ACO Technical Assistance to Healthcare Organizations

Executive Resource’s technical assistance is based on our prior and current ACO project development and taking into consideration a multitude of issues, tasks and providers. Select areas that involve hospitals and FQHC collaboration regarding ACOs, include, but are not limited, to the following:

  • How strong is the primary care physician complement relative to ACO development? Primary care is the driver of the beneficiary assignment to an ACO - it will be difficult for an ACO to be successful without a strong primary care physician base and this is an area that we assist regarding FQHC development.
  • Perform an environmental scan regarding the FQHC and what they are doing in the specific service area regarding penetration, market share, volume, unmet need, etc., which includes performing a UDS mapper report to determine FQHC capacity issues.
  • With the conversion from uninsured to Medicaid, FQHCs will be the vehicle in health reform  - as such, EXEC assesses the potential for another FQHC (one “friendly” to the hospital and one that wants to be part of the ACO) and consider Service Area Overlap issues in order to establish one.
  • FQHCs are not eligible to form an ACO, but they are allowed to be part of an ACO formed by eligible participants; in fact, ACOs, including FQHC members, can receive an enhanced percentage of shared savings.
  • Primary care services performed in an FQHC setting are used for the assignment of beneficiaries; however, the participant enrollment files with CMS must be done differently than non-FQHC providers so care is crucial in ensuring the enrollment is done properly.
  • Shared savings distributions - Track 1 ACOs that meet all quality and reporting standards can receive a 50% share of the savings achieved, and if the ACO has an FQHC in its organization, the distributions will increase by a maximum of 2.5%, depending on the percentage of beneficiaries with visits to the FQHC. Track 2 ACOs that meet all quality and reporting standards can receive a 60% share of the savings achieved, and if the ACO has a FQHC in its organization, the distributions will increase by 5%, depending on the percentage of beneficiaries with visits to the FQHC.
  • Regarding age 65+ and Medicare, EXEC assesses Medicare reimbursement for the potentially assigned beneficiaries over the next few years for both FQHC payments and for ACO development - effective 10/1/2014, Medicare has moved away from Upper Payment Limit payments to FQHCs to a PPS with a base rate of about $155 per encounter. 
  • EXEC assesses receipt of meaningful use incentive payments, wage index trends and other factors need to be considered for assessing future cost savings to the Medicare program and if they can be achieved.
  • With an ACO and establishing an FQHC presence, EXEC can demonstrate how effective can the ACO can be at controlling costs for organizations (will be better with FQHC in place).
  • EXEC can demonstrate if the benefit of shared savings distributions is greater than the potential increased cost and oversight of an ACO and assumption of risk on shared losses.

·         EXEC’s analysis of an ACO being presented is to ensure it stands to produce a shared savings and, hence, a profit for the - physician participant it is important to not only investigate the publicly reported data such as the percentage share to participants, quality metrics, and whether a shared savings was recognized in the prior year but also the private operations of the ACO body with regard to quality reporting and cost analysis infrastructure.   

  • EXEC analyzes Triple AIM to ensure that three critical objectives are accomplished:  1) Improve the health of the population served, 2) Improve the experience of each individual, 3) Affordability as measured by the total cost of care – concurrent with reducing per capita cost of health care.
  • EXEC emphasizes the importance of benchmarking, operations/financial analysis, documentation, and cost containment to meet or exceed the benchmarks set by the ACO.

 

EXEC’s team of professionals' successful track record in provider participant results in ACOs will result in improvements in the provider’s Triple AIM results, and the profits that could follow through the ACO's shared savings program.  

Contact us, and we'll be happy to tell you exactly how we can address your particular institutional situation.