Health Care Transformation

Do You Know if You’re in an ACO?

Hello There Health Care Transformation Tribe,

There has been some recent news on the Medicare Shared Savings front that’s a pretty big deal but honestly most people have probably never heard of an ACO, don’t realize they are in an ACO, and don’t know that ACO’s were a large part of the Affordable Care Act when it was passed back in 2010. So let me start from the beginning and lay this all out for you.

How Doctors/Health Systems Were Paid in the Past: Fee-For-Service (FFS)

What does this mean? They get paid a set amount every time they do something

What impact does it have? 

  • It incentivizes doctors to do more (more surgeries, more labs, more imaging, etc.).
  • It does not pay doctors based on the quality of care the patient receives.
  • Doctors are not incentivized to provide care if they don’t get paid for it or if the FFS reimbursement is low, even if it would actually improve care for the patient (responding to messages, making calls to patients, video visits, mental health, obesity educational classes, etc.).
  • It siloes the providers of care from one another because everyone gets paid for only the service they provide, i.e. care is not patient-centric.

Enter the Accountable Care Organization (ACO). ACO’s are groups of healthcare providers that assume responsibility for the cost and quality of care for their patients. 

What does this mean? The payer sets expected financial and quality benchmarks for the ACO’s patient population.  If the ACO is below the financial target and above the quality targets the ACO gets to share in the savings with the payer. Note- there are two types of ACO’s: one-sided risk (upside only) and two-sided risk (upside and downside). Those who enter into two-sided risk will have to pay money back to the payer if the patients spend more healthcare dollars than expected but if there are savings they get a higher percentage of the savings. That is their only incentive to take on downside risk.

What impact does it have?

  • It incentivizes health systems to provide the right care at the right time in the right setting by the right person.
  • It incentivizes prevention and high-quality patient care.
  • It incentivizes health systems to invest in people and resources that otherwise wouldn’t be reimbursed under FFS but keep patients healthy, for example, remote monitoring in the home and calling/visiting patients after being discharged from the hospital.
  • It incentivizes health systems to break down siloes and provide patient-centric care to make sure all these items are achieved.

The ACO led by CMS (Centers for Medicare and Medicaid Services) is called the Medicare Shared Savings Program (MSSP). Commercial payers have also followed suit and created their own ACO’s as well.

Little known fact: It is well established in health care that the government, i.e. CMS, is more progressive when it comes to cost reduction and quality improvement for patients, which is very surprising to most folks because they would assume it would be the private sector. Not the case in health care!

So now that you better understand what defines an ACO let’s talk about what CMS is proposing to change about the Medicare Shared Savings Program (MSSP):

  1. Renaming the program “Pathways to Success”. Not sure the need or impact of a title change but ok.
  2. Reduces the different tracks ACO’s can take and they must take on downside risk within 2 years of entering the program (right now they have six years).
  3. ACO’s must alert their patients that they are in fact in an ACO.
  4. Adjustments will be made to ACO financial targets based on local markets.
  5. Allows providers to receive payment for telehealth services to patients in their homes (which is currently not reimbursed under FFS Medicare)

What is “telehealth” you ask? Well let me explain…

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I actually believe that most of these proposed items are good things. We should be doing more telehealth to reach patients where they are. We should be pushing health systems to move away from FFS incentives and take downside risk. It would be a good thing for patients to know whether they are in an ACO and what that means so they can continue to further engage with the health system in the most optimal way. Many are concerned that ACO’s will drop out of the program when forced to take downside risk but I think that will remain to be seen.

In the meantime, I hope you better understand the major development of the ACO that occurred within the Affordable Care Act and how some adjustments may be made to the program in the near future.

Cheers to Health and Happiness!

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Health Care Transformation

The Academy is coming!

Hey Guys,

Happy 2018! I hope you and yours had a lovely holiday and a Happy New Year! I’m excited to kick off the new year with some very exciting news: The Health Care Transformation Academy launches this month!

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The Academy consists of concise, easy-to-use lessons on how to understand and navigate the U.S. health care system in order to achieve your best health outcomes at the best price. I’m so excited to have tangible lessons available soon that really support and guide you in giving you that peace of mind you need when navigating our confusing, messy, expensive health care system.

Stay tuned for more details in the coming days and I’m so excited to kick off 2018 by supporting you in taking control over your health outcomes!

Cheers to Health and Happiness!

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Health Care Transformation

Welcome to Health Care Transformation- For the People!

Hey everyone, I’m Meghan Nechrebecki and I’m the founder of Health Care Transformation. This is me: (It’s such a pleasure to meet you!)

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I earned my Master’s in Public Health from Johns Hopkins and for the past seven years I’ve been working with doctors, hospitals, and health insurance companies to improve the health outcomes of patients. And today, it is my great pleasure to welcome you to (drumroll please…

Health Care Transformation- For the People!

This blog will educate, engage, and empower you to better understand the health care system and to take control over your health- both for yourself and for your loved ones.

And why is this so important?

Because, as you probably know by now, we as a country have really high healthcare costs, which unfortunately most of us have experienced. And sadly, we don’t have that great of health outcomes either! 

In a report by the Commonwealth Fund that compares the U.S. to other high-income countries, the U.S. ranked last on performance overall and ranked last or near last on the Access, Administrative Efficiency, Equity, and Health Care Outcomes categories. We have a lot of work to do here guys and gals!

We all know there are a lot of issues with our U.S. health care system but I actually believe that there is at least one powerful solution in front of us and that’s YOU! That’s everyone that ever has been or will be a patient.

 I firmly believe that by engaging and empowering patients to understand and navigate the healthcare system, you will actually make more informed and better decisions for you and your loved ones, which believe it or not will have a large impact on reducing health care costs and improving your health

So let’s get started! What can you expect from Health Care for the People?

Every week there will be new material to support and empower you! You can access them here on our website, follow us on Instagram, or subscribe to our YouTube channel. 

There will be VIDEOS, like this:

 

There will be INSPIRATION, like this:

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There will be EDUCATIONAL TIPS, like this:

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So head to www.caretransformation.net every week for new posts on what you need to know about taking control over your health. I’m looking forward to this journey together- Cheers to Health and Happiness!  

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