1. Grassroots Physician Perspective of ACO Transition
Building & Executing
New Delivery Models
Philip Gaziano, MD
CEO and Chair of ACA
November 17th, 2013

2. ACA & QHI Introduction Accountable Care Associates, LLC (ACA):
Founded in 2010, it is physician owned and operated, and a provider MCO to support and partner with physicians and hospitals in managed healthcare delivery.
Philip Gaziano, M.D. is Chairman and CEO, and he helped develop some of ACA’s services from 1998 to 2010 in Hampden County Physicians Associates, a Massachusetts based multi-specialty physician practice now served by ACA .
ACA Provides: Contracting, Consulting, Care Coordination, Reinsurance, Coding, Clinical Rounding, Provider Educational, Chart Auditing, Risk Adjustment, Compliance, Quality Measures Management, Custom Work Flow Design, and Other Provider MSO Services for Managed Healthcare Delivery.
Quality Health Ideas, LLC (QHI):
Founded in 2003, it is an IT and Data Management Company, that is physician owned and operated by Philip Gaziano, M.D. and Felicitas Thurmayr, M.D. Ph.D.
QHI Builds and Provides: Data Management, Quality Registry, Decision Support, EMR/EHR Integration, HIE Integration, and Web Integration Tools and Services.
Phil to present slide

3. Healthcare Delivery & Payment Improvements Require:
Care Coordination, Clinical Support,
Admin & Medical Director Support, & New Data Services & Tools
The Good News Is That:
Costly, Slow, Data or Corporate Integrations
Are Not Necessary
© 2013 All Rights Reserved

4. About, Our Network, Integration, & Provider Diversity
In 7 States (soon to be 10 to 11) We are Now Serving:
1,500 PCPs & over 50,000 Network Specialists
Connected to 37 Hospitals (17 Hospitals = Partners)
50% of PCPs are in practice groups of 1, 2, or 3
20% of PCPs are still use paper charts
29 different PCP EMRs – that do not share data
Hospitals have different EHRs, not connected to PCPs
Integrated – Only By Our Web Tools
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5. We Are Adding Medicare ACO Members in up to 11 States for 2013
Our ACA & QHI Growth
HCPA
1996
Total PCPs Served: 7
Total Network Docs:
250
Managed Members:
300
Our Employees: 1
Counties / States:
1 / 1
Care Managed ($Million/yr.):
0.2
ACA
2010
140
2,000
18,000 18
3 / 1
125
January
2012
250
5,000
34,000 50
4 / 1
290
Late in
2013
1,500
>50,000
150,000
>150
30 / 10
$1.5 Billion
We Are Adding Medicare ACO Members in up to 11 States for 2013
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6. Global Delivery Systems
We Have or are Developing Services For:
Medicare Advantage (Including SNP)
Medicare ACOs (Pioneer & Shared Savings)
Managed Medicaid
Dual Eligible (Medicare + Medicaid: SCO, PACE…)
Commercial Plans (HMO & PPO)(Like BCBS-AQC)
State ACOs, Exchanges, Coops, and Pilots
Captives & Self Insured
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7. Old HMOs vs. New ACOs:
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8. Physician Perspectives
Change is hard (usually only done if no other option)
Choices: Independence vs. Practice Aggregation
“One size doesn’t fit all” & “Timing is Everything”*
Satisfaction from: quality, control, & compensation
Risks (financial & legal) must be low
Changes require new data, but (too much data –
or confusing & wrong data is worse)
Improved providers’ work flows are needed
(wrong tools can: reduce efficiency & increase risk)
Needed guidance, & support…
…whom to call & with whom to partner?
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9. Where is Healthcare Waste ?
Repeated Testing
Unmanaged Pharmacy
Reduced Prevention
Unmanaged Chronic Diseases
Some Post Acute Discharge Expenses
Member Psychosocial Needs
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10. Some Global Budget Examples
Healthcare Spending ($/Year) %
Possible Waste
% Physician Costs
% Hospital Costs
SNF
Costs
Rx.
Other Costs
% Management Infrastructure Costs (Old)
Commercial
$6,000
15+%
20%
22% 5%
23% 8%
Medicaid
$8,000
20+%
15%
30%
10%
Medicare
$11,000
30+%
11%
12%
24%
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11. Our Budgetary Goals 15+% 20% 22% 5% 23% 8% 20+% 15% 30% 10% 30+% 11%
Healthcare Spending ($/Year) %
Possible Waste
% Physician Costs
% Hospital Costs
SNF Costs
Rx. Costs
% Other Costs
% Management Infrastructure Costs (Old)
Commercial
$6,000
15+%
20%
22% 5%
23% 8%
Medicaid
$8,000
20+%
15%
30%
10%
Medicare
$11,000
30+%
11%
12%
24%
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12. Management Budgets Old Style Managed Care (HMO Type):
Newer Delegated Style (as by ACA) (HMO, PPO, ACO…) Managed Care:
New
Private &/Or
Hospital Based
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13. Medicare Budget Outcomes:
Medicare Members
Ranked by
% of & Total
Annual Expenses
% of Total Care
Budget Used
$ Million Used
For 6,000 Members
Not
Managed
ACA
Top 3%
50%
42%
30.0
20.2
Next 17%
30%
43%
18.0
16.3
Next 30%
10%
12%
6.0
5.8
Lower 50%
Total:
100%
60.0
48.0
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14. BCBS-AQC Efficiency Outcomes
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15. AQC Quality Measure Outcomes:
2012 BCBS-AQC PCP Scores for Quality/P4P -vs.- CareScreenTM Office (Not Necessarily the PCP) Use
/100 Members /Year
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© 2012 All Rights Reserved

16. Our 4 Year AQC Outcomes & Both Quality and Satisfaction Improved
7.9%
5.5%
4 yr. Ave. = below 2% /yr.
2011 & 2012 = 0%
= Real Savings
& Both Quality and Satisfaction Improved
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17. Unique Aspects of ACCS Our National Medicare SSP-ACO
Does Not Require Practice Integration
ACA Centralized Data and Compliance
Local Clinical Control & Branding
Proven Care & Quality Coordination
Proven Provider Education, Audits, & Feedback
No Initial Costs For Local Group
Free Data Tools + Clinical Support
New QVU Payment system available
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18. Our QVU Based CMS Innovation Center Grant
Based on our new QVU Payment Data
Medicare, Medicaid, Dual Eligible, & Chip
Commercial Too – We Have 6 Partners
Added Information Sharing
A Model for the Future
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19. Global Delivery Risk Reduction
Best practice activities increased
Test tracking = better than EMR alone
Malpractice cases are reduced
Malpractice premiums decreased
Satisfaction improved for all
Practitioner work flow redesigns help
Global Delivery Systems Should Reduce Risk
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20. Overall Quality Measures:
(Medicare, Medicaid, & Commercial)
All measures improved
All practitioners improved
Practice & provider cultures are changing
Members noticed and satisfaction is up
The health plans and employers noticed
Our MA Plans Ranked #2 & #4 in US

21. A Multi-Specialty Group Breakdown
16% of Members are in global managed care contracts,
And they require 19% of the PCPs’ time (about 5 to 10 extra min. /visit)
 Contributes 50% of practice revenues (for RVUs, QVUs, & management)
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22. Payment
Considerations
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23. Fee For Service (RVU Based) Payments = Volume Payments
Do not account for quality differences
Do not reward prevention
Do nor reward efficiency (savings)
Do not reward Care Coordination
May Reward adverse effects and bad outcomes
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24. Capitation Payment Considerations
May account for quality differences
Rewards prevention better
May reward efficiency (savings)
May reward Care Coordination
May change who sees the beneficiary
May be interoperated as an entitlement
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25. Global Payment Considerations
Accounts for and rewards quality
Rewards prevention best
(and promotes wellness)
Rewards efficiency (and gives savings)
Rewards Care Coordination
Produces the greatest innovation
The way of the future
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26. QVUs (Better than RVUs for Global Systems) QVUs = Quality Value Units
Designed by ACA & QHI for Payments
Tracked and Reported Real Time
Attributed QVUs Have Predictive Value
Provide Quality Tracking
Provide Budget Tracking
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27. Discussion