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TRANSCRIPT
Future of Health Care:
How Do You Fit In?
Brian M. McCook, CPA
Physician Leadership Institute – February 28, 2015
Learning Objectives
Industry Transitions
Challenges and Changes
ACO’s
Look at the Future
Where We Came From…
Fee For Service
Lack of Technology and Data
Silo mentality
Quantity without quality
Where we are going…
Value based payments
Utilization of Technology and Data
Population Health Management
Quality/Outcomes focused
Graph of Costs
Medical Care and Outcomes are suboptimal
Challenges
The best and brightest are not choosing the medical profession
Liability reform is an issue
Employment vs. private practice
Patient engagement
What needs to change?
New relationships between Hospitals,
Physicians, insurance plans, pharmacies,
employers and DME.
What needs to change in the new world for
physicians to be engaged?
Changes
Compensation based on training, experience
and effectiveness of physician with bonuses
based on team and individual goals.
Integration of team-based models
• Financial and clinical
Utilization of clinical and administrative IT
Changes
Physicians in Organizational Leadership
• Support tools and resources
Employed and independent physicians
Total patient engagement and experience
What care delivery models are available?
ACO’s
Joint Ventures
Independent Practice
ACOs
An accountable care organization (ACO) is a
healthcare organization characterized by a
payment and care delivery model that seeks to
tie provider reimbursements to quality metrics
and reductions in the total cost of care for an
assigned population of patients.
Why did Congress include ACOs
in the law?
Medicare became a prime target
ACOs make providers jointly accountable for
the health of their patients
ACOs are projected to save Medicare up to
$940 million in their first four years
How are ACOs paid?
ACOs create an incentive to be more efficient
by offering bonuses
Doctors and hospitals have to meet specific
quality benchmarks
ACOs –Payment
The law takes a carrot-and-stick approach by encouraging the formation ACOs in the Medicare program
• Providers make more if they keep their patients healthy.
• About four million Medicare beneficiaries are now in an ACO
• More than 428 provider groups have signed up
• An estimated 14 percent of the U.S. population is now being served by an ACO
ACOs Metrics
Quality performance standards
• 37 in total at this point
• Physician driven
Shifting towards prevention and wellness
services to manage chronic diseases and keep
populations healthier
Are ACOs the End Game?
“ACOs aren’t the end game,” says
Chas Roades, chief research officer
at The Advisory Board Company in
Washington D.C.
Current ACO results…
In July, nearly a third of the Pioneer ACOs announced they were dropping out of that program in which providers take on the greatest financial risk.
Some left because they didn’t save enough money, although seven said they would participate in a second Medicare ACO model with less risk of losing money.
Current ACO results…
There were also positive developments: All 32
Pioneers succeeded in improving quality and
performed better than fee-for-service Medicare
in 15 quality measures, according to CMS. And
they generated a gross savings of $87.6 million
in 2012, the first year of the program.
ACO’s End Game?
One of the key challenges for hospitals and physicians is that the incentives in ACOs are to reduce hospital stays, emergency room visits and expensive specialist and testing services
The ultimate goal would be for providers to take on full financial responsibility for caring for a population of patients for a fixed payment, but that will require a transition beyond ACOs.
So Where Is The Industry?
Moving from Fee-for-service to Quality Based Reimbursement
New Compensation Models
Population Health Management
Technology and Data
Questions
Future of Health Care: How Do You Fit In?
Anders Health Care Services optimizes staff,
resources and revenue for hospitals and
physicians by offering solutions and direction to
complex practice management issues.
We provide an integrated approach from the
financial, operational, compliance and strategic
perspectives
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