1. Accountable Care Organizations“Shifting Gears” Presented by Jeff Squier Executive Director NEWHVN

3. An alternative to the current fee-for-service payment system included in the Health Reform law

5. Return of health care cost inflation

6. New evidence – perverse cost/variation/quality relationship

8. Solo, small group physicians

9. No system of Care visibility

10. Clinton reform failed

11. Killed by an economic boom

12. Insurer-led HMOs

13. Slices and dices of risk

14. Better delivery system integration

15. Much better IT, information

16. Obama reform passed

17. Slow growth prospects

18. Provider-led ACOsCARE = Clinical Alignment and Resource Effectiveness; HMO = health maintenance organization IT = information technology Confidential and Proprietary 2010 Sg2

19. Why now? Average spending on healthper capita ($US PPP) Total expenditures on healthas percent of GDP International Comparison of Spending on Health, 1980–2007 16% $7,290 8% $2,454 Note: $US PPP = purchasing power parity. Source: Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).

20. Deaths per 100,000 population* * Countries’ age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke, and bacterial infections. See report Appendix B for list of all conditions considered amenable to health care in the analysis. Data: E. Nolte and C. M. McKee, London School of Hygiene and Tropical Medicine analysis of World Health Organization mortality files (Nolte and McKee 2008). Mortality Amenable to Health Care HEALTHY LIVES Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008

22. Care Coordination

23. Comprehensive

24. Patient Self Mgmt

25. Etc.Documentation Guidelines Protocols Contract Coding Service Statement Service Outcome Bonus $$$ Bill Quality Report Cash $$$ Salary Plus Bonus RVUs, Rev minus Exp (Oblivious to quality, safety, etc.)

27. Unable to get into clinic?

28. Failed to fill prescription?

29. Unable to get Rx refill?

30. PC / specialty miscommunication?

31. Patient misunderstanding

32. Failure to listen to patient?

33. Missed lab or xray report?Copyright 2010 – BDC Advisors

34. Shared Savings Bundle payment “Medium Risk” Pay for Performance “Low Risk” Global Payment “High Risk” Transparency Pay for coordination “No Risk”

35. Existing ACO Pilots & Programs

38. Center for Medicare & Medicaid Innovation (CMMI)

39. Partial capitation

40. Bundled payment -- Knee

41. Diabetes alternative care & payment model10

42. ACO Challenges (to start!) Leadership commitment Adequate population size Primary Care Base Physician Leadership IT integration Care Management Infrastructure to support 11

44. Engage and educate

45. Discuss with your colleaguesQuestions or Comments: Contact me at 920.831.1918 (Fox Valley phone #) 920.445.7211 (Green Bay phone #) Email – jcsqui@bellin.org M:-NEWHVNibraryresentationsEWHVN presentationsCOTalkCOBlended.pptx