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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

Physician Practice Acquisition and Employment Trends

A new report by the Physicians Advocacy Institute (PAI) in collaboration with Avalere Health analyzes recent trends in physician employment and the acquisition of physician practices by hospitals and health systems. Physicians may become employees through a group practice acquisition, or individual physicians may enter into employment arrangements directly with hospitals/systems. Here are some highlights from the analysis:

  • Between July 2012 and July 2015, the percentage of hospital-employed physicians increased nearly 50%
  • By 2015, 38% of physicians were employed by hospitals
  • Hospital or system ownership of physician practices grew by 86% from 2012 to 2015
  • By July 2015, there were 67,000 hospital-owned physician practices
  • One in four physician practices was hospital-owned by 2015

Regionally, nearly half of all physicians in the Midwest were employed by hospitals in 2015. Physician employment rates were lowest in the South and in Alaska and Hawaii where a third of physicians were hospital-employed. The pros and cons of these employment trends are briefly listed.

PAI and Avalere are planning additional analysis of this trend and its implications for early 2017.

 

Source: Avalere Health. Physician practice acquisition study: national and regional employment changes. Physicians Advocacy Institute, Sept. 2016. http://www.physiciansadvocacyinstitute.org/Portals/0/PAI-Physician-Employment-Study.pdf

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

Core Competencies for Behavioral Health Providers Working in Primary Care

Eight core competencies for licensed behavioral health providers working in primary care have been defined by a Colorado consensus group. Each of the following competencies are further expanded, and examples are provided:

  1. Identify and assess behavioral health needs as part of a primary care team
  2. Engage and activate patients in their care
  3. Work as a primary care team member to create and implement care plans that address behavioral health issues
  4. Help observe and improve care team function and relationships
  5. Communicate effectively with other providers, staff, and patients
  6. Provide efficient and effective care delivery that meets the needs of the population of the primary care setting
  7. Provide culturally responsive, whole-person and family-oriented care
  8. Understand, value, and adapt to the diverse professional cultures of an integrated care team

Source: Miller BF and others. Core competencies for behavioral health providers working in primary care. Prepared for Colorado Consensus Conference, Feb. 2016. Organized by Eugene S. Farley Jr. Health Policy Center, University of Colorado School of Medicine. http://www.umassmed.edu/globalassets/center-for-integrated-primary-care/non-images-links-etc/resources/core-competencies-for-behavioral-health-providers-working-in-primary-care.pdf

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

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

Characteristics of Hospitals Affiliated with Centralized Systems

More than half of the nation’s community hospitals are part of a multi-hospital health system. Some systems provide integrated care through centralized management, while other systems are more decentralized with hospitals unified primarily through a shared owner.

Do centralized services and increased communication affect cost and quality of care? Some literature suggests that’s the case. As a first step toward potentially gathering more data on the topic, Healthcare Cost and Utilization Project [HCUP] researchers explored the characteristics of hospitals in centralized health systems [those with centralized physician arrangements and insurance product development] compared to independent hospitals that were not part of a system. Hospitals affiliated with decentralized systems were excluded from the study.

Here are some of the findings:

  • Centralized system hospitals were more likely to be larger, urban, not-for-profit, and teaching facilities when compared to independent hospitals.
  • The South had the highest proportion of system affiliated hospitals (62%), but only 8% of its hospitals were in a centralized system.
  • The Northeast had the greatest ratio of independent hospitals (54%) but also the largest percentage of hospitals in a centralized system (11%).
  • Only small differences in payer mix were found between the two groups, although Medicaid as an expected source of payment for inpatient stays was about 5% higher in independent hospitals.
  • Patient severity of illness and mortality risk were greater for stays at centralized system hospitals.
  • Mean costs per inpatient stay were comparable for centralized system and for independent hospitals.

The researchers caution that these centralized system and independent hospitals  may differ in other ways, so inferences cannot be made from these metrics.

Source: Moore B and others. Characteristics and quality of inpatient stays at hospitals affiliated with health systems, 2009-2012. HCUP Statistical Brief [Agency for Healthcare Research and Quality], no. 197, Dec. 2015. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb197-Characteristics-Quality-Hospitals-Health-Systems.pdf

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

Role of Post-Acute Care in New Care Delivery Models

With new models for the delivery of health care, post-acute care provides — long-term care hospitals, skilled nursing  and rehabilitation facilities, and home health agencies — have an important role to play. They can help reduce hospital readmissions, improve care coordination and care setting transitions, and participate in the development of bundled payment approaches.

A new Trendwatch report from the American Hospital Association looks at the factors driving changes in post-acute care and highlights innovative examples of how leading post-acute care providers and health systems are adjusting and creating new business models to improve patient care.

A separate addendum report provides more background on Medicare spending by sectors within post-acute care and their patient characteristics. Medicare’s current fee-for-service system by post-acute care venue is also summarized.

Source: Role of post-acute care in new care delivery models. Trendwatch, American Hospital Association, Dec. 2015. http://www.aha.org/research/reports/tw/15dec-tw-postacute.pdf  Addendum: Background On Post-Acute Care. http://www.aha.org/research/reports/tw/15dec-tw-postacute-adden.pdf

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