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Accountable care organizations (ACOs) create integrated delivery systems that encourage teams of physicians, hospitals and other providers to collaboratively coordinate care for ACO members. Built into the ACO model is a business opportunity: provide a focal point of care while attaining health and cost containment goals.

However, to ensure the ACO's fiscal health, its planners must construct a strong clinical foundation for the ACO while meeting state and federal legal, regulatory and compliance requirements for ACOs.

Blueprint for ACO Success: Clinical, Quality and Compliance Considerations for an Accountable Care Organization provides perspectives and lessons learned in both critical areas from two organizations already far along the path to ACO creation:

• Advocate Physician Partners' clinical integration (CI) program, which includes over 3,000 physicians, has resulted in improvements in patient outcomes and significant cost savings and ideally positions them for an ACO.
  
  
• The Queens County Medical Society, which is launching one of New York States largest physician-owned ACOs, will allow more than 700 local physicians to share Medicare savings, best practices and access to new information technologies.

This 40-page resource will prepare healthcare organizations considering an ACO for clinical and regulatory success. First, Mark Shields, MD, MBA, senior medical director for Advocate Physician Partners and vice president of medical management for Advocate Health Care, details Advocate Physician Partners' CI program, from the structure of the CI group to funding, incentives, mechanisms and technology that support CI, and why a successful CI program can provide the ACO foundation.

Next, Jeffrey R. Ruggiero, Esq., a partner in Arnold & Porter LLP, the law firm advising the Queens County Medical Society on its ACO development approach, describes the operational and regulatory compliance requirements that must be met to ensure a highly cost-effective, high quality, safe and legally compliant ACO for patients and health plan members.

These areas include anticipating the mandates of the CMS Shared Savings program; achieving and maintaining compliance with state and federal regulations governing healthcare while positioning for possible changes; developing a multi-disciplinary compliance approach; and creating policies and procedures for ongoing compliance monitoring.

Blueprint for ACO Success: Clinical, Quality and Compliance Considerations for an Accountable Care Organization also presents new market research on ACO awareness and creation in the industry derived from the 2011 Healthcare Intelligence Network Accountable Care Organizations Survey.

Table of Contents

• ACO Benchmarks: Results from the 2011 Accountable Care Organizations Survey
• Framing an ACO Through Clinical Integration of Independent Physicians
  • Advocates Vision of Clinical Integration
  • Components of Clinical Integration
  • Pay for Performance Incentives
  • Performance Improvement Tools
  • Lessons Learned
  • Clinical Integration as ACO Chassis
• Physician-Owned ACOs: Overcoming Legal and Regulatory Challenges
  • Whats Driving ACO Development
  • Whos Eligible to be an ACO?
  • Understanding Shared Savings
  • Legal Considerations for ACOs
  • Antitrust, Anti-Kickback and Stark Laws
  • Fraud and Abuse Provisions
  • The Physician Organizational Process
  • Overcoming Physician Resistance to Change
  • Case Study: Queens County Medical Society ACO
  • Benefits of ACO Participation
• Q&A: Ask the Experts
  • Quality and Performance Measures
  • Focusing on Efficiency Measures
  • Exclusive vs. Non-Exclusive Programs
  • Responsibility for Tracking Care
  • Overcoming Physician Resistance
  • Post-Acute Network
  • Convincing Payors to Collaborate
  • Future Contracting Plans
  • What Physicians Should Ask Before Joining an ACO
  • Role of Health Plans in ACOs
  • Guidelines for Selecting ACO Managers
  • Defining Savings Targets
  • Challenges of Launching a Physician-Owned ACO
  • Choosing ACO Shareholders
  • The Ideal ACO Model
  • Ideal Practice for an ACO
  • Why Payors Should Partner in an ACO
• Glossary
• For More Information
• About the Presenters