Martin Pearson, President
Troy Gautier, Managing Director
YOUR LOGO
Accountable Care Organizations (ACO)
 ACOs are the future of integrated collaborative Health Care solutions and
provide the best opportunity to improve services and reduce costs.
 Alliances Progress and Revcon Alliances are professional consulting firms
specialized in designing and implementing ACOs.
 Our service offering provides the support and expertise to ensure
successful delpoyment of your ACO and the quickest return on
investment in the healthcare industry. Major workstreams include:
 Design – people, process, technology and lean operating models
 Build – health care team, payer-provide relations, shared best practices
 Optimize – assist physicians and adminsitrative staff to obtain & measure results
 The following pages provide an overview of our approach and credentials.
 Managment consultants and business/technology process specialists
 Alliance professionals with hundreds of projects building succesful ecosystems
 HC IT speicalists to carry-out package selction and implement solutions
Page  2
YOUR LOGO
ACO Presentation
Index
1
History and Context
2
Legislation – Affordable Care Act
3
ACO Examples
4
How to build an ACO
5
6
Roles & Responsabilities
7
Next Steps
8
Contact Us
Page  3
RevCon Alliances and Alliances Progress
YOUR LOGO
History - background for ACOs
Better health care solutions are a moral and economic imperative !
Accountable Care Organizations
 ACOs were created as a result of the Affordable Care Act (ACA) that was signed
into law March 23, 2010.
 CMS and the Congressional Budget Office agree the purpose of ACOs is to
ensure quality service and reduce costs. Also, to ensure that the Medicare
budget grows no faster than the rate of growth of the economy in general.
 Hospital specific index of costs has historically grown at a rate double that of the
consumer price index. This growth rate is unsustainable given the arrival of
Baby Boomer patients in the coming years.
 The ACA created a demonstration period that runs between 2012 and 2014. As
of 12/31/2012 close to 200 ACOs have been established and this number is
expected to double or triple by 2014.
 Full implementation begins 2015 and runs to 2020 when it’s expected that
virtually all Medicare payments to providers will flow through ACOs.
Page  4
YOUR LOGO
Context - for ACOs
Better health care solutions are a moral and economic imperative !
Context
 All ACOs have a common objective built around three core tenets:
1. Patient Satisfaction
2. Improved Outcomes
3. Affordability
 An ACO’s success requires thinking about all collaboration of
stakeholders and patient-centricty in a seamless care continuim.
 ACOs can be considered a preferred procurement program where by
Medicare only reimburses for services to its beneficiaries to providers
adhearing to this program.
 ACO design, build and optimization is greatly enhanced by the use of
alliance professionals and consultants who understand how to make the
complexities of advanced collaborative solutions work.
Page  5
YOUR LOGO
Legislation - Affordable Care Act (ACA)
Incentive Payments and Autorization
• Under the ACA, the Secretary of
Health and Human Services
established ACOs to promote best
practices and funnel incentive
payments to healthcare providers.
• Two ways to authorize an ACO:
1. Physician only with minimum of
5,000 Medicare enrollees
where physicians own and
control the network.
2. Hospital sponsorship as long
as there is physician cosponsorship with a minimum of
5,000 Medicare enrollees .
Page  6
YOUR LOGO
ACO Requirements
ACA requirements to form an ACO under Medicare Shared Savings Program
• Define processes to promote the practice of evidence-based medicine
and provide data to evaluate quality and cost measures.
• Build a management and leadership structure that includes
administrative and clinical systems.
• Develop a formal legal structure that allows the organization to receive
payments and distribute shared savings among participating providers.
• Have enough primary care providers to provide care to a minimum of
5,000 Medicare beneficiaries.
• Provide the Centers for Medicare & Medicaid Services with a list of
participating primary care practitioners and specialists.
• Contract with a core group of specialist physicians.
• Agree to participate in the program for a minimum of three years.
Page  7
YOUR LOGO
ACO Examples in Georgia
WellStar Health Network, LLC
 Located in Marietta, Georgia, is comprised of partnerships between hospitals
and ACO professionals, with 1,203 physicians. It will serve Medicare
beneficiaries in Georgia.
Piedmont Physicians Group
Piedmont Physicians Group launched a pilot ACO with Cigna in July 2010. The
ACO covers about 10,000 people in Cigna health plans. Under the pilot, Cigna
pays the providers of Piedmont Physicians Group — which includes more than
100 primary care physicians — as usual for medical services, along with an
additional fee for care coordination and medical home services. Physicians also
get bonus payments if they meet targets for better quality and lower costs.
Accountable Care Coalition of Greater Athens Georgia
The Coalition of Athens Area Physicians partnered with Collaborative Health
Systems to form the ACC of Greater Athens Georgia, which is participating in the
Medicare Shared Savings Program. The Coalition includes more than 230
independent physicians. Approximately 8,500 Medicare beneficiaries are covered
by this ACO.
Page  8
YOUR LOGO
Challenges to ACO Formation and Optimization
Capital
Investment
 ACO require significant up-front capital. The development of a strong IT
framework alone requires a sizable capital investment. Access to
capital may be challenging for some organizations but can be obtained.
•
Physician buy-in
Some physicians may have concerns about relinquishing autonomy
and may resist shared-payment arrangements. There is a cultural
challenge to obtain agreement. Alliance professionals and facilitating
consultants may be necessary at this stage.
Patient buy-in
 Patients likely will be assigned to an ACO, but they also will be allowed
to see providers outside of the ACO. ACOs will need to educate
consumers about their role in reducing costs and improving quality.
Organizational
Sharing
Strategies
 ACOs require the coalescing of diverse provider groups to develop a
new system of care with the aim of improving quality and reducing
costs. The move from a “fee for service” to a “fee for outcome”
system requires creative collaborative solutions: physician
alignment is key.
Page  9
Source: H&HN research 2011
YOUR LOGO
Design, Build and Optimize an ACO
Five crucial steps to implementing an ACO
•
Create legal entity
•
Patient-centered processes
•
•
Assess capital strategy
•
•
Conduct gap analysis
Patients involved in own
care and decision-making
Performance
improvements
•
•
Analyze market and
assess ACO position
Quality
improvements
•
Quality reporting
Formalize &
Funding
Page  10
•
Primary care model refined
•
Patient education
Physician
buy-in
Patient
buy-in
Shared
EMR
Change
Mgmt
•
Develop plan for
physician integration
•
Develop IT investment
plan
•
Design strategic
partnerships
•
Design & implement
EHR and HIE
•
Structure comp for
ACO-oriented culture
•
Real-time access of
clinical data
YOUR LOGO
Stages of ACO Development – where are you today?
Early Adapter – ACO has been launched
These organizations will have the funding, the physician support, the talented
leadership to make decisions, and the confidence to move before their
competitors. They will have first mover advantage.
Join Up – Partner with an existing ACO
These organizations will watch the first movers, save their own cash, and simply
join by contract with what they perceive to be the dominant local ACO.
Wait and see – join an ACO at the 11th hour
Many organizations choosing to stay outside the process for ideological reasons
will be sorry once the new Medicare juggernaut gets rolling. CMS encourages this
group to find ways to connect to larger organizations.
Next wave - ACO 2.0
In this approach regional competitor systems might come together with the
blessing of the antitrust watchdogs to create large networks to serve regional
populations more effectively..
Page  11
YOUR LOGO
Roles and Responsibilities
and Services Provided by Consultants
Provider Organizations
 Patient centered primary
care model
 Patient education
 Gather key decisionmakers together
 Agree to a governance
model
 Agree to operating
principals
 Establish a strong
communications plan
 Gain buy-in from key
stakeholders
Page  12
Alliance
professionals/consultants
 Executive leadership and
oversight
 Clinical managerment
systems
 Physician leadership and
synergy developement
 Quality recording and
reporting
 Drive and contract
relationships with other
service and technolgy
providers
 Robust IT infastructure
 Prepare and facilitate
meetings
 Assist in implementation
strategies
 Operationalize decisions
Source: H&HN research 2011
Governance
 Relations with
governement entities
 Relations with
adminsitrative staff
 Planning – short and long
term
 Formal reporting
YOUR LOGO
Alliances Progress and RevCon Alliances
Alliances Progress:
• Experts in creative collaborative solutions and
ecosystem development
• 20+ years in major global consultancy
• Strong network of HC and IT providers
RevCon Alliances:
• 15+ year management level with high tech
companies in the healchcare sector
• Expertise in health IT, physician alignment and
relationships with community providers along the
continuum
Page  13
YOUR LOGO
Martin Pearson, CPA, President
RevCon Alliances
2402 River Green Drive NW
Atlanta, GA 30327
O: 404-842-1215
C: 404-374-9565
martinp@revconalliances.com
Twitter: revconalliances
website: www.revconalliances.com
Troy J Gautier, Managing Director
Alliances Progress
1085 Richmond Glen Cir
Alpharetta, GA 30004
Tel: 678-644-2533
TroyGautier@AlliancesProgress.com
http://alliancesprogress.com/strategic-alliances/what-isan-accountable-care-organization-aco/
Page  14
YOUR LOGO