Accountable Care Organization (ACO) in
the country.
Presenters:

3. • ACO Network Options
• ACO Maturity Model
• Integrated Care System
• Examples Contributing to ACO Success:
o People
o Process
o Technology
o Financials
• Managing Risk & Margin
• Catholic Medical Partners (CMP) case study
• Questions?
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Agenda

4. ACO Network Options
• Physician Group Structure
• Physician – Hospital Network (Independent & Employed)
• Physician – Hospital Network (Employed Only)
• Academic Medical Center Network
• Fully integrated – Physician / Hospital / Insurance
• Health Plan / Physician
• Health Plan / Hospital
• Employer Group/Hospital
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5. * Develop Business Plan
* Leadership/Governance Structure
* Business Partnerships
* Gain Sharing, Benchmarks & Patient
Assignment
* Change Management Plan
* Organizational Readiness
* Identify Sponsors/Champions
* Define Health & Wellness
Programs
* Define Cost and Utilization
Benchmarks for Local Market
* Define Reporting Requirements -
Financial, Clinical, Operations,
Compliance
* Define Enterprise Architecture -
Business, Operations, Systems, Data
* Establish Real-time Feedback
* Evaluate Clinical Strategy
* Conduct regular Stakeholder
Meetings
* Enterprise Dashboards
* Report to Internal ACO Stakeholders
and Patients
* Trend & Predictive Analyses
ACO Maturity Model
0-9 Months
Assess & Plan
9-18 Months
Implement & Sustain
18-36 Months
Monitor, Evaluate & GrowKey Activities and Milestones Across the ACO Lifecycle
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6. April 30, 2015 INFORM | TRANSFORM | OUTPERFORM Page | 6
Integrated Care System
Member
• Integrated Data Reporting
• Provider/ Payment System Integration
• Patient Accessibility Member Portal
• Electronic Heath Records
• Cost Reporting
• Aligned Incentives
• Pay for Performance Modeling
• Capital Budget Planning
• Governance
• Communication
• Culture Change Management
• Human Capital Management
Process
• Quality Reporting
• Clinical Integration
• Population Focus
• Health and Wellness
• Care Management
Primary Care
Community
Care
Acute
Care
Behavioural/Social Support
People Process
Financials Technology

7. Examples Contributing to ACO Success - People
• People
People
• Culture/Change
Management
• Communication Plan
• Organizational/Governance
Structure
• Human Capital
Management
• Recruitment, Training &
Development
• Physician Incentive Plan
• Performance Monitoring
• Catastrophic Patient
Management
• ACO Steering Committee provides oversight and direction,
develops policies, and manages implementation
• All provider groups in the ACO are represented in
leadership/executive committee with shared accountability
Governance
Structure
• Single, consistent physician and contracting strategy across
system with appropriate incentive plans
• Physician engagement to change practice patterns (practice in
teams, implement EHRs, etc.)
Physician
Engagement/P
ayment
• Organization’s culture supports physician alignment and
leadership
Culture/Chang
e
Management
• More focused cost-containment strategies in order to control
the smaller population that is spending significant expenses
Catastrophic
Patient
Management
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8. Examples Contributing to ACO Success - Process
• Marketing & Product
Development
• Contracting/Network
Management
• Reimbursement
• Value Based
Benefits
• Coaching, Health &
Wellness Programs
• UM/CM/DM
• Clinical Decision Support
Guidelines
• Meaningful Use
• Admission
Diversion
• Readmission
Reduction
• Expand Primary Care
Services
• Nutritionist
• Care Coordinators
• Nurse Practitioners
• Encouraging patients to take an active role in care through
shared decision making and communication about self-
management, medications and change in lifestyle
Health and
Wellness
• Directing physicians to highest risk patients and to weightiest
quality measures for a Phase 1
• Developing goals for admission diversion and readmission
reduction
Focused Goals
• Care Delivery model "integrates" services from Health &
Wellness to Disease/Case Management
Care Delivery
• Referral patterns must be monitored
• Assignment of patient populations and movement in and out of
network must be monitored
Network
Management
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Process

9. Examples Contributing to ACO Success - Technology
• Connect EHRs across organizations (hospitals, providers, etc.)
• Hire technology support staff to maintain functionality of EHR
system
EHR
• Enterprise reporting addresses individual & population and
financial & clinical data
• Standardized reporting metrics across all providers
Reporting
• Data strategy and information sharing is owned by all participantsData Strategy
• Can track compliance and performance against contractual quality
goals and published guidelines – by patient, provider or practice
System
Tracking
• Interoperable IT Systems
• EHR
• PHR
• Patient Portals
• Advanced Care
Management
Systems
• Care Transition
Electronic
Plans/Monitoring
• Enterprise Reporting
Systems
• Clinical, Financial &
Operational
• Decision Support
• Predictive Modeling
• Workflow/Automate
d Triggers
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Technology

10. Examples Contributing to ACO Success - Financial
• Financial model offers returns required to support investment and
ensure financial goals
• Understanding how market and population impact utilization and
capacity to help define financial forecasts around resources, capital
and costs
Financial and
Capacity
Planning
• Populations are monitored directly against contracts, to get every
dollar available by closing gaps in care
Pay for
Performance
• Understanding of total medical expenditure and cost drivers across
the population of patients
• Moving some care to lower cost sites of service (e.g., ambulatory
clinics versus hospitals)
Total Medical
Expenditures
• Incentive model must account for geographic variability and
demographic risk
• Model is based on meeting cost targets, quality targets and
efficiencies
Physician
Incentive
Model
Financial
• Cost Reporting
• Actuary
• Gains Sharing/Revenue
Model
• Capital Budget Planning
• Pay-for-Performance
Modeling
• Competitive Cost
Benchmarking
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11. Managing Risk and Margin
Risk Performance
+
+
In-network utilization
Market Share growth (new patients)
Excellent Expense Management
Market Share loss
Poor expense management
Increased volume comes
from excess utilization in higher
cost settings
Preventable Admissions (PQI)
30 Day Readmissions
Care in “Lowest cost setting”
Population
Health
OperatingMargin
Fee for Service
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12. Catholic Medical Partners Path to Clinical Integration (CI)
Registry Program/
Align Clinical
Integration Between
Physicians and the
Health System
EHR
Adoption, Reporting
& Interoperability
Meaningful Use
Embedded Care
Coordination / Care
Transitions
NCQA Accreditation
Patient Centered
Medical Home
High Performing
Health Care System
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13. CIEvolution
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CI Mitigates Incentive Disconnect Between Fee-For-Service, ACO
Reimbursement
Source: The Advisory Board

14. Utilization
• Prevent unnecessary
inpatient admissions
• Minimize inappropriate or
duplicative care delivery
• Refer patients to most
appropriate and efficient
specialists, sites of care
Expense Management
• Create and follow evidence-
based care pathways
• Streamline costs through
adherence to standards
• Develop economies of scale
across continuum for all growth
service lines
Clinical Outcomes
• Minimize preventable
readmissions
• Proactively manage chronic
illness to prevent low-margin
inpatient utilization
• Promote community wellness
for at-risk populations
Physician Assistance Key to Achieving ACO Objectives
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Source: The Advisory Board

15. Trends in Expenditures per capita Benchmark Year 3 to Performance
Year 1
10,470
11630
8,844
10388
10810
7819
4,000
6,000
8,000
10,000
12,000
All ACOs Shared Savings CMP ACO
Expenditures
Per Capita Expenditures
Benchmark Year 3
Performance Year 1
-6.21% reduction
-13.45%
reduction
Avg of 58 ACOsAvg 220 ACOs
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16. Trends in Expenditures- Average percentage change in Inpatient and
other components Benchmark Year 3 to Performance Year 1
• Inpatient expenditures dropped for ACOs
with shared savings.
• ACOs that received shared savings showed
its largest reduction in expenditures in the
following categories:
o DME Expenditures
o Skilled nursing facilities
-19.84%
-12.95%
-9.48%
-45.33%
-14.39%
-17.88%
DME Expenditures
Inpatient and Other Component
Expenditures
CMP ACO Other ACOs w/Shared Savings
Inpatient
Expenditures
Skilled
nursing
facilities
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17. Trends in Utilization - Average percent change in hospital and other
utilization categories Benchmark Year 3 to Performance Year 1
• ACOs that received shared savings (and
were in the top 25 quartile for percent
changes) showed its largest reduction
in utilization in the following
categories:
o ED visits leading to
hospitalizations
o Hospitalizations
o 30 day readmissions
o SNF discharges (**not provided
data until Jan 2014)
-6.99%
-12.06%
-11.16%
-21.00%
-22.00%
-28.00%
Hospitalizations
Utilization Categories
CMP ACO Other ACOs w/Shared Savings
ED visits led to
hospitalizations
30 day
readmissions
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18. Performance Year 1 Challenging Measures
CMP ACO exceeded the average by 28% for
the diabetes composite measure.
ACO’s, on average, experienced challenges with mean
performance rate falling below 50% related to measures
for the Diabetes population, Falls Risk and Depression
screening.
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19. Performance Year 1 Room for Improvement Measures
CMP, ACO out performed other ACOs (on average) in reducing all condition admissions and admissions for
patients with COPD/Asthma, but there is room to improve for admissions related to HF.
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20. Washington, DC | Brussels |London | Los Angeles| New York | Zurich
Optimity Advisors
1600 K Street NW, Suite 202
Washington, DC 20006
www.OptimityAdvisors.com
Questions?