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ACO Capitation 101: Understanding Medicare ACOsí real potential to influence patterns of care 
 
Overview
The Medicare ACO is built on a fee for service chassis: ACO patients have the same benefits as any other beneficiary in fee for service Medicare, and providers are paid off the same Medicare fee-for-service fee schedule. Limitations within the standard Medicare fee-based payment system and delays in payment earned through the incentives of the shared savings approach both seriously dilute the effectiveness of incentives.

Medicare is experimenting with alternatives to the straight fee for service and shared savings model by using three different approaches to capitation. As the pioneer ACOs gain experience with the various capitation models and if CMS incorporates capitation in the standard model, Medicare ACOs will gain a powerful tool to influence patterns of care through payment contracts and incentives.

In partnership with MCOL, join Gorman Health Group for a discussion on Medicareís ACO Capitation experiments on February 15 from 1:00 Ė 2:00 pm Eastern Time.

Hear from William A. MacBain, Senior Vice President of Gorman Health Group, on the steps CMS is taking to evaluate and potentially change capitation in Medicare ACOs.
Learning Objectives
Key Discussion Topics include
  1. Medicareís demonstration Pioneer ACO programís experiment with three different approaches to capitation
  2. The CMS calculation of the guaranteed savings amount: Projections and concerns
  3. Differences between the core population-based model and the capitation alternatives for partial or full capitation.
  4. Projections and expectations: Anticipated results from the Pioneer ACO program
  5. Early lessons from the Pioneer program for commercial ACOs.
  6. Alternatives to the Pioneer ACO program: If you are not in the Pioneer program, what are your options, and are they viable?
Who Should Attend
Interested attendees would include:
  • C-Suite Executives
  • Medical Directors
  • Medicare Operations Executives
  • Provider Contracting Executives and Staff
  • Provider Network Executives and Staff
  • Revenue Cycle Executives
  • Strategy and Planning Executives and Staff
  • Regulatory Affairs and Compliance Executives and Staff  
  • Business Intelligence Executives and Staff
  • Other Interested Parties

Attendees would represent organizations including:

  • Medicare Advantage Health Plans
  • Provider Networks
  • Hospital Systems
  • Accountable Care Organizations
  • Government Agencies
  • Solutions Providers
  • Associations, Institutes and Research Organizations
  • Media
  • Other Interested Parties
 
Registration
ACO Capitation 101: Understanding Medicare ACOsí real potential to influence patterns of care 
 
  Individual Registration Fee: $195. Audio Conference CD-ROM: $40 for attendees; $285 for non-attendees after the event.

Corporate Site licensing also available. Click here to register or call 209.577.4888 We look forward to your participation in this event!

 
 
Faculty
 
William A. MacBain
William A. MacBain, MPS
Senior Vice President, Gorman Health Group
  Bill has more than thirty yearsí experience as a senior executive or strategic consultant to some of the nationís most progressive health plans.

In his role at Gorman Health Group, Billís client engagements include strategic planning, financial planning and feasibility analyses, due diligence reviews, and operational assessments. He provides guidance for health plans in developing and executing sustainably profitable business models, saving valuable resources with his operations experience and knowledge of CMS regulations.

Since the passage of health care reform in 2010, Billís work has focused on provider entities considering becoming Accountable Care Organizations (ACOs). This work has included developing business models, risk sharing arrangements, feasibility studies, model contracts and operational studies.

Most of Billís prior management experience has been in executive positions in health insurance finance and operations, primarily in provider-owned health plans. Bill also has more than ten years of experience in management consulting, where his financial management and analysis, business planning and budgeting, contract negotiations, product design, and government affairs skills have become invaluable to GHG clients.

Prior to joining GHG, Bill served as CFO for a large regional health plan, chief operating officer for one of the largest rural-based health plans in the nation, and held senior finance and operations positions with several start-up health plans. He also contributed to federal and state health insurance policy as a member of two federal Medicare advisory commissions (MedPAC and ProPAC), and as president of the Managed Care Association of Pennsylvania. Bill has also served as a board member of the American Association of Health Plans and the Group Health Association of America, predecessors of todayís AHIP. Bill also coauthored and published a series of successful HIPAA privacy rule policy templates.

Bill earned his BA and Master of Healthcare Administration degrees from Cornell University.

 
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