Post on 26-Aug-2020
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Bart Wald MDHealthCare Partners Medical Group
Accountable Care Organizations:Roadmap for “Bending the Cost Curve ?”
Brookings-Dartmouth / Anthem / HealthCare Partners (California)
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HCP National Delivery System
California
• More than 500K Commercial (full capitated)
• 100K MAPD (full capitated)
• 35K Managed Medicaid (full capitated)
• Modest PPO business in Group Model
• 500 Employed MDS
• 2000 contracted MD
Florida
• 40K MAPD (full capitated)
Nevada
• 36K MAPD (full capitated)
HealthCare Partners’ Vision
HealthCare Partners will be the role model for
integrated and coordinated care, leading the
transformation of the national healthcare
delivery system to assure quality, access, and
affordable care for all.
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HealthCare Partners’ Delivery System
• Global Capitation Predominates
• Physician-Led, Professionally Managed
• Centrally Coordinated
• Regionally Driven
• Strong Medical Management Infrastructure
• Robust Deployment of Technology
• Robust MAPD Growth: Acquisitions and Organic Growth
• Metrics Driven
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The Care Team Approach
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PCPs
Specialists
Nurses
Care Managers & Disease Managers
Disease Educators
Social Workers
MAs
Interactive and collaborative teams
of clinicians support HealthCare
Partners clinical programs.
High Risk Programs
• HomeCare
• Comprehensive Care Center
• ESRD
Disease Management Programs
• Diabetes
• CHF
• COPD
• ESRD
HCP selected by Dartmouth Brookings to be one of 5
national sites for Commercial ACO project
D-B developed ACO concept and advises Feds and
health plans on implementation
HealthCare Partners
Medical Group
Torrance, CA
Monarch HealthCare
Orange County, CA
Carilion Clinic
Roanoke, VA
Norton Healthcare
Louisville, KY
Tucson Medical
Center
Tucson, AZ
HealthCare Partners: A Brookings-Dartmouth
National ACO Pilot Site
Elements of this Pilot:
• Partnership with Commercial Insurer
• Attribution Model
• Historical Trending
• Multi-year Commitment
• Quality / Service / Transparency
• Financial Model
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“2011” ACO Pilot: Current Basic Assumptions
• Product is a Commercial PPO
• Anthem is the payer,
• Members will not prospectively select an ACO
provider,
• PPO benefits will stay same
• Patients will have choice to participate
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Evolving ACO Care Management
Encounter data submission: Delegation for ambulatory referrals:Delegation for preadmissions:Full hospitalist implementation:Telephonic case management: - complex/chronically ill attributed patientsPoint of care reminders: 1. Anthem downloads claims2. Identification of care gaps3. Clinical reviewer Patient education:Disease management:- complex/chronically ill attributed patientsContracted Provider incentives,Health Risk AssessmentsPCP/Provider Assignments (Health Coach)
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Where Do Future Savings Come
From?
Reduced Inpatient Days
Preventive Care
Increased Generic Rxs
Appropriate Use Of Specialists
Appropriate Place of Service
Value Based Hospital Selection
HCP ACO Objectives
• Strategic positioning for Medicare ACO pilots
starting in 2012
• Source of future profitable commercial growth
• IPA PCP differentiator
• Contribute to positive health care outcomes and
bend cost curve
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Hospitals Aligning Incentives
• Modified Contracts
• Incremental ACO volume
• Hospitalist assistance with public
programs
• Shared Savings?
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Brookings-Dartmouth ACO Collaborative
Pilot Sites
In-depth consultation, technical assistance, and data analysis for participating health
systems and payers.
Learning Network
Offers practical guidance and a forum for interested parties to learn from one another
throughout the process of planning and implementation
Community Initiatives
Serve as strategic support for regions interested in piloting this at the community-
level.
Washington Support
Serve as a resource for legislative and executive staff on delivery system reform,
specifically related to the ACO model.
Principal Goal
To engage stakeholders in piloting the ACO model and produce a
successful and replicable model that can be implemented nationwide.
THE BIGGEST CHALLENGE
PULL
Not A
PUSH
STRATEGY
So, What is an ACO?
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LET’s HOPE ITS NOT A
ANY CARTEL
ORGANIZATION
ANY CRAPPY
ORGANIZATION