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The Healthcare Executive's Guide to ACO Strategy, Second Edition Coker Group Max Reiboldt, CPA Ellis "Mac" Knight, MD The Healthcare Executive's Guide to ACO Strategy, Second Edition, provides healthcare leaders with new strategies and tools to implement and manage accountable care organizations (ACO). Based on the experiences of organizations that have started down the path of ACO development, the authors discuss what has and hasn't worked and share new strategies for organizations grappling with managing an ACO. Wherever an organization is on the timeline for structuring its alliances and addressing evolving reimbursement issues in the accountable care era, this book delivers valuable information to help healthcare executives meet their pending challenges. This resources offers: Discussion of all updated regulations pertaining to ACOs Academic and real-world examples of the evolution of the Pioneer program Explanation of a new approach to bedside care that moves from the volume/productivity model to a value-based model A physician's viewpoint on ACOs from author Ellis "Mac" Knight, MD A focus on taking ACOs from theory to practice in implementing a value-based model: Coker's "Care Process Design System" Analysis of what has and hasn't worked, based on real experience A chapter dedicated to the experiences of the Pioneer program Table of Contents Chapter 1: Accountable Care Organizations and Clinically Integrated Networks: An Overview Chapter 2: How We Got Here Chapter 3: What We Anticipate About Accountable Care Concept Chapter 4: Moving From a Structural Construct to a Functional Construct Chapter 5: Physician-Hospital Integration Chapter 6: Compensation and Anticipated Changes Chapter 7: Are You Ready for an ACO and CIN Environment? Chapter 8: Legal Considerations of ACOs and CINs Chapter 9: The Pioneer Program and Its Outcomes Chapter 10: The CMS Shared Savings Program Chapter 11: Benchmarks for CMS Shared Savings Program Chapter 12: Quality Measures Chapter 13: The Role of Information Technology Chapter 14: Patient-Centered Medical Homes Chapter 15: Where Do We Go From Here? Appendix A: Pilot Programs in Place Appendix B: SSP Participants by Region/State Appendix C: Glossary of Acronyms Who should read this book? Healthcare executives C-suite and other high level financial, administrative, and clinical leaders within a hospital setting and in large private practices Healthcare attorneys Medical Staff Quality/Patient Safety professionals
The Healthcare Executive's Guide to ACO Strategy The Healthcare Executive's Guide to ACO Strategy is the first comprehensive book dissecting the integral components of ACOs from physician, provider, and payer views, including analysis of the CMS final regulations. In the wake of healthcare reform, ACOs continue to emerge as the care delivery and reimbursement model of the future. Get the book that provides specifics on incorporating accountable care structure and strategy into your organization so you can enter the ACO era prepared and positioned to succeed. Get expert advice on ACOs and the elements for success, including how to: Participate in the CMS Shared Savings program Distinguish the various characteristics of an ACO and its operations Understand how ACO reimbursement structure will work Evaluate the process of forming an ACO-including the legal, financial, IT, and governance requirements Fulfill important quality measures for an ACO Reshape and refine hospital-physician alignment strategies Table of contents: Chapter 1: ACCOUNTABLE CARE ORGANIZATION OVERVIEW What Is an ACO? The Logic of ACOs Basic ACO Tenets Key Characteristics of Accountable Care Chapter 2: HOW WE GOT HERE A Look Back at the 1980s and '90s The Alternatives to HMOs Medicare Prospective Payment System Physician-hospital Organizations Chapter 3: WHAT WE ANTCIPATE ABOUT THE ACCOUNTABLE CARE CONCEPT Accountable Care Organizations Why ACOs? What Will an ACO Look Like? Structural Change Challenges of Collaboration Chapter 4: PHYSICIAN-HOSPITAL INTEGRATION ACOs as a Driver of Alignment Different Alignment Models Continuum of Care and Integration Chapter 5: COMPENSATION AND ANTICIPATED CHANGES Historical and Current Reimbursement Structures Proposed Reimbursement Structures Medical Home Payment Models Chapter 6: ARE YOU READY FOR AN ACO ENVIRONMENT? Organizational Assessment Financing: Startup and Ongoing Expenses Market Assessment Chapter 7: LEGAL CONSIDERATIONS Requirements Governance Antitrust Issues Stark Law and Anti-kickback Statute Chapter 8: THE CMS SHARED SAVINGS PROGRAM Program Overview Shared Savings Program Tracts Interim Payment Option Chapter 9: BENCHMARKS FOR SHARED SAVINGS PROGRAM Assignment of Beneficiaries Cost Benchmarks Review of the Norton Healthcare and Dartmouth-Hitchcock Health Care System ACOs Chapter 10: QUALITY MEASURES Benchmarks, Standardization, and Protocols Utilization of Evidence-based Medicine Measuring Outcomes Patient Compliance Chapter 11: THE ROLE OF INFORMATION TECHNOLOGY Technology Considerations Health IT Market as it Relates to ACOs Harmonizing the ACO through Connectivity Chapter 12: PATIENT-CENTERED MEDICAL HOMES How Consolidation Has Shaped the Future Positioning for an Evolving Healthcare System What is the Patient-Centered Medical Home? Comparing ACOs and Medical Homes Chapter 13: Where Do We Go From Here? Form Physicians-Hospital Alliances Partner in the Delivery of Quality and Cost-effective Medical Care Review Current Compensation and Reimbursement Models Recap of ACO Programs
An accountable care organization (ACO) is a healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned group of patients. Accountable Care Organizations: Value Metrics and Capital Formation explores the historical ba
Building on the foundation of the previous edition, this book takes readers to the next level of management of medical practices for the 21st century. The road to becoming a physician is not an easy one to travel, nor does it become easier once a doctor completes his\her training. After a long and arduous training process, doctors embark on their professional journey, and there are major crossroads that are fraught with challenges, unknowns and risk. The transition to professional practice is daunting, and many physicians leave their training unprepared for the business of medicine. Even at the peak of their careers, sustaining a successful and profitable practice is not easy. Opening chapters revisit the basic business concepts that every physician needs to know, emphasizing the benefits that accrue to a physician who understands the basics of business, from accounting and contracts to managing people and personal finances. The next set of chapters offers a roadmap for doctors who are beginning a medical practice and will include new methods and procedures that have become available since the original edition, defining the various options for doctors’ employment such as solo practice, group practice and academic medicine. The final chapters emphasize strategies on how to build and grow a successful practice, including the use of technology and telemedicine, cybersecurity, marketing and much more. Unfortunately, not every doctor has the background, training and skills to manage a medical practice. The Business of Building and Managing a Healthcare Practice simplifies the process of business management and provides the practicing physician with knowledge to be able to enjoy the business component of his\her medical practice.
This book features over 50 of the industry’s brightest female pioneers who share insightful lessons backed by several years of experience, as well as tips for navigating a successful career in HIT. The intent of this book is to provide the opportunity to capture stories from highly successful women to inspire the next generation who want to pursue a career in HIT and to inspire those already working in the field who are eager to advance in their careers. This book also provides insights on industry opportunities, ways to deal with harassment, the history of female tech innovators, and negotiating competitive salary and employment agreements. Additional industry experts provided guidance on tapping into venture capital funding and tools for career development. A comprehensive resource guide and glossary of industry terms are also included. Co-authors included: Amy Sabillon, MSI, Ayanna Chambliss, CAP, SHRM-CP, Lindsay Rowlands, MHA, and Stacey B. Lee, JD.
Today, it is not uncommon for practices and hospitals to be on their second or third EHR and/or contemplating a transition from the traditional on-premise model to a cloud-based system. As a follow-up to Complete Guide and Toolkit to Successful EHR Adoption (©2011 HIMSS), this book builds on the best practices of the first edition, fast-forwarding to the latest innovations that are currently leveraged and adopted by providers and hospitals. We examine the role that artificial intelligence (AI) is now playing in and around EHR technology. We also address the advances in analytics and deep learning (also known as deep structured or hierarchical learning) and explain this topic in practical ways for even the most novice reader to comprehend and apply. The challenges of EHR to EHR migrations and data conversions will also be covered, including the use of the unethical practice of data blocking used as a tactic by some vendors to hold data hostage. Further, we explore innovations related to interoperability, cloud computing, cyber security, and electronic patient/consumer engagement. Finally, this book will deal with what to do with aging technology and databases, which is an issue rarely considered in any of the early publications on healthcare technology. What is the proper way to retire a legacy system, and what are the legal obligations of data archiving? Though a lot has changed since the 2011 edition, many of the fundamentals remain the same and will serve as a foundation for the next generation of EHR adopters and/or those moving on to their second, third, fourth, and beyond EHRs.
Is the ACO strategy right for your organization? Accountable Care Organizations will help you understand the ACO framework and assess your readiness to embark on an ACO strategy. This book provides the structural blueprints, management skills, and cultural tools necessary to implement a successful ACO. Practical advice is bolstered with real world examples of leading healthcare providers that are pioneers in the rapidly changing world of accountable care. This guidebook is designed to facilitate critical conversations and decisions at all stages of the ACO development journey. Explore processes and structures and learn how to implement pilots to shape your own ACO delivery model. Each chapter includes takeaway points and tailored action steps for: (1) organizations interested in exploring the ACO concept, (2) organizations taking the first steps towards an ACO model, and (3) organizations already moving full speed ahead. This book will help you answer these questions and more: What does it take to become an ACO? What steps and actions should your organization take to implement an ACO strategy? How can organizational culture support your move to accountable care? How can you build a business plan to support an ACO strategy? What information technology is needed to implement an ACO strategy? How can an merging ACO best negotiate with third-party payers?
The Essential Guide to Accountable Care Organizations: Challenges, Risks and Opportunities of the ACO Model answers key questions surrounding ACOs so that hospitals, PHOs, IPAs and other physician organizations, networks or group practices can weigh the merits now of creating an ACO and complete the necessary groundwork before CMS's ACO operation date of January 2012.
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