Presented By: Lerla G. Joseph, MD, CEO and Chair, Central Virginia Coalition of Healthcare Providers, LLC

1. What to look for in an Accountable Care Organization • 108th ODMS Annual Meeting • June 07, 2013 • Virginia Beach, Virginia • Presented By: • Lerla G. Joseph, MD, • CEO and Chair, Central Virginia Coalition of Healthcare Providers, LLC

2. Background • In 2000, Congress via legislative mandates directs the Centers of Medicare and Medicaid Services to test models of care that share savings with physicians. • The Innovation Center was established by section 1115A of the Social Security Act(as added by section 3021 of the Affordable Care Act) • In 2006, researcher, Elliot Fisher of Dartmouth introduced the concept of “extended hospital medical staff”. • In 2002, the Physician Group Practice Demonstration Design Report was submitted to CMS • Physician Group Practice Demonstration implemented from 2005-2010

3. The Patient Protection and Affordable Care Act • Passage in April 2010 • CMS issues the final rule for the ACO concept October 2011 • Pioneer ACO’s awarded in January 2012 • The Supreme Court upholds the constitutionality of the now infamous “ObamacareAct” July 2012

4. Why Are We Here? • Increasing numbers of uninsured or underinsured Americans • Medical bills a leading driver of personal bankruptcies • Skyrocketing cost: with cost rising at the present rate medical cost will be 19.3% of GDP by 2019

5. National Healthcare Spending Projections CY 2003-2018 As the cost of health care continues to rise, averaging $20,728.00 per American family, and as the cost consumes more of the GDP Payers (Commercial and Public) are looking for more value for each dollar spent.

6. Losing Ground on Quality • The World Health Organization ranks the United States of America 37th among industrialized countries • 5% of the patients drive 44% of the healthcare expenditure

7. How the Performance of the U.S. Health Care System Compares Internationally,Source: The Commonwealth Fund 2010 Updated Chart

8. Iron Triangle of Health Policy Access to Care Value Cost Containment Quality of Care

9. Accountable Care Organization • Groups of Physicians, hospitals, SNF, Providers/Suppliers, etc. who agree to work together to achieve improved individual health, improved population health, reduced expenditures for health care in an Evidence-based approach • Legal Entity • Governing Body with 75% Physician Representation • Willing and able to distribute Shared Savings

10. The Medicare Shared Savings Program • Qualified legal entity • 3 year contract with CMS for a minimum of 5,000 Medicare A&B and dual eligible recipients • Achieve the triple goal of better care, better health, and lower cost • Pioneer ACO’s, Advance Payment Model, Shared Savings (one-sided or two-sided model)

11. The Landscape of Healthcare Delivery and Reimbursement has changed • Fee for Service continues to decline with physicians trying their best to keep up by volume business. • Bundled Payments • Chronic Disease Management or Intensivist Carve-Outs • Shared Savings Arrangement (Medicare and Commercial)

12. Can accountable care organizations save the independent medical practice

13. ACO as the Integrator • CVCHiP • Health IT • Health Analytics • Population Management • Care Coordination • Business Development • CMS Liaison • Outreach • MD • MD • MD • SNF • MD • HOSPITAL • MD • Provider Supplier • RN • NP • PA • STAFF

14. What to look for in an Accountable Care Organization • Governance (will you have a seat at the table?) • Mission • Policy and design input • IT, Quality Improvement, and Reporting support • Shared Savings

15. Early Experience from Coastal Carolina Health Care, PA

16. Early Experience from Coastal Carolina Health Care, PA

17. Early Experience from Coastal Carolina Health Care, PA

18. Accountable Care Organizations, ACO’s ACO’s Provide the Cover for Urban Practices • Health IT • Care Coordination • Population Management • Health Analytics

19. Reference • Centers for Medicare and Medicaid Services website • Medicare Shared Savings: A Practical Path to Accountable Care, sponsored by Medical Economics whitepaper • Commonwealth Fund 2010, Exhibit ES-1. Overall Ranking • Health Affairs, Volume 31 No.11, November 2012

20. Central Virginia Coalition of Healthcare Providers Thank You