value based purchasing prebacked
TRANSCRIPT
Contact: David Parpart, D.C. , CEO Socially Relevant Inc408-421-9508 [email protected]
What’s an ACO?
Accountable Healthcare Platform for Patient Engagement Solutions
Pharmacist Counseling | Mobile Applications | Remote Monitoring
Drivers of Healthcare Reform
Economics
Healthcare Reform Puts
6% of Hospital Revenue at Risk
2% annual payment update at risk by FY2017
1% DRG payment penalty FY2013, rising
to 3% by FY2015
1% DRG payment penalty for hospitals in
worst quartile beginning FY2015
•Value-based Purchasing
•Process of care
•Patient experience Begins FY2013
•30-Day Readmissions
•Up to 8 conditions targeted including AMI, HF, PNA
•Hospital-Acquired Conditions
•Up to 8 conditions targeted
Confidential- Socially Relevant Inc.
What’s an ACO?
Confidential- Socially Relevant Technology
Confidential- Socially Relevant Inc.Confidential- Socially Relevant Technology
Al a Carte All Inclusive
A Business Model Volume vs. Capitation
Accountable Care Organization (ACO)
Accountable Care Organization (ACO)
Risk and RewardEvery Hospital has risk of loss/penalties
2/3 penalized in Oct 2012
Health Organizations APPLY to form an ACO
Assume risk
Gain NEW REVENUE OPPORTUNITY through
Medicare Shared Saving Program
ACO’s Need New Patient Engagement Strategies
Section H of the MSSP Application
ACO – Healthcare’s New Business ModelValue Based Purchasing and Shared Savings
Better Care Experience
Lower Costs
Better Population Health
Metrics:
Patient Experience
Patient Activation Measures
Metrics:
Readmission Rate
Total PMPM & Trend
Metrics:
HEDIS
Cost Savings New Revenues
Capitated Payment
ACO – Healthcare’s New Business ModelExample: Nephrology
Better Care Experience
Lower Costs
Better Population Health
Doctor/Pharmacist/Patient
Collaboration
$178M Reduction in Part A
$ 23M Increase in Part D
$155M net savings
Cost Savings New Revenues
Capitated Payment
$155M net savings X 60% = $90M
What is the Lowest Hanging Fruit
for ACO Profitability?
$700Bn
$290Bn
$30Bn
• Duplication of Services
• Fraud
• Poor Med Adherence
• Avoidable Hospitalizations
Confidential Do Not Distribute
