National ACO: NACO - Excellence In Value Based Care

by Andre Berger

Beverly Hills, AL, United States Managed Care Clinical Interventions Community

All Team Company Patients Physicians Hospital Partners Mission Innovation Details Supporters Comments Updates

About our project

The problem we solve:
NACO is providing a way for independent physicians to practice medicine in the current regulatory environment in a way that generates savings for the system, higher revenues for the physicians and better outcomes for the patient. The much coveted triple-bottomline! As healthcare shifts to value based care we help the individual and small group practitioners stay compliant and generate additional savings - without the need to loose the freedom to operate in their own independent ways.

About our solution:
NACO is a Next Generation Accountable Care Organization that will share in up to 80% of the cost savings it generates with its members (physicians) and would be equally responsible for the downside should its accredited beneficiaries cost more than the CMS benchmark estimates. Once a provder is enrolled the NACO Provider Engagement Team begins a process of training, systems integration, and alignment that drives down the cost of care while improving access and quality, satisfying the goals of the triple aim of medicine and adding accountability for care.
Progress to date:

NACO was founded in 2012 and has been provding great returns the last 5 years to our members, as well as saving CMS over 14 million dollars in costs.  NACO and our providers have also increased their revenue while improving the quality of care for our patients.

As Dr. Foxman discusses in the video, our approach is to focus on the patient, especially those who need the most care.  With an approach that treats the whole patient and keeps the patient engaged, NACO has exceeding the ACO goals in three out of four full years in operation and is on track for exponential growth for our member physicians and our company as a whole.


About Our Team


Creator: Andre Berger
Location: California
Education: McGill University
Hospital Affiliation: Canon Surgery Center
Title: Chief Executive Officer

About Our Company

National ACO
Location: Beverly Hills, Alabama
Suite: Suite 405
Website: http://nationalacollc.com
Twitter: @NACOMSO
Product Stage: In the Market
YTD Sales: 5M...20M
Employees: 20-50

How We Help Patients

Healthcare has long been too inefficient, and directl;y or indirectly it is the patients that bear the brunt of the costs, either due to higher deductibles, inefficiencies in care or an overall lack in the quality of care. Value-based payment model is the most-sweepin change that has taken place with the focus on quality of care and the patient at its center. ACO is "an organization of health care practitioners that agrees to be accountable for the quality, cost, and overall care of beneficiaries" .

In short - an ACO is accountable to patients and third-party payers for the quality, appropriateness and efficiency of its services and as such we cannot succeed without patient interests being paramount.

 

How We Help Physicians

"We help Physicians do what they do best."

In our expereince as physicians, we have seen that a physician who can focus on helping and treating his patients, is a happy physician. And that is the way we approach everything at NACO. Before anything else, we are dedicated to making the life of our members easier, while generating additional revenues from care they are already providing.

 

Below is more detailed info

CMS estimates that Medicare Enrollment is expected to increase from 55.8 million in 2016 to 71.6 million by 2025. Of these enrollees 38.3 million are fee for services beneficiaries.  CMS has stated its intention to transfer half of Medicare spending to value-based contracts by 2018.With tremendous bipartisan support, the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”) introduced significant changes in the Medicare program. This legislation empowered CMS to create Alternative Payment Models (“APM”) in order to move fee for services Medicare Beneficiaries into value based risk bearing delivery models such as the NextGen ACO Model going forward.

Under MACRA, physicians who are participating in a qualified alternative payment model will automatically receive a 5% increase in the fee for service reimbursement for all their Medicare beneficiaries (both attributed and non-attributed).  Physicians not participating in alternative payment models are subject to a potential 9% reduction in Medicare reimbursement if they do not meet certain stringent qualified reporting requirements.  These requirements are expected to be difficult and expensive for Independent Physician Practices to meet without participating in a group like NACO

Congress authorized the creation of Accountable Care Organizations (ACO’s) as part of the Affordable Care Act (ACA) in order to facilitate the adoption of Alternative Payment Models mandated by MACRA.  ACO’s saved Medicare $466 Million in 2015 and nearly $1.29 billion over the last four years.  While there can be no guarantees, Management believes it is likely that programs necessary for the strongly supported movement to Merit-based Incentive Payment Systems and Advanced Alternative Payment Models initiatives like ACO’s will be continued or reauthorized under any replacement put forward by the current administration. .

CMS has announced that Year 2017 will be the last year of new NextGen Participants until 2020 and has approved only 45 Next Gen ACO to date including NACO. Many of the existing organizations are directly linked to a specific provider systems and as such are unlikely to expand beyond their existing networks.  NACO was specifically designed to accommodate independent physician practices which represent nearly 52% of the physicians nationwide and is uniquely position to take advantage of massive changes the delivery of care for the rapidly growing Medicare system.



How We Help Hospitals

NACO reduces the cost of providing care while also incrementally adding to the quality of care provided by its network of physicians.

 

Aligned Incentives

NACO aligns Primary Provider incentives to create a powerful professional and financial motivation to “Quarterback” care for their CMS Accredited Beneficiaries.

 

Proactive Information Systems to Identify High Risk Patients

Patient’s most at risk are identified by the NACO/RISARC Health Information System for greater monitoring. NACO then
makes this monitoring easier by providing access to a suite of telemedicine and home monitoring solutions. These
solutions enhance the level of ongoing patient engagement and provide notifications to care givers when key patient
monitoring measurements exceed predefined parameters.

 

Reduction in High Cost Expenditures

The Primary Care Physician is notified when a patient presents themselves for services at hospitals, skilled nursing
facilities, urgent care centers or other emergency care providers. This allows participating physicians to have input to
and coordinate the course of care and prevent duplicative diagnostics.

 

The Preferred Provider network

In each market served Preferred Providers are selected based on the historic quality and cost of patient care for their services.
In addition, many of these preferred providers have agreed to grant NACO’s Attributed Beneficiaries with extra discounts and
to participate in NACO’s population payment programs. Participating Physicians are encouraged to refer patients to NACO
preferred provider network to provide needed specialist and other services further reducing the cost of care.


How We Help Partners

 

Physicians are the partners at NACO.

Designed to help independent physicians achieve excellence in Value Based Care NACO is a Next Generation ACO founded in 2012 by independent physicians for independent physicians looking to thrive in the changing healthcare payment landscape.
The Company provides it’s participating primary care physicians with the training, information systems and supervision they need to succeed in this changing environment


NACO’s focus is to better coordinate patient care to achieve quality thresholds, create sustainable cost savings and meet or exceed CMS requirements. For 2013 NACO was in the top 10 performing Medicare Shared Savings Programs (“MSSP”) ACO’s in the United States and #1 in California with a $551 per beneficiary per year savings For 2015 NACO was in the top 20% of all ACOs and a top performer in California.

NACO has Achieved savings for CMS in every year of its existence.


Challenge Mission

Market Size

Massive Mandated Growth in Medicare and Shift to Value Based Care

Medicare expenditures totaled $646.2 billion in 2015 and are expected to continue to grow at a rate in excess of 7.5% per year through 2020 due to increasing mandates, shifting demographics and the increasing cost of care.


The Center from Medicaid and Medicare Services (“CMS”) has stated the intention of shifting at least half of its spending from fee for services to value based contracts by 2018. With 68.6% of its current enrollees participating in fee for service programs this implies $120 billion opportunity for value based care providers with substantial room for long term growth.



Projected 3 Year Growth

NACO expects to grow to 100k+ CMS beneficieries by 2020, and have $120 M in overall revenues, including $42 M in Shared savings and $75 M in Population Based Payments.

 

CMS Attributed Beneficiaries: NACO began 2017 with 21,334 CMS attributed beneficiaries from approximately 75 group and individual medical practices. Going forward, NACO is focused on adding primarily large group practices with between 1,500 to 3,000 beneficiaries each. Accordingly, NACO will grow by adding 10-15 larger practices per year. Shared Savings - based on the assumption of savings approximately 4% per beneficiary on spending of $13,400 per patient per year.


Provider Distributions of population based payments - based on the assumption of 30% to 70% pass through to participating physicians.


Information Technology Services – is based on the existing contract with RISARC based on a portion of shared savings in the early years then shifts to a cost per beneficiary later



How We Will Make Money

NACO has generated $11.1 M in savings for CMS, from 2013-2015 and has generated $6.9 M in MSSP share for its providers. This number would be ~ $ 9.4 M under the new Next-gen ACO model.



About our Competition

CMS has announced that Year 2017 will be the last year of new NextGen Participants until 2020 and has approved only 45 Next Gen ACO to date including NACO. Many of the existing organizations are directly linked to a specific provider systems and as such are unlikely to expand beyond their existing networks.  NACO was specifically designed to accommodate independent physician practices which represent nearly 52% of the physicians nationwide and is uniquely position to take advantage of massive changes the delivery of care for the rapidly growing Medicare system.



Progress with Customers to date

For 2013 NACO was in the top 10 performing Medicare Shared Savings Programs (“MSSP”) ACO’s in the United States and #1 in California with a $551 per beneficiary per year savings

For 2015 NACO was in the top 20% of all ACOs and a top performer in California. NACO has Achieved savings for CMS in every year of its existence.

Innovation Details

Intellectual Property Summary

We are a service provider in this evolving space, and while our techniques are built on the best accepted and reviewed practices, it is the implementation and our expertise that is the secret sauce. That is how we have generated outsized savings for CMS and maximised the shared savings for our providers in the 3 years of our operation. And now we expect to generate even larger returns for our partners / providers through our Next-gen ACO model.

Clinical Information

National ACO seeks to fulfill the goal of the triple aim of healthcatre to improve access, reduce costs and improve quality.  We are happy to report that we are doing great on all three axes.

How we will use the funds raised

Funds will be used for expansion of NACO’s provider network and the expansion of required infrastructure to meet member needs.

(Note - NACO is also raising additional capital to be used to provide for Surety bonds required by CMS to guarantee payment in the event that the cost of servicing the attributed beneficiaries under the Next Generation model exceed CMS’ historic benchmarks.)

Thank You

NACO aligns Primary Provider incentives to create a powerful professional and financial motivation to “Quarterback” care for their CMS Accredited Beneficiaries. We haver made it our mission to help the providers as they navigatethrough the evolving value-based care paradigm.

Supporters

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Andre Berger
Chief Executive Officer
McGill University

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