What's an ACO?

 Contact:    David  Parpart,  D.C.  ,  CEO    Socially  Relevant  Inc  408-­‐421-­‐9508    [email protected]    

What’s an ACO?

 Accountable  Healthcare  Pla9orm  for  Pa<ent  Engagement  Solu<ons  Pharmacist  Counseling  |  Mobile  Applica<ons  |  Remote  Monitoring  

Drivers of Healthcare Reform Economics

Healthcare Reform Puts 6% of Hospital Revenue at Risk

2%  annual  payment  update  at  risk  by  FY2017  

1%  DRG  payment  penalty  FY2013,  rising  

to  3%  by  FY2015

1%  DRG  payment  penalty  for  hospitals  in  

worst  quartile  beginning  FY2015

• Value-­‐based  Purchasing • Process  of  care • Patient  experience  Begins  FY2013

• 30-­‐Day  Readmissions • Up  to  8  conditions  targeted  including  AMI,  HF,  PNA  

• Hospital-­‐Acquired  Conditions

• Up  to  8  conditions  targeted  

ConfidenBal-­‐  Socially  Relevant  Inc.  

What’s an ACO?

ConfidenBal-­‐  Socially  Relevant  Technology  

ConfidenBal-­‐  Socially  Relevant  Inc.  ConfidenBal-­‐  Socially  Relevant  Technology  

Al a Carte

All Inclusive

A Business Model Volume vs. Capitation

IMAGE  SOURCE:  NEHI  Roadmap  to  Improving  MedicaBon  Adherence,  2012  

SOURCE:  New  England  Health  InsBtute,  2012    

Accountable  Care  OrganizaBon  (ACO)  

Accountable Care Organization (ACO) Risk and Reward

Every Hospital has risk of loss/penalties   2/3 penalized in Oct 2012 Health Organizations APPLY to form an ACO   Assume risk   Gain NEW REVENUE OPPORTUNITY through Medicare

Shared Saving Program ACO’s Need New Patient Engagement Strategies   Section H of the MSSP Application

ACO – Healthcare’s New Business Model Value Based Purchasing and Shared Savings

Better Care Experience

Lower Costs

Better Population Health

Metrics: Patient Experience Patient Activation Measures Metrics: Readmission Rate Total PMPM & Trend Metrics: HEDIS

Cost Savings New Revenues

Capitated Payment

ACO – Healthcare’s New Business Model Example: Nephrology

Better Care Experience

Lower Costs

Better Population Health

Doctor/Pharmacist/Patient Collaboration

$178M Reduction in Part A $ 23M Increase in Part D $155M net savings

Cost Savings New Revenues

Capitated Payment

$155M net savings X 60% = $90M

What is the Lowest Hanging Fruit for ACO Profitability?

$700Bn

$290Bn

$30Bn

• Duplication of Services

• Fraud

• Poor Med Adherence

• Avoidable Hospitalizations

ConfidenBal  Do  Not  Distribute