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From Volume to Value: ACOs and Value-based Care

From Volume to Value: ACOs and Value-based Care

The health care marketplace has always been dynamic, but with the rapid rise in alternative payment models in recent years, health care executives must understand the move from volume to value—and the opportunities that are arising from the evolving health care delivery marketplace.

From Volume to Value: ACOs and Value-based Care is a complete overhaul of our original ACO Outlook report first launched in 2014. In this extensive report, we provide key insights into the world of accountable care, bundled payments and other value-based health care delivery models. ACOs and Value-based Care is informed by primary research from November 2016 with Darwin's ACO Executive Panel, as well as trends gleaned from our earlier ACO leadership surveys.

ACOs and Value-based Care is packed with original research and insights you won't find anywhere else. See below for a detailed table of contents.

The report consists of a printed, wire-bound document plus a downloadable .pdf, 310 pages, including a 24-page executive summary and 89 figures and tables. Subscribers will receive periodic updates in .pdf format for one year from the date of purchase.

Purchasers of either a Department or Global Site License will receive a 90-minute, in-person Q&A with Darwin Health CEO John Marchica. Please contact service@darwinhealth.net for more information.


Executive Summary
Chapter 1: Introduction
Chapter 2: Value-based Care Models
1. Value-Based Care Defined
2. Medicare ACO Models
Pioneer Model
Medicare Shared Savings Program
Advance Payment ACO Model
ACO Investment Model
Next Generation ACO
Comprehensive ESRD Care (CEC) Model
Newest Medicare ACO Models
“Vermont receives federal approval for statewide all-payer ACO
3. Other Value-based Care Models
Medicaid ACOs
Commercial ACOs
Employer-led ACOs
Employer-driven bundles
Patient-Centered Medical Homes
4. Innovation Center Initiatives: National
Bundled Payments for Care Improvement (BPCI) Initiative
Comprehensive Primary Care Initiative (CPC)
Community-based Care Transitions Program (CCTP)
FQHC Advanced Primary Care Practice Demonstration
Independence at Home Demonstration
“Independence at Home: A Success Story”
Home Health Value-based Reimbursement Pilot
Nursing Home Value-Based Purchasing Demonstration
5. Innovation Center Models: State
6. Innovation Center Models: Local
7. Issue Brief: The Oncology Care Model
8. Issue Brief: The Cardiac Care Bundle
9. Issue Brief: Understanding MACRA
10. Issue Brief: Value-based Contracting in Pharmaceuticals
Chapter 3: 2016 ACO Executive Survey
1. Research Focus
2. Methodology
3. ACO Characteristics
4. Results
A. 2017 Initiatives
B. Reducing Readmissions
C. Patient Data Management
D. Issues Affecting Cost and Quality
E. Relationships with Suppliers and Providers
F. Relationships with Pharmaceutical Companies
5. Summary
Chapter 4: Influential ACOs
1. Advocate Health
2. Arizona Care Network
3. Atrius Health
4. Baylor Scott&White Quality Alliance
5. Beacon Health LLC
6. Beth Israel Deaconess Care Organization
7. Carolinas HealthCare System (Triad Health Network)
8. Dartmouth-Hitchcock
9. Memorial Hermann
10. Ochsner Accountable Care Network LLC
11. Optimus Healthcare Partners
12. Partners HealthCare
13. Physician Organization of Michigan
14. UCLA Health ACO
Chapter 5: Performance
A. Quality
Medicare ACO Quality Metrics
MSSP Average Quality Scores, 2013-2015
Pioneer Average Quality Scores, 2012-2015
Quality Metrics
1. Patient/Caregiver Experience
2. Preventive Medicine
3. Readmission Rates
4. SNF Admissions
5. Unplanned Admissions for Patients with Diabetes
6. Unplanned Admissions for Patients with Heart Failure
7. Unplanned Admissions for Patients with Multiple Chronic Conditions
8. COPD or Asthma Admissions
9. Heart Failure
10. Meaningful Use
11. Diabetes Composite
12. Overall Quality
B. Financial Performance 2015
C. Aggregate Financial Performance 2015
D. Bundled Payments
Chapter 6: Implications for Suppliers
1. Pharmacy
2. Pharmaceuticals and Biotechnology
3. Medical Device Providers
4. Durable Medical Equipment
5. Home Health Care
6. Ambulatory Care
7. Long-term Care
8. Other Providers and Suppliers
Chapter 7: Market Outlook
1. Issues and Opportunities
2. Critical Success Factors
Conclusion
Appendices
A: Innovation Awards
B: Original list of Pioneer ACOs
C. Convening Organizations
D: BPCI Participants and Convener Definitions
E: Darwin Health ACO of the Year Awards
F: Initial ACO Executive Survey Results
Figures
Figure 1.1 U.S. Population Growth Projections, 2015-2050
Figure 1.2 Weekly Closing Share Price: Astra Zeneca, Pfizer, GlaxoSmithKline, Novartis and Amgen
Figure 2.1 MSSP home office locations
Figure 2.2 Advance Payment ACO locations
Figure 2.3 Medicare Shared Savings Program locations
Figure 2.4 Home Health VBR Pilot Outcomes and Process Measures
Figure 3.1 Panel Distribution by Title: C-level Group
Figure 3.2 Panel Distribution by Region
Figure 3.3 2017 Initiatives: Behavioral Health, Alzheimer’s and Dementia
Figure 3.4 Factor Importance in Reducing Readmissions
Figure 3.5 EHR Usage in Practice
Figure 3.6 ACO Executive Concerns
Figure 3.7 Issues Affecting Quality of Care
Figure 3.8 Issues Affecting Ability to Control Costs
Figure 3.9 Existing Relationships with Suppliers and Other Providers
Figure 3.10 Exploring Relationships with Suppliers and Other Providers
Figure 3.11 Has a Simple Contract in Place
Figure 3.12 Has a Risk-based Contract in Place
Figure 3.13 Provider/Supplier Contracting 2014-2016
Figure 4.1 Advocate Health Care Value-based Initiatives
Figure 4.2 Advocate Physician Partners Accountable Care Visual Scorecard
Figure 4.3 Dignity Health Value-based Initiatives
Figure 4.4 Arizona Care Network Visual Scorecard
Figure 4.5 Atrius Health Value-based Initiatives
Figure 4.6 Atrius Health Pioneer ACO Visual Scorecard
Figure 4.7 Baylor Scott&White Value-based Initiatives
Figure 4.8 Baylor Scott&White MSSP Visual Scorecard
Figure 4.9 Beacon Health Value-based Initiatives
Figure 4.10 Beth Israel Deaconess Value-based Initiatives
Figure 4.11 Beth Israel Deaconess Pioneer ACO Visual Scorecard
Figure 4.12 Carolinas HealthCare System Value-based Initiatives
Figure 4.13 Triad HealthCare Network MSSP Visual Scorecard
Figure 4.14 Dartmouth-Hitchcock Value-based Initiatives
Figure 4.15 Dartmouth-Hitchcock Pioneer ACO Visual Scorecard
Figure 4.16 Memorial Hermann Value-based Initiatives
Figure 4.17 Memorial Hermann MSSP ACO Visual Scorecard
Figure 4.18 Ochsner Health System Value-based Initiatives
Figure 4.19 Ochsner Accountable Care Network MSSP Visual Scorecard
Figure 4.20 Optimus Healthcare Partners Value-based Initiatives
Figure 4.21 Optimus Healthcare Partners MSSP Visual Scorecard
Figure 4.22 Partners HealthCare Value-based Initiatives
Figure 4.23 Partners HealthCare Pioneer ACO Visual Scorecard
Figure 4.24 Physician’s Organization of Michigan Value-based Initiatives
Figure 4.25 POM ACO MSSP Visual Scorecard
Figure 4.26 UCLA Value-based Initiatives
Figure 4.27 UCLA Faculty Practice Group MSSP Visual Scorecard
Figure 7.1 Big Data in Health Care
Figure 7.2 Factors Affecting Readmission
Figure 7.3 The Patient-Reported Outcome-Quality of Life Tool
Figure 7.4 Prevalence of heart disease, hypertension, stroke and cancer among adults aged 65 and over
Figure 7.5 2016 Executive Survey—EHR Usage
Tables
Table 2.1 Pioneer ACOs
Table 2.2 Pioneer ACOs: What happened to the dropouts?
Table 2.3 Payment Characteristics
Table 2.4 MSSPs By Region
Table 2.5 Advance Payment ACOs
Table 2.6 Investment Model ACOs
Table 2.7 Next Generation ACOs
Table 2.8 Pioneer vs. Next Generation ACO
Table 2.9 ESCO Participating Providers
Table 2.10 Medicaid Program Structure
Table 2.11 Top Convening Organizations
Table 3.1 Sample Characteristics
Table 3.2 Factor Importance in Reducing Readmissions
Table 3.3 Simple Contracting, 2014-2016
Table 3.4 Risk-based Contracting, 2014-2016
Table 3.5 ACO Contracting by ACO Model
Table 5.1 Medicare ACO Quality Metrics
Table 5.2 MSSP Average Quality Scores, 2013-2015
Table 5.3 Pioneer Average Quality Scores, 2012-2015
Table 5.4 Top Decile MSSP ACOs, Patient/Caregiver Experience
Table 5.5 Top Decile MSSP ACOs, Preventive Medicine
Table 5.6 Top Decile MSSP ACOs, Readmission Rates
Table 5.7 Top Decile MSSP ACOs, SNF Admissions
Table 5.8 Top Decile MSSP ACOs, Unplanned Admissions for Patients with Diabetes
Table 5.9 Top Decile MSSP ACOs, Unplanned Admissions for Patients with Heart Failure
Table 5.10 Top Decile MSSP ACOs, Unplanned Admissions for Patients with Multiple Chronic Conditions
Table 5.11 Top Decile MSSP ACOs, COPD or Asthma Admissions
Table 5.12 Top Decile MSSP ACOs, Heart Failure
Table 5.13 All ACOs with 100 percent Meaningful Use Attestation
Table 5.14 Top Decile MSSP ACOs, Diabetes Composite
Table 5.15 Top Decile MSSP ACOs, Overall Quality
Table 5.16 MSSP ACOs with the Highest Earned Shared Savings
Table 5.17 MSSP ACOs with the Largest Losses
Table 5.18 MSSP ACO Financial Performance, 2013-2015
Table 5.19 MSSP ACO Performance per Beneficiary
Table 5.20 Pioneer ACO Financial Performance, 2013-2015
Table 5.21 Pioneer ACO Performance per Beneficiary
Table 7.1 Telehealth Private Insurance Coverage
Table 7.2 Cost Comparison of Medical Procedures, 2006 (U.S. dollars)

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