Great animation poking fun at Hospital Executives that have yet to learn about ACOs!

A must view to understand the level of insight around ACOs by Healthcare Executives!

http://www.youtube.com/watch?v=lF8bK7AJyL0

19 Health Systems to Participate in AMGA Collaborative on Developing Accountable Care Organizations

5 Million Patients to Benefit from Improved Quality and Efficiency

Newswise — The American Medical Group Association (AMGA) today announced 19 leading medical groups and organized systems of care that will be participating in its ACO Development Collaborative, scheduled to have its first meeting in conjunction with the AMGA National Summit on Accountable Care Organizations (ACOs). These organizations represent more than 10,500 providers serving approximately 5 million patients in the United States.

http://www.newswise.com/articles/19-health-systems-to-participate-in-amga-collaborative-on-developing-accountable-care-organizations

Washington Post: Debate over whether big health systems help cut costs

In Roanoke, Va., one company owns the city's two hospitals and six others in a region of 250,000 residents, commanding the area's largest economic engine and a workforce that includes 550 doctors, The Washington Post reports. Carilion Clinic's consolidation has sparked a local row: Is this the future of integrated, efficient health care delivery, or is it a gilded-age style monopoly?

http://www.news-medical.net/news/20100816/Washington-Post-Debate-over-whether-big-health-systems-help-cut-costs.aspx

Hospital CFOs as Quality Leaders

When Paul Weygandt was presenting to a room full of hospital CFOs about the potential ramifications of the not-yet-passed healthcare reform legislation last year, he asked for a show of hands of how many in the room were involved in their organization’s clinical quality program. Not many went up.

http://www.healthleadersmedia.com/content/FIN-255173/Hospital-CFOs-as-Quality-Leaders##

Insights From the Model for ACOs: Q&A With Harold Dash of Everett Clinic on the Medicare Physician Group Practice Demonstration Project

Harold Dash, MD, a cardiologist, is president of the Everett (Wash.) Clinic, a group practice with more than 300 physicians. Here Dr. Dash discusses Everett's participation in the Medicare Physician Group Practice Demonstration Project, the model for the accountable care organization, a new system that bundles charges for hospitals, physician and other providers.

Question: What was the goal of the Medicare Physician Group Practice Demonstration?Harold

Dash: The goal was to lower costs and improve the quality of patient care. It involved 10 large physician groups across the country serving a total of 223,203 Medicare fee-for-service patients. Some of the practices are freestanding like Everett and some are integrated into health systems. The project lasted five years, ending this spring. Participants received the usual fee-for-service payments and then were eligible for cost performance payments and quality performance payments.

http://www.beckershospitalreview.com/hospital-physician-relationships/insights-from-the-model-for-acos-qaa-with-harold-dash-of-everett-clinic-on-the-medicare-physician-group-practice-demonstration-project.html

AMGA releases the 7 principles of an ACO

http://www.amga.org/AboutAMGA/ACO/principles_aco.asp

Columbia, S.C.-Area Health Systems Poised to Expand Despite High Unemployment and Uninsured Rates

Columbia Market Overview Now Available from HealthLeaders-InterStudy
NASHVILLE, Tenn., Aug. 12 /PRNewswire/ -- HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that despite the state's high unemployment rate and an increasing number of uninsured residents in the Columbia, S.C. market, health systems will likely expand over the coming 12 months. According to the recent Columbia Market Overview, Palmetto Health, Lexington Medical Center and Sisters of Charity Providence Hospitals have brokered a deal that should allow each to expand services and facilities free from the presence of drawn-out certificate-of-need appeals.

http://www.prnewswire.com/news-releases/columbia-sc-area-health-systems-poised-to-expand-despite-high-unemployment-and-uninsured-rates-100532729.html

The Coming Challenges—and Opportunities—of Value-Based Purchasing

The Coming Challenges—and Opportunities—of Value-Based Purchasing
The Patient Protection and Affordable Care Act was signed into law in March, furthering the federal government’s commitment to increasing the efficiency of the U.S. healthcare system by decreasing cost and improving quality. An expansion of the “value-based purchasing” model, this law mandates that ratings and reimbursements to physicians and hospitals be increasingly tied to measured quality of care.

http://www.the-hospitalist.org/details/article/764899/The_Coming_Challengesand_Opportunitiesof_Value-Based_Purchasing.html

Health Care Transformation Leader to Present at Harvard Meeting

Taconic Health Information Network and Community's Susan Stuard will present building blocks for transformation Aug. 18 at Ninth National Quality Colloquium in Cambridge, Mass.
FISHKILL, N.Y., Aug. 12 /PRNewswire-USNewswire/ -- Across the nation, the changing health care environment is challenging physicians and other providers to redefine their roles within new models of care. The potential relationship between two models, the patient-centered medical home (PCMH) and the accountable care organization (ACO) will be explored by Susan Stuard, executive director of the Taconic Health Information Network and Community (THINC) at a meeting of quality leaders at Harvard University Aug. 16-19, 2010.

http://www.prnewswire.com/news-releases/hudson-valley-initiative-health-care-transformation-leader-to-present-at-harvard-meeting-100526509.html

Aurora joins accountability collaborative

Aurora Health Care has joined 50 other health care providers in a collaborative designed to boost accountability in health care.

Aurora said it joined the Accountable Care Organization Readiness Collaborative of Premier, a Charlotte, N.C.-based performance improvement alliance of more than 2,400 U.S. hospitals and 69,000-plus other health care sites working together to achieve quality, cost-effective care.Read more: Aurora joins accountability collaborative - The Business Journal of Milwaukee

Health Care Administrators Discuss Accountable Care at AMGA Meeting

Youtube video discussing ACOs at AMGA meeting.

http://www.youtube.com/watch?v=i0PgsH8QOoc&feature=related

Health reform will save Medicare billions, CMS says

Despite skepticism from Republicans, a new report concludes that the health system overhaul will more than double the life of the program.
By Chris Silva, amednews staff. Posted Aug. 10, 2010.

http://www.ama-assn.org/amednews/2010/08/09/gvsd0810.htm

New Collaboratives Getting Health Systems Ready for ACOs: Q&A With Blair Childs at Premier

Blair G. Childs, senior vice president for public policy at Premier Inc., explains how Premier's new accountable care collaboratives are helping health systems to get ready to launch accountable care organizations.

Question: Nineteen health systems are in Premier's Implementation Collaborative. What criteria have they met?

Blair Childs: These health systems are pretty much ready to begin implementing an ACO. They have executive sponsorship and participation, a payor partner is participating and the physician network has a sufficient population base, at least 5,000 lives. There is transparency and acceptance of common cost and quality metrics, such as QUEST or HEDIS. The system has population health data infrastructure through an EHR and is linked with the payor. Going forward, these systems must participate in work groups and meetings. They need to set up a legal entity that will function as an ACO contracting vehicle.

http://www.beckershospitalreview.com/hospital-physician-relationships/new-collaboratives-getting-health-systems-ready-for-acos-qaa-with-blair-childs-at-premier.html

BACON: A half-trillion-dollar delusion

After a three-month delay, the trustees of the Social Security and Medicare trust funds have finally published their annual report. Now we have an explanation for the wait. Thanks to program changes made by the Affordable Care Act (aka Obamacare), the report summary says, "The outlook for Medicare has improved substantially."

http://www.washingtontimes.com/news/2010/aug/6/a-half-trillion-dollar-delusion/

The Role of Physician-Directed Best Practices in Creating Successful Accountable Care Organizations

The economic challenges of the past decade have placed hospitals under unrelenting pressures to reduce costs while maintaining quality. With most of the stray dollars already found, any further cost cutting initiatives will likely bring with them the danger of compromised quality of care.

What healthcare organizations need to successfully respond to these challenges are new tools and new thinking with which they can maintain or increase their clinical quality and efficiencies. And more than ever before, physicians are the key. The next stage of improvement must be a collaborative effort among physicians, clinical staff members and executives, working together to develop innovative ways to improve patient care.

http://www.beckershospitalreview.com/hospital-physician-relationships/the-role-of-physician-directed-best-practices-in-creating-successful-accountable-care-organizations.html

5 Tips on Preparing for Accountable Care Organizations

In order to qualify as an ACO, an organization must:
1. Have a formal legal structure to receive and distribute shared savings.
2. Have at least 5,000 beneficiaries.
3. Participate in the program for at least three years.
4. Have sufficient information on participating ACO healthcare professionals.
5. Have a leadership and management structure that includes clinical and administrative systems.
6. Have defined processes to promote evidence-based medicine, report data to evaluate quality and cost measures and coordinate care.
7. Demonstrate that it meets patient-centered criteria.

http://www.beckershospitalreview.com/hospital-financial-and-business-news/5-tips-on-preparing-for-accountable-care-organizations.html

ACOs explained

http://www.youtube.com/watch?v=0y2zcynR8mE

Three Tiers of Accountable Care Organizations

If you've seen 1 ACO you have seen 1 ACO. See how they differ here...


http://healthcare-economist.com/2010/08/04/three-tiers-of-accountable-care-organizations/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+HealthcareEconomist+%28Healthcare+Economist%29

Kaiser Health News-8/3/10 Transcript

Transcript: Health On The Hill - August 3, 2010

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Topics: Medicaid, Health Reform, States, Politics
Aug 03, 2010
A Senate vote could come as early as Wednesday on a $16 billion Medicaid package for states. Meanwhile, a U.S. District Court judge has allowed a Virginia lawsuit challenging the health law’s requirement that individuals purchase health insurance to continue in the courts. A Missouri state ballot referendum to nullify the health law’s individual mandate is expected to pass today, although the measure is viewed as largely symbolic.
Watch video interview or Listen to audio version (.mp3)
Transcript:
LAURIE MCGINLEY: Good day. I am Laurie McGinley with Kaiser Health News, and this is Health on the Hill, where we discuss recent developments involving health care policy. Joining me today are Mary Agnes Carey with Kaiser Health News and Noam Levey with the L.A. Times/Tribune – Washington Bureau. Thank you both for joining us.
Mary Agnes, let’s start with you. Things have been pretty busy on the Hill, considering these are the dog days of August. There has been a lot of debate lately about Medicaid and whether Congress should provide the states with additional aid to Medicaid, considering the states’ budget problems, can you tell us where that stands at this point?
MARY AGNES CAREY: Senate Majority Leader, Harry Reid, is trying once again to pass a Medicaid package; we are talking about $16 billion that would extend the additional funding that was passed last year in the economic stimulus package for another six months.
Senator Reid had hoped to bring the Bill to a floor vote yesterday, but he found out a Congressional Budget Office score found that the bill would cost $5 billion more than they had realized. They are going to go back and they want to make it budget-neutral, so his hope is that he can bring the package to the floor as early as Wednesday for a vote.
LAURIE MCGINLEY: And if it comes to the floor, Noam, do you think it’s going to pass? How close will it be?
NOAM LEVEY: You know, they didn’t have the votes yesterday morning. They were working pretty hard to round them up. I think they think that they can get there if they come up with the offsets to actually make it budget-neutral.
The question then becomes when it goes, it has to go back to the House, can they round up the votes there? Because some of the offsets are going to be controversial with either liberals, cutbacks in some of the programs for helping the poor, or some of the taxes can be controversial as well, so I think that may be a big test as well.
LAURIE MCGINLEY: And if it doesn’t get wrapped up in the Senate this week, what is the likelihood it comes back in the fall after Labor Day?
MARY AGNES CAREY: I think it’s going to be a constant part of the discussion. I mean we have seen governors come to Washington, Democratic governors, Republican governors saying our budget started July 1st, we need this money. Several states have already included it in their budgets, and so you can continue the drum beat, the pressure from the governors to do this, and of course if it isn’t done before they adjourn for the elections, they being Congress, we could certainly see this in a lame duck session this fall.
LAURIE MCGINLEY: Noam, yesterday in terms of health care reform law, there was an important decision in Virginia, could you tell us a little bit about that court decision and what the implications are?
NOAM LEVEY: Sure. So this is the lawsuit that the state of Virginia filed challenging the new health care law, which is one of two legal challenges going on right now to the law. The decision yesterday was on a procedural question. The federal government, the Obama administration had moved to dismiss it, arguing that the state of Virginia didn’t have standing to challenge it, and that it was premature to do this.
Had the Obama administration prevailed in that, it sort of would have swept aside kind of this early legal test of the new law. The opposite happened. The judge in a fairly strongly-worded opinion said no. In fact, the state of Virginia’s case can go forward. The state has standing to do it. And there are some very big constitutional questions that this case raises.
Essentially what the judge signaled I think is that he doesn’t want to dismiss this case. He wants to have a full legal debate about whether congress can mandate people to buy health insurance, which of course is the central and very controversial question at the core of the health care reform bill.
LAURIE MCGINLEY: What was the reaction from both sides, from both supporters of the law and critics of the law?
NOAM LEVEY: Well, I mean, fairly predictable. The supporters, of course, the Virginia Attorney General, Ken Cuccinelli, who has sort of made himself into one of the leading critics of the bill, celebrated this as sort of a validation of his argument that this was constitutional overreach by the Obama administration and the Democratic congress.
The National Federation of Independent Business, a conservative advocate for small business groups, which has signed on to the second lawsuit I mentioned, which is going forward in a federal court in Florida involving other states, also celebrate it. The Obama administration interestingly sort of took I think two attacks.
One was to say look, this is just a procedural ruling, so let’s not get too excited, but I think almost more interestingly they made the argument against the overall lawsuit, arguing if this thing gets thrown out, here’s what is going to get thrown out as well, all of the benefits that we have sort of heart talked about in the past few months about aid for small business, helping people get insurance, so they are sort of I think trying to take a larger political view of this as well, perhaps in anticipation that this is going to be a long, drawn-out legal fight.
LAURIE MCGINLEY: Which probably ends up in the Supreme Court.
NOAM LEVEY: Very well may.
LAURIE MCGINLEY: Mary Agnes, the health care law faces another type of test in Missouri today, can you tell us about this, about the ballot referendum on the law?
MARY AGNES CAREY: Right. It is the first state ballot referendum talking about the individual mandate, the same issue. They want to change state law to say that no individual in Missouri would have to purchase insurance, nor could you be fined if you didn’t purchase it. It is viewed as a largely symbolic measure. They expect very heavy turnout for the Republican primaries. They expect this ballot measure to pass, but at this point it is viewed by many as it won’t have any legal standing. It is more symbolic than anything.
LAURIE MCGINLEY: And there are several more of these referendums coming down the pike, I understand.
MARY AGNES CAREY: Right. There are going to be other states that will try to enact the same thing. I mean, I think it is part of the ongoing view, the political view of this, and what is the role of federal government, what is the role of the state government? As we know, states have this really broad role in implementing the health care law, and I think that you are going to see this discussion continue all over the country.
LAURIE MCGINLEY: Meanwhile, Noam, as the debate goes on about the law, there are things that are happening outside the bell way, on the ground, in the marketplace, you had a very interesting story out of San Antonio, Texas about hospitals and doctors getting together as a result of the health care law, can you tell us about that and what the implications are?
NOAM LEVEY: Sure. I mean, you may recall during the health care debate, there was a lot of talk about whether this bill would do enough to change the way health care was delivered to make it more efficient, to get doctors, hospitals, other providers to work together, and a common critique of the bill was that the efforts to do that in the bill were small. They were not far reaching at all, and they were ultimately inadequate. to make the system more efficient and to really improve the quality of care than Americans get.
Interestingly, out in health care world, outside of Washington, some interesting things I think have been going on, where hospitals and doctors are actually very aggressively sort of courting one another in this sort of courtship dance in which they are talking about can they work together, can they form partnerships? Can they form these what are called accountable care organizations where they can work together to coordinate care better. And you see physician practices selling out to hospitals, insurance companies even getting involved in this, and at a rate that is much more quick than I think many people thought, and ultimately we don’t know what the upshot of this will be. I mean, there simply may be more consolidation in the health care industry that may mean just higher costs, more monopolies, etc.
But on the other side, there are some people who sort of think you know what, this is actually a hopeful sign that people in health care are reading the tea leaves, seeing that the system is going to change and they should figure out a way to work together to potentially provide better, cheaper care. So, we will see what happens.
LAURIE MCGINLEY: Does this raise antitrust issues?
NOAM LEVEY: It may. It may very well and the Department of Justice has actually sort of looked at this, is beginning to look at this. There are a number of discussions underway by national law firms as well as consulting firms trying to advise hospitals and physician groups about how to avoid antitrust issues.
You mentioned I was in San Antonio, if you have a major hospital system in a city buying up all the primary care doctors or all the cardiologists, I mean you could very well end up with a situation where patients have less choice and ultimately that probably means higher costs.

Healthcare Innovation Impact Debated at Health Quality Metrics Event

Stakeholders from the hospital and care provider communities are sharing the podium with health insurance and IT system companies at the 8th Annual Health Care Quality Congress in Boston from August 2 through August 4. Over 200 Congress participants are debating the dual impact of government reform, broader technology adoption and “a new generation of payment models and incentives” on healthcare quality, clinical outcomes, and cost-effective delivery of care.

http://medhealth.tmcnet.com/topics/healthcare-innovation/articles/94093-healthcare-innovation-impact-debated-health-quality-metrics-event.htm

Reform Law Includes Large New Fraud Enforcement Powers, but Many Provisions Are Unclear

By James Gutman, Managing Editor (jgutman@aispub.com)
Some of the least publicized but perhaps most far-reaching provisions of the new health reform law relate to fraud-and-abuse enforcement. The law grants the federal government dramatic new powers — many of them not clearly defined or in partial conflict with other statutes — to pursue both providers and health plans.

http://www.aishealth.com/Bnow/hbd080310.html

Health pilot eyes a new approach to reimbursement

Friday, July 30, 2010 By Cindy Kibbe

Pay-for-performance may be coming to New Hampshire’s health-care industry.Under a five-year pilot program unveiled earlier in July by Gov.John Lynch, health-care providers will be compensated based ontheir quality of care instead of the current fee-for-service model.

http://www.nhbr.com/business/healthcare/807581-276/health-pilot-eyes-a-new-approach-to.html

A New Concept in Health Care

By REED ABELSON
It’s one of the hottest concepts to emerge from the discussions about how best to overhaul the nation’s health care system: accountable care organizations. The idea is to encourage groups of doctors or hospitals to work together to oversee medical care so quality improves and costs go down. Having captured the fancy of Washington, the organizations are even a part of the new health care law.

http://prescriptions.blogs.nytimes.com/2010/07/28/a-new-concept-in-health-care/

Under the health reform law, Medicare will be able to contract with these to provide care to enrollees. What are they and how will they work?

What's the issue?
The health care reform legislation enacted in March 2010 authorizes the Medicare program to contract with accountable care organizations (ACOs). These are networks of physicians and other providers that could work together to improve the quality of health care services and reduce costs for a defined patient population. This brief describes the ACO concept as set forth in the new legislation, discusses how ACOs might evolve over time, and reviews the challenges and opportunities facing health systems, physicians, administrators, insurers, patients, and policy makers as ACOs take shape.

http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=20

Pilots key to ACO implementation

Clinical integration just the beginning of this emerging delivery model
Aug 1, 2010By: Jamie J. GoochManaged Healthcare Executive
NATIONAL REPORTS—Accountable care organizations (ACOs) have become a hot commodity since the Patient Protection and Affordable Care Act opened the door for health plans to contract through an ACO for commercial enrollees. With federal money becoming available as soon as 2012, and the promise of better quality healthcare via vertical integration, the momentum of ACOs will likely increase.

http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Pilots-key-to-ACO-implementation/ArticleStandard/Article/detail/680531?contextCategoryId=39911

Exeter Health Resources' pilot program envisions future of health care

By JOSHUA CLARK
jclark@seacoastonline.com
August 01, 2010 2:00 AM

EXETER — As one of five New Hampshire providers working to improve patient care and lower costs by becoming an "accountable care organization," Exeter Health Resources aims to pave the way for what may be the future of health care.

http://www.seacoastonline.com/articles/20100801-NEWS-8010317

Christus Santa Rosa forming an ACO

SAN ANTONIO -- There could soon be some big health care changes coming, and a local hospital is leading the way.Christus Santa Rosa Health System is developing a plan that it hopes will become a model for the future of health care. It would change the way we choose our doctors. Right now, many patients do what Chris Singer has done.

http://www.woai.com/content/health/story/Local-health-care-plan-may-become-model-for-nation/_R6Y9nMtfUSVLDUQhJM2UQ.cspx

Healthcare law has more doctors teaming up

Reporting from San Antonio — Tribune Washington BureauAs Congress debated the healthcare bill, many critics lamented it would do little to transform a system in which doctors and hospitals bounce patients around in an uncoordinated, costly, sometimes tragic process.

http://www.latimes.com/news/health/la-na-health-doctors-20100728,0,1991432.story