Starting an ACO: IT Lessons Learned. Robert Slepin, PMP, VP and CIO John C. Lincoln Health Network Nathan Anspach, SVP and CEO John C. Lincoln Accountable Care Organization John C. Lincoln Physician Network. John C. Lincoln Health Network Overview. John C. Lincoln Hospitals.
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Robert Slepin, PMP, VP and CIO
John C. Lincoln Health Network
Nathan Anspach, SVP and CEO
John C. Lincoln Accountable Care Organization
John C. Lincoln Physician Network
Approved by CMS July 2012
18,000 Medicare Shared Savings Program (MSSP) and Commercial members
All participating providers continue to be reimbursed by Medicare on a fee-for-service basis
Patients attributed to an ACO can continue to seek care from any Medicare participating physician, hospital or provider
If a Medicare ACO is able to reduce the cost of caring for assigned Medicare patients and meet required quality standards, a possibility of shared savings exists
In either risk model, all providers continue to bill Medicare fee-for-service using the normal Medicare fee schedule.
1. Determine the number of Medicare beneficiaries in the ACO. We will use 15,000 in our example.
2. Determine the average annual spend per beneficiary. In Phoenix, that figure is approximately $9,000.
3. Multiply 1 times 2 and the result is a very large number - $135M. This is the base spending level.
1. Hypothetical: average cost is reduced by 7.5% to $8,333 per beneficiary.
2. Multiply $8,333 times same number of members. Total Spend is now $125M.
3. Subtract $125M from $135M and savings are $10M. The ACO takes half, or $5M, up to a maximum amount.
CMS transmits attribution file to ACO
ACO locates patient demographic information
ACO sends prescribed letter to attributed patients
Update to CMS with patient data sharing preferences
Patients respond/don’t respond to letter
Third Party Data Analysis Tool
CMS Data Transmission
High cost Beneficiaries
High ER Utilizers
PCP office visit
Create and file HCC
Support patient outreach, care management, and data collection workflow
Clinical quality measure reporting
GPRO web site data entry