A Primer on Accountable Care Organizations

1. A Primer on Accountable Care Organizations Raymund C. King, MD, JD, FICS Law Offices of Raymund C. King, MD, JD, PLLC Plano, Texas TASCS 2013 Annual Meeting – Houston, TX November 8, 2013

4. Historical and Projected Number of Medicare Beneficiaries and Number of Workers Per Beneficiary Number of Beneficiaries (in millions) Number of Workers Per Beneficiary SOURCE: 2010 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.

5. The Patient Protection and Affordable Care Act (PPACA) • Enacted March 23, 2010 • Signed into law March 30, 2010 • Estimated Cost of Implementation = $940 M in first 10 years

6. Accountable Care Organization THE BASICS

7. ACO Requirements “Groups of providers that have established structures for reporting quality and cost of health care, leadership and management that includes clinical and administrative systems; receiving and distributing shared savings; and shared governance.”

8. ACO Requirements • Willing to become accountable for the quality, cost, and overall care of the Medicare fee-for-service beneficiaries assigned to it. • Minimum three-year contract. • Sufficient primary care providers to have at least 5,000 patients assigned. • Processes to promote evidence-based medicine, patient engagement, and coordination of care. • Ability to demonstrate patient-centeredness criteria, such as individualized care plans.

9. How is a benchmark determined for the ACO?

10. Physician Survival in an ACO • Decrease Cost AND Increase Quality • Physician alignment • Data sharing • Patient Care Coordination • Insurance contracting • Overhead expense controls • Risk sharing

11. CMS ACO Models

12. The Shared Savings Program • Improve beneficiary outcomes and increase value of care • Promote accountability for the care of Medicare FFS beneficiaries • Require coordinated care for all services provided under Medicare FFS • Encourage investment in infrastructure and redesigned care processes • The Shared Savings Program will reward ACOs that lower their growth in health care costs while meeting performance standards on quality of care and putting patients first.

13. How are beneficiaries assigned to an ACO?

14. How are patients assigned to the ACO? Providers sign agreement to participate with an ACO PCPs must be exclusive to one ACO Specialists can be part of multiple ACOs Patients are assigned to their PCP based on the majority of their outpatient E&M visits These are YOUR existing patients and those of your other ACO members

15. Measuring Quality ImprovementThe amount of shared savings received by an ACO is linked to its performance on quality measures. Quality Measures: • Patient/caregiver experience of care • Care coordination • Patient safety • Preventive health • At-risk population/Frail elderly health

16. The Bottom Line

17. Questions?

18. THE END Raymund C. King, MD, JD RKing@rkinglaw.com (972) 381-2792