A State Perspective On The Medicare ACO Adventure, To Date

A State Perspective onthe Medicare ACOAdventure, to DateGregory C. BurkeDirector, Innovation StrategiesUnited Hospital Fund of New York

Overview ACOs in New York State Status, Trajectory, Geography ACO Performance – PY‐4 (2016) Cost Savings, Quality What explains performance to date? Size, Length of time in program, Sponsorship, Location Some other issues Mechanics matter And, the intangibles

New York State MSSP ACOs, 2012‐2016ACO Name1234CareMount ACO (was ACC‐Mt. Kisco until 2016)Accountable Care Organization of the North Country, LLCCatholic Medical Partners‐Accountable Care IPA, Inc.Chinese Community ACOCrystal RunAccountable Care Coalition of Syracuse, LLCAsian American Accountable Care OrganizationBalance ACOBeacon Health Partners, LLPChautauqua Region Associated Medical Partners, LLCHealthCare Provider ACOMount Sinai Care, LLCProHEALTH Accountable Care Medical Group, PLLCWESTMED Medical GroupGoodHelp/BonSecours ACOHHC ACO IncAlliance for Integrated Care of New YorkAdirondacks ACO, LLCFamilyHealth ACO, LLCNew York State Elite (NYSE) ACOPrimary PartnerCare ACO IPARochester Regional ACOAledade Primary Care ACO LLCBassett Accountable Care Partners, LLCHealthcare Partners of the North Country, llcInnovative Health Alliance of New York, LLCNewYork Quality CareOrange Accountable Care of New YorkRichmond Quality, LLCCayuga Area Preferred, Inc.Empire State Health Partners, LLCHudson Accountable Care, LLCMatrix ACO LLCNorthwell Health ACOSt. Joseph's Health ACOOrganization TypeStart DatePhysician‐onlyPhysician‐onlyHosp‐MD an‐onlyHosp‐MD MD PartnershipPhysician‐onlyHosp‐MD an‐onlyHosp‐MD PartnershipPhysician‐onlyHosp‐MD an‐onlyHosp‐MD PartnershipPhysician‐onlyHosp‐MD PartnershipHosp‐MD PartnershipHosp‐MD PartnershipHosp‐MD PartnershipPhysician‐onlyHosp‐MD PartnershipHosp‐MD an‐onlyHosp‐MD PartnershipHosp‐MD 01420152016

MSSP ACOs in NY State byRegion, 2016Upstate (N 10)Accountable Care Organization of the North CountryCatholic Medical Partners-Accountable Care IPAChautauqua Region Associated Medical PartnersAccountable Care Coalition of SyracuseAdirondacks ACOHealthcare Partners of the North CountryBassett Accountable Care PartnersInnovative Health Alliance of New YorkCayuga Area PreferredSt. Josephs Health Accountable Care OrganizationNew York City (N 10)Chinese Community ACOBalance ACOAsian American ACOMount Sinai CareHHC ACOAccountable Care Coalition of Greater New YorkRichmond QualityNewYork Quality CareAledade Primary Care ACOEmpire State Health PartnersDownstate (N 12)Accountable Care Coalition of Mount KiscoWESTMED Medical GroupProHEALTH Accountable Care Medical GroupBeacon Health PartnersGood Help ACONew York State Elite (NYSE) ACOFamilyHealth ACOPrimary PartnerCare ACO IPAOrange Accountable Care of New YorkMatrix ACOHudson Accountable CareNorthwell Health ACO

MSSPs in NYS – FinancialResults, 829303132Start 127/1/2012ACONameBalance ACORichmond Quality, LLCOrange Accountable Care of NYChinese Community ACOHHC ACO IncWESTMED Medical GroupNewYork Quality CareMatrix ACO LLCAsian American ACOAledade Primary Care ACO LLCChautauqua Medical Partners, LLCGood Help ACOACC of Mount Kisco, LLCACC of Syracuse, LLCEmpire State Health Partners, LLCCayuga Area Preferred, Inc.ACO of the North Country, LLCHudson Accountable Care, LLCProHEALTH Medical GroupSt. Josephs Health ACONorthwell Health ACOAdirondacks ACO, LLCHC Partners of the North CountryCatholic Medical PartnersNew York State Elite (NYSE) ACOFamilyHealth ACO, LLCBassett Accountable Care PartnersACC of Greater New York, LLC.Primary PartnerCare ACO IPAInnovative Health AllianceBeacon Health Partners, LLPMount Sinai Care, 218BenchmarkSpend 119,762,995 73,459,544 105,483,084 91,862,414 85,426,675 127,419,819 375,268,362 70,764,228 103,903,899 136,467,887 60,492,360 694,209,251 216,584,282 142,241,741 77,408,726 49,066,101 84,083,672 112,841,481 309,021,566 123,618,338 495,901,332 57,707,024 84,458,247 192,077,909 140,981,277 80,771,488 136,200,837 251,879,111 219,781,843 219,220,927 451,892,091 461,461,185Actual Spend 91,531,752 66,070,074 98,408,718 85,471,266 81,834,510 124,405,157 373,548,567 69,085,256 102,916,678 135,547,751 60,281,160 694,109,458 216,767,340 142,637,327 78,521,607 50,286,682 85,825,057 114,885,409 311,107,881 125,819,749 498,595,662 60,702,870 90,444,325 198,408,192 147,387,241 88,006,156 144,115,028 260,106,370 228,237,224 228,017,339 472,828,968 486,171,043Savings/Loss Shared Savingsvs. Benchmark(Losses) 28,231,243 11,976,300 7,389,470 3,473,744 7,074,366 3,242,894 6,391,148 2,797,831 3,592,166 1,586,859 3,014,662 0 1,719,794 0 1,678,972 0 987,221 0 920,136 0 211,199 0 99,792 0( 183,058) 0( 395,586) 0( 1,112,881) 0( 1,220,580) 0( 1,741,386) 0( 2,043,928) 0( 2,086,315) 0( 2,201,411) 0( 2,694,330) 0( 2,995,846) 0( 5,986,078) 0( 6,330,283)( 2,532,113)( 6,405,964) 0( 7,234,668) 0( 7,914,192) 0( 8,227,259) 0( 8,455,381) 0( 8,796,411) 0( 20,936,877) 0( 24,709,858) 0

MSSPs in New York StateSummary of FinancialPerformance, 2016AssignedBeneficiariesBenchmarkSpendACOs Generating Shared Savings(N 5)40,697 475,994,712ACOs w Savings , but MSR(N 7)Savings/Loss Shared SavingsActual Spend vs. Benchmark (Losses) 423,316,320 52,678,393 23,077,628156,771 1,568,525,806 1,559,894,027 8,631,776 0ACOs w Expenses Benchmark(N 20)379,406 3,907,199,178 4,028,871,470 ( 121,672,292) ( 2,532,113)NYS MSSP Totals576,874 5,951,719,696 6,012,081,817 ( 60,362,123) 20,545,515

Does Size Matter?

Does Experience Matter?

Does Location Matter?

Does Sponsorship Matter?

What Does matter? Mechanics, for Sure AttributionRisk adjustmentBenchmarkingMinimum Savings Rates And, the Un‐quantifiables Pre‐existing InfrastructureLeadershipTribal Identity, and “Us‐ness”Patience, and a sense that these are tricks we allneed to learn

Catholic Medical Partners-Accountable Care IPA: Chautauqua Region Associated Medical Partners . Accountable Care Coalition of Syracuse . Adirondacks ACO. Healthcare Partners of the North Country. Bassett Accountable Care Partners . Innovative Health Alliance of New York . Cayuga Area Pr