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Our Accountable Care Organization (ACO) Strategy Meredith Marsh Director Health Choice Care, LLC PowerPoint Presentation
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Our Accountable Care Organization (ACO) Strategy Meredith Marsh Director Health Choice Care, LLC

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  1. Y • Our Accountable Care Organization (ACO) Strategy • Meredith Marsh • Director • Health Choice Care, LLC

  2. Health Reform • The Affordable Care Act (ACA) strives to achieve the Triple AIM: • Improving the experience of care for individuals • Patient Experience of Care • Care Coordination & Patient Safety • Preventive Health • At-risk populations • Improving the health of populations • Lowering per capita costs

  3. ACA provision for shared savings program “to establish a Shared Savings Program that promotes accountability for a patient population, coordinates items and services under Parts A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery.”

  4. What is an Accountable Care Organization (ACO)? • ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. • The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. • The overarching goal of the ACO pilot is to tie Medicare reimbursements to reduced cost and better care

  5. Health Reform & care Delivery redesign • The Centers for Medicare and Medicaid Services (CMS) are currently piloting several models of care delivery re-design • Pioneer ACO Demonstration • Advance Payment Incentive • Medicare Shared Savings Program → Health Choice Care

  6. Purpose of Shared Savings Program • Achieve savings against a benchmark, through improvements in the coordination and quality of care provided to Medicare beneficiaries • Controls growth in Medicare expenditures • Meets established quality performance standards • When an ACO succeeds both in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.

  7. Performance Standards • Must report and meet thresholds for 33 quality measures • Patient/Care Giver Experience: • Care Coordination/Patient Safety • Preventive Health • At-Risk populations • Each domain will be weighed equally at 25%

  8. Performance Standards • Year 1: Pay for Reporting - Performance standards will be set at the level of complete and accurate measures reporting of all 33 measures • Year 2: Pay for performance on 25 measures and 8 pay for reporting • Year 3: Pay for performance on 32 measures and 1 pay for reporting

  9. Quality Measures Reporting • 7 measures collected via patient survey • 3 calculated via claims • 1 calculated from EHR Incentive Program data • 22 are collected via the GPRO web interface • ACOs must achieve quality performance standards on 70% of the measures in each domain starting in 2015

  10. Minimum Savings Rate

  11. Health Choice Care – Your ACO! • Medicare Shared Savings Program ACO • Track 1: 50% share in savings; no share in losses • Start Date: January 1, 2014 • 17,711 Medicare Beneficiaries attributed • 23 Participants across 3 states – FL, MO, RI • 350 Providers • 9 Member Board – 75% provider controlled and Medicare Beneficiary • Sharing of savings • 50% Participating Providers • 50% Plan to support ongoing operations and infrastructure re-investment

  12. HOW do WE Tackle these priorities? • HCC is currently focusing our efforts in two areas: • Care Management • Information Technology

  13. Care Management – IMPACT Areas Today • ACO Participants have been tasked with focusing efforts on the following impact areas: • High risk/Medium risk patients • Hospitalizations • Readmissions • Emergency Room Utilization • Medication Adherence

  14. IT Priorities • Ingestion of EHR data into CLEAR • Beneficiary Notification Tracking • Claims Data Analytics Cube • HCC Provider Portal • Quality Measurement Reporting

  15. ACO Strategy: A WIN-Win For All • Comprehensive view of patients’ spectrum of care • Enhance patient engagement strategies • Redesign care coordination practices • Forefront of health delivery reform • Develop best practices as we shift away from FFS • Realize savings to incentivize providers and reinvest into operations • Regardless of savings achieved, strategies promote enhanced patient continuity of care