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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

Best performing ACO weakened by flawed model

Bellin Theda-Care Health Partners is an accountable care organization (ACO) in Wisconsin that has participated in the Medicare Pioneer ACO pilot project.  Despite doing well in the pilot project, Bellin Theda-Care has found that there are shortcomings in the Medicare ACO model that lead to decreased reimbursement.  Why?  The ACO has implemented various improvements, such as measures to decrease readmissions, that have decreased utilization for patients.  The ACO shares in savings associated with the Medicare patients, but not for the non-Medicare patients who also benefit from the improvements.  For these patients, there is a decrease in revenue, with no opportunity for the providers to share in the savings.  The authors argue for the establishment of multipayer ACOs to address this inequity.

Source: Toussaint, J., Milstein, A., and Shortell, S.  How the Pioneer ACO model needs to change: lessons from its best-performing ACO.  JAMA;310(13):1341-1342, Oct. 2, 2013.  Click here for publisher website: http://jama.jamanetwork.com/article.aspx?articleid=1745687  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Value-Based Contracting for Hospitals

A new guide on value-based contracting is available to assist hospitals and health systems with the evolution of the nation’s health delivery system from a fee-for-service to a value-based payment model. The guide discusses the following:

  • Foundational requirements, including the need for shared goals and incentives, strong leadership and governance, and unified persistence
  • Assessment and preparation, covering desired position, service area, system infrastructure, resources, contract scope, types of arrangements and risks, capacity to carry risk, and the time frame for the transition
  • Financial and operational requirements, such as capital needs, unit costing/tracking, financial and actuarial assessment/planning, contracting capabilties, and data infrastructure
  • Evaluating a contract from the perspectives of responsibilities and risk, financial impact, and credit risk
  • Implementation success factors, encompassing physician engagement, transparency and accountability, and performance measurement and improvement

Other helfpul resources are also listed in the guide.

Source: Pizzo JJ and others of Kaufman, Hall and Associates. Value-based contracting. Signature leadership series. Health Research and Educational Trust/American Hospital Association, July 2013. http://www.hpoe.org/Reports-HPOE/Value-Based_Contracting_KaufHall_2013.pdf

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

Continued Growth of Public and Private Accountable Care Organizations

See also updated post at https://aharesourcecenter.wordpress.com/2013/08/21/updated-count-on-number-of-accountable-care-organizations/

There were 428 total accountable care organizations in the US as of January 10, 2013, according to Leavitt Partners’ Center for Accountable Care Intelligence. Every state but Delaware had at least one ACO. This count includes both Medicare and private ACOs.

The Center also reports that physician group-led ACOs increased the most over the past year and are now more numerous, though generally smaller, than hospital-run ACOs. Insurers or community-based groups sponsor some ACOs as well, but there are fewer of them.

While Medicare ACOs have similar structures, the private ACOs have a wider range of payment models – full or partial capitation, bundled payments, retainer agreements, in-kind services and subsidies, and pay-for-performance incentives.

Source: Muhlestein D. Continued growth of public and private accountable care organizations. Health Affairs blog, Feb. 19, 2013. http://healthaffairs.org/blog/2013/02/19/continued-growth-of-public-and-private-accountable-care-organizations/

Earlier post on ACO data from Leavitt Partners: https://aharesourcecenter.wordpress.com/2012/06/15/2012-update-on-growth-and-dispersion-of-acos/

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

How many ACOs are there? 250 and counting

Here’s one just-published answer to the popular question: “How many accountable care organizations (ACOs) are there?”  These authors, with Weill Cornell Medical College in New York, state that there are currently more than 250 ACOs and that the number increased rapidly in 2012.  They anticipate that the number will continue to grow lickety-split not only due to federal government initiatives but because commercial insurers are signing ACO-like contracts with various entities.  The authors go on to discuss the meaning of population health (buzzword alert!) and what ACOs can realistically be expected to take on in that regard.

What do I like about this article?  It’s topical.  There’s a useful quotable number in it.  Even though it is not completely free full text online, the publisher will let you see the first page for free.

Source: Noble, D.J., and Casalino, L.P.  Can accountable care organizations improve population health? Should they try?  JAMA;309(11):1119-1120, Mar. 20, 2013.  Click here for the publisher’s website: http://jama.jamanetwork.com/article.aspx?articleid=1669825  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Which Providers and Employers Have Commercial Bundled Payments?

According to Becker’s Hospital Review, the Advisory Board is tracking which hospitals and systems have commercial bundled payment agreements with employers or insurers. The listing currently includes 28 providers with 32 agreements.

The Advisory Board’s commercial bundled payment tracker maps both the provider and payer locations and allows viewing by service line. Brief details on each agreement are provided.

Sources:

Herman B. Which providers and employer have commercial bundled payments? Becker’s Hospital Review, Mar. 8, 2013. http://www.beckershospitalreview.com/racs-/-icd-9-/-icd-10/which-providers-and-employers-have-commercial-bundled-payments.html

Commercial bundled payment tracker. The Advisory Board, Feb. 1, 2013. http://www.advisory.com/Research/Health-Care-Advisory-Board/Resources/2013/Commercial-Bundled-Payment-Tracker

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

ACO Surprise – Growing Number of Patients Getting Care from an ACO

The consulting firm Oliver Wyman estimated late last year that as many as 31 million Americans  — roughly 10% of the population — were already receiving health care through an accountable care organization. This includes 2.4 million in Medicare ACOs, another 15 million non-Medicare patients in a Medicare ACO, and 8 to 14 million more in non-Medicare ACOs. Forty-five percent of the US population were living within a primary care service area served by at least one ACO.

These estimates were made before the Centers for Medicare and Medicaid Services announced the formation of another 106 Medicare ACOs in January, adding another 4 million Medicare beneficiaries.

The report discusses the significance of  the surprisingly fast growth the study found, concluding that “Successful ACOs won’t just siphon patients away from traditional providers. They will change the rules of the game.”

Feb. 18, 2013 UPDATE: Becker’s Hospital Review reports updated figures from Oliver Wyman, indicating ACOs now cover as many as 43 million Americans , and 52% of the U.S. population now lives in a primary care service area covered by at least one ACO.

Sources:

Gandhi N & Weil R. The ACO surprise. Oliver Wyman, Nov. 26, 2012.  http://www.oliverwyman.com/media/OW_ENG_HLS_PUBL_The_ACO_Surprise.pdf

Press release: More doctors, hospitals partner to coordinate care for people with Medicare. Centers for Medicare & Medicaid Services, Jan. 10, 2013. http://www.cms.gov/apps/media/press/release.asp?Counter=4501&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date

Punke H. Half of U.S. lives in ACO area. Becker’s Hospital Review, Feb. 18, 2013. http://www.beckershospitalreview.com/hospital-physician-relationships/acos-reach-half-of-us-population.html

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

ACOs: Oregon experiments with coordinated care

The federal government has agreed to allow the State of Oregon to modify its Medicaid and Children’s Health Insurance Program by establishing the Oregon Health Plan, which will, among other things, set up coordinated care organizations.  The CCOs will be like accountable care organizations (ACOs), but are intended to yield cost savings more quickly.  The author describes the features of the new Oregon model and identifies features that are likely to contribute to its success or failure.

For the official site of the Oregon Health Plan, click here: http://www.oregon.gov/OHA/healthplan/pages/index.aspx 

Source: Stecker, E.C.  The Oregon ACO experiment: bold design, challenging execution.  The New England Journal of Medicine, published online, Feb. 13, 2013.  Click here for full text: http://www.nejm.org/doi/pdf/10.1056/NEJMp1214141.  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

What are the core components of an ACO?

A model of the core components of an accountable care organization (ACO) was developed as part of this research sponsored by the Commonwealth Fund.  These capabilities are grouped under the following six general headings:

  • People-centered foundation
  • Health home
  • High-value network
  • Payer partnership
  • Population health data management
  • ACO leadership

The researchers then went on to assess how various organizations interested in becoming ACOs were doing in putting these capabilities in place.  The assessment of 59 organizations found that during the mid-2010 to mid-2011 evaluation period, no ACO developer had fully implemented any of the 6 core components.  Moreover, some of the organizations had not undertaken implementation of any of the capabilities in the model.

Source: Kroch, E., and others.  Measuring Progress Toward Accountable Care.  New York: The Commonwealth Fund, Dec. 2012.  Full text free here: http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2012/Dec/1652_Kroch_Measuring_Progress_web_1212.pdf  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

New Organization Formed: National Association of ACOs

The new National Association of ACOs has been founded by 60 accountable care organizations from across the country. It’s already planning a conference for next month. For more information, see www.naacos.com.

Source: News release – National Association of ACOs (NAACOS) is founded in Washington DC. PR Newswire, Feb. 8, 2013. http://www.prnewswire.com/news-releases/national-association-of-acos-naacos-is-founded-in-washington-dc-190359521.html

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