1. Copyright 2011 Medical Group Management Association. All rights reserved. If you’ve seen one ACO…., you’ve seen more than the rest of us William F. Jessee, MD, FACMPE MGMA / ACMPE President and CEO May 13, 2011

2. Copyright 2011 Medical Group Management Association. All rights reserved. Accountable Care Organizations Vs. Accountable Care Organizations

3. Copyright 2011 Medical Group Management Association. All rights reserved. Accountable for what? Safety Quality Cost-effectiveness Patient satisfaction Staff satisfaction (including physicians)

4. Copyright 2011 Medical Group Management Association. All rights reserved. Accountable to whom? Patients Payers –Private (insurers, employers) –Public (Medicare, Medicaid) Public at large

5. Copyright 2011 Medical Group Management Association. All rights reserved. Accountability is manifested by… Measures of performance (safety, quality, cost-effectiveness, satisfaction) Revenues (payments) based at least in part on performance

6. Copyright 2011 Medical Group Management Association. All rights reserved. An Accountable Care Organization (ACO) is, by definition, a provider organization that bears some degree of financial risk for effective performance in caring for a population of patients. Within any ACO there may be a mix of payment methods, and a mix of risks. In general, higher risk payment methods can be higher reward, but they also require higher degrees of provider integration and care coordination.

7. Copyright 2011 Medical Group Management Association. All rights reserved. Accountability and payment

8. Copyright 2011 Medical Group Management Association. All rights reserved. Issues and concerns The term “ACO” has rapidly come to have different meanings to different audiences---including CMS The “statutory” Medicare ACO model---set forth in the recent proposed rule---has numerous issues: –Modeled on Medicare demos that were only partially successful in large, sophisticated organizations after 3 years –Beneficiary attribution –Requires significant new costs to the provider organizations, but offers no up front Stark & anti-kickback waivers –Offers VERY modest incentives –Includes penalties that were absent in the demos –Creates significant new data reporting burdens

9. Copyright 2011 Medical Group Management Association. All rights reserved. Suggestions Clarify the difference between the limited Medicare Shared Savings Program and the broader ACO concept Modify the MSSP proposal to make it more attractive to smaller organizations: less risk, lower savings thresholds, better predictability re who the patients are, reduced data burden Broaden fraud & abuse waivers to facilitate necessary up front investments

10. Copyright 2011 Medical Group Management Association. All rights reserved. Suggestions Medicare MUST coordinate with the private sector in each geographic area---standard measures, standard incentives---for both MSSP and CMMI demos CMMI should be aggressive in allowing providers to accept global financial risk, AND to be accountable for results (quality, safety, satisfaction and cost- effectiveness)---but let the ACO innovate in how it pays its providers