ACOs: What are transitions home visiting programs like?

With permission, [the home visitor will] look in the refrigerator, they’ll look to see that the patient has food or that the area that they’re living in is safe to get around in.  Are we dealing with a home that is infested?”

Use of transitions home visits by accountable care organizations (ACOs) for patients with complex needs was studied based on recent data from the National Survey of Healthcare Organizations and Systems.  The motivation for these visits was found to be:

• Conducting needs assessment (the condition of the home and patient’s support system)
• Checking on patients who have stopped making office visits
• Building relationships

ACOs found to be more likely to have this type of program were those which are part of an integrated delivery system, to have a hospital member and to participate in risk-bearing contracts.

Source: ‘Eyes in the home’: ACOs use home visits to improve care management, identify needs, and reduce hospital use. Health Affairs, 38(6), 1021-1027. Click here for abstract:  https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.00003  Also described in a news release here:  https://tdi.dartmouth.edu/news-events/dartmouth-institute-study-reveals-how-acos-use-home-visits-improve-care-and-reduce-hospital-use  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

 

 

 

ACCOUNTABLE CARE ORGANIZATIONS: It is cost effective to have specialists see patients, up to a point

Some specialist involvement in care processes for patients appears to be necessary for accountable care organizations to lower their costs.”

Health care spending in accountable care organizations (ACOs) was studied based on the percent of patient visits which were provided by specialists.  Data from 620 ACOs for the period April 2012 through September 2017 were analyzed.  It was found that ACOs in which specialists provided 40 to 45 percent of office visits had the lowest expenditures.  ACOs at either extreme – the fewest or the most specialist encounters – had the highest expenditure rates.

Source: Shetty, V.A., Balzer, L.B., Geissler, K.H., and Chin, D.L. (2019, July 10). Association between specialist office visits and health expenditures in accountable care organizations. JAMA Network Open, 2(7).  Click here for free full text:  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2737841  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

30 Largest Accountable Care Organizations

SK&A has released an updated ranking of the largest accountable care organizations based on the number of participating physicians. The marketing contacts firm has identified 703 ACOs involving 479,000 healthcare providers and business personnel aligned with ACOs. Topping its published list of the 30 largest ACOs are:

1. HealthCare First South Los Angeles, a Medicaid ACO with 7,237 participating physicians and 2,668 health facilities
2. Heritage Provider Network & Anthem Blue Cross of California, a commercial ACO with 7,207 physicians and 4,177 facilities
3. Heritage California ACO, a Medicare Shared Savings Program with 6,876 physicians and 3,905 facilities
4. Tenet Healthcare & Humana, a commercial ACO with 6,644 physicians and 1,963 facilities
5. Hill Physicians/Dignity Health/University of California, San Francisco & Health Net, a commerical ACO with 5,883 physicians and 2,118 facilities

Source: Top 30 accountable care organizations. SK&A, Feb. 2017. http://www.skainfo.com/reports/top-accountable-care-organizations [free registration required to view/download]

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

OBAMACARE: President Barack Obama and others report on health reform progress and future

If you are working up a presentation on the current and near term future of the health care system in the United States, take a look at this great source material.

President Barack Obama, writing a special communication in the first person, summarizes the effect of the first years of his landmark health reform legislation, the Affordable Care Act, popularly known as Obamacare.  Issued online July 11, the communication will also be published more formally in JAMA, the Journal of the American Medical Association, an influential journal intended for medical professionals but widely read in policy and academic circles as well.

The president opens by describing what it was like when he took office – the challenges of working through the Great Recession.  He discusses progress, noting that there has been a decline in the rate of insured Americans – from 16 percent in 2010 to 9.1 percent in 2015 – a 43 percent decrease.  He reviews how the health care delivery system has been changed, with movement toward alternative payment models.  Mr. Obama closes not only by expressing his sense of pride in the accomplishments to date but also by indicating how to build on progress and take the next steps.

WAIT, WAIT, there’s more!  This July 11 “online first” communication also includes related editorials by other eminent individuals.  Look below for more specifics on these sources.

Sources:

Obama, B. (2016, July 11). United States health care reform: Progress to date and next steps. JAMA. Click here: http://jama.jamanetwork.com/article.aspx?articleid=2533698

Bauchner, H. [editor in chief, JAMA] (2016, July 11). The Affordable Care Act and the future of US health care. JAMA. Click here: http://jama.jamanetwork.com/article.aspx?articleid=2533694

Orszag, P.R. [Lazard] (2016, July 11). US health care reform: Cost containment and improvement in quality. JAMA.  Click here: http://jama.jamanetwork.com/article.aspx?articleid=2533695

Butler, S.M. [Brookings] (2016, July 11). The future of the Affordable Care Act: Reassessment and revision. JAMA.  Click here: http://jama.jamanetwork.com/article.aspx?articleid=2533696

Skinner, J. [Dartmouth], and Chandra, A. [Harvard] (2016, July 11). The past and future of the Affordable Care Act. JAMA.  Click here: http://jama.jamanetwork.com/article.aspx?articleid=2533697

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

 

Accountable Care Organizations in 2016: Private and Public-Sector Growth and Dispersion

There were 838 active accountable care organizations as of January 2016, and they have service areas in every state. That’s all according to a new analysis by Levitt Partners  and the Accountable Care Learning Collaborative. The count of ACOs has grown from 64 in early 2011, and has increased 12.6% just over the past year. The number of accountable care contracts is now at 1,217, and an estimated 28.3 million people are covered by an accountable care arrangement.

The report also charts:

• ACOs over time
• ACOs by state
• ACOs by hospital referral region
• ACO lives over time
• ACO lives per payer type
• ACO penetration by state
• ACO penetration by hospital referral region

ACO contract renewals and dropouts, policy drivers, ACO challenges, and the future of accountable care are all discussed briefly.

Source: Muhlestein D; McClellan M. Accountable care organizations in 2016: private and public-sector growth and dispersion. Health Affairs Blog, April 21, 2016. http://healthaffairs.org/blog/2016/04/21/accountable-care-organizations-in-2016-private-and-public-sector-growth-and-dispersion/

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

ACCOUNTABLE CARE: Top 10 ACOs according to savings

This article is an analysis by the consulting firm Veralon of 333 accountable care organizations participating in the Medicare Shared Savings Program (MSSP).  Here are some overall findings:

• 28 percent of ACOs have posted positive bottom-line financial success to date
• There are a total of 434 ACOs participating in the currently, although data were only available for 333 for this article
• 201 of the ACOs studied were physician sponsored (60 percent)
• 132 of the ACOs studied were hospital sponsored (40 percent)

Top 10 ACOs According to Total Shared Savings in 2014 (I rounded the dollar figures)

1. Memorial Hermann ACO (Houston) $22.7 million
2. Palm Beach Accountable Care Organization (Palm Springs, FL) $14.5 million
3. Physician Organization of Michigan ACO (Ann Arbor, MI) $12.1 million
4. Oakwood Accountable Care Organization (Dearborn, MI) $8.2 million
5. ProHEALTH Accountable Care Medical Group (Lake Success, NY) $8 million
6. Millennium Accountable Care Organization (Fort Myers, FL) $8 million
7. RGV ACO Health Providers (Donna, TX) $7.5 million
8. Qualuable Medical Professionals (Kingsport, TN) $7.4 million
9. Delaware Valley ACO (Villanova, PA) $6.6 million
10. Mercy Health Select (Cincinnati) $6.5 million

Source: Harris, J.M., Elizondo, I, and Brown, A.M. (2016, Mar.). Healthcare Financial Management 70(3), 43-50.  Click here: http://www.veralon.com/wp-content/uploads/2016/03/Orchestrating-ACO-Services-HFM-3-2016.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

AMA Physician Benchmark Reports on Compensation Methods and on Prevalence of New Models of Care

Two 2014 Physician Practice Benchmark Survey reports have been released by the American Medical Association within the past few months. The first looks at compensation models used to pay physicians, and the second provides data on the prevalence of physician participation in accountable care organizations and medical homes and the use of alternative payment methods [capitation, pay-for-performance, bundled payments, or shared savings].

Here are some of the key findings from the reports:

• For many physicians, compensation was a blend of different methods. Half of compensation for non-solo physicians came from salary, another third was productivity-based, 12% was based on practice financial performance, and 4% came from bonuses. The proportions varied when analyzed by type of practice and its ownership.
• Fee-for-service is still the dominant payment method for physicians, although 59% of physicians said their practice received some revenue from an alternative payment method. An average 72% of practice revenue came from fee-for-service. Unsurprisingly, practices participating in a medical home or ACO received a larger proportion of their revenue from alternative payment methods.
• In 2014, 24% of physicians worked in practices that were part of a medical home, and 29% reported working in a practice that was part of an ACO. Participation rates were higher in multi-specialty practices and lower in solo practices. Hospital-owned practices also had higher medical home and ACO participation rates.
• In single specialty practices, participation in a medical home was lowest for surgery and its subspecialties and highest for family practice and pediatrics. However, ACO participation was highest for general surgery and family practice but low for pediatrics

Sources:

Kane CK. Payment and delivery in 2014: the prevalence of new models reported by physicians. American Medical Association Policy Research Perspectives, Dec. 2015. http://www.ama-assn.org/ama/pub/advocacy/health-policy/policy-research.page – expand Medical Practice section to select report [free web site registration and login required to view/download]

Kane CK. How are physicians paid? A detailed look at the methods used to compensate physicians in different practice types and specialties. American Medical Association Policy Research Perspectives, Aug. 2015. http://www.ama-assn.org/ama/pub/advocacy/health-policy/policy-research.page – expand Medical Practice section to select report [free web site registration and login required to view/download]

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Payment and Delivery System Reform in Medicare: a Primer on Medical Homes, Accountable Care Organizations, and Bundled Payments

In response to the Affordable Care Act, Medicare has been testing new payment models to improve patient care and control costs. A recent Kaiser Health Foundation report is a primer on three of these models — medical homes, accountable care organizations, and bundled payments:

• Medical homes are team-based care models focused on primary care practices for delivery and coordination of patient care. The payment model typically provides a monthly management fee or other payment in addition to fee-for-service reimbursement.
• ACOs are groups of physicians, hospitals, and other providers that collectively share accountability for the quality and cost of care delivered to patients in an ACO. Financial incentives involve shared savings or losses for ACO performance based on meeting quality and cost benchmarks.
• Bundled payments focus on setting an episode of care budget for a particular clinical condition over a defined time period rather than paying separately for each delivered service. By better managing and coordinating care, providers can come in ‘under budget’.

Each payment model is discussed, including its goals, financial incentives, number of participants, potential implications for beneficiaries, and early results on quality and savings. Preliminary results from these models have been mixed and are summarized in the report.

Source: Basement S. and others. Payment and delivery system reform in Medicare: a primer on medical homes, accountable care organizations, and bundled payments. Kaiser Family Foundation, Feb. 2016. https://kaiserfamilyfoundation.files.wordpress.com/2016/02/8837-payment-and-delivery-system-reform-in-medicare1.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Projected Growth of Accountable Care Organizations

According to a new Leavitt Partners report, the number of accountable care organizations had grown to 782 by December 2015, covering 23 million lives.

What does future growth of ACOs look like? To find out, Leavitt staff made projections based on 4 different scenarios. In a baseline scenario that seemed most likely under current conditions, ACO coverage would reach 105 million people by 2020, but under ideal conditions, that number could reach 176 million lives [over half the population] in the next five years.

There’s been strong government support, including incentives and penalties, for accountable care organizations, but the future growth of ACOs remains unclear. That’s because the concept is still fairly new, and early results from ACOs so far have been mixed.

Despite the wide variation in growth projections for the four scenarios presented, the number of ACO covered lives grows in the five years ahead under each scenario.

Source: Muhlestein D and others. Projected growth of accountable care organizations. Leavitt Partners, Dec. 2015. http://leavittpartners.com/2015/12/projected-growth-of-accountable-care-organizations/ [free registration required to view]

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

HFMA Survey: Value-Based Payment Readiness

Earlier this year the Healthcare Financial Management Association surveying a sampling of senior financial executives in hospitals and health systems to learn more about healthcare’s readiness for value-based care. The survey probed for the current state of readiness, projected needs, anticipated gaps and penetration, the financial impact to date of their efforts, and perceptions on enabling risk-based contracting.

Here are some of the key findings:

• Over half of respondents said their system had achieved a positive return on investment from a value-based program.
• Yet nearly 40% don’t feel their organization has the needed capabilities to succeed within 3 years in risk-based value arrangements when if comes to interoperability, business intelligence, real-time data access, and effective chronic care management.
• Such gaps are of concern when respondents expect 30-70% of their payments will include value-based mechanisms with 3 years.
• Competencies involving data analytics ranked highest among respondents in the likelihood of enabling value-based payment success.

Sources:

HFMA’s executive survey: value-based payment readiness. Healthcare Financial Management Association; Humana, May 2015. http://www.hfma.org/WorkArea/DownloadAsset.aspx?id=30969

Value-based payment readiness; HFMA research highlight. Healthcare Financial Management Association, June 3, 2015. http://www.hfma.org/value-basedpaymentreadiness/

Posted by AHA Resource Center (312) 422-2050 rc@aha.org