Focus Magazine - Winter 2015 - (Page 24)

FEATURESTORY The ACO Opportunity: Defining the Value ■ By Troy Prehar T he prevalence of accountable care organizations (ACOs) in the past three years permanently changed the selling landscape in healthcare. e Center for Medicare and Medicaid Service's (CMS) innovations team developed ACOs specifically to hasten the transition from volumebased care to value-based care. Medicare ACOs fall under a program called MSSP or the Medicare Shared Savings Program. ACOs started with a small Medicare pilot cohort called "Pioneer ACOs" and according to e Advisory Board, there are more than 750 public and private ACOs nationwide today. ACOs, by definition, are simply any group of providers who agree to be held accountable for the cost and health of a given population. ere are both public (government Medicare and Medicaid) ACOs and private ACOs (Cigna, Blue Cross, etc.) and you can have multiple providers participating in both at the same time. CMS has done a great job with explaining this program and has robust learning materials on its website, www.cms.gov. Also available is much of the leadership information, legal construct and other pertinent details to support appropriate account pre-call planning. Value Definition for ACOs As sale professionals, we know that value has many definitions, but for CMS it ultimately defines ACO value as meeting minimum quality metrics 24 and measuring performance on the "Medicare Spend Per Beneficiary" or MSPB metric. is metric is a relative measure of the growth in healthcare spending for the patients in an ACO vs. the national average in growth for Medicare spending. Some of you will note that this metric has found its way into a number of the government's programs to include both the hospital value-based purchasing program and the new physician value-based modifier. e financial upside for ACOs occurs when they demonstrate that they can keep their growth in healthcare spending less than the national average growth. When that happens, the government "shares the savings" with them, according to which of three models or tracks the ACO chooses when it starts the program. e sales opportunity for us occurs when we align our product's solutions to how we can help the ACO achieve this goal. is is more easily said than done, as the rules governing how ACOs operate and are organized are deliberately loose, in an eﬀort to help foster innovation. ACOs face numerous challenges in becoming successful. In their first year, most ACOs simply focus on getting common metrics, information systems and care coordination patterns defined and established (and some never successfully achieve this!). Into the second year, many ACOs transition their focus to the specific performance of teams via a variety of scorecards. ese scorecards are a great source of information for the sales professional and the ability to demonstrate your products value relative to those metrics is a key achievement. In year three, most ACOs hope to be focused on eliminating the waste and redundancy identified previously. Understanding FOCUS | WINTER 2015 | www.L-TEN.org http://www.cms.gov http://www.L-TEN.org

Table of Contents for the Digital Edition of Focus Magazine - Winter 2015

Focus Magazine
From the President: Put a Bow on It!
Table of Contents
Table of Contents
Guest Editor: Mastering Connections of the Construct
Directions: New Year, New Opportunities
Front of the Room: 'Where Is This Going?'
Neuroscience: The Neuroscience of Messaging
Carol Wells: Training's Shining STAR
LTEN Events: Connecting Members
The ACO Opportunity: Defining the Value
Cloud-Based Collaborative Platforms: Raising Productivity
Transformational Leaders: From Fear to Followership
Field Development: 4 Steps to Success
Delivering Messages that Drive Business
Virtual How: The Learning Technology Landscape
Ad Index
Focus Contacts
5 Questions with Thuy and Milo Sindell

Focus Magazine - Winter 2015