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Harmony Healthcare International, Inc.

Copyright © 2012 All Rights Reserved 1

Copyright © 2012 All Rights Reserved Harmony Healthcare International, Inc. 1

HARMONY UNIVERSITY

The Provider Unit of


(HHI)

Presented by:

Kris Mastrangelo, OTR/L, MBA, NHA President & CEO

ACOs: Where Are We At?


The learner will be able to summarize goals of ACOs

The learner will be able to identify and articulate examples of the ACO process

The learner will be able to identify strategies for interdisciplinary management of ACOs

Objectives

Copyright © 2012 All Rights Reserved Harmony Healthcare International, Inc. 3 Copyright © 2012 All Rights Reserved Harmony Healthcare International, Inc. 3

Accountable Care Organizations

“Voluntary groups of physicians, hospitals, and other health care providers that are willing to assume responsibility for the care of a clearly defined population of Medicare beneficiaries attributed to them on the basis of patients’ use of primary care services.

If an ACO succeeds in both delivering high-quality care or improving care and reducing the cost of that care below what would otherwise have been expected, it will share in the savings it achieves for Medicare.”

The New England Journal of Medicine (NEJM), October 20, 2011

Making Good on ACOs’ Promise – The Final Rule for the Medicare Shared Savings Program

Donald M. Berwick MD, Administrator, CMS




Team Medicine

First building blocks of integrated team medicine: Model, data and leadership

Create a care team that maximizes impact for patients

Build a physician culture of multidisciplinary practice


Team Medicine

1. An integrated, flexible physician model

“Multispecialty group medical practice maximized physicians’ abilities to care for patients through doctor-to-doctor consultation, through the training and mentoring of young physicians, and through the inherent quality controls built into the group”


Team Medicine

2. Physician-Friendly Data

Yields evidence-based medicine




Team Medicine

3. Rethink physician leadership

“We recruit physicians with a sense that we’re a group practice. We stand for quality. We measure quality and results. We think it’s important that we tell patients we’re going to give them the kind of quality they deserve. You then orient, evaluate, and promote people based on the same set of values and expectations. Eventually you end up with a culture that is very comfortable with a focus on quality, measurement, comparison, and improvement.”

Jack Cochran, MD


Healthy Bones: Tests and Prescriptions to Prevent

Problem: In 2010, osteoporosis was the ninth most costly major illness among the top 5% highest cost Medicare beneficiaries

In 2005, 2 million fractures cost the United States $17 billion for both acute and long-term care. By 2025, the annual fracture rate is expected to increase by 50% to about 3 million at a cost of $25 billion per year.

On average, 24% of patients presenting with a osteoperosis-related fracture die within one year, and the mortality rate of men exceeds women

Only 21% of women age 67 or older who have had an osteoporosis-related fracture had a bone mineral density test or a drug prescription to treat or prevent osteoporosis in the six months after the fracture

* Information provided by Kaiser Permanente


Healthy Bones

Solution: Care managers, primary care physicians, and surgeons use daily reports generated from the electronic health record to identify members at risk for osteoporosis and fractures

Care managers coordinate care for these patients to close care gaps

Working together, the team provides patients with education, screening, treatments, and monitoring as needed. The multidisciplinary team includes:

Orthopedic surgeons, endocrinologists, gerontologists, family practitioners, internists, rheumatologists, gynecologists, physical therapists, disease/care managers, radiologists and member education




Healthy Bones

Impact:

Annual bone density screening rates increased by 474% from 2002 to 2009

People on anti-osteoporosis medications increased by 214% from 2002 to 2009

Over 45% reduction in rate of hip fractures (preventing >1400 hip fractures) by 2010

If the Healthy Bones approach were adopted in the United States, the country could achieve a 25% reduction in the rate of hip fractures, preventing 75,000 hip fractures per year


Improvement Standard

As the New York Times reported on its front page Tuesday, Reuters (10/24, Morgan) reports that the Obama Administration has proposed a settlement to a class-action lawsuit, promising to broaden current Medicare regulations to allow coverage to "maintain the patient's current condition or ... prevent or slow further deterioration." Previously, beneficiaries had to demonstrate improvement to continue to receive coverage, the change will likely benefit thousands of Americans with degenerative conditions like multiple sclerosis, Parkinson's, and cerebral palsy.

An HHS spokeswoman said the settlement merely "clarifies" current policy, and continued, "We expect no changes in access to services or costs."



The case, Jimmo v. Sebelius, resulted in a focus on skilled service delivery in the context of maintenance programs

Historically, patients with chronic conditions and anticipated functional deterioration were considered skilled for the establishment of a maintenance program

This settlement now allows for coverage of the actual delivery of maintenance therapy by licensed nurses and therapy professionals





Current Medicare skilled guidelines state:

The services must be provided with the expectation, based on the assessment made by the physician of the patient’s restoration potential, that the condition of the patient will improve materially in a reasonable and generally predictable period of time,

Or the services must be necessary for the establishment of a safe and effective maintenance program



The Proposed Settlement:

“Instead, providers, contactors, and adjudicators must recognize “maintenance” coverage and a beneficiary’s need for skilled care that is performed or supervised by professional nurses and therapists.”

The manual revisions will clarify that, under the Skilled Nursing Facility, Home Health, and Outpatient Therapy maintenance coverage standards, skilled therapy services are covered when an individualized assessment of the patient’s clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist (“skilled care”) are necessary for the performance of a safe and effective maintenance program

Such a maintenance program to maintain the patient’s current condition or to prevent or slow further deterioration is covered so long as the beneficiary requires skilled care for the safe and effective performance of the program



Quality Care is our number one objective

Harmony embraces the OBRA 87 regulations which require facilities to provide services to meet “the highest practicable physical, medical and psychological well-being” of every resident

This practice has been our standard since its inception. This new Improvement Standard, further supports our core values as providers of specialized services to the post acute care population.




Continuum of Care Post Discharge

“When the asthma attack is done, the patient goes home, and the game’s over. No one is accountable for any of the follow-up care.”

George Halvorson , Chairman & CEO Kaiser Permanente


Integrated Follow-up

Call patient to make sure they are taking their meds

Call patient to make sure they are avoiding any allergic trigger


Prevention

Problem: One in eight women develops breast cancer, and nearly 40,000 die from it every year

Regular mammograms – which can identify breast cancer early, when it is most treatable – can reduce breast cancer deaths by more than 30 percent

The United States Preventive Services Task Force recommends screenings every one to two years for women aged 50-74 years. However, current screening rates fall short of these guidelines, and they have been steadily declining




Prevention

Through the Proactive Office Encounter program, the health care team identifies and targets patients with care gaps (including whether a patient is due for a mammography) or chronic medical conditions and encourages them to actively participate in own care


Proactive Office Encounter and Mammography

The program engages all members of the clinical care team in a coordinated and collaborative effort to encourage and support patient health

Automated creation of care checklists for all patients whose records indicate gaps in care

At every point of contact with patients, clinical care teams review checklists and help patients get the care they need

Based on identified gaps in care, medical assistants during office visits discuss with patients the need for preventive screenings and routine care, such as cancer screenings and tests for abnormal blood sugar or cholesterol levels, and schedule appointments on the spot


Proactive Office Encounter Also Helps:

Along with other concurrent improvement initiatives, the Proactive Office Encounter has contributed to:

30% increase in colon cancer screening

11% increase in breast cancer screening

5% increase in cervical cancer screening

13% improvement in cholesterol control




Data, Data, Data

“You cannot make bricks without clay.” ~Sherlock Holmes


Better Patient Management Using Evidence-Based Medicine

Patient Registry and Concurrent Tracking System

Identifies all members in the population

Risk stratifies population for targeting interventions and resources

Tracks and monitors each patient for key indicators (lab, pharmacy, encounters, clinical indicators)

Easy access (web-based)


Better Patient Management Using Evidence-Based Medicine

Care Management Systems

Flags/alerts

Supports telephone management and documentation

Identifies all members in the population

Supports Automated Clinical Decision Support and Practice Tools

In-reach/outreach

Health Education and Self-Care Support




Evidence-based Medicine/Prevention

Proactive care instead of reactive care

Patients who have the largest “gaps” in recommended care do not routinely visit their primary care physicians

Specialty clinics must play a role to achieve optimal results. Fewer than 40% of patients needing a mammogram or testing for diabetes visited their primary care physician.

Appointments can be made on the spot or referrals generated so gaps can be readily addressed


Beyond the Patient: Widen Your Gaze

Focus on primary care and prevention, and addressing chronic disease requires looking at larger communitywide issues

Behavioral factors are as important as specific treatments: better diet, promoting physical activity, and reducing smoking

Community education for adults and children in recognizing bad health habits and taking action to create a better health outlook


What is an Accountable Care Organization?

Healthcare organization with a coordinated set of providers…

Provider mix dependent on whether federal or commercial ACO structure

Who share responsibility for the continuum of care… Clinical accountability – Quality of care

Financial responsibility – Cost of care

By providing the highest possible value of care… Increase quality

Decrease costs




What is an Accountable Care Organization?

For financial incentives or “shared savings” Value-based payments

Reimbursement for achieving cost and quality goals

From participating payors Public payors (e.g., Medicare, Medicaid)

Commercial payors (e.g., BCBS of MA)


Key Principles and Elements of ACOs

Local accountability Ability to provide and manage continuum of care

Responsible and accountable for quality and cost of care

Incentivize providers for quality – not quantity

Shared Savings Legal entity and governance structure that allows receiving/distributing shared savings payments

Invest shared savings in delivery system improvements

Capable of financial and resource planning

“AC0 Model Principles,” The Accountable Care Organization Learning Network, http://www.acolearningnetwork.org/why-we-exist/aco-model-principles (Accessed 09/16/2011)


Key Principles and Elements of ACOs

Performance Measurement

Ongoing metrics to obtain evidence of meaningful outcome improvements and cost impacts

Measurements must be transparent and accessible

Essential cost savings are result of meaningful improvements

“AC0 Model Principles,” The Accountable Care Organization Learning Network, http://www.acolearningnetwork.org/why-we-exist/aco-model-principles (Accessed 09/16/2011)




Why Accountable Care?

National Health Expenditures per Capita, 1960-2009 Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; NHE summary including share of GDP, CY 1960-2009; file nhegdp09.zip).


Why Accountable Care?

Hospital Care

31 %

Physicians & Clinics

20%

1. Includes Research (2%) and Structures and Equipment (4%) 2. Includes expenditures for residential care facilities, ambulance providers, medical

care delivered in non-traditional settings (such as community centers, senior citizens centers, schools, and military field stations, and expenditures for Home and Community programs under Medicaid

3. Includes Durable (1%) and Non-durable (2%) goods

Dental Services and Other Professionals

7%

Government Administration & Net Cost of Health

Insurance 7% Nursing Care Facilities &

Continuing Care Retirement Communities

6% Rx Drugs

10%

Other – 14%

Other Health, Residential, and Personal Care2

5%

Home Health Care 3%

Government Public Health Activities

3%

Other Medical Products3 3%

Investment1

6%

Note: Sum of pieces may not equal 100% due to rounding.

Centers for Medicare & Medicaid Services,

Office of the Actuary, National Health Statistics Group.


ACOs by Sponsoring Entity

60%

16%

23%99

Hospital

Systems

27

Health Plans

38

Physicians

Groups

Note: Percentages don’t total 100% due to rounding. Source: Leavitt Partners




Perspective: Final Rule for Medicare Shared Savings Program

“We believe that today’s ACO rule is the next step in our shared commitment to a better, more lasting health care system. We look forward to being a trusted partner in our nation’s journey toward patient-centered, coordinated care.”

Donald M. Berwick MD, Administrator, CMS The New England Journal of Medicine (NEJM)

October 20, 2011

Making Good on ACOs’ Promise

The Final Rule for the Medicare Shared Savings Program


Medicare Shared Savings Program ACO Requirements

Legal Entity Formal legal structure established

To receive and distribute any shared savings

Proposed rule modified to allow participation of entities organized under Federal or tribal law

Sufficient Size Sufficient number of primary care physicians

To provide care for at least 5,000 beneficiaries

“Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations; Final Rule” Federal Register, Vol. 76, No . 212 (November 2, 2011), p. 67807-08, 67814-16, 67821-22, 67825, 67827, 67829, 67891, 67980.



3-Year Commitment Must commit to participate in the program for at least three years

Must provide CMS with 60 days advance notice if terminating agreement

Participating ACO will not share in any savings in the performance year for which it notifies CMS of termination






Leadership & Governance Must have a mechanism for shared governance and responsibility

Management structure must include both clinical and administrative systems

ACO participants must hold at least 75% control of the ACO’s governing body

Where ACO comprises multiple, otherwise independent entities not under common control, governing body must be separate and unique to the ACO

Must provide for beneficiary representation on governing body




Leadership & Governance (Cont.) If governing body does not meet requirements, ACO must describe why it seeks to differ from requirements and how it will involve ACO participants in governance in innovative ways and/or provide for meaningful governance participation by Medicare beneficiaries

ACO’s operations must be managed by an executive, officer, manager, or general partner, whose appointment and removal are under the control of the governing body

Clinical management and oversight must be managed by a senior-level medical director who is one of the ACO’s physicians, is physically present in an established ACO location on a regular basis, and is board-certified and licensed in one of the states in which the ACO operates

“Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations; Final Rule” Federal Register, Vol. 76, No. 212 (November 2, 2011), p. 67807-08, 67814-16, 67821-22, 67825, 67827, 67829, 67891, 67980.



Performance Measurement Must define, establish, implement, and periodically update processes to promote evidence-based medicine

Guidelines must cover those diagnoses with significant potential for achieving quality improvements, while taking into account individual beneficiaries’ circumstances

Must define, establish, implement, and periodically update processes and infrastructure for ACO participants and providers/suppliers to internally report on quality and cost measures

Must report data on 33 quality measures for each year of performance agreement






Patient-Centered Must adopt a focus on patient-centered care that is promoted by the governing body and integrated into practice by leadership and management



Medicare Shared Savings Program Eligible Entities

Final Rule Designation Potential Provider Organizations

ACO professionals in group practices • Primary Care Physician Practices

Networks of individual practices of ACO professionals

• Independent Practice Associations (IPA)

• Multispecialty Physician Groups (MSPG)

Partnerships or joint venture arrangements between hospitals and

ACO professionals

• Integrated Delivery Networks (IDN)

• Clinical Integrated Networks (CIN)

Hospitals employing ACO professionals

• Hospital Medical Staff Organizations (MSO)

• Physician Hospital Organizations (PHO)

• Extended Hospital Medical Staff

• Critical Access Hospitals

Such other groups of providers of services and suppliers as the Secretary determines

“Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations; Final Rule” Federal Register, Vol. 76, No . 212 (November 2, 2011), p. 67812; “Accountable Care Organizations: A Roadmap for Success: Guidance on First Steps” By Bruce Flareau and Joe Bohn, 1st ed., Virginia Beach, VA: Convergent Publishing, LLC, 2911, pg. 45.


Medicare Shared Savings Program Quality Reporting Requirements

33 quality reporting criteria across 4 domains include:

Domain CMS Criteria

1. Patient/Caregiver Experience Measures 1-7

2. Care coordination/Patient Safety

Measures 8-13

3. Preventive Health Measures 14-21

4. At-Risk Population Measures 22-33

“Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations; Final Rule” Federal Register, Vol. 76, No . 212 (November 2, 2011), p. 67889-67890, 67897.





Patient/Caregiver Experience (1-7):

Getting Timely Care, Appointments, and Information

How Well Your Doctors Communicate

Patients’ Rating of Doctor Access to Specialists

Health Promotion and Education

Shared Decision Making

Health Status/Functional Status



Care coordination/Patient Safety (8-13):

Risk-Standardized, All Condition Readmission: The rate of readmissions within 30 days of discharge from an acute care hospital for assigned ACO beneficiary population.

Ambulatory Sensitive Conditions Admissions: Chronic Obstructive Pulmonary Disease [AHRQ Prevention Quality Indicator (PQI) #5]

Ambulatory Sensitive Conditions Admissions: Congestive Heart Failure [AHRQ Prevention Quality Indicator (PQI) #8]

Percent of PCPs who successfully qualify for an EHR incentive program payment

Medication Reconciliation: Reconciliation After Discharge from an Inpatient Facility

Falls: Screening for Fall Risk


Preventive Health (14-21):

Influenza Immunization

Pneumococcal Vaccination

Adult Weight Screening and Follow-up

Tobacco Use Assessment and Tobacco Cessation Intervention

Depression Screening

Colorectal Cancer Screening

Mammography Screening

Portion of Adults 18+ who have had their Blood Pressure measured within the preceding two years





At-Risk Population (22-33):

Diabetes Composite (All or Nothing Scoring): Hemoglobin A1c Control (9%)



At-Risk Population (Cont.)

Hypertension (HTN): Blood Pressure Control: Percentage of patient visits for patients aged 18 years and older with a diagnosis of HTN with either systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥ 90 mmHg with documented plan of care for hypertension Ischemic Vascular Disease (IVD): Complete Lipid Profile and LDL Control




Medicare Shared Savings Program Payment Mechanism – Shared Savings

ACOs to receive payment for shared Medicare savings provided it

Meets the quality performance requirements

Demonstrates that it has achieved savings against benchmark of expected average per capita Medicare FFS expenditures

An ACO shall be eligible for payment of shared savings

“[O]nly if the estimated average per capita Medicare expenditures under the ACO for Medicare FFS beneficiaries for Parts A and B services… is at least the percent specified by the Secretary below the applicable benchmark.”

“Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations; Final Rule” Federal Register, Vol. 76, No . 212 (November 2, 2011), p. 67910, 67927-67930.


Medicare Shared Savings Program Payment Mechanism – Shared Savings

ACOs receive bonuses for achieving resource use and quality targets over the course of a year

ACOs face penalties for failing to meet these requirements

The final rule sets out two risk models with various incentives for ACOs to receive shared savings payments

“Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations; Final Rule” Federal Register, Vol. 76, No . 212 (November 2, 2011), p. 67910, 67927-67930.


Federal Anti-Kickback Statute (AKS)

Federal Physician Self-Referral Law (Stark Law)

Federal Civil Monetary Penalty (CMP)

Federal Antitrust Law

Federal Tax Law

State Regulations Antitrust

Fraud and Abuse

False Claims

Corporate Practice of Medicine

Insurance Law

Regulatory Considerations




Regulatory Considerations Federal Anti-Kickback Statute

Definition

Prohibition against soliciting, receiving, or paying

remuneration in exchange for the referral healthcare service

billed to Medicare, Medicaid, or any other federal healthcare

program.

ACO Implication

Current safe harbors to potentially shield ACOs from possible

violations

Direct employment

Co-management arrangements

Gainsharing

“Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations and Medicare Program: Waiver Designs in Connection With the Medicare Shared Savings Program and the Innovation Center; Proposed Rule and Notice” Federal Register, Vol. 76, No. 67 (April 7, 2011).


Regulatory Considerations Federal Stark Law

Definition

Prohibition against physician referrals to providers of

Designated Health Services with whom the referring physician has a financial

relationship .

ACO Implication

Compliance with the AKS and Stark may be waived, “as may be

necessary,” to conduct:

Any payment model for ACOs that the Secretary determines will

improve the quality and efficiency of items and services furnished

under the Medicare program

The bundled payment/episode of care pilot



Regulatory Considerations Federal Civil Monetary Penalties

Definition

Civil penalties against hospital payments to physicians for

Reducing length of stay

Reducing readmission rates

Other forms of fraud and abuse

ACO Implication

HHS has provided a waiver similar to those given for Stark Law and

the AKS.





Regulatory Considerations Federal Tax Law

Definition

Integration between providers coordinating

care may cause nonprofit, tax exempt providers and for profit, taxable entities,

to merge.

ACO Implication

Tax-exempt participants in ACOs should be able to

remain that way as long as ACO furthers charitable

purposes.

“Accountable Care Organizations: Promise of Better Outcomes at Restrained Costs; Can They Meet Their Challenges?” By C. Frederick Geilfuss and Renate M. Gray, BNA’s Health Law Reporter, Vol. 19, no. 956 (July 8, 2010).

“Herding Cats? What Health Care Reform Means for Hospital-Physician Alignment and Clinical Integration,” By Daniel H. Melvin and Chris Jedrey, McDermott, Will & Emery (October 13, 2010), p.38.


Regulatory Considerations Federal Antitrust

Definition

Sherman Act, Section 1 prohibits contracts, combinations and conspiracies that unreasonably restrain trade

•Applies to independent, competing providers

•Does not apply to:

•Physicians all within the same group

•A hospital and its full-time, employed physicians

•A hospital and its controlled subsidiaries

ACO Implication

FTC and DOJ released proposed rules governing mandatory antitrust monitoring, based on the percentage of market share an ACO has for any

specific service line.

“Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Saving Program” 76 FR 75 (April 19, 2011), p. 21895.


Large health systems may be in best position to form ACOs

Attract more PCPs

Vertical Integration will likely aid in transition to ACO

May easily meet quality requirements

Greater access to capital and IT requirements

Potential Hurdles:

May need to lower cost or increase private insurers’ cost to generate shared savings

Reimbursement Considerations Hospitals

“Investors Not Likely to Provide ACO Funding Under Proposed Rule, Venture Capitalist Says” By Sara Hansard, Bureau of National Affairs, Health Law Reporter, Vol. 20, No. 1026, 2011; “Quality over Quantity” By Bryn Nelson, The Hospitalist (December 2009), www.the-hospitalist.org/details/article/477391/quality_over_quantity.html, (Accessed 2/28/11).; “Will Mayo Clinic save money as an ACO?” By Christopher Snowbeck and Don McCanne, Physicians for a National Health Program (February 8, 2011), www.pnhp.org/print/news/2011/february/will-mayo-clinic-save-money-as-an-aco, (Accessed 2/28/11).




Technology Considerations

Electronic Medical Records

Significant cost

Help eliminate silos and increase continuity of care

Meaningful use standards

The technological impacts on providers choosing to participate in an ACO are rooted in the primary issue of purchasing or updating an EHR system

Costly

Must meet meaningful use standards to be eligible for savings

EHR integration and alignment among ACO participants is critical to ensure benefits of HIT utilization are obtained

“Technology Fundamentals for Realizing ACO Success”, Medicity, September 2010, http://www.himss.org/content/files/Medicity_ACO_Whitepaper.pdf, (Accessed June 30, 2011).


Key Principles of Accountable Care

Underlying Causes of Poor Performance Principles of Accountable Care

Lack of clarity about aims, and about whose perspectives are most relevant.

Clear aims: better overall health through higher-quality care and lower costs with a focus on patients.

Providers are fragmented and unable to coordinate care well; providers accept responsibility only for what they directly control.

Establish provider organizations accountable for achieving better results for all of their patients at a lower cost.

Payment system drives fragmentation, rewards unnecessary care, and penalizes care coordination and overall efficiency.

Align financial, regulatory, and professional incentives with the aims of better health through higher-quality care, lower costs.

Inadequate information to support provider and patient confidence about the value of reforms.

Valid, meaningful performance measures that support provider accountability for aims and support informed and confident patient care choices.


Where The ACOS Are

http://www.himss.org/content/files/Medicity_ACO_Whitepaper.pdf




ACO STATE

Banner Health Network AZ

Brown & Toland Physicians CA

Healthcare Partners Medical Group CA

Heritage California ACO CA

Monarch Healthcare CA

Primecare Medical Network ACO CA

Sharp Healthcare ACO CA

Physician Health Partners CO

JSA Medical Group FL

TriHealth, Inc. IA

OSF Healthcare System IL

Franciscan Alliance ACO IN

Atrius Health MA

Beth Israel Deaconess Physician Organization MA

Mount Auburn Cambridge Independent Practice Association (MACIPA) MA

Partners Healthcare MA

Steward Health Care System MA

32 Pioneer ACOs


ACO STATE

Eastern Maine Healthcare Systems ME

Genesys Physician Hospital Organization MI

Michigan Pioneer ACO MI

University of Michigan Health System MI

Fairview Health Services MN

Park Nicollet Health Services MN

Allina Hospitals & Clinics MN/WI

Dartmouth-Hitchcock ACO NH/VT

Presbyterian Healthcare Services – Central New Mexico Pioneer Accountable Care Organization NM

Healthcare Partners of Nevada NV

Bronx Accountable Healthcare Network (BAHN) NY

Renaissance Medical Management Company PA

North Texas ACO TX

Seton Health Alliance TX

Bellin-Thedacare Healthcare Partners WI

32 Pioneer ACOs


ACO STATE

Arizona Connected Care, LLC AZ

AppleCare Medical ACO, LLC CA

Premier ACO Physician Network CA

Accountable Care Coalition of Coastal Georgia FL

Accountable Care Coalition of the Mississippi Gulf Coast, LLC FL

Florida Physicians Trust, LLC FL

Primary Partners, LLC FL

West Florida ACO, LLC FL

Accountable Care Coalition of Greater Athens Georgia GA

Jackson Purchase Medical Associates, PSC KY

Jordan Community ACO MA

Physicians of Cape Cod ACO Description of Organization MA

Accountable Care Coalition of Caldwell County, LLC NC

Accountable Care Coalition of Eastern North Carolina, LLC NC

Coastal Carolina Quality Care, Inc. NC

27 Shared Savings Program ACOs




ACO STATE

North Country ACO NH

AHS ACO, LLC NJ

Hackensack Physician-Hospital Alliance ACO, LLC NJ

Optimus Healthcare Partners, LLC NJ

Accountable Care Coalition of Mount Kisco, LLC NY

Accountable Care Coalition of the North Country, LLC NY

Chinese Community Accountable Care Organization NY

CIPA Western New York IPA, doing business as Catholic Medical Partners NY

Crystal Run Healthcare ACO, LLC NY/PA

Accountable Care Coalition of Texas, Inc. TX

RGV ACO Health Providers, LLC TX

Accountable Care Coalition of Southeast Wisconsin, LLC WI

27 Shared Savings Program ACOs


89 Additional ACOs

As of July 1, 2012 89 new Accountable Care Organizations (ACOs) began serving 1.2 million people with Medicare in 40 states and Washington, D.C.

Brings total number of organizations participating in Medicare shared savings initiatives to 154, including the 32 ACOs Pioneer ACOs and six Physician Group Practice Transition Demonstration organizations that started in January 2011

As of July 1, more than 2.4 million beneficiaries are receiving care from providers participating in Medicare shared savings initiatives


The Spread of ACOs




Impact on SNF

Transparency Might as well adjust to the fact that entities, other than surveyors, will be more interested in what SNFs are doing

Outcomes Coordinated, efficient, error free “transitions of care”

Length of Stay

Functional rehabilitation progress: Service delivery

Re-hospitalization rates

Patient and Family Satisfaction


Impact on SNF

Regulatory Level Outcomes Clinical QMs (falls, pressure sores, infection, restraints, pain, psychotropic meds, etc)

Pharmacy error rates and Safety

Annual and Complaint Survey compliance


Depression, PH Q9

The monitoring and prevention in the geriatric population requires closer scrutiny




Questions/Answers

Harmony Healthcare International

1.800.530.4413

www.Harmony-Healthcare.com


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