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Commonwealth paper reviews accountable care organization strategies

Posted on August 21, 2012 | No Comments

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Key Developments

Accountable care organizations (ACOs) are groups of providers that agree to take collective responsibility for delivering and coordinating care for a designated population. A report recently released by the Commonwealth Fund shares the perspectives of hospitals and health systems taking part in the Premier health care alliance’s accountable care implementation collaborative. Lessons emerging from the collaborative relate to the need for ACOs to have six core structural components: 1) the viability of different organizational models; 2) the importance of people-centered care in all interactions; 3) the need to align business with value-based payments and design incentives to encourage providers to collaborate; 4) the use of financial modeling to assess the impacts of the accountable care model; 5) the need for investments in information technology to enable care coordination; and 6) the importance of performance assessment across a broad range of clinical quality, efficiency, and satisfaction measures.

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The Center for American Progress released a report proposing an approach known as the “Accountable Care States” in order to control health care costs. The model will keep costs down by giving states flexibility and incentives to control costs. A state that designates itself an Accountable Care State will be accountable for health care costs, quality of care, and access to care with sizable financial rewards for keeping overall costs low. Using Congressional Budget Office (CBO) data, the report estimates that if half of the states participate, the Accountable Care States model would yield $1.7 trillion in savings on total health care spending over 10 years.
On April 9th, the Senate Finance Committee held a confirmation hearing for Marilyn Tavenner to be the Administrator of the Centers for Medicare and Medicaid Services (CMS). Committee members submitted additional questions to Tavenner post-hearing on topics ranging from consumer outreach in state insurance Exchanges to pediatric dental services. Health Reform GPS has compiled a list of the Affordable Care Act related questions submitted by the Senate Finance Committee members. The list contains the name of the Senator asking the question, the question number, and the relevant ACA topic addressed.
In a field report published yesterday, the Commonwealth Fund discusses the progress made by accountable care organizations (ACOs) in improving health care quality and efficiency. ACOs, established by the Affordable Care Act (ACA) as a Medicare delivery system option, are designed to systematically improve health care delivery and mitigate cost increases by forming contractual relationships between physicians and payers. This report details the successes and challenges experienced by seven hospital-physician groups that are considered early-adapters of the ACO model. These entities are involved, or will soon be involved, in risk-sharing arrangements with public and private payers. Representatives from the featured ACOs discuss their strategies for integrating clinicians, managing practices, designing incentives, and sharing rewards. The goal of this report is to educate providers in methods that promote partnership and success in ACOs.
Health care delivery systems that reward providers for coordinating and improving care hold promise for slowing the rise of health care costs for the most vulnerable patients, according to a new study by Dartmouth researchers published in the Journal of the American Medical Association (JAMA). To learn how such models, such as accountable care organizations (ACOs), are likely to perform for patients with severe health conditions, researchers from the Dartmouth Atlas Project and The Dartmouth Institute for Health Policy & Clinical Practice studied the Medicare’s Physician Group Practice Demonstration (PGPD). The study focused on the care provided to patients covered by both Medicare and Medicaid, also known as “dual eligible” patients. The nation’s 9 million dual eligibles comprise 20 percent of the Medicare population but account for 31 percent of its spending, and comprise 15 percent of the Medicaid population but 39 percent of its spending. The study highlights the potential benefits of the ACO model for dual eligible patients. Dartmouth’s analysis of Medicare spending for PGPD patients found that the participating health systems achieved their savings largely by reducing hospital stays. An accompanying analysis of quality indicators also showed that quality of care did not decline.
Affordable Care Act (ACA) provisions have spurred efforts to develop integrated health care delivery systems that seek to coordinate the continuum of health services. It remains to be seen how safety-net providers, which include community health centers and public hospitals, will be included in integrated delivery systems. An issue brief released by the National Academy of State Health Policy (NASHP) and the Commonwealth Fund explores key considerations for incorporating safety-net providers into integrated delivery systems and discusses the roles of state and federal agencies in supporting and testing models of integrated care delivery. The authors conclude that the most important principles in creating integrated delivery systems for vulnerable populations are: 1) an emphasis on primary care; 2) coordination of all care, including behavioral, social, and public health services; and 3) accountability for population health outcomes.
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The Centers for Medicare & Medicaid Services (CMS) announced that 15 new accountable care organizations (ACOs) were selected to participate under the Center for Medicare and Medicaid Innovation's (CMMI's) Advance Payment ACO Model. This brings the total number of advance payment ACOs to 20. The initiative is designed for smaller physician practices and rural practitioners who would benefit from additional start-up resources while participating in the Medicare Shared Savings Program (MSSP). Each participating ACO will receive advance payments to help establish care coordination for beneficiaries.
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