IU Health Accountable Care Organization (ACO) Direct Contracting Model

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An Accountable Care Organization (ACO) is a group of doctors and other healthcare providers who agree to work together with Medicare to give you the best possible care. ACOs may take different approaches to giving you coordinated care.

Some ACOs may have special nurses that help you set up appointments or make sure your medications are in order when you enter or leave a hospital. Other ACOs may help your doctors get you equipment for monitoring your medical conditions better at home, if you need it. Most ACOs use advanced systems that let them more carefully track your care, and make sure your doctor has the most up-to-date information about your health.

The goal of the ACO is to support your doctor in caring for you. ACOs help your doctor and healthcare providers work together more closely, by making sure they have the most up-to-date information about your health and your care.

For you, this means your doctors communicate better with each other, and you avoid having duplicate tests or answering the same questions over and over. Working together, your doctors can do more to follow your health, make sure you get the best possible care, and may hire additional staff to help meet your unique care needs, depending on what works best for you.

Doctors and other healthcare providers choose to participate in an ACO because they’re committed to your care experience. They may also be rewarded for offering you better, more coordinated care. If your physician is part of the Indiana University Health ACO, you will be notified, either in person or by letter.

An ACO isn’t the same as a Medicare Advantage Plan or Health Maintenance Organization (HMO). You’re still in Original Medicare, and your Medicare benefits, services, rights and protections won’t change. And you still have the right to use any doctor or hospital that accepts Medicare at any time, the same way you do now. Additionally, patients can receive acute care treatment at urgent care facilities aligned with Indiana University Health ACO, Inc. Search for an IU Health Urgent Care location close to you.

What is an ACO?

An Accountable Care Organization (ACO) is a group of doctors and other healthcare providers who agree to work together with Medicare to give you the best possible care. ACOs may take different approaches to giving you coordinated care.

Some ACOs may have special nurses that help you set up appointments or make sure your medications are in order when you enter or leave a hospital. Other ACOs may help your doctors get you equipment for monitoring your medical conditions better at home, if you need it. Most ACOs use advanced systems that let them more carefully track your care, and make sure your doctor has the most up-to-date information about your health.

The goal of the ACO is to support your doctor in caring for you. ACOs help your doctor and healthcare providers work together more closely, by making sure they have the most up-to-date information about your health and your care.

For you, this means your doctors communicate better with each other, and you avoid having duplicate tests or answering the same questions over and over. Working together, your doctors can do more to follow your health, make sure you get the best possible care, and may hire additional staff to help meet your unique care needs, depending on what works best for you.

Doctors and other healthcare providers choose to participate in an ACO because they’re committed to your care experience. They may also be rewarded for offering you better, more coordinated care. If your physician is part of the Indiana University Health ACO, you will be notified, either in person or by letter.

An ACO isn’t the same as a Medicare Advantage Plan or Health Maintenance Organization (HMO). You’re still in Original Medicare, and your Medicare benefits, services, rights and protections won’t change. And you still have the right to use any doctor or hospital that accepts Medicare at any time, the same way you do now. Additionally, patients can receive acute care treatment at urgent care facilities aligned with Indiana University Health ACO, Inc. Search for an IU Health Urgent Care location close to you.

Indiana University Health ACO is participating in the Professional Direct Contracting Model. The goal of the Model is to reduce program expenditures and improve quality of care and health outcomes for Medicare fee-for-services (FFS) beneficiaries through alignment of financial incentives and an emphasis on beneficiary choice and care delivery while maintaining access to care for beneficiaries.

Included in the Professional Direct Contracting Model are strong patient protections to ensure that patients have access to and receive high-quality care. This model will be evaluated on its ability to deliver better care for individuals, better health for populations, and lower growth in expenditures.

Professional Direct Contracting Model Details

Indiana University Health ACO is participating in the Professional Direct Contracting Model. The goal of the Model is to reduce program expenditures and improve quality of care and health outcomes for Medicare fee-for-services (FFS) beneficiaries through alignment of financial incentives and an emphasis on beneficiary choice and care delivery while maintaining access to care for beneficiaries.

Included in the Professional Direct Contracting Model are strong patient protections to ensure that patients have access to and receive high-quality care. This model will be evaluated on its ability to deliver better care for individuals, better health for populations, and lower growth in expenditures.

Indiana University Health ACO, Inc.

IU Health ACO: 317.963.5522 or iuhealthaco@iuhealth.org.

Centers for Medicare and Medicaid Services (CMS): 800.633.4227 (TTY 877.486.2048)

Indiana University Health ACO, Inc.,
340 West 10th Street, Indianapolis, IN 46202

Hours: Monday-Friday, 8am-5pm

Primary Contact: Emily Fortier, Project Manager of ACO & Medicare Risk Models
Contact Information:
iuhealthaco@iuhealth.org

Indiana University Health ACO, Inc.’s Governing Body

  • Ron Stiver, Voting Member & Chair, Indiana University Health Inc.
  • Jennifer Alvey, Voting Member, Indiana University Health Inc.
  • Stephanie Motter, MSN, MHA, RN, NP-C, Voting Member, Indiana University Health Inc.
  • Greg Kiray, M.D., Voting Member, Indiana University Health Inc.
  • David Burton, Voting Member, Indiana University Health Inc.
  • Arthur Vasquez, Voting Member, Indiana University Health Inc.
  • Nichole Wilson, DPT, MBA, FACHE, Voting Member, Indiana University Health Inc.
  • David Ingram, M.D., Voting Member, Indiana University Health Inc.
  • Judy Coleman, Voting Member, IU Health Physicians
  • Pete Voss, M.D., Voting Member, Indiana University Health Ball Memorial Physicians, Inc.
  • Judy Palmer, Voting Member, Consumer Advocate
  • Johnny Ayres, M.D., Voting Member, Beneficiary Representative, Indiana University Health Urgent Care Centers, LLC.

Key Clinical and Administrative Leadership (all employed by Indiana University Health, Inc.)

  • Stephanie Motter, MSN, MHA, RN, NP-C, Chief Executive Officer of IU Health ACO, Inc. and SVP of Value Based Care
  • Greg Kiray, MD, SVP of Value Based Care and Chief Medical Officer for System Health Solutions
  • Roxanne Binford, MSN, RN, CHC, CHPC, ACO Chief Compliance Officer
  • Mike Resener, JD, General Counsel
  • Rick Bernhardt, MD, Medical Director
  • Scott Black, VP and Chief Financial Officer for System Health Solutions
  • Adam Ternet, Executive Director, CMS and Third Party Risk Arrangements
    • ACO Professionals in a group practice arrangement
    • Network of individual practices of ACO professionals
    • Partnership or joint venture arrangements between hospitals and ACO professionals
      • No such partnerships or joint ventures exist at this time
    • Hospital employed ACO professionals

    Types of ACO participants, or combination of participants, that formed the ACO

    • ACO Professionals in a group practice arrangement
    • Network of individual practices of ACO professionals
    • Partnership or joint venture arrangements between hospitals and ACO professionals
      • No such partnerships or joint ventures exist at this time
    • Hospital employed ACO professionals

    Indiana University Health ACO, Inc.'s Participants

    First Quarter DCE data is not yet available.

    Public Reporting

    First Quarter DCE data is not yet available.

    Information Related to Indiana University Health ACO, Inc.’s (“IU Health ACO”) Qualification for ACO waivers, including but not limited to the ACO Pre-Participation and Participation Waivers, applicable to The CMS Global and Professional Direct Contracting Model ACO Waiver.

    IU Health ACO is eligible to utilize the 3-Day Skilled Nursing Facility Waiver, Telehealth Waiver, Cost Sharing Support for Part B Services Waiver, Chronic Disease Management Waiver, Home Health Homebound Waiver and Post Discharge Home Visit Waiver.

    The IU Health ACO Board of Directors approved execution of a Memorandum of Understanding Regarding Contribution of Support Services by and among IU Health ACO and Indiana University Health, Inc. (“IU Health”) and Indiana University Health Care Associates, Inc. d/b/a IU Health Physicians (“IU Health Physicians”). In order to assist IU Health ACO in its pursuit of the ACO Model’s three-part aim of (1) better care for individuals, (2) better health for populations, and (3) lower growth in Medicare Parts A and B expenditures, IU Health and IU Health Physicians have agreed to provide certain support services to IU Health ACO for startup and ongoing operations of IU Health ACO. The support services include:

    • Personnel resources
    • Information technology resources
    • Patient communication media, including patient notifications, printings and mailings, website development, call center training, Service Excellence training, and facilities signage

    IUHACO previously participated in the Next Generation ACO Model and is currently participating in the CMS Global and Professional Direct Contracting Model (“DC Model”) pursuant to a Participation Agreement with the Centers for Medicare & Medicaid Services (“CMS”) entered into effective January 1, 2022. The Secretary of the U.S. Department of Health and Human Services has provided waivers of certain fraud and abuse laws that otherwise limit innovation by Accountable Care Organizations (“ACO Waivers”). The ACO Waivers provide for a waiver of federal fraud and abuse laws for arrangements entered into by an ACO that are reasonably related to the purposes of the ACO (ACO Participation Waivers”).

    In order to receive the benefit and protection of the ACO Participation Waiver, the Board of Directors of IUHACO, after discussion and deliberation, made a bona fide determination that the following Arrangement (“Arrangement”) is reasonably related to the purpose of the IUHACO, and is publicly disclosing the Arrangement in accordance with the requirements of the ACO Participation Waiver.

    IUHACO has worked with IU Health Physicians to develop IU Health Connected Care Clinics at IU Health Saxony Hospital and in Indianapolis. The Connected Care Clinic is an alternative care model that allows healthcare and other providers to focus on IUHACO beneficiaries and other value based care members. The Connected Care Clinic is a move away from a volume-based care model to a care model based on providing additional care management resources to support the reduction of the cost of health care through better coordination of care, more robust chronic disease management and improved quality of care. The Board of Directors of IUHACO has made a bona fide determination that the Connected Care Clinics are reasonably related to and meets the purposes of the ACO by providing resources to provide better care for individuals, better health outcomes, reducing the cost of healthcare and improving the work life balance of healthcare providers and staff.

    Future arrangements, future waiver utilization, and modifications to current arrangements, will be disclosed in accordance with CMS requirements.”

    Waiver Disclosures

    Information Related to Indiana University Health ACO, Inc.’s (“IU Health ACO”) Qualification for ACO waivers, including but not limited to the ACO Pre-Participation and Participation Waivers, applicable to The CMS Global and Professional Direct Contracting Model ACO Waiver.

    IU Health ACO is eligible to utilize the 3-Day Skilled Nursing Facility Waiver, Telehealth Waiver, Cost Sharing Support for Part B Services Waiver, Chronic Disease Management Waiver, Home Health Homebound Waiver and Post Discharge Home Visit Waiver.

    The IU Health ACO Board of Directors approved execution of a Memorandum of Understanding Regarding Contribution of Support Services by and among IU Health ACO and Indiana University Health, Inc. (“IU Health”) and Indiana University Health Care Associates, Inc. d/b/a IU Health Physicians (“IU Health Physicians”). In order to assist IU Health ACO in its pursuit of the ACO Model’s three-part aim of (1) better care for individuals, (2) better health for populations, and (3) lower growth in Medicare Parts A and B expenditures, IU Health and IU Health Physicians have agreed to provide certain support services to IU Health ACO for startup and ongoing operations of IU Health ACO. The support services include:

    • Personnel resources
    • Information technology resources
    • Patient communication media, including patient notifications, printings and mailings, website development, call center training, Service Excellence training, and facilities signage

    IUHACO previously participated in the Next Generation ACO Model and is currently participating in the CMS Global and Professional Direct Contracting Model (“DC Model”) pursuant to a Participation Agreement with the Centers for Medicare & Medicaid Services (“CMS”) entered into effective January 1, 2022. The Secretary of the U.S. Department of Health and Human Services has provided waivers of certain fraud and abuse laws that otherwise limit innovation by Accountable Care Organizations (“ACO Waivers”). The ACO Waivers provide for a waiver of federal fraud and abuse laws for arrangements entered into by an ACO that are reasonably related to the purposes of the ACO (ACO Participation Waivers”).

    In order to receive the benefit and protection of the ACO Participation Waiver, the Board of Directors of IUHACO, after discussion and deliberation, made a bona fide determination that the following Arrangement (“Arrangement”) is reasonably related to the purpose of the IUHACO, and is publicly disclosing the Arrangement in accordance with the requirements of the ACO Participation Waiver.

    IUHACO has worked with IU Health Physicians to develop IU Health Connected Care Clinics at IU Health Saxony Hospital and in Indianapolis. The Connected Care Clinic is an alternative care model that allows healthcare and other providers to focus on IUHACO beneficiaries and other value based care members. The Connected Care Clinic is a move away from a volume-based care model to a care model based on providing additional care management resources to support the reduction of the cost of health care through better coordination of care, more robust chronic disease management and improved quality of care. The Board of Directors of IUHACO has made a bona fide determination that the Connected Care Clinics are reasonably related to and meets the purposes of the ACO by providing resources to provide better care for individuals, better health outcomes, reducing the cost of healthcare and improving the work life balance of healthcare providers and staff.

    Future arrangements, future waiver utilization, and modifications to current arrangements, will be disclosed in accordance with CMS requirements.”