Report compares Pioneer ACO with Medicare Shared Savings Program
Milliman recently published a briefing on the difference between Medicare Shared Savings Program ACOs and the more flexible Pioneer ACOs. It outlines their key features in six major areas: payment arrangements, beneficiary alignment, interim payment methodology, benchmark methodology, trending methodology and calculation of shared savings/losses. It also includes a summary of risk, incentives and associated performance benchmarks. (Milliman briefing; ACO Watch)
ACO location could affect penalties, bonuses
"Because of geographic variation in spending growth, Medicare's use of national growth factors to set targets could cause ACOs in any HRR [hospital referral region] to gain or lose financially without altering their delivery of care," reports a Perspective piece in the New England Journal of Medicine. According to the authors, Pioneer ACOs in low population growth, low-spending regions are positioned to gain the most, while ACOs in high population growth, high-spending areas have more to lose because of Medicare's policy. Using local growth factors initially "may better align savings for ACOs with savings for Medicare and reduce the financial uncertainty involved in participation," but they conclude it might "be reasonable to consider some blend of local and national growth rates as ACO programs expand." (Becker's Hospital Review; New England Journal of Medicine)
Critic questions value of health IT incentives
In a San Francisco Chronicle commentary, Sally Pipe of the Pacific Research Institute says research suggests the federal government's investments in health IT might not be the boon their proponents claim. "Of course, hospitals and doctors' offices should be free to adopt useful and cost-effective technological innovations. But government mandates that they do so distort incentives--and could end up doing more harm than good. By trying to speed the adoption of HIT, the government might slow it down--and cost taxpayers a lot of money in the process." (San Francisco Chronicle)
ACOs could help solve Medicare shortfall
According to HIMSS' Thomas Keefe, MA, FHIMSS, rapid implementation of more ACOs is one way to address the anticipated shortfall in the Medicare health care fund. ACOs will fundamentally alter the clinical, operational and business models driving much of today's health care industry, he writes in a blog post. "By the time I am collecting Medicare, I am hopeful ACOs will be the law of the land, and the financial savings will result in extending the Medicare health care fund beyond 2024," he concludes. (HIMSS blog)
Infographic: Health plan ACO readiness
Fred Pennic, founder of HIT Consultant, turned the data from a recent panel discussion and survey on health care reform into an infographic. Among the data presented: Nearly 40 percent of health plans are implementing ACOs; more than half are in planning stages. The survey and the discussion were conducted by Infosys Public Service. (HIT Consultant)
Health IT experts disagree on health IT and ACOs
Health IT experts disagree on the role of technology in accountable care, FierceHealthIT reports. Health IT executive and former Accenture consultant Dave Chase contends in iHealthBeat that EHR vendors are still creating systems for the threatened fee-for-service, acute-care world; as a result, he said, providers vying for Meaningful Use incentives are investing in soon-to-be-obsolete systems. But in an interview with Executive Insight, Linda Reed, VP and CIO of Atlantic Health System, predicts health IT will play a critical role in ACOs--and health IT departments will perform the same functions and use many of the same tools they use today. (FierceHealthIT; commentary published in iHealthBeat; interview with Executive Insight)
Providers, insurers must collaborate and be transparent
For ACOs to reduce costs and increase collaboration, insurers and providers alike must develop more transparent policies and procedures for analyzing data, Cynthia Burghard of IDC Health Insight, writes in a recent blog post. Transparency and consensus, particularly on reimbursement and performance measurement, will be critical. She suggests ACO participants can avoid debates on data accuracy by agreeing up front to use the same methodologies and terminologies; that also helps establish trust. (IDC blog post; FierceHealthPayer)
AMA: Physicians will lead ACOs forward
Giving doctors more opportunities to participate in programs targeting costs and quality allows them to demonstrate innovation can flow from practices of all sizes, according to an American Medical News editorial. "That 21 of the 27 accountable care organizations chosen to participate in the Medicare shared-savings program are physician-led is a positive sign for doctors--and for the health system overall." The ACO program is an opportunity to demonstrate physicians in any practice of any size can have a voice and a role in finding ways to reform the health payment system. (American Medical News)
AHA releases ACO guides
Two new guides from the AHA's Hospitals in Pursuit of Excellence initiative help hospitals and health systems improve quality and efficiency of care delivery. "Managing Population Health: The Role of the Hospital" defines population health and describes essential strategies, including potential partnerships with other stakeholders, to improve the health of a hospital's patient population. "Hospital Readiness for Population-based Accountable Care" presents results from a 2011 national survey of all hospitals to assess their current state of readiness for the development of accountable care organizations, and provides a tool for hospitals to gauge their own preparedness for ACO participation. (AHA News)
HealthLeaders offers C-suite advice on ACO The Affordable Care Act is driving interest in ACOs, but another big factor, reports HealthLeaders Magazine, is industry-wide acceptance that the current system is simply unsustainable. The article looks at how some of these organizations are moving forward with the ACO model, and offers some questions payer and provider C-suite executives need to ponder as they consider ACOs. (HealthLeaders Magazine)
Experts discuss medical liability and ACOs
Best's Insurance News recently covered the issue of medical professional liability vis-à-vis ACOs. Paul Greve of Willis Health Care Practice says his company is seeing considerable variation in the degrees of preparedness--and physician insurers must respond appropriately. ACOs may be a new market for physician insurers, but the risk insured will be a familiar one, according to Milliman's Chad Karls: Know the medical professional liability risks an ACO will have, he counsels. "That is the elephant in the room when it comes to ACO insurance coverage needs. That medical professional liability is the single largest risk." (Healthcare Town Hall; Best's Insurance News)
Oncology ACO launched in Florida
Florida's major health insurer has joined forces with two South Florida health care providers to create a specialty accountable care organization that will focus on oncology services. Florida Blue, Baptist Health South Florida and Advanced Medical Specialties are partners in the collaboration. HealthLeaders Media notes that dedicating an ACO to a specific specialty such as oncology is relatively new; the Florida ACO is believed to be among the first in the country. (HealthLeaders Media)
MGMA chief discusses ACOs, reform and Medicare reimbursement
Jessica Zigmond, Modern Healthcare's Washington bureau chief, talks with Dr. Susan Turney, president and CEO of the MGMA-ACMPE, to discuss the role physicians are playing in accountable care organizations, the future legal status of the ACA and possible reform of Medicare's physician reimbursement. (Modern Healthcare, via YouTube)
