ACO ADLS: Minneapolis, Minnesota

Opening Remarks from CMS

Rich Baron, MD
Group Director, Seamless Care, CMS Center for Innovation

Jon Blum
Deputy Administrator & Director, CMS Center for Medicare

Setting Priorities and Leading ACO Formation

How becoming an ACO changes perspective, priorities, and leadership (PDF)

John Bertko, F.S.A., M.A.A.A.
CMS

Essential questions an ACO needs to ask - and what it takes to answer them

Paul M. Katz, MBA
Chief Executive Officer, Intelligent Healthcare

• This session introduced the two-day program. It demonstrated the importance of grounding the ACO's strategy on a solid understanding of the population for which it will be responsible, existing patterns of care and opportunities for improvement in that population, clearly defining the role and responsibility of all participating providers for meeting the needs of the population and achieving strategic goals for improvement, establishing a workable organizational structure, and leading efforts to change the way care is organized, delivered and managed. This session introduced the notion of a "recipe for success" that reflects an ACO's understanding of the local market it operates in, the specific goals that it will need to achieve, and the core competencies it both has and needs to develop, given the different starting points of each organization.

Insights from the Field

• Participants learned from the real-world experience of ACO leaders who have developed and implemented organizations that perform the functions of an ACO.
• Issues addressed included leadership and management functions such as priority setting, decision making, and negotiating provider relationships.

Case Study 1: Building an ACO on the foundation of an Integrated Delivery System (IDS)

Craig Samitt, MD
Chief Executive Officer, Dean Health

Case Study 2: Building an ACO on the foundation of an IPA

Karen van Wagner, PhD
Executive Director, North Texas Specialty Physicians

Case Study 3: Building an ACO on the foundation of a Physician-Hospital Organization (PHO)

Lee Sacks, MD
Chief Executive Officer, Advocate Physician Partners

Remarks by CMS Leadership

Don Berwick, MD, MPP
Administrator, Centers for Medicare & Medicaid Services

Rick Gilfillan, MD
Acting Director, Center for Medicare and Medicaid Innovation, CMS

Overview of Core Competencies Essential to ACO Success

Overview of Competencies Related to Organizing & Delivering Care

James Rogers, MD
St. John's Health System, Springfield, Missouri

Overview of Competencies Related to Assuming & Managing Risk

Mark Eustis, MHA
Chief Executive Officer, Fairview Health Services

Learning Modules:
The remainder of Day 2 was structured as a series of break-out sessions, each presenting a learning module related to one or more core competencies.

• One track of learning modules addressed the competencies related to the delivery of care. These modules were attended by clinician member(s) of each team.
• A second track of learning modules addressed the competencies related to financial and risk management. These modules were attended by the manager member(s) of each team.

Within each track, participants broke into two smaller groups.

Module 1: Connecting providers (EHR/HIT)

Glenn Loomis, MD
St. Elizabeth Physicians

Keith Hepp
HealthBridge

John Blair, MD
MedAllies

Susan Stuard, MBA
THINC

Module 6: Describing your population's risk profile

David Knutson, MS
Department of Health and Human Services

David E. Kelleher, MS
HealthCare Options Inc.

Module 2: Describing your population's clinical profile

Steve Bernstein, MD
University of Michigan

James Rogers, MD
St. John's Health System

Module 7: Risk management

Shashank Kalokhe, PhD
Everett Clinic

Greger Vigen, FSA
Independent Actuary

Module 3: Coordinating care for high-risk patients

Steve Bernstein, MD
University of Michigan

Barbara Walters, MD
Dartmouth-Hitchcock Medical Center

Module 8: Financial modeling

Greger Vigen, FSA
Independent Actuary

Rob Parke, FSA
Milliman

Module 4: Primary care and specialist services (PDF)

Rich Baron, MD
CMS

Jeff Schiff, MD
State of Minnesota Public Programs

Module 9: Capitalization

Barbara Spivak, MD
Mount Auburn Cambridge Independent Practice Association

Matthew Mazdyasni, MS
HealthCare Partners

Module 5: Leading care process improvement

Christine Sinsky, MD
Medical Associates Clinic and Health Plans

David Moen, MD
Fairview Physician Associates

Module 10: Incentive payments

Craig Sammit, MD
Dean Health

Barbara Spivak, MD
Mount Auburn Cambridge Independent Practice Association

Methods for meeting patient needs while reducing the total cost of care

William Chin, MD
HealthCare Partners

• This session summarized the competencies that were covered in the learning modules on Day 2 and demonstrated how these competencies come together in the effort of the ACO to compete successfully on the basis of value.

ACOs and successful competition in a mixed payment environment

Scott Sarran, MD, MM
Chief Medical Officer Blue Cross Blue Shield of Illinois

• Concluding keynote address by a leading private purchaser on how the development of successful ACOs that compete on value will change the relationship between providers and purchasers.