the journey to accountable care
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The Journey to Accountable Care. Variations in Practice and Spending: Implications for Reform. An additional 1 in 5 patients survive. Delivering safe reliable, and effective care. Cost decreases by $20,000 per patient. Avoiding unnecessary care (hospital stays, visits, tests). - PowerPoint PPT PresentationTRANSCRIPT
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ELLIOTT S. FISHER, MD, MPHJAMES W. SQUIRES PROFESSOR OF MEDICINEGEISEL SCHOOL OF MEDICINE AT DARTMOUTH
DIRECTORTHE DARTMOUTH INSTITUTE FOR HEALTH POLICY AND CLINICAL PRACTICE
THE JOURNEY TO ACCOUNTABLE CARE
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Variations in Practice and Spending: Implications for Reform
An additional 1 in 5 patients
survive
Delivering safereliable, and effective care
Cost decreases by $20,000 per patientAvoiding unnecessary care (hospital stays, visits, tests)
Source: The Dartmouth Atlas
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Flawed conceptual model: Healthis produced by face-to-face visits with physicians. Care is fragmented.
New model: It’s the system. Establish organizations capable of redesigning practice and eliminating waste.
Wrong incentives reinforce model, reward fragmentation, induce overuse of unnecessary care.
Rethink our incentives: Realign incentives – both financial and professional – with aims.
Confusion about aims: Is it about money or something more?
Clarify aims: Better health, better care, lower costs – for patients and communities.
Absent or poor data leaves practice unexamined and unable to improve; choices uninformed by evidence.
Better information that engages physicians, supports improvement; informs consumers and patients.
Variations in Practice and Spending: Implications for Reform
Underlying Problem Key Principles
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The Current Opportunity: Health Care Reform
Affordable Care Act Investments in public health Health information technology Expanded coverage New payment models
“No Outcome, No Income”
David NashDean, Jefferson School of Population Health
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The Current Opportunity: ACOs
Core Ideas Population-based virtual budgets Real or virtual organizations Performance measurement Patient choice Accommodate diversity
Fisher ES, Staiger DO, Bynum JP, Gottlieb DJ. Creating accountable care organizations Health affairs 2007;26:w44-57.Fisher ES, McClellan MB, Bertko J, et al. Fostering accountable health care: moving forward in medicare. Health affairs 2009;28:w219-31.McClellan M, McKethan AN, Lewis JL, Roski J, Fisher ES. A national strategy to put accountable care into practice. Health affairs 2010;29:982-90.
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What Will We Do? An Unfolding Story
ACOs: 2009 (21)
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What Will We Do? An Unfolding Story
ACOs: 2013 (328)
Note: The sum of ACOs reflects the total number of unique, publicly identifiable, confirmed private-payer ACOs as of 08/2012 and public-payer ACOs as of 01/2013.
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Might it work? The evidence so far…
Overall Duals
All PGP $114 $532 (1%) (5%)
Marshfield $642 $987 (9%) (11%)
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Might it work? Encouraging population-based models of care
Primary care system
Patients with diabetes(and their caregivers)
Endocrinologists
Evidence review, updated monthlyCare pathways well-specifiedTechnology to support “right” careCare delivered by “right” provider
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Might it work? For specialists
Project EchoSanjeev Arora, MD
Professor of Medicine,University of New Mexico
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ELLIOTT S. FISHER, MD, MPHJAMES W. SQUIRES PROFESSOR OF MEDICINEGEISEL SCHOOL OF MEDICINE AT DARTMOUTH
DIRECTORTHE DARTMOUTH INSTITUTE FOR HEALTH POLICY AND CLINICAL PRACTICE
THE JOURNEY TO ACCOUNTABLE CARE