1. Medicare Shared Savings Program: Responding to the Proposed Rule May 13, 2011 Mark McClellan, MD, PhD Director, Engelberg Center for Health Care Reform The Brookings Institution

2. 2 The Medicare Shared Savings Proposed Rule Proposed rule Refinement of Regulatory Approach Refinement of Implementation Strategy Proposed Rule is First Step – Much More to Come Commentsand current implementation activitieswill be crucial to making recommendations to CMS and advancing ACOs.

3. Brookings and Dartmouth are leading over 120 organizations through the ACO implementation process with webinars, peer-learning workshops, newsletters, and online resources (www.ACOLearningNetwork.org)www.ACOLearningNetwork.org Secretary Sebelius and Jonathan Blum are keynoting the Brookings-Dartmouth sponsored 2 nd National ACO Summit on June 27 th & 28 th focusing on ACO core competencies, advanced payment methods, performance measurement and more (www.ACOSummit.com)www.ACOSummit.com The ACO Toolkit is a comprehensive implementation guide with 6 in-depth sections written by over 20 experts on core ACO design features (http://www.acolearningnetwork.org/resources/aco-toolkit)http://www.acolearningnetwork.org/resources/aco-toolkit Brookings-sponsored ACO learning resources

4. A Framework for Ramping Up Successful ACOs Levels of ACO Readiness Goals & milestones for each level? Maximizing Benefits of becoming an ACO (shared savings) Minimizing the Costs of becoming an ACO (start-up & operating costs, shared losses) Quality Measurement HIT implementation Data Sharing Leveraging Existing Initiatives Others 4

5. 5 Five Key Areas for Consideration 1.Supporting ACOs by Maximizing the Benefits & Minimizing the Costs of Improving Care 2.Leveraging Existing Initiatives 3.Optimizing Assignment, Notification, and Data-Sharing to Support ACOs in Providing Patient-Centered Care 4.Building a Pathway to Improving Quality 5.Other Areas for Consideration & Recommendations