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Accountable Care: Taking the Lead

About the Webinar Program Objectives Webinar Will Answer These Questions Speakers Who Should Attend Purchase Options Continuing Education Questions About URAC

Attend from your desktop or conference room. Invite your whole team to attend!   Rate:  $329 per location, includes access to CE portal and continuing education credits for up to five (5) users. Additional seats may be purchased at rate of $50.00. Special rate available for solo practitioners and the military. Please call 301-354-1769 for details.  Each registration comes with access to the archived version of the program and the materials until December 31, 2012. Continuing Professional Education: This program is approved for 1.5 contact hour for  nurses, social workers, and certified case managers

Today, case managers and other members of the healthcare team have a tremendous opportunity to be part of the sea change taking place in the dynamic healthcare system as the industry moves to emerging medical models of care that are changing how care is delivered and paid for.

About the Webinar

As the healthcare system reaches a tipping point and the country struggles to find ways to contain escalating healthcare costs, new models of care are emerging. The latest models on the health reform runway, medical homes (MHs) and Accountable Care Organizations (ACOs), are actually not all that new.

Medical Homes were first proposed by the American Academy of Pedi­atrics (AAP) in the late 1960s as a way of focusing on children with special (chronic) health needs. The Medical Home model relies on primary care providers and practices to act as the hub for coordinating comprehensive, quality patient care.

The Accountable Care Organization model has a shorter history. Having begun around 2006, it represents an integrated healthcare delivery system that typically includes primary care physicians, specialists, and hospitals. ACOs are charged with collaboratively improving care quality and controlling costs for a defined patient population and are rewarded by payers for meeting these targets.

As a result of the passage of the Patient Protection and Affordable Care Act of 2010 (ACA) and the recent decision by the US Supreme Court to uphold the majority of the Act, Accountable Care Organizations and Patient Centered Healthcare Homes have received a jump start and are now positioned to expand. Both are committed to delivering accessible, high-quality, patient-centric care with payment models that will compensate healthcare providers for meeting performance metrics for better quality and health outcomes.

As these models continue to expand, it is important to understand some of the key distinctions that exist between these two models in terms of size, scope, structure, accountability, payment incentives, legal requirements, and overall acceptance. At the simplest level, a PCHCH consists of one or more primary care practices and physicians coordinating patient-centered care for better health outcomes. An Accountable Care Organization is much larger, as it combines multiple PCHCHs with hospitals, specialists, long-term care facilities, and other care providers to create an integrated network of care that improves health outcomes and controls costs. PCHCHs can operate independently of ACOs, efficiently coordinating primary care for their patients and receiving reimbursements directly from payers. ACOs, often referred to as medical home neighborhoods or villages, rely on PCHCHs and a circle of providers to deliver quality care within the primary care relationship and beyond. In this model, the ACO contracts to receive reimbursements from Medicare, Medicaid, and/or private payers and make payments to the PCHCH physicians and other ACO providers.

Care coordination is one of the core functions of the patient centered healthcare home and accountable care organization. To be successful, care coordination must be well-orchestrated, well-defined, with sufficient supporting resources, and of the highest caliber clinical skills.

The goals of care coordination are:

• To transfer information, such as medical history, medication lists, test results, and patient preferences, appropriately from one participant in a patient‘s care to another. This includes transferring information to or from the patient; and
• To establish accountability by clarifying who is responsible for each aspect of a patient‘s overall care. This includes specifying who is primarily responsible for key care delivery activities, the extent of that responsibility, and when that responsibility will be transferred to other care participants.

Program Objectives

• Describe the value of the emerging role of the patient centered healthcare home and its role in Accountable Care Organizations.
• Outline care coordination for improved care.
• Explain the role of the case manager and other members of the care coordination team in closing gaps in care.

Our Webinar Will Answer These Questions

• What is an Accountable Care Organization?
• How does the Medical Home fit into an ACOs?
• Does care coordination and data drive action?
• How do these models impact the delivery of care?
• How will organizations and providers be reimbursement in these models of care?
• What systems are required to be in place when implementing these models of care?
• Who is responsible to oversees these programs?
• How does the patient and the family fit into these model of care?
• How are professionals addressing the scarcity of healthcare resources in trying to meet the needs of the patient?
• Is continued measurement needed once the program is in place? 

Faculty

David K. Dafilou is a Principal with Premier Performance Partners. His main area of focus is Population Health Management and supporting the Premier Partnership for Care Transformation (PACT) collaboratives. He is actively involved with payor relationships, financial management, population health data management and other aspects of ACOs and value based reimbursement. Previously, Mr. Dafilou served as Director of Consulting Services for Presscott Associates. He has extensive experience in medical policy, coverage and reimbursement issues, contracting, negotiating, medical cost analysis, healthcare financial modeling, and project management. Mr. Dafilou was Director of Contracting and Provider Networks at AmeriHealth Insurance Company, a wholly owned subsidiary of Independence Blue Cross. While at AmeriHealth, he had responsibility for a provider network of over 80 hospitals and 15,000 physicians as well as several hundred ancillary providers. His experience encompasses the management of commercial, Medicare, and Medicaid provider networks including regulatory compliance and reporting. Previous experience includes Business Development and Marketing for Honeywell Inc. and other Fortune 100 companies. Mr. Dafilou received a Bachelor of Science in Commerce and Engineering from Drexel University in Philadelphia, PA. He went on to obtain a Master of Science in Finance from Drexel University. Mr. Dafilou has received certificates of accomplishment from the Program on Negotiations at Harvard Law School and in Leadership Training from Rutgers University. Mr. Dafilou served on his local town council in 2009 and is active in numerous community activities.

Janet Coulter, RN, MSN, CCM, is a Nurse Case Manager with WORKSTAR Health Service Inc. Janet has been an RN for over 38 years, during which time she was a staff nurse, charge nurse, nurse educator, nurse administrator, and case manager.  Currently Janet is a case manager working with lost time injured workers at WorkStar, an MCO in Ohio.  Janet holds a Master of Science in Nursing from West Virginia University, Morgantown, WV, and a Master of Science in Adult Education from Marshall University, Huntington, WV.  She has been very active in the Southern Ohio Valley Chapter of CMSA, serving as a founding member, Board Member, Vice President, President elect, and chairperson of numerous committees.  Janet has served two terms as President of the Southern Ohio Valley Chapter of CMSA and is currently Immediate Past President. She has presented at six CMSA Annual Conferences.  Currently she is holds the office of 2012-2013 Chapter Presidents Council Representative on the CMSA Board of Directors and “Bridge” liaison for the Case Management Foundation.

Sheila Johnson, RN, MBA, Director of Clinical Services at Dartmouth-Hitchcock. Sheila has responsibility for Ambulatory Care Management, patient data management, and health plan quality metrics across Dartmouth-Hitchcock.  Sheila serves as the clinical resource for the CMS Pioneer ACO Program, three commercial ACOs, and Dartmouth-Hitchcock Wellness Plus (a care coordination program for employees, dependents, and retirees). Sheila has previously served as the clinical administrator for the CMS Physician Group Practice Demonstration and Transition Demonstration project.  In her work, Sheila works with interdisciplinary care teams to improve quality and efficiency of patient/family centered care and business operations.  Sheila has an extensive background in Physician Group Practice Administration and Ambulatory Nursing.  Sheila has experience in health care within the settings of hospitals and physician group practices. Sheila holds a Bachelor of Arts with a major in nursing degree and a Masters of Business Administration degree.

Moderator:  Anne Llewellyn RN-BC, MS, BHSA, CCM, CRRN  Editor in Chief, Case Management Products  Dorland Health, a division of Access Intelligence

Who Should Attend

Purchase Options

• $329 per location, unlimited viewing per location (a special rate is available for solo practitioners and the military. Please call 301-354-1769 for promo code for a price reduction if you qualify.
• Live Webinar Registration – $329 (per-site fee)
• Webinar Recording on CD-ROM – $329
• Live Webinar and CD-ROM – $379

About URAC

URAC has developed its Patient Centered Health Care Home (PCHCH) programs to educate and guide health care practices, and their sponsoring health plans, insurers and pilot programs through transformation into truly patient-centered health care homes. Learn more »

Continuing Professional Education

Nurses: This program is approved for 1.5 contact hours for nurses by Commonwealth Educational Seminars (CES). As an approved provider by the California Board of Registered Nursing (Provider Number CEP 15567), CES Programs are accepted by every State Board of Nursing with the exception of Delaware.

Certified Case Managers: This program is approved for 1.5 contact hours for case managers through the Commission for Case Manager Certification.

Social Workers: This program is approved for 1.5 CE hours for Social Workers. Commonwealth Educational Seminars (CES) is approved as a provider for Social Work Continuing Education (ACE Provider #1117) by the Association of Social Work Boards (ASWB, 400 South Ridge Parkway, Ste B, Culpepper, VA 22701) www.aswb.org. ASWB Approval Period: 10/6/09-10/5/12.

Questions?

For questions regarding the Webinar or to register by phone, contact Hope Kabik at 301-354-1769.

For content questions regarding this Webinar, contact Anne Llewellyn at 954-254-2950 or email allewellyn@dorlandhealth.com.

*Dorland Health does not offer any refunds for the webinar.  All sales are final.

For technical support questions, you can contact the Webex technical support line at 1.866.229.3239.
 

How Does the Webinar Work?

The live audio is delivered to your location over the telephone or your computer speakers. The Power-Point presentations are presented over the Internet and are available to print out before the program. This is like a talk-radio program with visuals on the Web. You and your team will be able to have a live Q&A with all the speakers.

More details on webinar equipment and connections