Pioneer ACO Model

SFMS and CMA has partnered with the Centers for Medicare & Medicaid Services to present an informative webinar on ACOs. Mai Pham, MD, Director of ACO Activities at the CMS Center for Medicare & Medicaid Innovations will describe the Center’s Pioneer ACO Model and answer SFMS/CMA members’ questions.

The Pioneer ACO Model is designed to support organizations with experience operating as an accountable care organization (ACO) or in similar arrangements, providing more coordinated care to beneficiaries at a lower cost to Medicare. The Pioneer ACO Model is testing the impact of different payment arrangements in helping these organizations achieve the goals of providing better care to patients and reducing Medicare costs.

Thursday, February 23
12:15 – 1:15pm

All CMA hosted webinars are FREE as a benefit of your SFMS Membership. Non-CMA Members are invited to join this webinar for $99. Medical staff are eligible to receive 1 PMI CEU for their participation.

To register for this webinar, please visit www.cmanet.org/calendar.

ACO Visionary Talks Implementation, Health Care Reform

Medscape One-on-One interviews Elliott Fisher, MD, MPH, Director of the Center for Population Health at the Dartmouth Institute for Health Policy and Clinical Practice, about ACOs, the final rules, and how it affects Americans.

Click here to view the full video and interview transcript.

 

 

Source: Medscape.com, January 25, 2012.

Last Day to Sign Up for CMS’ ACO Program

Today is the last day to submit applications for the April 1 start date of the CMS’ Medicare Shared Savings Program, the government’s payment and delivery program for accountable care organizations (ACOs).

The CMS began accepting applications on December 1, and applicants will receive notice of their approval or denial by March 16, according to a timeline in the 21-page application (PDF). The application period for the program’s July 1 start date runs from March 1 through March 30.

“Program start dates have varying agreement periods,” the CMS said. Organizations that begin on April 1 will commit to an agreement period lasting three years and nine months, while those starting in July will agree to three years and six months.

The application questions cover a range of topics, including governance, legal issues and finance. It also asks applicants to “submit narratives” describing how their ACOs will tackle issues such as beneficiary engagement, quality reporting and care coordination.

Applications must be received by 5 p.m. ET, the CMS said.

Health Care Reform You Can Expect in 2012

It will be a busy year for health care reform as the Patient Protection and Affordable Care Act, commonly referred to as the Affordable Care Act, continues to reshape America’s health care system. Here’s what lies ahead for health care reform in 2012.

Accountable Care Organizations

Effective: January 1, 2012.  The Affordable Care Act started providing a financial incentive for physicians, hospitals, and health care providers that voluntarily join together to form Accountable Care Organizations (ACOs) and coordinate care for patients with original Medicare. Under the law, those that demonstrate improved quality and outcomes in care, lower costs and patient priority will share the savings with the Medicare system. ACOs are expected to save Medicare $960 million over three years, according to HealthCare.gov.

Fewer disparities in health care

Effective: March 2012. Not all Americans have equal access to or similar outcomes from health care, according to HealthCare.gov. Depending on your race, ethnicity, or income level, you may have a higher incidence of certain diseases, fewer treatment options and reduced access to care and insurance.

Countering decades of disparity is a tall order, but the Affordable Care Act aims to do so by accelerating data collection, funding community health centers, increasing racial and ethnic diversity in the health care professions and, by 2014, providing affordable health insurance for all through insurance exchanges.

Insurance rebates

Effective: June 1, 2012. The biggest impact from health care reform consumers may feel in 2012 is actually the result of an initiative that began last year called the medical loss ratio (MLR). This formula requires health insurance companies to spend at least 80 percent of their premiums on direct medical care or quality improvement or 85 percent for large group-based plans. Those that don’t meet the mark must provide a rebate to policyholders.

Electronic records

Effective: October 1, 2012. Health care remains one of the few industries still tied to paper records. The new law kicks off a series of changes to usher in electronic records.

The savings from non-duplication of services alone could be staggering. One physician points out, “Say a patient comes to me with a painful knee, and I take an X-ray. And tomorrow, their knee is worse, and they go to the emergency room. If the ER physician can’t see the X-ray I did yesterday, they’re going to do another X-ray. The patient is going to get double X-ray exposure and double expense.” If the information is available to other physicians, it helps both on cost and patient safety.

Value-based purchasing

Effective: October 1, 2012. Another piece of health care reform that starts in 2012 under the law is Medicare’s new Value-based Purchasing program (VBP) which is designed to improve the quality of patient care by linking provider payments to the cost and quality of the care they provide. It also requires that hospital performance statistics be made publically available for the first time.

Some physicians believe VBP is the payment paradigm of the future. The idea is to pay better for quality medical groups and doctors who have low infection rates (and) high scores on quality measures for care of diabetes, asthma, heart failure, low hospital readmission rates. The model pays for quality—meaning value—as opposed to just volume.

Source: Jay MacDonald, January 06, 2012, Bankrate.com

Brown & Toland Among 32 “Pioneers” to Test HHS’ New Health Care Model for Seniors

Thirty-two groups were named by the Department of Health and Human Services (HHS) on Monday to test a new health care model, called for in the health care law, which is designed to improve quality of health care while reducing costs.

The groups, which range from Boston-based Partners Healthcare, the largest health care provider in Massachusetts, to San Francisco-based Brown & Toland, were selected as the first Medicare accountable care organizations (ACOs) by HHS. The networks, which begin January 1, are designed to save $1 billion over five years by promoting coordination between doctors and hospitals and ensuring that people with chronic conditions such as diabetes or high blood pressure get the care they need to stay out of the hospital.

The Pioneer ACO Model is designed for health care organizations and providers that are already experienced in coordinating care for patients across care settings. It will allow these provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with, but separate from, the Medicare Shared Savings Program. And it is designed to work in coordination with private payers by aligning provider incentives, which will improve quality and health outcomes for patients across the ACO, and achieve cost savings for Medicare, employers and patients.

The payment models being tested in the first two years of the Pioneer ACO Model are a shared savings payment policy with generally higher levels of shared savings and risk for Pioneer ACOs than levels currently proposed in the Medicare Shared Savings Program. In year three of the program, participating ACOs that have shown a specified level of savings over the first two years will be eligible to move a substantial portion of their payments to a population-based model. These models of payments will also be flexible to accommodate the specific organizational and market conditions in which Pioneer ACOs work.

The Pioneer ACO Model includes strong patient protections to ensure that patients have access to and receive high quality care. To accomplish this goal, Pioneer ACOs will be expected to improve the health and experience of care for individuals, improve the health of populations, and reduce the rate of growth in health care spending. Participating ACOs will be held financially accountable for the care provided to their aligned beneficiaries. In addition, CMS will publicly report the performance of Pioneer ACOs on quality metrics, including patient experience ratings, on its website.

Click here for the full list of selected Pioneer ACOs.

Click here for the Pioneer ACO Fact Sheet.

Click here for FAQs about ACOs and Pioneer ACOSs.