Livestream Podcast, Seton Hall Law Review ACO Symposium

In conjunction with the Center for Health & Pharmaceutical Law & Policy, this year’s SETON HALL LAW REVIEW Symposium explored recent changes in the structure of health care delivery, in particular the rising popularity of Accountable Care Organizations (ACOs).

Legal scholars and practitioners from around the country presented in panel discussions on structural development, public health implications and lessons learned from state ACO programs. The luncheon keynote speaker was Dr. Jeffrey Brenner, founder of the Camden Coalition of Healthcare Providers.

Streaming Audio Podcasts of Each Panel are Below, Beside the Radio in Blue–Just Click and Listen

Panels & Panelists

Introduction to Accountable Care Organizations

Introduction to ACOs Panel, Seton Hall Law Review_Symposium_1.asx

Jorge Lopez (Partner, Akin Gump Strauss Hauer & Feld LLP): Promise and Pitfalls: Health Reform’s Medicare ACO Shared Savings Program

Hal Teitelbaum (CEO and Managing Partner, Crystal Run Healthcare): The Prospect of Being Hanged: Focusing the Physician Mind on ACOs

Michael Kalison (Chairman of Applied Medical Software, Inc.; Of Counsel, McElroy, Deutsch, Mulvaney, & Carpenter): The Lessons of Gainsharing

ACOs in Theory: Issues Raised by Integrated Delivery

ACO Theory: Issues, Seton Hall Law_Review_Symposium_2.asx,,

Jessica Mantel (Co-Director, Health Law & Policy Institute, University of Houston, Law Center): ACOs: Can we have our cake and eat it too?

Priscilla Keith (Adjunct Professor and Director of Research and Projects, Hall Center for Law and Health, Indiana University School of Law - Indianapolis): The Impact of Accountable Care Organizations on Public Health

Tara Ragone (Research Fellow, Seton Hall Law School): The Role of Competition in Integrated Delivery: ACOs, Federal and State Antitrust Law, and the State Action Doctrine

Keynote

Dr. Brenner, Seton Hall Law_Review_Symposium _Keynote.asx

Jeffrey Brenner, M.D., Founder & Executive Director, Camden Coalition of Healthcare Providers

Jeffrey Brenner is a family physician and has practiced in Camden for eleven years as a front-line primary care provider for patients of all ages. Having owned a private practice in Camden, he has experience in implementing electronic health records and running a paperless office, open-access scheduling, as well as first-hand knowledge of the various challenges facing primary care in the current health system.

He currently serves full-time as the Coalition’s Executive Director, where he spends much of his time meeting with stakeholders and policymakers, advocating for the models of care the Coalition has developed and demonstrated through data centric results. Jeff is a faculty member of the Robert Wood Johnson Medical School in Camden and is also a former resident of Camden, having lived in the city for over 8 years. He is a graduate of Vassar College and the Robert Wood Johnson Medical School.

ACOs in Practice: Research on Current Implementation of ACOs

ACOs in Practice, Current Implementation Research, Seton Hall Law_Review_Symposium_3.asx

Louise Trubek (Adjunct Professor of Law, Seton Hall Law, Clinical Professor Emerita, University of Wisconsin Law School), Barbara Zabawa (Whyte Hirschboeck Dudek, S.C); Felice Borisy-Rudin (University of Wisconsin Law School): Accountable care organizations in two states: A preliminary analysis

Sallie Sanford (Assistant Professor of Law, University of Washington - School of Law & School of Public Health): State-based ACO and Medical Home Pilots: Early Lessons from the Other Washington

John Jacobi (Faculty Director & Dorothea Dix Professor of Health Law & Policy, Seton Hall University School of Law), Lessons from ACO Implementation in New Jersey.

Thomas Greaney (Chester A. Myers Professor of Law and Director, Center for Health Law Studies, Saint Louis University School of Law), Accountable Care Organizations: A New New Thing with Some Old Problems.

A Symposium Law Review with papers from the event is forthcoming. For more information regarding the Symposium, please contact Gianna Cricco-Lizza, Symposium Editor, at gianna.criccolizza@student.shu.edu

ACO Symposium: Professor Tim Greaney to Present Accountable Care Organizations: A New New Thing with Some Old Problems

In conjunction with the Center for Health & Pharmaceutical Law & Policy, this year’s Seton Hall Law Review Symposium on October 28, 2011, will explore recent changes in the structure of health care delivery, in particular the rising popularity of Accountable Care Organizations (ACOs). For more information or to register, click here.

The keynote speaker will be Dr. Jeffrey Brenner, founder of the Camden Coalition of Healthcare Providers, and legal scholars and practitioners from around the country will present panel discussions on structural development, public health implications and lessons learned from state ACO programs. One such distinguished presenter is  Thomas Greaney, Chester A. Myers Professor of Law and Director, Center for Health Law Studies, Saint Louis University School of Law, who has been a frequent contributor to HRW,  will take part in the panel on “ACOs in Practice: Research on Current Implementation of ACOs,” and will be presenting Accountable Care Organizations: A New New Thing with Some Old Problems.

A nationally recognized expert on health care and antitrust law, Professor Thomas (Tim) Greaney has spent the last two decades examining the evolution of the health care industry and is a vocal advocate for reforming the health care system and protecting consumers. He also has a strong interest in comparative antitrust law, having been a Fulbright Scholar in Brussels and a visiting lecturer at several European law schools.

After graduating from Harvard Law School, Greaney began his career as a legislative assistant on Capitol Hill and as a law clerk with the Federal Communications Commission. He then moved on to the Antitrust Division of the U.S. Department of Justice where he was a trial attorney and became the assistant chief in charge of antitrust matters in health care. His career at Justice spanned ten years and involved him in civil and criminal antitrust litigation in health care, banking, communications and other regulated industries as well as policy formulation and legislative matters.

Greaney came to SLU LAW in 1987 after completing two fellowships and a visiting professorship at Yale Law School. Professor Greaney became Chester A. Myers Professor of Law in 2004 and was named Health Law Teacher of the Year by the American Society of Law, Medicine and Ethics in 2007. His academic writing has been recognized six times by the Thompson Coburn Award for SLU Faculty scholarship.

Professor Greaney’s extensive body of scholarly writing on health care and antitrust laws encompasses articles published in some of the country’s most prestigious legal and health policy journals. Professor Greaney has authored or co-authored several books, including the leading health care casebook, Health Law. A frequent speaker in academia and the media, Professor Greaney has also offered expert testimony at hearings sponsored by the Federal Trade Commission on the issues of applying competition law and policy to health care, and submitted invited testimony to the U.S. Senate on competition policy and health care reform.

ACO Symposium: Professor John V. Jacobi to Present: Lessons from ACO Implementation in New Jersey

In conjunction with the Center for Health & Pharmaceutical Law & Policy, this year’s Seton Hall Law Review Symposium on October 28, 2011, will explore recent changes in the structure of health care delivery, in particular the rising popularity of Accountable Care Organizations (ACOs). For more information or to register, click here.

The keynote speaker will be Dr. Jeffrey Brenner, founder of the Camden Coalition of Healthcare Providers, and legal scholars and practitioners from around the country will present panel discussions on structural development, public health implications and lessons learned from state ACO programs. One such distinguished presenter is John V. Jacobi , Faculty Director, Center for Health & Pharmaceutical  Law & Policy,Dorothea Dix Professor of Health Law & Policy, Seton Hall University School of Law. Professor Jacobi, who frequently contributes to HRW,  will take part in the panel on “ACOs in Practice: Research on Current Implementation of ACOs,” and will be presenting Lessons from ACO Implementation in New Jersey.

Professor John Jacobi’s work is primarily in the areas of Health Insurance and Access, Mental Health Law, and Disability Law.

Professor Jacobi received his B.A., summa cum laude, from the State University College of New York at Buffalo and his J.D., magna cum laude, from Harvard Law School. He teaches Health Law, Health Finance, Disability Law, Public Health Law, Mental Health Law, and Torts. Professor Jacobi spent five years working for the New Jersey Department of the Public Advocate as Special Assistant to the Commissioner, where he worked on health, civil rights, and disability issues through litigation and advocacy in legislatures and regulatory agencies. He then became a Gibbons Fellow at the law firm of Gibbons, Del Deo, Dolan, Griffinger & Vecchione, where he pursued health, prisoners’ rights, and disability issues. During 2007-2008 he was on leave from the law school, serving as Senior Associate Counsel to N.J. Governor Jon S. Corzine on Health, Human Services, and Chrildren’s Issues.

Professor Jacobi writes and speaks on issues including disability rights, health access and finance, public health, and mental health. His recent and current scholarly projects include examining the improvement of chronic care in health systems, the funding and structure of Early Intervention Services for children with disabilities, examining the obligations of government to provide services to people with serious mental illness, the clash of disability rights and public health interests, and the prospects and social effects of “consumer-driven” health insurance models on health costs and rights of access for the poor and people with disabilities. He served on the Governor’s Task Force on Mental Health, the Board of Advisors of the New Jersey Office of Child Advocacy, the New Jersey Olmstead Advisory Council on disability rights, and on other government and non-profit boards and committees.

ACO Symposium: Professor Sallie Sanford to Present: State-based ACO and Medical Home Pilots: Early Lessons from the Other Washington

In conjunction with the Center for Health & Pharmaceutical Law & Policy, this year’s Seton Hall Law Review Symposium on October 28, 2011, will explore recent changes in the structure of health care delivery, in particular the rising popularity of Accountable Care Organizations (ACOs). For more information or to register, click here.

The keynote speaker will be Dr. Jeffrey Brenner, founder of the Camden Coalition of Healthcare Providers, and legal scholars and practitioners from around the country will present panel discussions on structural development, public health implications and lessons learned from state ACO programs. One such distinguished presenter is Sallie Sanford, Assistant Professor of Law, University of Washington — School of Law & School of Public Health. Professor Sanford will take part in the panel on “ACOs in Practice: Research on Current Implementation of ACOs,” and will be presenting State-based ACO and Medical Home Pilots: Early Lessons from the Other Washington.

Professor Sanford teaches Health Law both at the law school and the School of Public Health. Her research interests include health care delivery systems, health administration law, Medicare and Medicaid, comparative health law, and medical and administrative ethics.

Professor Sanford began her legal career as a law clerk for The Honorable Robert R. Beezer of the United States Court of Appeals for the Ninth Circuit. She then served for six years as an Assistant Attorney General representing the University of Washington Medical Center, Harborview Medical Center and the UW’s health sciences schools. Professor Sanford is a member of the Order of the Coif and is admitted to practice in Washington and the U.S. Court of Appeals for the Ninth Circuit. She is the president of the Washington State Society of Healthcare Attorneys.

ACO Symposium: Professor Louise Trubek, Barbara Zabawa, Felice Borisy-Rudin to Present: Accountable care organizations in two states: A preliminary analysis

In conjunction with the Center for Health & Pharmaceutical Law & Policy, this year’s Seton Hall Law Review Symposium on October 28, 2011, will explore recent changes in the structure of health care delivery, in particular the rising popularity of Accountable Care Organizations (ACOs). For more information or to register, click here.

The keynote speaker will be Dr. Jeffrey Brenner, founder of the Camden Coalition of Healthcare Providers, and legal scholars and practitioners from around the country will present panel discussions on structural development, public health implications and lessons learned from state ACO programs. A trio of such distinguished presenters are Louise Trubek, Adjunct Professor of Law, Seton Hall Law School, and Clinical Professor of Law Emerita, University of Wisconsin Law School; Barbara Zabawa, Whyte Hirschboeck Dudek, S.C; and Felice Borisy-Rudin, University of Wisconsin Law School. They will take part in the panel on “ACOs in Practice: Research on Current Implementation of ACOs,” and will be presenting Accountable care organizations in two states: A preliminary analysis.

Louise G. Trubek is an Adjunct Professor of Law at Seton Hall Law School and an Emerita Clinical Professor at the University of Wisconsin Law School. A graduate of the University of Wisconsin and the Yale Law School, Louise is an active scholar and teacher in the fields of health law, public interest law, and regulation and governance. She is publishing three articles in 2011. The recent articles are: “Improving Cancer Outcomes Through Strong Networks and Regulatory Frameworks: Lessons from the United States and the European Union” Journal of Health Care Law and Policy spring 2011 (with others); Public Interest Law: Facing the Problems of Maturity, University of Arkansas/Little Rock Law Review 2011; New Roles to Solve Old Problems: Lawyering for Ordinary people in Today’s Context” New York Law Journal 2011(with Marsha Mansfield).  Louise is a co-organizer of a Law and Society sponsored International Research Collaboration on Reflective Practitioners/Public Interest Law.She is coordinating the IRC with Scott Cummings (UCLA) and Frank Munger (New York Law School). She is teaching a seminar on Health Law and Governance at Seton Hall in 2011.

Barbara Zabawa is an attorney in the Madison, Wisconsin, office of Whyte Hirschboeck Dudek S.C. Ms. Zabawa practices business and intellectual property litigation. From 2003-2005, Ms. Zabawa clerked for the Honorable Barbara B. Crabb in the United States District Court for the Western District of Wisconsin and worked on numerous litigation matters, including patent infringement, civil rights, employment and contract matters. She also was a Skadden Fellow through the Skadden Fellowship Foundation, working on private health insurance issues from 2001 to 2003.

In addition to her valuable litigation experience and skills, Barbara has almost 20 years of experience in the health care field, first receiving her Master’s in Public Health from the University of Michigan before attending law school at UW Madison.

Barbara’s passion for improving health care and coverage is unmatched and is demonstrated through her representation of stakeholders across the spectrum of health care stakeholders throughout her career. Her depth and breadth of experience provides her clients with an important understanding of all sides of the pressing issues facing health insurers and providers today.

For example, Barbara clerked for the Wisconsin Medicaid Fraud Control Unit, helping prosecute Medicaid fraud cases. She maintains contact with the current Medicaid Fraud Control Unit Director, and develops continuing legal education programs regarding Medicaid and Medicare fraud cases. In private practice, Barbara has defended health care providers against investigations by the Wisconsin Medicaid Fraud Control Unit, investigations by the US Attorney’s Office and the Office of Inspector General and qui tam actions.

In addition, Barbara is adept at drafting and reviewing provider and insurer contracts, federal and state reimbursement and fraud and abuse rules, and advising on HIPAA and HITECH privacy and security requirements. She has been at the helm of health care reform in Wisconsin, being appointed to the Legislative Study Committee on Health Care Reform. She also currently serves as Chair of the State Bar Health Law Section and has taught Health Law at the UW Law School. Barbara has written and spoken on Medicaid expansion initiatives, health information privacy concerns and the impact of health reform on various health care stakeholders.

Felice Borisy-Rudin holds a Ph.D. in Neuroscience from the Johns Hopkins University School of Medicine and a B.S. in Biology from Caltech. Felice is a third year law student with special interests in patent law, emerging biomedical technologies, and health law. Pursuing this interest, she has taken courses in: Administrative Law, Antitrust,  Business Organizations, Health Law & Administration, Intellectual Property, Patent Law and Tax Law. Felice has interned at Clean Wisconsin and at the Center for Patient Partnerships and is a Managing Editor for the Wisconsin Law Review. Felice is currently serving her third term as Trustee for the Village of Shorewood Hills. She enjoys long walks, science fiction and spending time with her family and friends.

ACO Symposium: Michael Kalison, Chairman of Applied Medical Software, Inc.; Of Counsel, McElroy, Deutsch, Mulvaney, & Carpenter, LLP to Present The Lessons of Gainsharing

In conjunction with the Center for Health & Pharmaceutical Law & Policy, this year’s Seton Hall Law Review Symposium on October 28, 2011, will explore recent changes in the structure of health care delivery, in particular the rising popularity of Accountable Care Organizations (ACOs). For more information or to register, click here.

The keynote speaker will be Dr. Jeffrey Brenner, founder of the Camden Coalition of Healthcare Providers, and legal scholars and practitioners from around the country will present panel discussions on structural development, public health implications and lessons learned from state ACO programs. One such distinguished presenter is Michael Kalison, Chairman of Applied Medical Software, Inc.; Of Counsel, McElroy, Deutsch, Mulvaney, & Carpenter, LLP. He will take part in the panel concerned with the “Introduction to Accountable Care Organizations,” and will be presenting The Lessons of Gainsharing.

Michael Kalison is Chairman of Applied Medical Software, Inc., which successfully worked with the New Jersey Hospital Association to commence a CMS approved 3 year pilot project approved in 2009 called “Gainshairing.” As Healthcare Finance noted at the time, “Under gainsharing, physicians may share a portion of the savings that are realized by working with the hospital to make a patient’s stay more efficient. The overall savings could ultimately benefit the Medicare program.”

In addition, Mr. Kalison is Of Counsel at McElroy, Deutsch, Mulvaney & Carpenter, LLP. He is a graduate of the Wharton School of Economics (B.S., 1967) and the University of Pennsylvania School of Law (J.D., 1973). He has served as Law Secretary to the Hon. Nathan L. Jacobs of the Supreme Court of New Jersey, 1973-1974. Mr. Kalison concentrates his practice in health and hospital law, healthcare reimbursement, finance, administrative law and general corporate law. His current focus is aligning provider incentives, including the Medicare Physician-Hospital Collaboration Demonstration involving hospitals in New Jersey and New York.

In 1976, Mr. Kalison led the development of a prospective payment system for acute care hospitals, based on patient case mix, for the New Jersey Department of Health. This system, which used Diagnosis Related Groups (DRGs) as the basis of payment, became the model for the Medicare Prospective Payment System (PPS). Mr. Kalison also co-authored the methodology for prospective capital payment that was incorporated into PPS. He has published many articles and has been a frequent lecturer on the financial and corporate issues affecting hospitals. He has consulted to Congressional committees and individual members of Congress. Mr. Kalison is consistently named to the “Best Lawyers in New Jersey” list in New Jersey Monthly Magazine, and to “The Best Lawyers in America,” published by Woodward / White.

Mr. Kalison is admitted to practice in New Jersey and to practice before the United States District Court for the District of New Jersey.  He is a member of the American Health Lawyers Association (Member, Board of Trustees, 1990-1996) and is certified by that organization as an Alternative Dispute Resolver.

ACO Symposium: Hal Teitelbaum, CEO & Managing Partner, Crystal Run Healthcare to Present, The Prospect of Being Hanged: Focusing the Physician Mind on ACOs

In conjunction with the Center for Health & Pharmaceutical Law & Policy, this year’s Seton Hall Law Review Symposium on October 28, 2011, will explore recent changes in the structure of health care delivery, in particular the rising popularity of Accountable Care Organizations (ACOs). For more information or to register, click here.

The keynote speaker will be Dr. Jeffrey Brenner, founder of the Camden Coalition of Healthcare Providers, and legal scholars and practitioners from around the country will present panel discussions on structural development, public health implications and lessons learned from state ACO programs. One such distinguished presenter is Hal Teitelbaum, M.D., MBA, and CEO and Managing Partner, Crystal Run Healthcare; he will take part in the panel concerned with the “Introduction to Accountable Care Organizations,” and will be presenting The Prospect of Being Hanged: Focusing the Physician Mind on ACOs.

Hal Teitelbaum is the managing partner, CEO and founder of Crystal Run Healthcare, among the largest, fastest growing and most technically advanced medical practices in New York State. Dr. Teitelbaum completed his training in Internal Medicine at New York Hospital-Cornell Medical Center, and in Medical Oncology and Hematology at Memorial Sloan-Kettering Cancer Center. After beginning his career in full-time academic practice, Dr. Teitelbaum established a solo practice in Orange County, New York, in 1982.  He established Crystal Run Healthcare in 1996.  He is a 1998 honors graduate of Columbia Business School, where he earned his MBA and is currently enrolled in Columbia Law School, Class of 2012.

Dr. Teitelbaum has served as a trustee of Horton Medical Center and in numerous other capacities for the hospital, medical staff organization, managed care organizations and regulatory agencies.  He is a recipient of the ADL Americanism Award, the Rhulen Award of the Sullivan County Partnership for Economic Development, and the Alliance for Balanced Growth’s ‘Golden Shovel Award’ of the Orange County Partnership. He was recognized by the Medical Group Management Association (MGMA) as the 2006 Physician Executive of the Year. Over the years, Dr. Teitelbaum and Crystal Run Healthcare have been the subjects of numerous articles for health care and business publications.

ACO Symposium: Jorge Lopez, Partner, Akin Gump, to Present: Promise and Pitfalls: Health Reform’s Medicare ACO Shared Savings Program

In conjunction with the Center for Health & Pharmaceutical Law & Policy, this year’s Seton Hall Law Review Symposium on October 28, 2011, will explore recent changes in the structure of health care delivery, in particular the rising popularity of Accountable Care Organizations (ACOs). For more information or to register, click here.

The keynote speaker will be Dr. Jeffrey Brenner, founder of the Camden Coalition of Healthcare Providers, and legal scholars and practitioners from around the country will present panel discussions on structural development, public health implications and lessons learned from state ACO programs. One such distinguished presenter is Jorge Lopez, Partner, Akin Gump Strauss Hauer & Feld LLP; he will take part in the panel concerned with the “Introduction to Accountable Care Organizations,” and will be presenting Promise and Pitfalls: Health Reform’s Medicare ACO Shared Savings Program.

Jorge Lopez Jr. heads the national health industry practice and is a member of the firmwide management committee at Akin Gump, working out of the DC office. The health practice’s clients include major academic medical centers, health care systems, manufacturers of drugs and devices, managed care enterprises, lenders and investors involved with health industry projects and various other health care-related enterprises.

Mr. Lopez has more than two decades’ worth of experience advising these clients on a wide range of health regulatory and public policy issues. He has advised clients on many of the major Congressional health care initiatives considered in the past 20 years-including the Clinton Administration health care reform proposal, the Balanced Budget Act of 1997, the Medicare Modernization Act of 2003 and the Affordable Care Act of 2010-and the implementation of many of these initiatives by the federal Centers for Medicare and Medicaid Services. He has particular experience in matters involving health care policy and regulation affecting cancer care; applications of the federal fraud and abuse laws to the hospital, pharmaceutical, pharmacy and medical device industries; and issues relating to the Health Insurance Portability and Accountability Act (HIPAA) and other state and federal privacy laws.

Mr. Lopez is nationally ranked as a top healthcare lawyer in the 2008-2011 editions of Chambers USA: America’s Leading Lawyers for Business. He is very active in charitable organizations in the Washington, D.C. community. He has served on the board of directors of the D.C.-area Catholic Charities or one of its affiliates since 1985. He was board chairman of one of these affiliates, Anchor Mental Health, a large provider of services to mentally disabled adults in the D.C. area, from April 2003 to June 2004.

ACO Symposium: Tara A. Ragone to present: The Role of Competition in Integrated Delivery: ACOs, Federal and State Antitrust Law, and the State Action Doctrine

In conjunction with the Center for Health & Pharmaceutical Law & Policy, this year’s Seton Hall Law Review Symposium on October 28, 2011, will explore recent changes in the structure of health care delivery, in particular the rising popularity of Accountable Care Organizations (ACOs). For more information or to register, click here.

The keynote speaker will be Dr. Jeffrey Brenner, founder of the Camden Coalition of Healthcare Providers, and legal scholars and practitioners from around the country will present panel discussions on structural development, public health implications and lessons learned from state ACO programs. One such distinguished presenter is Tara Adams Ragone, Research Fellow & Lecturer in Law at Seton Hall Law School’s Center for Health & Pharmaceutical Law & Policy; she will take part in the panel concerned with “ACOs in Theory: Issues Raised by Integrated Delivery,” and will be presenting The Role of Competition in Integrated Delivery: ACOs, Federal and State Antitrust Law, and the State Action Doctrine.

Tara Adams Ragone joined the Center for Health & Pharmaceutical Law & Policy as a Research Fellow and Lecturer in Law in 2011. Her research and writing for the Center focus on implementation of health care reform, accountable care organizations, health care access, bioethics, and issues related to the representation of health care professionals. Ms. Ragone also advises the health law moot court team and regularly contributes here at Health Reform Watch.

Ms. Ragone came to Seton Hall Law from the State of New Jersey, Office of the Attorney General, Division of Law, where she served as Deputy Attorney General in the Professional Boards Prosecution Section. She primarily prosecuted licensing actions before the State Board of Medical Examiners and the Office of Administrative Law and represented the State in federal civil rights actions brought by licensees. Before joining the New Jersey Attorney General’s Office, Ms. Ragone served as a law clerk to the Honorable Allyne R. Ross of the U.S. District Court for the Eastern District of New York and the Honorable Robert A. Katzmann of the U.S. Court of Appeals for the Second Circuit.

The CareMore Model and the Need to Better Coordinate Care for Dual Eligibles

In The Quiet Health-Care Revolution, an article by Adrian Slywotzky and Tom Main in the November issue of The Atlantic, the authors tell the story of CareMore, a for-profit company serving more than 50,000 elderly patients through 26 care centers located in Arizona, California, and Nevada.  Founded by Sheldon Zinberg, a gastroenterologist, CareMore was originally a group physician practice but it has since become a Medicare Advantage managed care plan.  As such, it is paid a capitated, risk-adjusted rate for each patient it serves, giving it a financial incentive to hold down costs.  Slywotzky and Main report that, through an emphasis on care coordination and creative “upstream” interventions, CareMore has improved outcomes, held down costs, and stayed in the black.

Each CareMore patient has a personal physician, called an “extensivist,” who ensures, with the help of an electronic medical record, that all of the members of the patient’s care team are communicating and coordinating with one another.  The extensivist is also charged with ensuring that the patient understands and is able to comply with his or her treatment plan.  One of Dr. Zinberg’s early decisions was that “noncompliance is our problem, not the patient’s.”  As a result, among other things, CareMore provides its patients with free-to-them transportation to medical appointments.

Going hand-in-hand with CareMore’s emphasis on coordination is a focus on “upstream” interventions. For a patient with congestive heart failure, a wireless scale transmits the results of her daily weigh-in to a clinic allowing fluid build-up to be caught early.  For a frail patient, “light muscle-training sessions and periodic toenail clipping” reduce the risk of falls.  And for a diabetic patient, aggressive treatment of a cut foot reduces the risk of infection and amputation.

How does all of this impact quality and cost?  Slywotzky and Main report that:

“CareMore, through its unique approach to caring for the elderly, is routinely achieving patient outcomes that other providers can only dream about: a hospitalization rate 24 percent below average; hospital stays 38 percent shorter; an amputation rate among diabetics 60 percent lower than average.  Perhaps most remarkable of all, these improved outcomes have come without increased total cost. …  CareMore’s overall member costs are actually 18 percent below the industry average.”

As with other, better known providers like the Mayo Clinic, whether the CareMore model is scalable is a question, one that may be answered in coming years because the company is growing and is likely to grow more after its purchase in August by WellPoint.

In a recently-released study conducted for AHIP–the industry group representing health plans–Kenneth Thorpe makes the financial case for enrolling more individuals, in particular those who are eligible for both Medicare and Medicaid, into health plans like CareMore that employ a coordinated, team-based approach to care.  As Thorpe explains, so-called “dual eligibles” are among the most chronically ill and therefore expensive of all patients, accounting, despite their relatively small numbers, for “36 percent of total Medicare spending and 39 percent of Medicaid spending.” In 2011, Thorpe writes, “the federal government–through Medicare and Medicaid–will spend over $230 billion on dual eligibles.” Currently, “[f]ewer than 2 percent of dual eligibles are enrolled in a coordinated care program that managed all Medicare and Medicaid covered benefits.”  Thorpe projects that if all dual eligibles were required to enroll in such a program, the federal government would save up to $125 billion and the states up to $34 billion over the next ten years.

Achieving better alignment of Medicare and Medicaid for the benefit of dual eligibles is not without its complications, of course.  Yesterday, AHIP issued a proposal reviewing key differences between the programs-including the nature and scope of covered services, eligibility and enrollment rules and procedures, provider networks and access requirements, and beneficiaries’ right to information and to appeal-and recommending ways to eliminate or work around them.  Among AHIP’s recommendations is that “States be given opportunities to share with the Federal government and with health plans, as appropriate, in savings generated through increased integration.”  As it stands, “it may be difficult for States to justify State investment in efforts to generate such savings, for example through programs intended to decrease acute hospitalizations or increase reliance on Medicaid-covered [i.e. partially State-funded] services.”

ACO Symposium: Profesor Priscilla D. Keith to Present:The Impact of Accountable Care Organizations on Public Health

In conjunction with the Center for Health & Pharmaceutical Law & Policy, this year’s Seton Hall Law Review Symposium on October 28, 2011, will explore recent changes in the structure of health care delivery, in particular the rising popularity of Accountable Care Organizations (ACOs). For more information or to register, click here.

The keynote speaker will be Dr. Jeffrey Brenner, founder of the Camden Coalition of Healthcare Providers, and legal scholars and practitioners from around the country will present panel discussions on structural development, public health implications and lessons learned from state ACO programs. One such distinguished presenter is Priscilla Keith, Adjunct Professor and Director of Research and Projects, Hall Center for Law and Health, Indiana University School of Law — Indianapolis.

Professor Keith will take part in the panel concerned with “ACOs in Theory: Issues Raised by Integrated Delivery,” and will be presenting The Impact of Accountable Care Organizations on Public Health.

Priscilla D. Keith serves as Director of Research and Projects, as well as Adjunct Professor, at Indiana University Law School’s Hall Center for Law and Health. As Director, she manages the legal and policy research projects of the Center. She is also responsible for the development of the curriculum and other arrangements for the graduate law degree program (L.L.M.) in health law, policy and bioethics. Before returning to work for her alma mater, Keith served as the General Counsel of the Health & Hospital Corporation of Marion County, in Indianapolis, including Wishard Health Services, the Marion County Health Department, and Environmental Services. Her primary focus was litigation, corporate transactions, and risk management, and serving as the counsel for the Marion County Health Department’s Ryan White HIV AIDS Legal Project. Prior to her appointment as General Counsel, she served as Assistant Counsel to former Indiana Governor, Frank O’Bannon. She also served as an executive assistant to the Department of Insurance, State Board of Accounts, Utilities and Telecommunications, and the Women’s Commission. Additionally, Keith was Chief Counsel of the Advisory Section under Attorneys General Jeff Modisett and Karen Freeman-Wilson. Prior to her legal career, Keith worked for Eli Lilly and Company in discovery research, environmental and medical plans. She is a member of the American Bar Association’s Health Law Section, and serves on its Council, and is the Interest Group Leader. She also serves on the Board of Directors of the Providence Cristo Rey High School in Indianapolis, Visiting Nurses Service, the State of Indiana Ethics Commission and St. Mary’s Child Center. In addition to earning her J.D. from our law school, she holds an M.S. in Anatomy from Atlanta University, and a B.S. from Spelman College. She is admitted to the Indiana Bar.

ACO Symposium: Professor Jessica Mantel to Present, ACOs: Can we have our cake and eat it too?

In conjunction with the Center for Health & Pharmaceutical Law & Policy, this year’s Seton Hall Law Review Symposium on October 28, 2011, will explore recent changes in the structure of health care delivery, in particular the rising popularity of Accountable Care Organizations (ACOs). For more information or to register, click here.

The keynote speaker will be Dr. Jeffrey Brenner, founder of the Camden Coalition of Healthcare Providers, and legal scholars and practitioners from around the country will present panel discussions on structural development, public health implications and lessons learned from state ACO programs. One such distinguished presenter is Jessica Mantel, Co-Director of the Health Law & Policy Institute, University of Houston, Law Center and  Assistant Professor of Law. Professor Mantel will take part in the panel concerned with “ACOs in Theory: Issues Raised by Integrated Delivery,” and will be presenting ACOs: Can we have our cake and eat it too?

Professor Jessica Mantel joined the University of Houston Health Law & Policy Institute as co-director after eight years of service with two government agencies in Washington, D.C. She worked most recently as a senior attorney in the Office of the General Counsel for the Department of Health and Human Services. In that position she advised Centers for Medicare and Medicaid Services on legal issues dealing with Medicare matters, including implementation of the prescription drug benefit, hospital payments, incentive payments for the adoption of electronic health records, and health care reform. She previously worked as a health policy analyst in the Government Accountability Office evaluating Medicare payment issues. Prior to her service with government agencies, she practiced as an associate in the Health Care Department of the firm of Ropes & Gray in Boston and clerked for the Honorable Karen Nelson Moore of the U.S. Court of Appeals for the Sixth Circuit in Cleveland. Her research interests include the impact of various legislative and regulatory schemes on emerging trends in the health care delivery system and the allocation of limited health care resources. In 1997, Mantel received both her J.D. from the University of Michigan Law School and an M.P.P. from the University of Michigan School of Public Policy. She also holds a B.A. in psychology from the University of Pennsylvania.

Symposium: Implementing the Affordable Care Act: What Role for Accountable Care Organizations?

In conjunction with the Center for Health & Pharmaceutical Law & Policy, this year’s SETON HALL LAW REVIEW Symposium will explore recent changes in the structure of health care delivery, in particular the rising popularity of Accountable Care Organizations (ACOs).

Legal scholars and practitioners from around the country will present panel discussions on structural development, public health implications and lessons learned from state ACO programs. Luncheon keynote speaker will be Dr. Jeffrey Brenner, founder of the Camden Coalition of Healthcare Providers.

Scheduled Panels & Panelists include

Introduction to Accountable Care Organizations

Jorge Lopez (Partner, Akin Gump Strauss Hauer & Feld LLP): Promise and Pitfalls: Health Reform’s Medicare ACO Shared Savings Program

Hal Teitelbaum (CEO and Managing Partner, Crystal Run Healthcare): The Prospect of Being Hanged: Focusing the Physician Mind on ACOs

Michael Kalison (Chairman of Applied Medical Software, Inc.; Of Counsel, McElroy, Deutsch, Mulvaney, & Carpenter): The Lessons of Gainsharing

ACOs in Theory: Issues Raised by Integrated Delivery

Jessica Mantel (Co-Director, Health Law & Policy Institute, University of Houston, Law Center): ACOs: Can we have our cake and eat it too?

Priscilla Keith (Adjunct Professor and Director of Research and Projects, Hall Center for Law and Health, Indiana University School of Law - Indianapolis): The Impact of Accountable Care Organizations on Public Health

Tara Ragone (Research Fellow, Seton Hall Law School): The Role of Competition in Integrated Delivery: ACOs, Federal and State Antitrust Law, and the State Action Doctrine

Keynote

Jeffrey Brenner, M.D., Founder & Executive Director, Camden Coalition of Healthcare Providers

Jeffrey Brenner is a family physician and has practiced in Camden for eleven years as a front-line primary care provider for patients of all ages. Having owned a private practice in Camden, he has experience in implementing electronic health records and running a paperless office, open-access scheduling, as well as first-hand knowledge of the various challenges facing primary care in the current health system.

He currently serves full-time as the Coalition’s Executive Director, where he spends much of his time meeting with stakeholders and policymakers, advocating for the models of care the Coalition has developed and demonstrated through data centric results. Jeff is a faculty member of the Robert Wood Johnson Medical School in Camden and is also a former resident of Camden, having lived in the city for over 8 years. He is a graduate of Vassar College and the Robert Wood Johnson Medical School.

ACOs in Practice: Research on Current Implementation of ACOs

Louise Trubek (Clinical Professor, University of Wisconsin Law School), Barbara Zabawa (Whyte Hirschboeck Dudek, S.C); Felice Borisy-Rudin (University of Wisconsin Law School): Accountable care organizations in two states: A preliminary analysis

Sallie Sanford (Assistant Professor of Law, University of Washington - School of Law & School of Public Health): State-based ACO and Medical Home Pilots: Early Lessons from the Other Washington

John Jacobi (Faculty Director & Dorothea Dix Professor of Health Law & Policy, Seton Hall University School of Law), Lessons from ACO Implementation in New Jersey.

Thomas Greaney (Chester A. Myers Professor of Law and Director, Center for Health Law Studies, Saint Louis University School of Law), Accountable Care Organizations: A New New Thing with Some Old Problems.

The event will take place at Seton Hall Law School with luncheon served at The Newark Club, One Newark Center, 22nd floor. There is no charge for Seton Hall Law alumni; cost for all others, $25.  Four NJ/NY CLE credits will be available. Visit http://law.shu.edu/lawreviewsymposium to register. For more information regarding the Symposium, please contact Gianna Cricco-Lizza, Symposium Editor, at gianna.criccolizza@student.shu.edu.

Community Based Medicaid ACOs in New Jersey: A Signature Away

Almost daily, there is a new article or study emphasizing the need for innovative reform to save Medicaid amidst growing threats of deep cuts to the already struggling program.  New Jersey, as one of the states with the highest Medicaid spending per beneficiary in the country, is paying attention.  And help may be on the way in the form of a medical home/safety net.

Showing promise, the medical home model of care is an oft proposed reform.  As Mary Takach explains in the July 2011 edition of Health Affairs, “[a] patient-centered medical home is an enhanced model of primary care in which care teams, led by a primary care provider, attend to the multifaceted needs of patients and provide whole-person, comprehensive, coordinated, and patient-centered care.”  (See “Reinventing Medicaid: State Innovations to Qualify and Pay for Patient-Centered Medical Homes Show Promising results,” Health Affairs, July 2011, 30(7):1325-34.)

According to the National Academy for State Health Policy, thirty-nine states are working to implement medical homes for Medicaid and CHIP participants, and New Jersey is one of them.  In September 2010, Governor Christie signed Assembly Bill 226 into law, which established a three-year Medicaid medical home demonstration project that, at minimum, will include “primary care providers utilizing a multi-disciplinary team that provides patient-centered care coordination through the use of health information technology and chronic disease registries across the patient’s life-span and across all domains of the health care system and the patient’s community.”  The statute requires that the payment system “be structured to reward quality and improved patient outcomes” and that Medicaid “[c]onsider payment methodologies that support care-coordination through multi-disciplinary teams, including payment for care of patients with chronic diseases and the elderly, and that encourage services such as: (a) patient or family education for patients with chronic diseases; (b) home-based services; (c) telephonic communication; (d) group care; (e) oral health examinations, when applicable; and (f) culturally and linguistically appropriate care.”   You can learn about various medical home initiatives in New Jersey at the National Center for Medical Home Implementation web site.

Takach’s report focuses on seventeen states that have aligned “patient-centered medical home standards with incentive payments to support reform in the delivery of primary care” — Colorado, Iowa, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Rhode Island, Vermont, Washington, and West Virginia.

Although these programs are in their infancy, Takach interprets limited early data from a few states as encouraging. Vermont, for example, documented that inpatient use had decreased twenty-one percent, with a corresponding twenty-two percent decrease in per person per month inpatient costs, and that emergency department use had decreased thirty-one percent, with a corresponding reduction of thirty-six percent in per person per month costs (although its second pilot community had what Takach describes as “mixed results”).  Colorado similarly has seen decreases in its median Medicaid costs per patient for children.

Both Colorado and Oklahoma also have seen increases in participating providers since the medical home model started operating.  In Oklahoma, more than 244 new physicians enrolled in Medicaid.  Ninety-six percent of pediatricians now accept Medicaid in Colorado, up from only twenty percent before the program began.  Increasing the number of Medicaid providers is critical, given national shortages of available primary care Medicaid providers.

As Takach summarizes:

Some of the early findings from Colorado and Oklahoma, which have statewide Medicaid initiatives, demonstrate that modest increases in payment aligned with quality improvement standards have not only resulted in promising trends for costs and quality, but have also greatly improved access to care.  This is an important finding for other states as they consider how to meet the tremendous increase in demand for care that will result from the expansions to Medicaid in the Affordable Care Act of 2010.

But beyond a medical home, there needs to be a safety net for the most vulnerable urban populations who are, in a sense, medically homeless– and are, by EMTALA default,  frequent utilizers of high cost emergency room services.

As this blog and other sources, including The New Yorker, have discussed, New Jersey  is home to the Camden Coalition of Healthcare Providers, which describes itself as “a citywide organization of social workers, nurses, physicians, administrators, hospitals, health services organizations, and clinics that serve the health needs of Camden, New Jersey residents.  [It] work[s] in a variety of settings — from small neighborhood based practices to hospital based offices — with the goal of improving the coordination and capacity of the healthcare system for residents of Camden.” Dr. Jeffrey Brenner has been leading this effort since 2002.  His work offers promising program models for safety-net providers throughout the country to “improve the quality, capacity, and accessibility of the healthcare system for vulnerable populations.” Indeed, even though the budget bill signed by Governor Christie slashed Medicaid funding in New Jersey by $540 million, his Commissioner of Human Services has expressed continuing support for the Coalition’s pilot because it is seen as a smart reform that could save money while improving care.  Newark and Trenton also have established citywide healthcare coalitions to improve medical care for their vulnerable, underserved residents. And we at the Center for Health and Pharmaceutical Law and Policy have worked closely with the Greater Newark Healthcare Coalition.

In a recent post on the Health Affairs blog, Dr. Brenner and Nikki Highsmith note that although the Camden Coalition “has had preliminary successes and offers potential long-term savings, such community-based endeavors are difficult to initiate and sustain without start-up financing, ground-level technical assistance, and buy-in from state and local policymakers, health plans, patients, and community members.”  They thus call on CMS to “jump start investments in safety-net ACOs” by pursuing a national demonstration project to support programs similar to Camden’s pilot.

New Jersey is poised to be ready if CMS heeds this call for a national Safety Net ACO demonstration project because the Coalition and other New Jersey stakeholders, including Seton Hall Law Professor John Jacobi, have been active in advocating for a bill (S2443) authorizing geography-based Medicaid ACOs in New Jersey. As the Coalition’s web site summarizes:

The proposed New Jersey law would authorize a three-year Medicaid ACO demonstration project whereby community-based, non-profit coalitions can apply for recognition by the State of New Jersey as a Medicaid ACO.  The applicants must propose a geographic focus and will need 100% of the [general] hospitals, 75% of the primary care providers, [four] behavioral health providers, and two community [organizations] from that geography on the board of the organization.  The providers in the community will continue to receive their usual Medicaid payments and the ACO, if its providers meet quality benchmarks, would be eligible to receive shared savings payments, that can be distributed to participants based on a proposed gain sharing plan.

The proposed legislation specifically recognizes that patient-centered medical home models are one way, among others, to achieve coordination. On June 27, 2011, the Assembly and Senate passed S2443, and it is awaiting Governor Christie’s signature.

New Jersey’s proposed Medicaid ACOs go beyond Medical Homes. They are built on a foundation of sound primary care, but they offer the promise of reaching vulnerable populations in many settings, and of assuring that the right care is provided at the right location for people who are often left out of health reform efforts. The financing mechanisms provided by the bill awaiting the governor’s signature go some way towards financing these innovating community organizations, although, as Brenner and Highsmith point out, more needs to be done –particularly in the way of providing start-up funding for community providers.

Appropriately cultivated, patient-focused collaborations such as these may  yield synergies in care and cost of a substantial scale.   But another recent Health Affairs article suggests that adoption of the medical home may well develop at a slower pace in states, like New Jersey, where physicians tend to be organized in smaller practices.  New Jersey’s Medicaid ACO pilot could  help to accelerate the development of practice reformation in New Jersey — particularly if CMS provides the support advocated by Jeff Brenner and Nikki Highsmith.

It’s an exciting time for growth and innovation in the Garden State … if we just get that signature.

ACOs and Racial and Ethnic Disparities: A Role for Community Stakeholders? Part Two

Part I of this post reviewed concerns raised by Craig Evan Pollack, MD, MHS, and Katrina Armstrong, MD, MSCA in their recent commentary in JAMA that implementing accountable care organizations (ACOs) will exacerbate racial and ethnic disparities in health care.  After considering the authors’ suggestions for steps CMS can take before finalizing its proposed rule to avoid this unintended consequence, I wondered whether community stakeholders might also be able to help stave off this negative policy outcome.  Now we pick up where I left off … what are community stakeholders and what role might they play in ACO formation and implementation?

CMS’s proposed rule has vague language requiring that the ACO  “establish partnerships with community stakeholders in order to advance the three-part aim of better care for individuals, better health for populations, and lower growth in expenditures” (proposed Section 425.5(d)(3)(v)).  The ACO also must describe in its application how it will partner with community stakeholders (proposed Section 425.5(d)(3)(iv)(B)(9)(ix)(H)). The lengthy preamble to the proposed rule further states that an ACO will be deemed to have satisfied this application requirement by including a community stakeholder organization on its governing body.  See 76 Fed. Reg. 19,527, 19,541 (Apr. 7, 2011).

The proposed rule, despite its length, does not shed much light on what the community stakeholder is.  Who or what is the community stakeholder?  Who does the community stakeholder represent?  Does it have an obligation to represent only the beneficiaries in the ACO or all in the relevant community?  Regardless of the answer, how can it know who its member beneficiaries are or what the relevant community is, since assignment is done retrospectively?  How is the community stakeholder selected — by the ACO?  Its beneficiaries?  What does CMS mean by partnership? If a community stakeholder is on the ACO’s governing body, is it a voting member?  There are myriad questions left unanswered by the proposed rule.

The preamble to the proposed rule, however, reveals a glimpse of CMS’ thinking when it discusses integrating community resources within the context of developing individualized care plans for targeted high-risk and multiple chronic condition patient populations as part of adherence to a “patient-centeredness criterion”:

The individualized care plans should include identification of community and other resources to support the beneficiary in following the plan. To this end, we believe that a process for integrating community resources into the ACO is an important part of patient centeredness. A wide variety of organizations, although not necessarily ACO participants may be considered a community resource, including: Employers, commercial health plans, local businesses, state/local government agencies, local quality improvement organizations or collaboratives (such as health information exchanges).  Collaboration with these types of community resources can be an important part of enabling ACOs to take account of the entirety of Medicare beneficiary population’s needs relative to their environment. Community stakeholder engagement in an ACO could be explicitly incorporated via community representation on the governing body, by having a community representative on an advisory board, or by other innovative mechanisms.

[76 Fed. Reg. 19,527, 19,550 (Apr. 7, 2011).]

CMS specifically invited ACOs in their applications to “describe additional target populations that would benefit from individualized care plans.”  76 Fed. Reg. 19,527, 19,551 (Apr. 7, 2011).]

Community stakeholders should be responsible for coordinating this collaboration with community resources and partners and helping beneficiaries most at-risk by directing ACO resources to the toughest cases.  Given the racial and ethnic segregation concerns discussed in Part One of this post, CMS should make clear that racial and ethnic minorities are among the targeted high-risk patient populations to which community stakeholders — and the ACO — must attend to satisfy the “patient-centeredness criterion.”  Part of helping ACOs “take account of the entirety of Medicare beneficiary population’s needs relative to their environment,” 76 Fed. Reg. 19,527, 19,550 (Apr. 7, 2011), must involve community stakeholders who are keenly aware of underserved or segregated groups in the ACO’s geographical area and help the ACO use community resources to outreach to these groups.

This outreach can start with education.  Patients of any race or ethnicity may gain access to higher quality care by choosing to see a doctor in an ACO that is reporting stronger quality measures — if they are aware of their rights and supported in making a change.  Community stakeholders can educate these groups about the quality data available to help them evaluate the care available to them and their right to seek care from any Medicare provider.  Helping patients, regardless of their race or ethnicity, embrace their power to cherry pick providers based on quality could mitigate the risks of further segregation that concerned the authors of the JAMA article (at least in regions where beneficiaries have a choice of providers).  Community stakeholders can help find the Rosa Parks of health care segregation to stand up and say, “I will not ride in the lower quality back of the health care bus anymore!”

But we could miss this bus if the final rule remains as skeletal as the proposed rule.  I am confident that CMS has a clear vision of productive partnerships with community stakeholders that advance its goals for better care for individuals and better health for populations.  I hope it paints a fuller picture in its final rule.

Next Page »