Accountable Care Organization

1. Accountable Care Organization HealthCare.gov Accountable Care Organizations: Improving Care Coordination for People with Medicare

2. Need for Coordination of Care • Provider focus of activity • Patient Obligations absent • Implied goal to reduce re-admissions and save $960 Million per year via aggressive outside of hospital care.

3. Goals • Deliver seamless, high quality care. • Patient centered • Patient and providers are partners in care decisions. • Partnership in responsibility and economic risk is absent.

4. Shared Savings • Risk model of capitation? FFS? Care Management? Shared savings? • Linkage between physicians in hospitals is implied but not specific. • Need for large, sophisticated physician group practice arrangements. • 5000 beneficiaries for at least three years • Medicare beneficiaries on the ACO Governing Board. • Beneficiary assignment vs. attribution

5. Measuring Quality Improvement • Auditable reporting of performance on over 30 quality metrics. • Reports on provider performance. • Options to select out of network providers?

6. Take Away Points • ACO’s have a low probability of adoption in Alaska. HMO’s and capitated products never gained acceptance in this market. • Few communities in Alaska have the infrastructure and continuum of care to embrace ACO’s as a delivery model. • Low probability of provider acceptance. • Very high economic exposure to out of network expenses.