The Journey to Accountable Care

Sept. 28, 2010

The Journey to Value-Based Accountable Care

The health care marketplace is changing rapidly, creating significant financial and clinical challenges for hospitals and health systems. Increasingly, providers are expected to simultaneously trim costs, improve care and realign capacity—all in an environment of tighter reimbursement, increased regulation, public reporting, expanding service demand and heighented competition.

Carol Corp. provides the strategies and solutions to help providers meet these challenges by profitably transitioning to value-based accountable care. Carol helps providers make the fundamental changes in financing and care delivery—to move from the status quo, volume-based financing model to a genuinely value-driven approach that rewards delivery of high-quality accountable care.

Benefits of Accountable Care

Link Clinical and Financial Performance — Improving Both

Accountable care offers innovative providers an array of financial, clinical and competitive benefits.

Creating an ACO?

Aligning Medicare and Commercial Strategy

Is your organization ready to benefit from Medicare's shared savings program? Interested in improving private health plan reimbursement with a commercial accountable care organization?

The Carol assessment and redesign process provides the full range of strategies and solutions to help:
• Implement profitable and sustainable accountable care with comprehensive care redesign to achieve evidenced-based, patient-centered care.
• Negotiate new, favorable reimbursement from private health plans.
• Maximize shared savings and quality incentives from both Medicare and private health plans.
• Meet Medicare clinical, operational, and financial requirements for an ACO.
• Create or participate in multi-payer ACOs.

Medicare ACO requirements are outlined in the Patient Protection and Affordable Care Act (PPACA). Forthcoming rules from Centers for Medicare and Medicaid Services (CMS) will set requirements for ACOs in detail. As a successful implementer of accountable care, Carol has held numerous conversations with CMS leadership and staff to share advice and best practices in advance of the ACO rules.

Advantages for Early Adopters of Accountable Care

Improve Market and Competitive Position

Early adoption of the value-based accountable care model offers considerable advantages for innovative health systems in both the private and Medicare markets.
• Create a strong commercial ACO platform in advance of competitors.
• Better positioned for Medicare shared savings in 2012.
• Invaluable lead in establishing ACO partnerships with provider community.
• Additional time to redesign care systems, realign capacity and effect internal change.
• Improved competitive position in the marketplace—for Medicare, private plan business and health reform coverage expansion.
• Early opportunities to negotiate shared savings and incentive payments with private health plans and Medicaid.

Getting Started

Take the First Step to Profitable Accountable Care

Get started on your organization's journey to accountable care by arranging for a Carol Opportunity Assessment.

The Opportunity Assessment is a comprehensive review of a provider's readiness to transition to accountable care. Our in-depth assessment tool uniquely combines:
• Quantitative analysis informed by market benchmarks and payer data.
• Qualitative analysis of culture, payer contracts, and clinical performance improvement opportunities.

The Opportunity Assessment provides a customized inventory of actionable activities—evaluated against your peers and industry best practices—to increase efficiency, improve quality and frame payer contract negotiations. These are synthesized into solution sets, each with clinical, operational and financial components.

Your organization's assessment results are scored using the Carol Index™—our proprietary system of providing an objective view of a provider's ability to transition to accountable care. The Carol Index compiles the identified efficiency opportunities matched against the organization's culture, operational capabilities and technology to adopt the identified solutions, drive change and ultimately deliver profitable accountable care.