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ACO’s

ACO’s. Al Kurose, M.D. President & CEO Coastal Medical. Coastal Medical: A Snapshot. 70 doctors, 25 NP’s/PA’s; 18 offices across RI. Predominantly primary care. 100,000 patients. Founded in 1995. Physician owned and governed. Ancillaries: lab, imaging, billing, and CME.

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ACO’s

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  1. ACO’s Al Kurose, M.D. President & CEO Coastal Medical

  2. Coastal Medical: A Snapshot • 70 doctors, 25 NP’s/PA’s; 18 offices across RI. • Predominantly primary care. 100,000 patients. • Founded in 1995. Physician owned and governed. • Ancillaries: lab, imaging, billing, and CME. • First Medicare Shared Savings ACO in RI: July, 2012. • 9,400 beneficiaries • First BCBSRI Shared Savings contract: January, 2012 • 37,000 commercial and Medicare Advantage members

  3. What is an ACO? An ACO is an Accountable Care Organization. • Accountable for what? • Accountable for delivering on the Triple Aim goals: • BETTER POPULATION HEALTH • BETTER EXPERIENCE OF CARE • LOWER PER CAPITA COST

  4. Will ACO’s Make a Difference? • YES – because of the opportunity to deliver an unprecedented level of service to patients. • How? • Accountability for quality of care and patient/caregiver experience. • Alignment of financial incentives.

  5. Medicare Shared Savings:How it works • Based on total cost of care for a population (~$109.4 M ) • Costs are compared to prior 3 years • Costs are adjusted for risk scores and CPI • If you save at least 3%, you earn up to 50% of that savings. ($1.6 M)

  6. What does this have to do with patient care? 1. Medicare requires performance on 33 quality measures across 4 domains: • Patient/caregiver experience • Care coordination and patient safety • Preventive Health • Care of at-risk populations (disease management) 2.. The best path to financial success in shared savings: outstanding care, enhanced access and improved services.

  7. (Some of) What We’re Doing • Coastal 365 • Patient Portal • NCM in every office • Pharm D’s • ER Communication Pilot • Utilization Analytics

  8. Early Results Coastal/BCBSRI Trend by CategoryQ1 of 2011 vs. Q1 of 2012 • Hospital admits: Commercial down 9%; Medicare flat • Readmits down: Commercial -31%; Medicare -14% • Urgent care down: Comm. – 31%; Medicare -18%

  9. Implications of ACO’s for Long Term Care: • ACO’s will be interested in cost efficiency of care. • Possible impact on utilization of SNF’s • Example: total joint replacement

  10. Implications of ACO’s for Long Term Care • ACO providers may become more active in long term care settings. • ACO’s will want preferred relationships with SNF’s • ACO’s will be incented toward: • Better communication, and better coordination of care • Better management of transitions of care • Better end of life care

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