1. Financial and Clinical Integration of Accountable Care Organizations Stephen M. Shortell, PhD, MPH, MBA Blue Cross of California Distinguished Professor of Health Policy and Management Dean Emeritus, School of Public Health Director, Center for Healthcare Organizational and Innovation Research (CHOIR) University of California-Berkeley Berkeley ACO Workshop May 8, 2015

2. What Are We Trying to Do? Reaching for the Triple Aim Improved quality and overall patient experience Constrained costs Improved population health

3. What Will it Take? Performance measurement IncentivesCapabilities VALUE Quality + Experience Cost Fundamental Changes in How Care is Paid for and Delivered

4. Pooling and management of assets under various organizational and governance models: Horizontal acquisitions and mergers Vertical acquisitions and mergers Virtual contractual arrangements and alliances Joint ventures What Is Meant by Financial Integration?

5. The extent to which services provided to patients are coordinated across activities, conditions, providers and settings over time so as to maximize the value of care delivered. What Is Meant by Clinical Integration?

6. What organizational forms can create clinically integrated care? Key Question

8. ACO Participation in Physician Performance Management/Accountability, Percent within Cluster Who Participate Source: Shortell S.M., F. Wu, V.A. Lewis, C.H. Colla and E. Fisher. “A Taxonomy of Accountable Care Organizations for Policy and Practice.” Health Services Research., online, September 16, 2014. DOI: 10.111/1475-6773.12234.

9. Schematic overview of the Accountable Care Organization (ACO) Evaluation Logic Model Source: Fisher, E. S., Shortell, S. M., Kreindler, S. A., Van Citters, A. D., & Larson, B. K. (2012). A framework for evaluating the formation, implementation, and performance of accountable care organizations. Health Affairs, 31(11), 2368-2378.

10. Six Key Success Factors for ACOs Size/scale Care management Electronic health record functionality Effective partnerships Patient/family engagement Measurement standardization and transparency Source: Accountable Care Organizations: Promise and Performance. Berkeley Forum, February 2015.

11. What Our Panelists Will Cover Jerry KominskiCMS Quality Performance Measurement and Balancing Clinical and Financial Integration Jill YegianFour Case Studies Bruce BodakenACO Sustainability Ken KizerClinical Integration Functionality and St. Luke’s Antitrust Case John WeigandACO Antitrust Analysis Loren BakerFinancial Incentive Alignment

12. Thank You QUESTIONS/DISCUSSION http://choir.berkeley.edu/ shortell@berkeley.edu