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Essential Guide to Accountable Care Organizations: Challenges, Risks and Opportunities of the ACO Model
Essential Guide to Accountable Care Organizations: Challenges, Risks and Opportunities of the ACO Model
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Integrated delivery model? Check. Coordinated care and services? Check. Improved quality and reduced costs? Check. Survival strategy to maintain market share and improve profitability? Check.

Provider partnerships forged through accountable care organizations (ACOs) hit all of the marks for healthcare delivery reform set forth by the Affordable Care Act (ACA) and offer a key opportunity to boost revenue. With the publication of CMS's proposed guidelines for Medicare ACOs under its Shared Savings Program and the NCQA seeking comments on its ACO guidelines, it's not too early for healthcare organizations to assess market position and readiness for the ACO model and move quickly to improve profitability and market share.

The Essential Guide to Accountable Care Organizations: Challenges, Risks and Opportunities of the ACO Model answers key questions surrounding ACOs so that hospitals, PHOs, IPAs and other physician organizations, networks or group practices can weigh the merits now of creating an ACO and complete the necessary groundwork before CMS's ACO operation date of January 2012.

Healthcare decision-makers must consider their organizations' competitive landscape and market share now because the new law provides that physicians and other professionals in group practices or networks of practices, hospitals employing physicians/professionals, partnerships or joint ventures between hospitals and physicians and others can become an ACO.

The 60-page Essential Guide to Accountable Care Organizations: Challenges, Risks and Opportunities of the ACO Model delivers a detailed analysis of CMS's Medicare ACO Shared Savings Program as well the short- and long-term financial opportunities afforded by ACOs and an inside look at two existing ACOs and the lessons learned from their development and launch:

  • Healthcare thought leaders William Shea, partner, health industry consulting for Cognizant Business Consulting, Steven T. Valentine, president, The Camden Group, and John Harris, principal, DGA Partners, evaluate the CMS ACO model as well as the revenue opportunities proposed by ACOs.

  • Laurel Karabatsos, Colorado's deputy Medicaid director, shares lessons learned from the ACO development process in Colorado, where the Colorado Accountable Care Collaborative for Medicaid beneficiaries is set to launch in early 2011.

  • Dean Health System President and CEO Craig Samitt, MD, MBA, describes the recruiting, incentives and performance management strategies built into Dean's ACO model, as well as the improvements in patient satisfaction and access, HEDIS and quality scores and membership numbers that resulted from the practice reengineering. Dean Health System is now third in Wisconsin, the state ranked first for healthcare by the NCQA.

This comprehensive guide provides details on the following:

  • Defining ACOs;
  • Assessing ACO risks and opportunities;
  • Developing an organizational strategic assessment;
  • Estimating the size of the ACO opportunity for hospitals and other organization;
  • Determining system changes required before launching an ACO;
  • Developing performance measures and an incentives program for year one and beyond;
  • Enlisting healthcare providers to be accountable to their outcomes;
  • Setting provider payments to support an ACO;
  • Gaining stakeholder support early in the process;
  • Creating the ACO roll-out plan.
and much, much more, including answers to nearly 30 FAQs on accountable care organizations.

Table of Contents

  • ACOs: Key Healthcare Trend for 2011 and Beyond
  • Opportunities and Risks of CMS ACOs
    • ACOs and ACA
    • Definition and Timeline for an ACO
    • Requirements for an ACO Contract
    • CMS Shared Savings from ACOs
    • Eight Key Areas of ACO Infrastructure
    • Future Opportunities for ACOs
    • How Big is the ACO Opportunity?
    • How Hospitals Should Proceed with ACOs
  • Lessons from the Colorado Medicaid ACO
    • Facilitating the ACO Stakeholder Process
    • Drafting the RFI
    • Resolving Conflicts
    • Designing the ACO
    • Performance Measurement
  • Meet the Medical Home Neighbor: The ACO
    • The Eight Realities of Healthcare Today
    • Defining the ACO
    • 10 Strategies for a Successful ACO
    • Fitting the ACO into the Medical Home Model
    • Results from Dean Health System ACO
  • Q&A: Ask the Experts
    • Controlling Market Share
    • When a Patient Switches Providers
    • Expected Financial Returns
    • Fitting Long-Term Care in an ACO
    • Rules for Freestanding Hospices
    • Schedule for CMS Data Sharing
    • Role of Essential Community Providers
    • Shared Savings
    • ACOs and Medicare Part D
    • Health Plans and ACO
    • Structuring ACO Payments for Independent Entities
    • Payment Modeling for ACOs
    • Role of Specialists in the ACO
    • Impact of ACO on Quality Outcomes and Physician Payments
    • Defining Roles for ACO Players
    • Setting Capitation and Bonuses in the ACO
    • Health Reforms Impact on Medical Homes and ACOs
    • Enrolling and Educating Members in the ACO
    • ACO Utilization Measures
    • Partnering in ACO Development
    • Defining the Stakeholders
    • Choosing a Reimbursement Model
    • Challenges of Setting Payment Levels
    • Goals for Cross-Savings
    • Role of the RFI in ACO Development
    • Final Planning and Rollout
    • Entities in the ACO
    • Applying Medical Home Standards
  • Glossary
  • For More Information
  • About the Presenters
Publication Date: December 2010
Number of Pages: 60
ISBN 10: 1-936186-60-8 (Print version); 1-936186-61-6 (PDF version)
ISBN 13: 978-1-936186-60-0 (Print version); 978-1-936186-61-7 (PDF version)
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Physician-Owned ACOs: Overcoming the Legal and Regulatory Compliance Challenges, a 45-minute webinar on January 19, 2011. Archive Version
Physician-Owned ACOs: Overcoming the Legal and Regulatory Compliance Challenges, a 45-minute webinar on January 19, 2011. Archive Version
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2011 Benchmarks in Accountable Care Organizations: Metrics from Early ACO Adopters
2011 Benchmarks in Accountable Care Organizations: Metrics from Early ACO Adopters
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