Developing Your ACO Strategy

1. Spoto & Associates Developing Your ACO Strategy Mike Scribner Beth Spoto Jimmy Lewis Kathy Whitmire Michelle Madison February 4, 2011

2. Spoto & Associates Webinar on the development of Accountable Care Organizations here in Georgia You will hear from the experts like Michelle Madison with Morris, Manning & Martin, Mike Scribner with SHP, Beth Spoto with Spoto & Associates, Keith Williams and Jimmy Lewis with HTH, Learn the definition and background of ACO's, Hear about the types of ACO's and the legal implications.   Find out who has already developed their strategy and how to receive help in developing your ACO strategy.   Learn how you can use your SHIP funds to employ the experts to help develop your strategy. NOTHING IS MORE IMPORTANT TO YOUR ORGANIZATION THAN DEVELOPING AN OFFENSIVE ACO STRATEGY TO REMAIN COMPETITIVE IN THE NEXT 5 YEARS!

3. Spoto & Associates What is an Accountable Care Organization (ACO)? Defined as a group of healthcare providers who accept accountability to manage the care of a patient population across multiple care settings, the ACO has the primary focus of improving the overall health of its patients while managing the total cost of care received by them as well as improving the experience of care.

4. Spoto & Associates What are the Characteristics of an ACO? 1) First, it must have the ability to manage patients across the continuum of care and in different settings including ambulatory, hospital inpatient and post hospital care. 2) Second, it should have the ability to do prospective planning that includes the development of a budget and identification of resources needed. 3) Third, it should be sufficient in size to support a comprehensive, validated and reliable set of measurements that will enable it to monitor quality and cost of care.   Read more at Suite101: What is an Accountable Care Organization?http://www.suite101.com/content/what-is-an-accountable-care-organization-a283099#ixzz19JtnsCR4

5. Spoto & Associates Legislation:Medicare “Accountable Care Organizations” Section 1899 of Title XVIII Title III, Subtitle A, Part III, §3022 (Medicare shared savings program) By January 1, 2012, the Secretary shall establish a shared savings program to promote accountability for the coordination of items and services under Medicare Parts A and B for a specified population(with a minimum of 5000), and to encourage investment in infrastructure and redesigned care processes for high quality and efficient service delivery.

6. Spoto & Associates Legislation:Medicare “Accountable Care Organizations” Section 1899 of Title XVIIITitle III, Subtitle A, Part III, §3022 Under this program, groups of service providers meeting criteria (yet to-be-determined) may work together to manage and coordinate care for Medicare FFS patients through an ACO, and ACOs that meet quality performance standards will be eligible to receive payments from shared savings. Eligible providers will include professionals in group practices; networks of individual practices of ACO professionals; partnerships or joint venture arrangements between hospitals and professionals; hospitals employing professionals; and other entities with the Secretary may deem appropriate. All ACOs must have established a mechanism for shared governance.

7. Develop ACOStrategic Principles • Well coordinated delivery of care. • Use of technology to increase efficiency in patient care. • Efficiencies balanced with quality. • Reimbursement linked to outcomes. • Management of quality outliers. Spoto & Associates

8. Research ACO Infrastructure • Legalities • ACO ownership. • Contracting with providers. • Contracting with payers. • Contracting with administrative stakeholders. • Governance • Collaboration on clinical and financial decisions. • Development of performance benchmarks. • ACO leadership. Spoto & Associates

9. Research ACO Infrastructure • Administrative • Network development, maintenance, and provider relations. • Coordination with payer(s). • Payment functions including cost-savings bonuses. • Point-of-Care reminders. • Operational • Data analyses and decision-support. • IT and technology support. • Provider scorecards. • Payer scorecards. Spoto & Associates

10. Research ACO Infrastructure • Clinically • Medical Directorship. • Utilization review and management. • Medical review and decision-making. • Disease management. Spoto & Associates

11. Develop Customized Hospital Strategy • Identify referral sources – incoming and outgoing; rank and scatter plot. • Analyze practitioner base and medical staff; primary vs. specialty care. • Identify geographic or travel parameters and implications on patient access. • Identify all services and product lines – determine cost to deliver. Spoto & Associates

12. Hospital Strategy (con’t) • Analyze the political parameters of hospital leadership and board; consider impact. • Identify hospital’s managed care affiliations; analyze participation across spectrum of hospitals in group; identify gaps. • Determine appropriate ACO affiliation. • Recommend reimbursementmechanisms. Spoto & Associates

13. Spoto & Associates IN CONCLUSION: NOTHING IS MORE IMPORTANT TO YOUR ORGANIZATION THAN DEVELOPING AN OFFENSIVE ACO STRATEGY TO REMAIN COMPETITIVE IN THE NEXT 5 YEARS!   SOLUTION: ENGAGE THE ACO EXPERT TEAM TO DEVELOP AN ACO STRATEGY FOR YOUR HOSPITAL AND TO EXPLORE YOUR INVOLVEMENT WITH OR THE ESTABLISHMENT OF AN ACCOUNTABLE CARE ORGANIZATION (ACO).

14. Spoto & Associates The HomeTown Health “Develop Your Rural Hospital ACO Strategy” program deliverables include: 1) The development of ACO principles; 2) A hospital by hospital ACO strategy; 3) Assistance with the development of the ACO infrastructure & legal structure; 4) Interim Cost Review and Medicare Reimbursement Analysis; and 5) Clinical Systems, Quality Improvement & EHR component. FUNDED THROUGH SHIP GRANT OR THROUGH PRIVATE FUNDING - $8600

15. Spoto & Associates WHO MAKES UP THE ACO EXPERT TEAM? Managed Care and Reimbursement Specialists – Mike Scribner, CEO Strategic Health Partners and Beth Spoto, Spoto & Associates Healthcare Attorneys Morris, Manning & Martin – Michelle Madison Cost Reimbursement Experts Clinical Systems/Quality Improvement Specialist ACO Program Coordinated by HomeTown Health – Jimmy Lewis and Kathy Whitmire

16. Spoto & Associates WHAT IS THE MEASURE OF SUCCESS /OUTCOMES? How well the ACO can encourage and support individual physicians, hospitals, and medical communities to reach Dr. Don Berwick’s “Triple Aim” of:   Better Care –Better Quality and Better Cost-Effectiveness Healthier Communities –With Reduction in Preventable Disease Better Costs –With Reduced Per Capita Expenditures

17. Spoto & Associates PROGRAM PARTNER CONTACTS:Mike Scribner - mscribner@shpllc.com Michelle Madison – mmadison@mmmlaw.com Beth Spoto - spotoea@att.net Kathy Whitmire – kfw@windstream.net