Maine Association of Area Agencies on Aging:
Aging Advocacy Summit
November 14, 2012
Bill Wypyski, LCSW, MPA, MS
Chief Executive Officer
Harrington Family Health Center
Chair, Management Committee
Maine Community Accountable Care Organization
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Describe Accountable Care Organizations
Describe the 4 Maine Based Accountable
Care Organizations
Describe how Patients/Consumers fit into
the system and where they have
opportunities to advocate for change
An ACO is a legal entity, typically comprised of a health system or independent
provider organizations, that contracts with CMS under the Shared Savings
Program with an objective of creating efficiency against historical benchmarks for
service delivery
CMS will share a portion of the savings generated by the ACO with the organization
ACOs were designed with a three-part objective – Donald Berwick’s “Triple Aim”:
1. Better Care – in a safe environment, equitable to all who seek
it and available when needed
2. Improved Health – accomplished through prevention and
chronic care management
3. Lower Costs – intended to reduce the trend of cost increases
associated with the Medicare FFS population
• Patients are assigned to the ACO based upon their
pattern of utilization
• Minimum 3-year agreement
• Required to have structure to receive and distribute
payments for shared savings
• Enough Primary Care Physicians (PCPs) and other
providers to care for assigned patients (minimum 5,000)
• Participation voluntary for providers
• PCPs can only participate in one ACO
• Providers still paid fee-for-service payments by CMS
• Shared savings payments distribution made by ACO
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Maine Community Accountable Care
Organization
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Central Maine Accountable Care Organization
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MaineHealth Accountable Care Organization
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EMHS Accountable Care Organization
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Maine’s Accountable Care Organizations
Patient Centered Medical Homes
Meaningful Use – Measuring Quality
Electronic Medical Records/Practice
Management Systems
Integration of Primary Care and
Behavioral/Mental Health Treatment
Partnering w/ Hospital, Healthcare
Systems and Outpatient Care Systems
Exchange of Electronic Patient Data
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Healthcare is about all of us working together
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Providers
Patients
Family Members
Community Members
Getting Educated
◦ Attend workshop/join organizations
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Speaking Up and Asking Questions
◦ Ask your providers, insurance comp., etc. Questions
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Taking responsibility for your own health
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Accountable Care Organization Boards
◦ Medicare Beneficiary Representative
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Health Organization Boards
◦ Contact you local community health center, hospital
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Network
◦ There are healthcare related conferences/meetings
throughout the year – example: Quality Counts
◦ News – local and national
◦ Organizations such as the AARP
◦ Healthcare Legislation
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We have a “Disease Management” system
Need to base reimbursement on outcomes
Simple life choices = Big difference
Discover people’s true problems
“Interested in patients, not productivity”
2.7 Trillion spent annually on health care
We spend more and get worse outcomes
◦ High Tech, Rescue Care, Medications, etc.
Questions?
It’s up to all of us where we go from here!
Bill Wypyski, LCSW, MPA, MS
Chief Executive Officer
Harrington Family Health Center
(207)483-4502
bill.wypyski@harringtonfamilyhealth.org