Accountable Care, ACO, Affordable Care Act, health reform

National ACO Association Weighs In On Sector Performance

by Gregg A. Masters, MPH Amidst the aggressive assault on the Affordable Care Act (ACA) via an unrelenting but unsuccessful ‘repeal and replace‘ agenda, much conversation and debate in the health reform theater since Donald Trump was elected the 45th President of the United States has witnessed considerable speculation about the probable directional vector(s) of reform. The initial source of these speculative insights have been from available ‘tea leaves‘ interpretation associated with key Trump administration appointments to craft and seed a ‘TrumpCare‘ alternative. Trump’s first appointment to serve as Secretary Health and Human Services (HHS) was Tom Price, MD, a conservative Republican Congressman and orthopedic surgeon from Georgia. Tom Price’s credentials as a warrior against legacy Medicare and Medicaid regulations and incentives is well known, as is his advocacy for a ‘putting patients first‘ narrative. Trump also tagged Seema Verma, MPH as Administrator of CMS who’s credentials included advocacy for and implementation of Healthy Indiana, a waiver enabled block grant to the State of Indiana, intended to introduce both flexibility and opportunities for ‘innovation‘ in their Medicaid program. While a sexy and somewhat logical idea, ie, delegate block (capped) funding to the state and let it innovate on the delivery and financing side, the results of block grants nationally including Indiana’s have been admittedly mixed. With Price’s controversial tenure and the successor appointment of Secretary Alex Azar to lead HHS, Seema Verma remains at the helm of the Centers for Medicare and Medicaid Services and is advocating for and introduced a number of reforms to both CMS and the Center for Medicare and Medicaid Innovation (CMMI) operations. Amidst the leadership deck shuffling and shifting sands of policy initiatives offered via the a series of related Notice of Proposed Rule Making (NPRM) processes, many in the ACO space have been heads down but mindful of how amended Federal policy would affect the operations and viability of ACOs active in the Medicare Shared Savings Program (MSSP) and sequelae, ie, Next Generation ACO models and now the offered NPRM ‘CMS Proposes “Pathways to Success,” an Overhaul of Medicare’s ACO Program‘.  EDITOR’s NOTE: For additional reflection see summary via Evolent Health: ‘CMS’ New MSSP Proposal: The Five “So What’s” Every ACO Exec Should Know.’ Meanwhile, ACOs are reporting results and the community is weighing in on the efficacy of the ACO model with respect to its intended deliverables, see: Farzad Mostashari, MD, CEO of Aledade recent unbundling of results on twitter, here and a recent New England Journal of Medicine piece Medicare Spending after 3 Years of the Medicare Shared Savings Program‘.  Perhaps the most comprehensive take on the state of the industry is to be found in a recent study commissioned by the National Association of ACOs. The introduction to its Executive Summary is pasted below:
Introduction The stated goal of the Medicare Shared Savings Program (MSSP) is to lower the rate of growth in healthcare spending while improving patient access to quality care. (12) MSSP Accountable Care Organization (ACO) progress toward this goal of achieving savings or reducing expenditure growth has proven controversial, in part because there are a variety of ways to measure savings that may generate different results. In this report, we describe the Dobson | DaVanzo team approach13 to measuring MSSP savings and contrast this with reported findings from CMS. We also compare our results to other published work. Dobson | DaVanzo & Associates was commissioned by the National Association of Accountable Care Organizations (NAACOS) to conduct an independent evaluation of MSSP ACO cost savings. The CMS method of measuring ACO performance is based on an administrative formula that creates spending targets constructed with ACOs’ historical expenditures that are used to determine whether they will receive bonus payments. It is problematic when this financial target setting approach is used as if it were a program evaluation. Indeed, when independently evaluating both the Pioneer ACO and Next Generation ACO programs, CMS contractors used a difference-in-differences regression approach to estimate savings rather than the CMS benchmarking methodology used to set financial targets and calculate bonuses or penalties. (14,15).  The CMS benchmarking methodology addresses the question “How has ACO spending changed compared to prior years’ spending?” While this may be an appropriate way to set performance benchmarks, it produces a biased estimate of program savings when compared to what may have occurred in the Medicare Fee-for-Service market had the ACO program not been in place. Instead, evaluation of program savings should incorporate a carefully designed comparison group or counterfactual to account for prevailing trends in order to address the question: “How have ACOs changed expenditures compared to other providers not participating in the ACO program?” Read the complete report from National Association of ACOs, here Florida Association of ACOs - FLAACOS
Given the release of the NPRM and the October 16th deadline for comments with an expected ‘go live’ date in early 2019, the Florida Association of ACOs (FlaACOs) upcoming annual meeting in Orlando is a timely event to compare notes and process the impact of CMS’ proposed changes with your peers. For those of you in the Southeast with an interest in ACOs or valued based healthcare models and their performance in the greater Florida market, take note the Florida Association of ACOs (FlaACOsconvenes in Orlando, October 18th and 19th for their fourth annual meeting. This year’s impressive faculty line-up and agenda include a keynote presentation by former Health and Human Services Chief Technology Officer Todd Park For the 5th year in a row, Health Innovation Media, publisher of ACO Watch, including Fred Goldstein, President, Accountable Health, LLC and me will be onsite interviewing keynote faculty and select participants at the FlaACOs conference. A video recap of last year’s gathering is here, as are two recent interviews with Farzad Mostashari, MD, CEO Aledade, and David Bjork, CEO, Commonwealth Health Advisors. Wednesday, September 12th at 3PM Eastern, 12 Noon Pacific, we chat with FlaACOs CEO and founder Nicole Bradberry on PopHealth Week. Join us! ==##==
Accountable Care, ACO, LTPAC

Florida Association of ACOs Partners with Caredove

Sponsored Post:

22 Aug 2017 7:00 AM | Jacksonville, FL

Partnership Broadens Florida Based Organization

The Florida Association of ACOs (FLAACOs), the premier professional organization for Accountable Care Organizations (ACOs) and value based healthcare leaders throughout Florida, announced today a strategic partnership with Caredove, Inc. to provide its Statewide ACO membership with access to Caredove’s advanced, online e-referral platform which focuses on making it easy to transition patient care into home care and community services.  Under the agreement, Caredove will work with FLAACOs and its ACO members to establish and build out trusted networks between its ACO members and the organizations and agencies providing home care and community support services in the communities they serve.

Nicole Bradberry, CEO of FLAACOs, states:

“Our partnership with Caredove shows our continued commitment to bring additional value to our members and to take a leadership role in helping to address those aspects of care needs to help our member’s patients stay healthier in their homes and communities and to avoid costly readmission into the Acute care system”.

 It is anticipated that over 1000 home care and community agencies will be implemented on the platform, serving some 40+ ACOs across the state.  Caredove’s CEO, Jeff Doleweerd, said

“We spent thousands of hours examining how patients access service to different home care and community services. We saw the same problems over and over. Clinicians couldn’t locate helpful services, patients didn’t know what would happen next, intake staff were overwhelmed while triaging referrals, voicemails would pile up, and patients wouldn’t get connected with the care they needed. We created Caredove to solve these problems”. 

The development of the initial e-Referral networks in Florida under this agreement will pave the way for additional parties to join the platform.  We’re happy to be working with FLAACOs to bring Caredove to benefit the patients of their ACO members.”

Richard Lucibella, CEO of Accountable Care Options (Boynton Beach Florida) and FLAACOs Board member, is an early adopter on the Caredove platform. 

“As we’ve extended our Chronic Care Management efforts, we’ve gained a better understanding of the extent to which behavioral health and community social services can impact out patients’ health status. We’ve all known this to be an issue, particularly in the Medicare population.  Our CCM teams at Accountable Care Options continue our leadership position here on behalf of our patients, and are excited about the very real promise of the Caredove platform to support and potentially multiply our current efforts.”

“Overall, we’re seeing great interest and excitement about the platform in Florida and elsewhere”, says Jim Atkinson (Chief Growth Officer at Caredove), “and, we are working to expand the network through Community & Public Health groups as well as to bring Payers and Health Systems into the trusted exchange.”

ABOUT FLAACOs                                                                                                 

FLAACOs, also known as the Florida Association of Accountable Care Organization, mission is to provide members a vehicle to collaborate, ensuring that each healthcare organization grows and thrives. The Florida-based association aligns goals to help member ACOs shift physician incentives and improve health-care outcomes across the state. FLAACOs provides a voice for the accountable care marketplace and its participating providers, payers, and individual physicians. The goal of FLAACOs is to provide advocacy and support to all Florida accountable care organizations so that together they can become the health-care models of the future. To learn more click here.

ABOUT CAREDOVE                                 

Caredove is a healthcare solutions company providing its online platform to make it easy for patients to gain access to home care and community services.  Providers and care coordinators, as well as patients and family caregivers, can Search for geo-available home care and community services, Book appointments and e-referrals directly into those services, and Connect through secure data communication and organization-specific referral and intake workflows.  Caredove is a true healthcare platform that builds trusted webs between Referrers (Providers/Care Coordinators), Service Providers and their mutual patients.   Caredove currently covers over 80 categories of Home Care and Community Services.  On the platform referrals are always free and it’s easy to invite referrers and service providers to the network so there is no impediment to its growth in serving each local community. For more information, click here.


Accountable Care, ACO, Affordable Care Act

FLAACO? What’s That?’

by Gregg A. Masters, MPH

First there was section 30222 prescribed by the Patient Protection and Affordable Care Act (“ACA”), which added section 1899 to the Social Security Act that requires the Secretary of Health and Human Services to establish the [Medicare] Shared Savings Program (MSSP), see: ‘Summary of Final Rule Provisions for Accountable CareOrganizations under the Medicare Shared Savings Program‘.

Leading up to and continuing to this day is a literal potpourri of aligned industry stakeholders and interests who support this emerging ‘new, new thing‘. From the ACO Congress to the ACO Summit and a host of others including the National Association of Accountable Care Organizations (NAACOs) and most recently the ACO Coalition forged by principals at The American Journal of Managed Care (who launched a sister publication the American Journal of Accountable Care) they advocate for and provide both networking opportunities and continuing education into best practices for these nascent entities on which much of the success of the ACA is vested.

ACOs, a once ‘DOA’ (dead on arrival) too little too late or ‘HMO-lite’ model version, seems to be working it’s way into not only the lexicon of managed competition via a growing body of endorsements and reported outcomes data by many both in the public (CMS) and private (Aetna, United, Blues plans, etc) sectors as the preferred mechanism to implement the vision of the triple aim and fuel the transition from volume to value based medicine.

Like much of its era-specific innovation industry predecessors HMOs, PPOs, EPOs, OWAs), i.e., greasing the skids for if not enabling the HMO industry migration beyond the limited appeal of staff models to mainstream medicine penetration via Independent Practice Associations (IPAs), and later followed by the growth and penetration of PHOs (physician hospital organizations), ACO ‘enablers’ (as well as this value based platform) seem to be here to stay.

Enter the Florida Association of Accountable Care Organizations (“FLACCOs”) led by former health plan executive Nicole Bradberry (for context listen to interviews with Nicole here and here), which holds its annual conference in Orlando, Florida October 1 & 2nd 2015.

FLAACOs Orlando Conference

The agenda is packed with entrepreneurs and operators in the space from ACO enablement companies including Aledade, to ACOs and vendors who support their risk readiness assessments if not assumption such as RowdMap. Aledade founder and CEO Farzad Mostashari, MD will keynote (see: ‘Former ONC Director Farzad Mostashari, MD Launches @AledadeACO).PopHealthWeek-logo-TWTTR-sq (2)

For the FLAACO agenda, click here and the list of participating faculty click here.

This year my colleague and co-founder of PopHealth Week (formerly, This Week in Accountable Care) Fred Goldstein and I will broadcast live from the event.

If you are not following FLAACOs and are interested in the road to accountable care, you may want to take note and perhaps even consider attending this gathering.

Accountable Care, ACO, Affordable Care Act

ACO Alignment: The Holy Grail?

By Gregg A. Masters, MPH

So one view holds, ‘the more things change, the more they stay the same’ (i.e., it’s deja vu all over again), while the present day, ‘enlightened’ [or perhaps event horizon naive] view suggests, ‘no this time, things really are/can be different’. Just enter the key enabler: [ _________ ] e.g, technology, ubiquitous internet/device access, healthcare costs are now threatening countries, not just industries, patient empowerment, better ‘skin-in-the-game’ plan design, pure desperation, you name it, etc.

ACO Alignment Summit MastheadEven at this late stage in the early implementation of the Patient Protection and Affordable Care Act (ACA) we still find ourselves in a muddled and often confusing if not selectively implemented [or waived] regulatory market with respect to the ability of the Act to achieve its ends via the proscribed means. Yet, ACA is the law and most of us ‘on the ground’ [or closely following the action] are either muddling though and/or boldly going forward amidst a vague and ambitious yet mandatory journey – enabling the ‘triple aim‘.

One large moving part of the ACA that disproportionately bears the burden of the Act’s efficacy, that is mission critical and must be interstitially infused inside delivery system [and financing/risk sharing if not assumption] transformational efforts is ‘the ACO’ – including it’s many non Federal derivatives operating in the commercial space.

Unfortunately once you’ve seen an ACO, well, you’ve seen one ACO

[NOTE: For some context see More or Less Confusion in ACO World: Who Really ‘Certifies’ ACOs?‘Accountable Care: In Search of Anchor Business Model(s) for the ‘All In’ Healthcare Eco-system’, and ‘IPA 2.0 the Preferred ACO Chassis?’].

Other then some broad brush guidance in the ACA and the regulatory follow-up via rules implementation, there is much room for variation on how the ‘Ark’ is to be built, governed and operated. Ergo the continuing conversation around one key pillar in the launch of a viable ACO, i.e., physician alignment with enterprise and market goals, or by proxy achieving the underlying clinical integration essential to seamless, coordinated, efficient and appropriate delivery of evidenced based care.

While there is much to learn, there are principles in evidence on which to build, i.e., successes in the market. If you want to learn more from an eclectic mix of players in the space, consider attending the ACO Alignment Summit.

Details of the panel session on alignment are here:ACO Alignment Summit

I am pleased to say that I will be moderating the Keynote Panel Discussion:
Drive Towards the Development of Tomorrow’s Accountable Health Care Delivery System’ with some talented colleagues from different markets around the country.

Joining me in this deep dive are: Nicole Bradberry, Chief Executive Officer, Florida Association of ACOs, President and Co-Founder, Citra Health Solutions; President, MZI Healthcare, Diwen Chen, Executive Director, Payment Innovation and Accountable Care, Dignity Health, and Bruce Miller, FACHE, Vice President, Network Development, Baylor Quality Alliance, Baylor Scott and White.

This is a unique blend of talented thought leaders and host business models from three different domestic U.S. markets all with distinctly different geo-political healthcare footprints. Nicole sits atop a member based association of ACOs in Florida (in addition to her leadership role at MZI Healthcare a vendor, consultant and health IT infrastructure play), while Diwen hails from a progressive institutionally managed integrated delivery system with hospital DNA Dignity Health, and Bruce stewards Network and Quality Management issues for an integrated group medical practice/IDN Scott and White that recently merged with the flagship Baylor Health System to combine two trophy properties (with distinctly different cultures, imj) in the Lonestar state.

This will be a ‘roll up your sleeves’ exchange on lessons learned in ACO alignment as well insights into the ‘how do I navigate the white waters of clinical integration’ given the local market considerations I face?



Accountable Care, ACO, Affordable Care Act

My Chat with Nicole Bradberry

This Week in Accountable Care Meet Nicole BradberryOn the anniversary of the launch of the Florida Association of ACOs and the vital role of MSOs in supporting the operations of disruptive business models chasing the sustainable healthcare ecosystem I had a round two conversation with Nicole Bradberry, President and Chief Operating Officer of Orange Health Solutions and CEO of the Florida Association of ACOs.

Listen as we learn more about the accountable care market one year later, including insights on the investment by Great Point Partners in Orange Health Solutions enabling the acquisition of MZI Healthcare including it’s suite of products built on the EZCAP chassis.