Pathways to a Successful Accountable Care Organization

Peter A. Gross, Joshua Bennett, Denise Patriaco, Guy D'Andrea, Kris Corwin, Kris Gates, Mitchel Easton, Brent Hardaway, Elyse Pegler, Bryan Smith, Andy Edeburn, Shawn Griffin, Glen Champlin, John Pitsikoulis, Seth Edwards, Jeremy Mathis, Morey Menacker, Thomas Kloos, Joseph F. Damore, Seth Edwards, Mark Hiller, Beth Ire, Peter A. Gross

• Publisher: Johns Hopkins University Press
• Year: 2020
• eBook ISBN: 9781421438269
• Topic: Medicine
• Subtopic: Health Policy

A valuable guide to starting and running a successful accountable care organization.

Health care in America is undergoing great change. Soon, accountable care organizations—health care organizations that tie provider reimbursements to quality metrics and reductions in the cost of care—will be ubiquitous. But how do you set up an ACO? How does an ACO function? And what are the keys to creating a profitable ACO?

Pathways to a Successful Accountable Care Organization will help guide you through the complicated process of establishing and running an ACO. Peter A. Gross, MD, who has firsthand experience as the chairman of a successful ACO, breaks down how he did it and describes the pitfalls he discovered along the way. In-depth essays by a group of expert authors touch on

• the essential ingredients of a successful ACO
• monitoring and submitting Group Practice Reporting Option quality measures
• mastering your patients' responses to the Consumer Assessment of Health Plans Survey
• how bundled payments and CPC+ can meld with your ACO
• how MACRA and MIPS affect your ACO
• the role of an ACO/CIN
• the complexities of post-acute care
• data analytics
• engaging and integrating physician practices

Dr. Gross and his colleagues are in a perfect position to guide other health care leaders through the ACO process while also providing excellent case studies for policy professionals who are interested in how their work influences health care delivery. Readers will come away with the necessary knowledge to thrive and be rewarded with cost savings.

Contributors: Joshua Bennett, Allison Brennan, Glen Champlin, Kris Corwin, Guy D'Andrea, Joseph F. Damore, Mitchel Easton, Andy Edeburn, Seth Edwards, Jennifer Gasperini, Kris Gates, Shawn Griffin, Peter A. Gross, Brent Hardaway, Mark Hiller, Beth Ireton, Thomas Kloos, Jeremy Mathis, Miriam McKisic, Morey Menacker, Denise Patriaco, Elyse Pegler, John Pitsikoulis, Michael Schweitzer, Bryan F. Smith

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• Contributors
• Preface
• Acknowledgments
• 1. Essential Ingredients of a Successful Accountable Care Organization
• 2. Patient-Centered Medical Homes: A Key Building Block for Accountable Care Organizations
• 3. Care Coordination: Initial Plans and Evolution
• 4. Quality Measurement in Accountable Care Organizations
• 5. Monitoring and Submitting Quality Measures for the Group Practice Reporting Option: CMS Web Interface
• 6. Live Experience of a Quality Measure Validation Audit
• 7. Ready, Risk, Reward: Building Successful Two-Sided Risk Models
• 8. Post-Acute Care: A Key Consideration for an Accountable Care Organization
• 9. Data Analytics: Making a Choice
• 10. Impact of Coding and Documentation on Risk Scores
• 11. Legal and Compliance Considerations
• 12. Employee Health Management and the Role of an Accountable Care Organization
• 13. The Role of Primary Care in the Future of Health Care
• 14. Practice Transformation: Engaging and Integrating Physician Practices
• 15. Population Health Management Consulting
• 16. The Comprehensive Primary Care Plus Initiative
• 17. Keys to Success in Bundled Payments
• Afterword
• Index