Value based purchasing prebacked
This document discusses Accountable Care Organizations (ACOs) and healthcare reform. It notes that healthcare reform puts 6% of hospital revenue at risk and includes penalties for hospitals based on various quality measures. It defines ACOs as groups of doctors, hospitals, and other healthcare providers that come together voluntarily to give coordinated high quality care to their patients. ACOs can earn shared savings through the Medicare Shared Savings Program if they meet quality performance standards and spend less than their estimated costs. The document argues that ACOs will need new patient engagement strategies to be successful and control costs. It provides an example where an ACO model for nephrology could generate $90 million in new revenues through reduced costs and capitated payments
Value based purchasing prebacked
- 1. Contact: DavidParpart,D.C.,CEO Socially Relevant Inc 408-421-9508 drparpart@impactmeds.com What’s an ACO?
- 2. Accountable Healthcare Platform for Patient Engagement Solutions Pharmacist Counseling | Mobile Applications | Remote Monitoring Drivers of Healthcare Reform Economics
- 3. Healthcare Reform Puts 6% of Hospital Revenue at Risk 2% annual payment update at risk by FY2017 1% DRG payment penalty FY2013, rising to 3% by FY2015 1% DRG payment penalty for hospitals in worst quartile beginning FY2015 •Value-based Purchasing •Process of care •Patient experience Begins FY2013 •30-Day Readmissions •Up to 8 conditions targeted including AMI, HF, PNA •Hospital-Acquired Conditions •Up to 8 conditions targeted
- 4. Confidential- Socially Relevant Inc. What’s an ACO? Confidential- Socially Relevant Technology
- 5. Confidential- Socially Relevant Inc. Confidential- Socially Relevant Technology Al a Carte All Inclusive A Business Model Volume vs. Capitation
- 6. Accountable Care Organization (ACO)
- 7. Accountable Care Organization (ACO) Risk and Reward Every Hospital has risk of loss/penalties 2/3 penalized in Oct 2012 Health Organizations APPLY to form an ACO Assume risk Gain NEW REVENUE OPPORTUNITY through Medicare Shared Saving Program ACO’s Need New Patient Engagement Strategies Section H of the MSSP Application
- 8. ACO – Healthcare’s New Business Model Value Based Purchasing and Shared Savings Better Care Experience Lower Costs Better Population Health Metrics: Patient Experience Patient Activation Measures Metrics: Readmission Rate Total PMPM & Trend Metrics: HEDIS Cost Savings New Revenues Capitated Payment
- 9. ACO – Healthcare’s New Business Model Example: Nephrology Better Care Experience Lower Costs Better Population Health Doctor/Pharmacist/Patient Collaboration $178M Reduction in Part A $ 23M Increase in Part D $155M net savings Cost Savings New Revenues Capitated Payment $155M net savings X 60% = $90M
- 10. What is the Lowest Hanging Fruit for ACO Profitability? $700Bn $290Bn $30Bn • Duplication of Services • Fraud • Poor Med Adherence • Avoidable Hospitalizations Confidential Do Not Distribute