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Bart Wald MDHealthCare Partners Medical Group

Accountable Care Organizations:Roadmap for “Bending the Cost Curve ?”

Brookings-Dartmouth / Anthem / HealthCare Partners (California)

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HCP National Delivery System

California

• More than 500K Commercial (full capitated)

• 100K MAPD (full capitated)

• 35K Managed Medicaid (full capitated)

• Modest PPO business in Group Model

• 500 Employed MDS

• 2000 contracted MD

Florida

• 40K MAPD (full capitated)

Nevada

• 36K MAPD (full capitated)

HealthCare Partners’ Vision

HealthCare Partners will be the role model for

integrated and coordinated care, leading the

transformation of the national healthcare

delivery system to assure quality, access, and

affordable care for all.

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HealthCare Partners’ Delivery System

• Global Capitation Predominates

• Physician-Led, Professionally Managed

• Centrally Coordinated

• Regionally Driven

• Strong Medical Management Infrastructure

• Robust Deployment of Technology

• Robust MAPD Growth: Acquisitions and Organic Growth

• Metrics Driven

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The Care Team Approach

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PCPs

Specialists

Nurses

Care Managers & Disease Managers

Disease Educators

Social Workers

MAs

Interactive and collaborative teams

of clinicians support HealthCare

Partners clinical programs.

High Risk Programs

• HomeCare

• Comprehensive Care Center

• ESRD

Disease Management Programs

• Diabetes

• CHF

• COPD

• ESRD

HCP selected by Dartmouth Brookings to be one of 5

national sites for Commercial ACO project

D-B developed ACO concept and advises Feds and

health plans on implementation

HealthCare Partners

Medical Group

Torrance, CA

Monarch HealthCare

Orange County, CA

Carilion Clinic

Roanoke, VA

Norton Healthcare

Louisville, KY

Tucson Medical

Center

Tucson, AZ

HealthCare Partners: A Brookings-Dartmouth

National ACO Pilot Site

Elements of this Pilot:

• Partnership with Commercial Insurer

• Attribution Model

• Historical Trending

• Multi-year Commitment

• Quality / Service / Transparency

• Financial Model

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“2011” ACO Pilot: Current Basic Assumptions

• Product is a Commercial PPO

• Anthem is the payer,

• Members will not prospectively select an ACO

provider,

• PPO benefits will stay same

• Patients will have choice to participate

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Evolving ACO Care Management

Encounter data submission: Delegation for ambulatory referrals:Delegation for preadmissions:Full hospitalist implementation:Telephonic case management: - complex/chronically ill attributed patientsPoint of care reminders: 1. Anthem downloads claims2. Identification of care gaps3. Clinical reviewer Patient education:Disease management:- complex/chronically ill attributed patientsContracted Provider incentives,Health Risk AssessmentsPCP/Provider Assignments (Health Coach)

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Where Do Future Savings Come

From?

Reduced Inpatient Days

Preventive Care

Increased Generic Rxs

Appropriate Use Of Specialists

Appropriate Place of Service

Value Based Hospital Selection

HCP ACO Objectives

• Strategic positioning for Medicare ACO pilots

starting in 2012

• Source of future profitable commercial growth

• IPA PCP differentiator

• Contribute to positive health care outcomes and

bend cost curve

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Hospitals Aligning Incentives

• Modified Contracts

• Incremental ACO volume

• Hospitalist assistance with public

programs

• Shared Savings?

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Brookings-Dartmouth ACO Collaborative

Pilot Sites

In-depth consultation, technical assistance, and data analysis for participating health

systems and payers.

Learning Network

Offers practical guidance and a forum for interested parties to learn from one another

throughout the process of planning and implementation

Community Initiatives

Serve as strategic support for regions interested in piloting this at the community-

level.

Washington Support

Serve as a resource for legislative and executive staff on delivery system reform,

specifically related to the ACO model.

Principal Goal

To engage stakeholders in piloting the ACO model and produce a

successful and replicable model that can be implemented nationwide.

THE BIGGEST CHALLENGE

PULL

Not A

PUSH

STRATEGY

So, What is an ACO?

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LET’s HOPE ITS NOT A

ANY CARTEL

ORGANIZATION

ANY CRAPPY

ORGANIZATION