Accountable Care Organizations (ACOs)

With its team of veteran executives from leading payers, providers, and regulatory agencies, Gorman Health Group is at the forefront of the development of ACOs under health reform. Our seasoned healthcare professionals will assist clients in navigating the requirements for innovative payment arrangements more suited to mature organizations and markets, as well as assisting less mature systems interested in developing turnkey ACO enterprises.

GHG’s clients were the first to submit concept papers to CMS for partial capitation ACOs in 2010, and GHG’s clients have been awarded 21 out of 23 demonstration or pilot programs we have sought with CMS in the last decade. In 2011, GHG successfully supported 5 out of 7 Pioneer ACO applicants to the contracting phase.

CMS Application Deadlines for Shared Savings ACOs

Organizations interested in participating in the Medicare Shared Savings Program must complete the 2012 ACO application process as instructed by CMS. For a start date of April 1, 2012, the deadline is January 20, 2012. For a start date of July 1, 2012, the deadline is March 30, 2012. For more information regarding the application process, contact ghg@gormanhealthgroup.com.

Successful ACOs will be the result of solid strategy and exceptional execution. GHG is experienced in providing both to its clients through strategy development, project management and implementation, CMS and insurer relationships, and compliance and application development. This gives clients a series of flexible services beginning with a strategic assessment and financial feasibility analysis and concluding in implementation support. Our services include:

Regulatory Analysis

GHG’s renowned policy analysis department assesses the rules immediately upon their release, translating them into practical operational and financial guidance and timelines for providers. To read GHG's summary of the CMS Final Rule and Guidance for the Shared Savings Program issued on October 20, click here.  To access GHG's webinar discussion recorded on November 1, click here. To request a copy of the audio file, contact ghg@gormanhealthgroup.com.

Board of Directors and/or Management Team Education

Successful ACOs are likely to start with governance and management possessing a consistent understanding of what an ACO is and what it isn’t. GHG tracks and monitors the developing understanding of Medicare, Medicaid, and commercial ACOs and provides written or presentation based materials to boards of directors and executives in advance of a more detailed strategic assessment of an ACO’s value to the organization.

Strategic Assessment of ACO Value to the Organization

Typically conducted as an in-person, onsite discussion with the organization’s leadership, the strategic assessment reviews a detailed set of questions designed to refine an organization’s reasoning behind developing an ACO. The session is designed to answer such critical questions as:

• Why develop the ACO?
• Who should we pursue the ACO with?
• Where should the ACO operate and which beneficiaries can we claim for assignment?
• What measures and results define success for the ACO in one year, three and five years?
• What are the risks to the organization in pursuing the ACO strategy?
• What readiness gaps exist and what broadly must be accomplished to submit an ACO application or engage an insurer regarding an ACO?

At GHG, we believe that sound strategy drives sound structure, thereby enabling us to build clinical, financial and operational models to attain an ACO’s strategic goals.

Financial Analysis

Anticipated financial performance of the ACO is a key consideration in evaluating the opportunity. GHG brings to its clients dynamic financial modeling tools and skills to support clients in considerations ranging from the current healthcare costs of the ACO population to projected healthcare costs and capital investment and operational costs under an ACO model. GHG staff has experience with financial models ranging from global and partial capitation to fee‐for‐service shared savings incentive models, enabling GHG to customize the financial modeling to the strategic ACO direction desired by the client – and to present it to CMS in a form and manner they can understand and support.

Gap Analysis

Few organizations are fully prepared to submit an ACO application or engage an insurer around an ACO agreement. GHG works with its clients to consider the financial ramifications of such an arrangement, and to determine areas of deficiency with respect to ACO requirements, such as chronic care management or healthcare information technology. This allows the client to make a fully informed decision with respect to readiness to proceed and resources required to do so.

CMS Application Development

GHG has extensive experience in demonstration project and defined application format submissions to CMS. GHG is able to complete the application documents and support the client throughout the application process. GHG’s clients have been awarded 21 out of 23 demonstration or pilot programs we have sought with CMS in the last decade.

Organizations interested in participating in the Medicare Shared Savings Program must complete CMS 2012 ACO application materials as detailed here.  Applications must be submitted by 5:00 PM EST on January 20 for the April 1, 2012 start date and by 5:00 PM EST on March 30 for the July 1, 2012 start date. To discuss ways GHG can support your team in the application process, contact us.

Implementation Planning and Implementation Project Management and Support

ACOs require execution in a number of key areas. Support in each of the following areas can be provided by GHG:

• Provider network development and engagement
• Risk score optimization and management
• Member communication
• Health Information technology support
• Compliance
• CMS agency relationship support
• Quality metrics and reporting
• ACO Governance

For more information, click here or please contact us at ghg@gormanhealthgroup.com or at 202.364.8283.