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The Journey to Accountable Care

The Journey to Accountable Care. Variations in Practice and Spending: Implications for Reform. An additional 1 in 5 patients survive. Delivering safe reliable, and effective care. Cost decreases by $20,000 per patient. Avoiding unnecessary care (hospital stays, visits, tests).

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The Journey to Accountable Care

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  1. The Journey to Accountable Care

  2. Variations in Practice and Spending: Implications for Reform An additional 1 in 5patients survive Delivering safereliable, and effective care Cost decreases by $20,000 per patient Avoiding unnecessary care (hospital stays, visits, tests) Source: The Dartmouth Atlas

  3. Key Principles Underlying Problem Variations in Practice and Spending: Implications for Reform Clarify aims: Better health, better care, lower costs – for patients and communities. Confusion about aims: Is it about money or something more? Absent or poor data leaves practice unexamined and unable to improve; choices uninformed by evidence. Better information that engages physicians, supports improvement; informs consumers and patients. Flawed conceptual model:Healthis produced by face-to-face visits with physicians. Care is fragmented. New model: It’s the system. Establish organizations capable of redesigning practiceand eliminating waste. Wrong incentives reinforce model, reward fragmentation, induce overuse of unnecessary care. Rethink our incentives: Realign incentives – both financial and professional – with aims.

  4. The Current Opportunity: Health Care Reform • Affordable Care Act • Investments in public health • Health information technology • Expanded coverage • New payment models “No Outcome, No Income” David Nash Dean, Jefferson School of Population Health

  5. The Current Opportunity: ACOs • Core Ideas • Population-based virtual budgets • Real or virtual organizations • Performance measurement • Patient choice • Accommodate diversity Fisher ES, Staiger DO, Bynum JP, Gottlieb DJ. Creating accountable care organizations Health affairs 2007;26:w44-57. Fisher ES, McClellan MB, Bertko J, et al. Fostering accountable health care: moving forward in medicare. Health affairs 2009;28:w219-31. McClellan M, McKethan AN, Lewis JL, Roski J, Fisher ES. A national strategy to put accountable care into practice. Health affairs 2010;29:982-90.

  6. ACOs: 2009 (21) What Will We Do? An Unfolding Story

  7. ACOs: 2013 (328) What Will We Do? An Unfolding Story Note: The sum of ACOs reflects the total number of unique, publicly identifiable, confirmed private-payer ACOs as of 08/2012 and public-payer ACOs as of 01/2013.

  8. Might it work? The evidence so far… Overall Duals All PGP$114 $532 (1%) (5%) Marshfield $642 $987 (9%) (11%)

  9. Might it work? Encouraging population-based models of care Evidence review, updated monthly Care pathways well-specified Technology to support “right” care Care delivered by “right” provider Endocrinologists Primary care system Patients with diabetes(and their caregivers)

  10. Might it work? For specialists Project EchoSanjeevArora, MD Professor of Medicine, University of New Mexico

  11. The Journey to Accountable Care

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