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The National Accountable Care Organization Summit ( in Washington, D.C. on June 7th - 9th will provide an unprecedented opportunity to discuss, dissect, and identify effective ways to implement ACOs, which are a key component of the recently passed health care reform. The ACO model focuses on achieving accountability for improving quality and efficiency through organizational development, transparent performance measurement, and payment reforms that align financial incentives with patients' best interests. The Summit will take place as the Department of Health and Human Services (HHS) takes steps to advance Medicare's participation in ACOs, and as many states and private payers take steps to implement ACOs as well. The Summit brings together leading policymakers, experts, and ACO implementers to provide unique and in-depth insights for moving forward at this critical point in health care reform and ACO implementation.

What is an ACO?
ACOs are provider collaborations that support the integration of groups of physicians, hospitals, and other providers in different ways around the opportunity to receive additional payments by achieving continually advancing patient-focused quality targets and demonstrating real reductions in overall spending growth for their defined patient population. The ACO model is highly flexible and can be organized in a number of ways - ranging from fully integrated delivery systems to networked models within which physicians in small office practices can work effectively together to improve quality, coordinate care and reduce costs. They can also feature different payment incentives ranging from "one-sided" shared savings within a fee-for-service environment, to a range of limited or substantial capitation arrangements with quality bonuses.

ACOs provide a mechanism to transition from paying for volume and intensity to paying for value. They are compatible with a range of other payment reforms to improve quality, such as medical homes and bundled payments; they can help assure that these reforms lead to sustainable quality improvements and cost reductions.

What will the National ACO Summit Do?
The National Accountable Care Organization Summit has gathered thoughtful health care leaders from around the country and across the spectrum of health care stakeholders to discuss the promise as well as the challenges and limitations of ACOs. The first day of the summit will help define the guiding principles of ACOs, discuss recent experiences with pilot projects that implemented ACO-like models, and indentify key questions that have to be addressed to implement ACOs effectively. Day two of the summit will present in-depth discussion and analysis of the key issues that ACO implementation must address, including:

  • Governance and legal issues;
  • Ensuring care quality;
  • ACOs interactions with other reforms; and
  • Steps to improve care within an ACO.

The conference will conclude with a look forward, examining the new Federal and state health care policies that will affect ACO development. The Summit will also feature a pre-conference on advancing accountable care in physician organizations sponsored by the California Associate of Physician Groups (CAPG). This Summit will be the key forum for understanding how ACO reforms can be implemented effectively, and how the new health care reform law can support ACO implementation.

What Does Health Care Reform Legislation Mean for ACOs?
ACOs are one of the key efforts in the recent health care reform law to address the challenges facing U.S. health care: rising costs that threaten the affordability of care and the fiscal integrity of the U.S. government; care that is often impersonal, inaccessible, unsafe, unreliable, fragmented and poorly coordinated; and concern that the current fee-for-service payment system poses a barrier to progress. In contrast to many proposals that seek to improve care without imposing reductions in payment rates on providers, the Congressional Budget Office (CBO) has estimated that ACOs are expected to reduce costs by an estimated $4.9 billion dollars. This estimate assumes a limited pilot program starting in 2012. However, the Secretary of HHS has the authority to expand successful ACO models, so that ACOs could have a much larger impact on reducing costs and improving quality.

The National ACO Summit will include opportunities to address questions raised by this new legislation. Section 3022: Medicare Shared Savings Program in the recently passed health reform law (H.R. 3590) requires the Secretary of HHS to establish a shared savings program through ACOs. By January 1st, 2012 the Secretary will need to define performance measures, attribution methods, expenditure benchmarks, and savings thresholds for ACOs. Support for ACOs, and for integrating ACOs with other payment reforms, will also come from the Center for Medicare and Medicaid Innovation (CMI). The CMI will test innovative payment and service delivery models, including ACOs, to reduce program expenditures while preserving or enhancing the quality of care. Congress has budgeted $10 billon beginning in FY 2011 to support this work.

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