accountable care organizations
DESCRIPTION
ACCOUNTABLE CARE ORGANIZATIONS. Changing the Payor – Provider Relationship Presentation for the California Association of Health Plans 2011 Seminar Series: Accountable Care Organizations: The Evolution of Healthcare Delivery February 23, 2011. I. HOW IMPORTANT ARE ACOS?. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/1.jpg)
MEYER CONSULTING5900 N. Granite Reef RoadSuite 100Scottsdale, AZ 85250
Phone: 602/321.0753
www.meyerconsultinginc.com
Changing the Payor – Provider Relationship
Presentation for the CALIFORNIA ASSOCIATION OF HEALTH PLANS
2011 Seminar Series:
Accountable Care Organizations: The Evolution of Healthcare Delivery
February 23, 2011
![Page 2: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/2.jpg)
MEYER CONSULTING5900 N. Granite Reef RoadSuite 100Scottsdale, AZ 85250
Phone: 602/321.0753
www.meyerconsultinginc.com
Results from a nationwide survey
of hospitals, health plans and
multi-specialty medical groups
regarding trends in contracting
and partnerships
![Page 3: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/3.jpg)
MEYER CONSULTING Proprietary & Confidential3
![Page 4: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/4.jpg)
MEYER CONSULTING Proprietary & Confidential4
![Page 5: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/5.jpg)
MEYER CONSULTING Proprietary & Confidential5
![Page 6: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/6.jpg)
MEYER CONSULTING Proprietary & Confidential6
![Page 7: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/7.jpg)
MEYER CONSULTING Proprietary & Confidential7
![Page 8: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/8.jpg)
MEYER CONSULTING Proprietary & Confidential8
![Page 9: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/9.jpg)
MEYER CONSULTING Proprietary & Confidential9
![Page 10: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/10.jpg)
MEYER CONSULTING Proprietary & Confidential10
“Hospital and physician partnerships are obvious…hospitals need
the physicians’ cooperation to drive more effective and efficient
outcomes. The health plan partnership will need to evolve to align
financial incentives equitably and appropriately. It will be a
challenge to change from the current adversarial partnership of
necessity to one that is collaborative.” – Health Plan Respondent
![Page 11: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/11.jpg)
MEYER CONSULTING Proprietary & Confidential11
![Page 12: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/12.jpg)
MEYER CONSULTING Proprietary & Confidential12
![Page 13: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/13.jpg)
MEYER CONSULTING5900 N. Granite Reef RoadSuite 100Scottsdale, AZ 85250
Phone: 602/321.0753
www.meyerconsultinginc.com
![Page 14: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/14.jpg)
MEYER CONSULTING Proprietary & Confidential14
Old Paradigm
● Reimbursement,
● Market Share,● Quality
New Paradigm● Quality● Improving
patient/provider satisfaction
● Bending the cost curve
● Market Share● Aligned Incentives
![Page 15: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/15.jpg)
MEYER CONSULTING Proprietary & Confidential15
Health Plan• Culture• Mission• Vision
Hospital• Culture• Mission• Vision
Physicians• Culture• Mission• Vision
Leadership
Leadership
Leadership
ACO• Culture• Mission• Vision• Leadership
![Page 16: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/16.jpg)
MEYER CONSULTING Proprietary & Confidential16
Health Plan• Culture• Mission• Vision
Major Corporation• Culture• Mission• Vision
Physicians• Culture• Mission• Vision
Leadership
Leadership
Leadership
ACO• Culture• Mission• Vision• Leadership
![Page 17: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/17.jpg)
MEYER CONSULTING5900 N. Granite Reef RoadSuite 100Scottsdale, AZ 85250
Phone: 602/321.0753
www.meyerconsultinginc.com
![Page 18: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/18.jpg)
MEYER CONSULTING Proprietary & Confidential18
Basically, “organizational culture” is the defining characteristics of an organization.
Culture is comprised of the values, norms, mission and vision of organization members and their behaviors.
![Page 19: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/19.jpg)
MEYER CONSULTING Proprietary & Confidential19
● Physician-Centric● Academic● Technology-Centric● Intrapreneurial● Continuous Process Improvement● Not-For-Profit● For-Profit● System
![Page 20: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/20.jpg)
MEYER CONSULTING Proprietary & Confidential20
Culture A
Xxx
Xxx
Xxx
Xxx
Culture B
Xxx
Xxx
Xxx
Xxx
First, break down the member’s cultures into their defining characteristics.
Identify those that are similar, coordinating, or synergistic.
![Page 21: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/21.jpg)
MEYER CONSULTING Proprietary & Confidential21
Partnership Culture
Xxx
Xxx
Xxx
Culture A
Xxx
Xxx
Xxx
Xxx
Culture B
Xxx
Xxx
Xxx
Xxx
Those make up your partnership culture!
![Page 22: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/22.jpg)
MEYER CONSULTING5900 N. Granite Reef RoadSuite 100Scottsdale, AZ 85250
Phone: 602/321.0753
www.meyerconsultinginc.com
![Page 23: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/23.jpg)
MEYER CONSULTING Proprietary & Confidential23
Good or bad partners?
![Page 24: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/24.jpg)
MEYER CONSULTING Proprietary & Confidential24
Put three in mix – even harder
![Page 25: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/25.jpg)
MEYER CONSULTING Proprietary & Confidential25
Four even harder
![Page 26: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/26.jpg)
MEYER CONSULTING5900 N. Granite Reef RoadSuite 100Scottsdale, AZ 85250
Phone: 602/321.0753
www.meyerconsultinginc.com
![Page 27: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/27.jpg)
MEYER CONSULTING Proprietary & Confidential27
Would HCA and Humana be good partners?
![Page 28: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/28.jpg)
MEYER CONSULTING Proprietary & Confidential28
Would Mayo and Humana be good partners?
![Page 29: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/29.jpg)
MEYER CONSULTING Proprietary & Confidential29
What about HCA, Mayo and Humana?
![Page 30: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/30.jpg)
MEYER CONSULTING Proprietary & Confidential30
Blue Shield, CHW, Hill Physicians Group and CALPERS (actual case)
![Page 31: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/31.jpg)
MEYER CONSULTING Proprietary & Confidential31
Test motivation of the potential partner Are they responding promptly? Have they assigned senior people? Do you have a shared vision? Will the partnership work in the long
run?
![Page 32: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/32.jpg)
MEYER CONSULTING Proprietary & Confidential32
● Test if Potential Partner has Ability to Execute On core competencies Financial resources If not, can they get there?
![Page 33: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/33.jpg)
MEYER CONSULTING Proprietary & Confidential33
● If Partner is a Provider how are Physicians being paid?
● Test Sophistication to be a Partner● Is there a solid Board structure?● Is there a commitment to Evidence-
Based Medicine?
![Page 34: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/34.jpg)
MEYER CONSULTING5900 N. Granite Reef RoadSuite 100Scottsdale, AZ 85250
Phone: 602/321.0753
www.meyerconsultinginc.com
![Page 35: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/35.jpg)
MEYER CONSULTING Proprietary & Confidential35
● Embedded model● Separate company by one or more of
the partners● Separate ACO/corporation formed by
the partners
![Page 36: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/36.jpg)
MEYER CONSULTING Proprietary & Confidential36
●Ability to align financial and quality incentives
●Commitment to ACO Mission and Vision
●Physician-centric● Innovator●Capable of integrating teams●Technology-centric●Understanding of quality●Entrepreneurial●Someone who gets things done
![Page 37: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/37.jpg)
MEYER CONSULTING Proprietary & Confidential37
● Evaluate existing leadership team against characteristics listed on prior slide.
● Each partner must have a leader who other partners see as competent, fair and committed. If you don’t have that the ACO partnership WILL FAIL.
![Page 38: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/38.jpg)
MEYER CONSULTING Proprietary & Confidential38
● If you don’t have the right leadership, consider:● Using consultants to help formulate
mission, vision and core competencies you are looking for.
● Having consultants drive the process (but only for a limited period of time).
● Using executive search to find the right leaders if they don’t exist in your organization or if they are overcommitted.
THE RIGHT STRATEGIES OFTEN FAIL BECAUSE OF POOR EXECUTION!
![Page 39: ACCOUNTABLE CARE ORGANIZATIONS](https://reader031.vdocuments.site/reader031/viewer/2022032612/568132a0550346895d994148/html5/thumbnails/39.jpg)
MEYER CONSULTING Proprietary & Confidential39
Mike MeyerPresident
Meyer Consulting5900 North Granite Reef Road
Suite 100Scottsdale, AZ 85250
Phone: 602/[email protected]
www.meyerconsultinginc.com