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Presented by David Parpart to Wellmark's Prebacked Ignition Startups 6/27/2013.
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Contact: David Parpart, D.C. , CEO Socially Relevant Inc 408-‐421-‐9508 [email protected]
What’s an ACO?
Accountable Healthcare Pla9orm for Pa<ent Engagement Solu<ons Pharmacist Counseling | Mobile Applica<ons | 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
ConfidenBal-‐ Socially Relevant Inc.
What’s an ACO?
ConfidenBal-‐ Socially Relevant Technology
ConfidenBal-‐ Socially Relevant Inc. ConfidenBal-‐ Socially Relevant Technology
Al a Carte
All Inclusive
A Business Model Volume vs. Capitation
IMAGE SOURCE: NEHI Roadmap to Improving MedicaBon Adherence, 2012
SOURCE: New England Health InsBtute, 2012
Accountable Care OrganizaBon (ACO)
Accountable Care Organization (ACO) Risk and Reward
Every 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 Model Value 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 Model Example: 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
ConfidenBal Do Not Distribute