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Dale Jarvis, CPA dale@djconsult

What is an Accountable Care Organization... And Why Should I Care?. Dale Jarvis, CPA dale@djconsult.net. Has Anyone Ever Seen an ACO?. Some health policy leaders compare Accountable Care Organizations to Unicorns. Not true, say others… They’ve been right in front of us for many years.

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Dale Jarvis, CPA dale@djconsult

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  1. What is an Accountable Care Organization... And Why Should I Care? Dale Jarvis, CPAdale@djconsult.net

  2. Has Anyone Ever Seen an ACO? • Some health policy leaders compare Accountable Care Organizations to Unicorns • Not true, say others… • They’ve been right in front of us for many years

  3. The Group Health Cooperative Story 2002-2006: Move towards Medical Home • Email your Doctor • Online Medical Records • Same Day/Next Day Appointment (Increased patient satisfaction but also saw provider burn-out and decline in quality scores) 2007: More robust Healthcare Home Pilot • Added more staff (15% more docs; 44% more mid-levels; 17% more RNs; 18% more MAs/LPNs; 72% more pharmacists) • Shifted to 30 minute PCP slots (Reduced burnout, increased quality scores, broke even in the first year, reduced ER usage by 29%, reduced inpatient usage by 6%, reduced PMPM costs by $10.30 over the 21 month pilot)

  4. Integrated Health SystemsThe Holy Grail Global Capitation to an Integrated Health System But... Integrated Health Systems represent only 10% of the US Delivery System

  5. Meanwhile…The Status Quo • Fee-For-Service, Non-Integrated Model: All the wrong incentives and disincentives

  6. Leading to the Two-Part Problem: Quality

  7. The Two-Part Problem: Cost

  8. The Two-Part Problem is Closely Linked to a Third Problem • Americans with a Serious Mental Illness die, on the average, at age 53 • The high prevalence of persons with these disorders, combined with high cost, directly affect the quality and cost problems

  9. The Fix… • Better Health for Populations • Better Care for Individuals • Reduced Costs through Improvement • (Don Berwick’s latest description of the Triple) • By creating Organized Systems of Care for the Other 90% through Payment Reform and Service Delivery Redesign

  10. Starting with Patient Centered Medical Homes/Person Centered Health Homes Picture a world where everyone has... • An ongoing relationship with a PCP; • A Care Team who collectively takes;responsibility for ongoing care; • A Care Team that provides all healthcare or makes appropriate referrals; and • A Care Team that helps ensure that care is coordinated and/or integrated. And where... • Quality and safety are hallmarks; • Enhanced access to care is available (evenings & weekends); and • Payment appropriately recognizes the Added Value (Joint Principles of the Patient-Centered Medical Home: www.pcpcc.net)

  11. But…It takes more than a high performing Health Homes to achieve the Triple Aim Harold Miller, Center for Healthcare Quality and Payment Reform, How to Create Accountable Care Organizations, www.chqpr.org

  12. Accountable Care Organizations Creating the Healthcare Neighborhood • ACOs are provider groups that accept responsibility for the cost and quality of care delivered to a group of patients that are cared for by ACO clinicians • ACOs: the organizing infrastructure to help health homes coordinate care with specialists, hospitals and other parts of the healthcare delivery system. • ACOs will also manage new payment models that incentivize prevention, early intervention and supports for persons with complex and costlyhealth conditions.

  13. So, How Do These Things Get Started? • All healthcare is local • ACOs are being organized by hospitals and physician practices, multi-specialty group practices without hospitals, health plans, groups of primary care practices, existing integrated health systems, existing independent practice associations…

  14. ACOs are Legal Entities • The most common legal form is expected to be a Limited Liability Company (LLC) owned by the entities that organize the ACO and their invitees

  15. Who’s In, Who’s Out?

  16. Then What? • The process begins…

  17. Then What? • Patient Attribution and Budget Development is followed by…

  18. But what about At-Risk, Vulnerable Populations? • Social Determinants of Health • There is a distinct relationship between an individual’s health status and the social and environmental conditions in which he or she lives

  19. “Houston, we have a problem…” • For many children, families, and adults in the safety net, good healthcare is not enough • Consider a mom with depression and diabetes • Add to this scenario the facts that she is the head of household of a family of three, has lost her job, is experiencing domestic violence and she and her children are on the brink of homelessness

  20. Which requires the Customization of the Accountable Care Organization

  21. And Organizing the Safety Net Payors Washington State’s fledgling two-part effort: • Organizing the payors to create a supportive payment and regulatory system • Organizing the delivery system to create accountable systems of care

  22. How should MH/SU Providers Prepare? • I’d offer Four Choices… • Become a Preferred Provider for the ACO • Become an Acquisition Targetfor one of the “big dogs”that’s organizing the ACO • Become a Member of the ACO • Get in on the groundfloor and become a Founding Member/Owner of the ACO

  23. Will ACOs Work?

  24. Questions and Comments…

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