Accountable Care, ACO, Triple Aim

Leavitt Partners Weigh in on Medicare, APMs and Provider Readiness for Pivot

by Gregg A. Masters, MPH

It’s been busy since our re-launch at This Week in Accountable Care primarily due to the heavy lifting support from National ACO co-founders, Andre Berger MD, CEO, and Alex Foxman, MD, President and Chief Medical Officer, respectively.

While I moderate the series, Drs. Berger and Foxman serve as co-hosts and subject matter experts as we engage thought leaders and best-in-class ACO operators in focused conversation around local or regional market challenges including headwinds, tailwinds, lessons learned and emerging best practices.

Recently we’ve chatted with top national talent including: Don Crane, CEO, of CAPG, Hal Sadowy, the IPA Association of America, Jay Parkinson, MD, Founder and CEO of Sherpaa Health and author, consultant and futurist Ian Morrison.

Our all-star line-up continues in October with David Muhlestein, PhD, JD, Chief Research Officer, Leavitt Partners on Tuesday October 3rd, Farzad Mostashari, MD, Founder & CEO of Aledade on October 17th, and the rock-star advocate to fix the Affordable Care Act and former Acting Administrator of the Centers for Medicare and Medicaid Administration (CMS), Andy Slavitt on October 31st.

For our chat with David Muhlestein, PhD, JD, Leavitt Partners, Chief Research Officer you may want to read: Medicare Alternative Payment Models: Not Every Provider Has a Path Forward.

An informative Whitepaper that lays out the range of challenges most health systems, IDNs, physicians whether in groups or not face in the pivot to a value based (alternative payment models – APMs).

From the Whitepaper:

The Centers for Medicare and Medicaid Services (CMS) has shown significant support for the development of Alternative Payment Models (APMs).

CMS’ development and testing of 45 payment models has led to the adoption of similar models by other payers. Initial reports indicate that APMs could be key to producing the health care delivery reform necessary to decrease health care costs and increase delivery quality.

However, these models are only available to select provider types, and some providers, such as emergency physicians and audiologists, have no Medicare APMs in which they can participate. To realize the full benefits of APMs, additional collaboration between CMS leadership and providers is needed to develop new models for providers who do not currently have access to them.

Be sure to join us October 3rd at 5PM Pacific/8PM Eastern for a conversation with David Muhlestein on This Week in Accountable Care with Andre Berger, MD and Alex Foxman, MD. co-founders of National ACO.

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Accountable Care, ACO, Affordable Care Act, Medicaid ACO

Tufts Health Plan Forms MassHealth Accountable Care Organization Partnership with Four Provider Organizations

Press Release | Watertown, MA | August 18, 2017 

The Massachusetts Executive Office of Health and Human Services (EOHHS) recently announced that Tufts Health Plan has signed contracts to form Medicaid (MassHealth) Accountable Care Organization (ACO) partnerships with four provider organizations:  Atrius HealthBeth Israel Deaconess Care OrganizationCambridge Health Alliance, and Boston Children’s Accountable Care Organization.

The new ACOs feature a value‐based payment structure for providers who had largely been paid fee for service for MassHealth members in the past.  For members, this means the opportunity to receive medical, behavioral, dental and long-term support services in an integrated model of care.  This will improve quality of care, the member experience, and potentially help stabilize Medicaid costs in Massachusetts.

“We support the Commonwealth’s goal of providing integrated health care to MassHealth members that is more efficient and improves their overall health,” said Tom Croswell, president and CEO of Tufts Health Plan.  “We have partnered with four highly-regarded provider groups, all of whom share our vision of what collaboration and highly coordinated care can look like.”

Continued Croswell:  “Tufts Health Plan has an excellent reputation for our collaborative approaches with providers.  We’ve been working with value-based contracts for more than 20+ years, starting in our Medicare Advantage plans.  We know first-hand that working closely with providers on coordinating care results in healthier members.  We’re excited to broaden our success and bring this approach to our Medicaid members.”

MassHealth ACO transformation is a major component in the state’s five-year innovative 1115 Medicaid waiver from the federal government, which allows Massachusetts to restructure the current health care delivery system for 1.9 million MassHealth members.

Tufts Health Plan’s ACO partners are:

  • Atrius Health, which provides high quality, patient-centered and coordinated care to more than 740,000 adult and pediatric patients in eastern and central Massachusetts.
  • Beth Israel Deaconess Care Organization, a value-based physician and hospital network that partners with providers to improve quality of care while effectively managing medical expenses.
  • Boston Children’s Accountable Care Organization is an ACO comprising Boston Children’s Hospital and its affiliated primary and specialty care physicians. Boston Children’s Hospital is the No. 1 ranked Children’s Hospital in the nationand is a 415-bed comprehensive center for pediatric and adolescent health care.
  • Cambridge Health Alliance, an academic community health system committed to providing high quality care in Cambridge, Somerville and Boston’s metro-north communities. CHA has expertise in primary care, specialty care and mental health/substance use services, as well as caring for diverse and complex populations.

 

Editor’s Note: We are in the process in scheduling a Tufts Health Plan executive on an episode of This Week in Accountable Care with Andre Berger, MD and Alex Foxman, CEO and President/CMO of National ACO. Once confirmed we’ll post the details here with a profile of Tufts Health.

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