Maine’s Health Care Reform Movement: What does it mean to you & your community? Is it working?

1. Maine’s Health Care Reform Movement: What does it mean to you & your community? Is it working? 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

2. Three Learning Objectives • 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

3. What is an Accountable Care Organization? 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

4. ACO Basics • 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

5. Maine’s 4 Accountability Care Organizations • Maine Community Accountable Care Organization • Central Maine Accountable Care Organization • MaineHealth Accountable Care Organization • EMHS Accountable Care Organization

6. Innovations in Healthcare • 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

7. Where Do Patients/Consumers Fit In? • Healthcare is about all of us working together • Providers • Patients • Family Members • Community Members • Getting Educated • Attend workshop/join organizations • Speaking Up and Asking Questions • Ask your providers, insurance comp., etc. Questions • Taking responsibility for your own health

8. Opportunities to Advocate for Change • Accountable Care Organization Boards • Medicare Beneficiary Representative • Health Organization Boards • Contact you local community health center, hospital • Network • There are healthcare related conferences/meetings throughout the year – example: Quality Counts • News – local and national • Organizations such as the AARP • Healthcare Legislation

9. “Escape Fire: The Fight to Rescue American Healthcare” • 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.

10. Maine’s Health Care Reform Movement: What does it mean to you and your community? Is it working? 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