Impact of ACOs on Care Coordination Presented by: Michelle L. Templin Vice President Legislative Affairs and Business Development MHA ACO Network March 2, 2017
Agenda Agenda Key Regulatory Drivers Accountable Care Organizations (ACOs) in the Public Market Other Alternate Payment Models in Place Bundled Payment Models Cardiac Rehabilitation Incentive Payment Model Modifications to CJR Medicare/Medicaid ACO Impact on Care Coordination Across Continuum 2
Recent History 3
Key Regulatory Drivers HHS Announcement January 2015 Pledge Created Path for Increased Financial Risk Assumption Obama Administration Medicare Payment Tied to Alternate Payment Models Set Goals: 30% by 2016 50% by 2018 4
Key Regulatory Drivers Four Payment Taxonomies Source: http://www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2015-fact-sheets-items/2015-01-26-3.html 5
Key Regulatory Drivers HHS Goals for FFS Achieved Mar 2016 Source: http://www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2015-fact-sheets-items/2015-01-26-3.html 6
Where Are We Today? 7
Key Regulatory Drivers National Health Expenditures CMS report released Projections 2016-2025 Healthcare 19.9% of GDP totaling $5.5 trillion Growth expected at annual rate of 5.6% for 2016-2025 Medicare and Medicaid are one of biggest drivers By 2025 Medi/Medi expenditure will be $2.2 trillion Doubling 2015 spending of $1.2 trillion Source: NaviHealth Essentials Insight Report. February 22, 2017. 8
Key Regulatory Drivers Trump Administration Affordable Care Act (ACA) aka Obamacare Traditional Repeal and Replace Becoming Update and Repair Focus on Taxation and Insurance Exchanges Address Premium Increases Purchase Across State Lines Keep Pre-existing Coverage Mandate 9
Key Regulatory Drivers Trump Administration Health and Human Services Dr. Tom Price Confirmed Generally please with APMs Supported Legislation by APM Does not Support Mandatory APMs Centers for Medicare and Medicaid Services Seema Verma Nominated Initial Confirmation Hearing went well Extensive Medicaid Experience Next Steps.???? 10
ACOs in the Public Market 11
ACOs in the Public Market 2017 ACO Public and Private Markets Total ACOs: 929 ACO Majority Sponsor Government Physician Group Source: Accountable Care Learning Cooperative Membership Weekly News. Feb 28, 2017 12
ACOs in the Public Markets Public ACO Models ACO Type Number Shared Savings Rate Contract Length Advanced Payment ~ 45 Prepaid 3 years Medicare Share Savings 480 Track 1 438 Up to 50% 3 years Track 1+ New Up to 50% 3 years Track 2 6 Up to 60% 3 years Track 3 36 Up to 75% 3 years Next Generation ACO 45 Varies 80%-100% 3 years with options for 2 additional years Source: The NAACOS ACO Comparison Chart. NAACOS. February 2017. 13
ACOs in the Public Market 2017 MSSP Cohort MSSP ACOs cover 9 million attributed Medicare lives 99 New Participants 79 Renewing Participants 2014 Cohort 123 enrolled 64% renewed Increased participation in Two Sided Risk 9% of ACO in Two Sided Risk Up from 5% 2017 MSSP Cohort Source: A Closer Look at the 2017 APM Cohorts. ACLC. Leavitt Partners December 2016 14
Other Alternate Payment Models New 2017 APMs The Acute Myocardial Infarction (AMI) Model The Coronary Artery Bypass Graft (CABG) Model The Surgical Hip and Femur Fracture Treatment (SHFFT) Model The Cardiac Rehabilitation (CR) Incentive Payment Model Modifications to the Comprehensive Care for Joint Replacement (CJR) Model Medicare-Medicaid ACO Model (MMACO) Source: ACLC Policy Brief New CMMI ACO and Bundled Payment Expanded Advanced APM Opportunities December 2016 15
Other Alternate Payment Models New Bundled Payment Models: AMI + CABG + SHFFT Mandatory for all hospitals not participating in BPCI Models 2, 3, or 4 All-Payer States and Critical Access Hospitals Exempted Retroactive Episode-Based Payments AMI and CABG in 98 randomly selected MSA SHFFT in same 67 MSA as CJR 1,120 hospitals will participate in AMI and CABG 860 hospitals in SHFFT Begins July 1, 2017 Source: ACLC Policy Brief New CMMI ACO and Bundled Payment Expanded Advanced APM Opportunities December 2016 16
Other Alternate Payment Models Cardiac Rehabilitation Incentive Payment Model Hospitals may receive rewards based upon number of CR services offered Current CR services underutilized in Medicare population Available in 45 MSAs that are also selected for AMI and CABG Additional 45 MSAs with no other programs Two Part Payment Design Initial Payment and Service Payment 1,320 Hospitals Begins July 1, 2017 Source: ACLC Policy Brief New CMMI ACO and Bundled Payment Expanded Advanced APM Opportunities December 2016 17
Other Alternate Payment Models Modifications to CJR Adjustments to current CJR Program implemented in 2016 Efforts to improve Orthopedic Care Use of 3 Day SNF Waiver Exclusion of Beneficiaries in other ACO Programs Revising Target price of Current CJR Target Start Date not yet Announced Source: ACLC Policy Brief New CMMI ACO and Bundled Payment Expanded Advanced APM Opportunities December 2016 18
Other Alternate Payment Models Medicare-Medicaid ACO (MMACO) Address Care for High Needs Dual Eligible Patient Populations Higher Spending than Single Payer Counterparts Goals Align with Triple Aim of all Other ACOs Initially Six States Will be Selected to Participate Shared Saving Set Up Quality Measures include MSSP plus those set by State May Chose Start Date of Jan 1, 2018, 2019 or 2020 Source: ACLC Policy Brief CMS Announces New Medicare-Medicaid ACO Model December 2016 19
Impact on Care Coordination What Does This All Mean? New Models call for Care Coordination across all settings Partners Need to provide and prove value across the continuum Successful ACOs need to continue to be successful Flexibility to deal with New Administration Source: ACLC Policy Brief CMS Announces New Medicare-Medicaid ACO Model December 2016 20
Impact on Care Coordination Other Known Considerations Policy remains focused on Patient Care across Continuum Programs Continue to Evolve Payment Models based upon Individual s Care Needs and Characteristics Not Setting Focus will be on Individual's Outcomes, Quality and Cost Diagnosis Driven care vs. Traditional Care PAC Greater Focus ACO Success in 2017 due mainly to PAC Utilizations Trends Blurring of Lines across PAC (LTAC/IRF/SNF and HHA) Greater Emphasis on Shared Common Services Pharmacy/Lab/DME 21
Contact Information THANK YOU! Michelle L. Templin MHA ACO Network VP Legislative Affairs and Business Development mtemplin@mhainc.com (973) 819-6574 cell 22
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