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Presentation on theme: "OUR ACCOUNTABLE CARE ORGANIZATION (ACO) STRATEGY Meredith Marsh Director Health Choice Care, LLC."— Presentation transcript:


2 HEALTH REFORM The Affordable Care Act (ACA) strives to achieve the Triple AIM: Improving the experience of care for individuals Patient Experience of Care Care Coordination & Patient Safety Preventive Health At-risk populations Improving the health of populations Lowering per capita costs

3 ACA PROVISION FOR SHARED SAVINGS PROGRAM “to establish a Shared Savings Program that promotes accountability for a patient population, coordinates items and services under Parts A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery.”

4 WHAT IS AN ACCOUNTABLE CARE ORGANIZATION (ACO)? ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. The overarching goal of the ACO pilot is to tie Medicare reimbursements to reduced cost and better care

5 HEALTH REFORM & CARE DELIVERY REDESIGN The Centers for Medicare and Medicaid Services (CMS) are currently piloting several models of care delivery re-design 1.Pioneer ACO Demonstration 2.Advance Payment Incentive 3.Medicare Shared Savings Program → Health Choice Care

6 PURPOSE OF SHARED SAVINGS PROGRAM Achieve savings against a benchmark, through improvements in the coordination and quality of care provided to Medicare beneficiaries  Controls growth in Medicare expenditures  Meets established quality performance standards When an ACO succeeds both in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.

7 PERFORMANCE STANDARDS Must report and meet thresholds for 33 quality measures Patient/Care Giver Experience: Care Coordination/Patient Safety Preventive Health At-Risk populations Each domain will be weighed equally at 25%

8 PERFORMANCE STANDARDS Year 1: Pay for Reporting - Performance standards will be set at the level of complete and accurate measures reporting of all 33 measures Year 2: Pay for performance on 25 measures and 8 pay for reporting Year 3: Pay for performance on 32 measures and 1 pay for reporting

9 QUALITY MEASURES REPORTING 7 measures collected via patient survey 3 calculated via claims 1 calculated from EHR Incentive Program data 22 are collected via the GPRO web interface ACOs must achieve quality performance standards on 70% of the measures in each domain starting in 2015


11 HEALTH CHOICE CARE – YOUR ACO! Medicare Shared Savings Program ACO Track 1: 50% share in savings; no share in losses Start Date: January 1, 2014 17,711 Medicare Beneficiaries attributed 23 Participants across 3 states – FL, MO, RI 350 Providers 9 Member Board – 75% provider controlled and Medicare Beneficiary Sharing of savings 50% Participating Providers 50% Plan to support ongoing operations and infrastructure re-investment

12 HOW DO WE TACKLE THESE PRIORITIES? HCC is currently focusing our efforts in two areas: -Care Management -Information Technology

13 CARE MANAGEMENT – IMPACT AREAS TODAY ACO Participants have been tasked with focusing efforts on the following impact areas: High risk/Medium risk patients Hospitalizations Readmissions Emergency Room Utilization Medication Adherence

14 IT PRIORITIES  Ingestion of EHR data into CLEAR  Beneficiary Notification Tracking  Claims Data Analytics Cube  HCC Provider Portal  Quality Measurement Reporting

15 ACO STRATEGY: A WIN-WIN FOR ALL -Comprehensive view of patients’ spectrum of care -Enhance patient engagement strategies -Redesign care coordination practices -Forefront of health delivery reform -Develop best practices as we shift away from FFS -Realize savings to incentivize providers and reinvest into operations Regardless of savings achieved, strategies promote enhanced patient continuity of care

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