Even though accountable care organizations are a somewhat new care delivery model, they have made quite an impact on the world of healthcare already. New commercial ACOs are announced on a regular basis, and many organizations applied to be part of CMS’ 2013 class of ACOs. In fact, there were more than 324 self-identified ACOs across the country as of December 2012, according to a Leavitt Partners report.
The care models have already started reducing healthcare costs for some organizations. “Depending on the relationship, we have generated savings within the first year of operations,” says Charles Kennedy, MD, MBA, CEO of Aetna Accountable Care Solutions. “It doesn’t take long to see the fruits of this way of operating.”
Forming ACOs and working toward coordinated, accountable care does more than just generate savings, however. “It opens up windows of innovation, because [before] we wouldn’t get reimbursed for doing that kind of work,” says Chuck Lehn, CEO of Banner Health Network in Phoenix, Ariz. Banner has developed commercial ACOs and is also part of the Medicare Pioneer ACO program. “In accountable care models, we can be creative, and we’re seeing successes in creativity,” Mr. Lehn says.
ACOs across the country are harnessing that creative spirit as they continually strive to achieve the triple aim of higher quality care and better patient outcomes at a lower cost. Here’s a look at what is developing in the world of accountable care.
Reimbursement model experimentation
Different payment models are expected to evolve throughout 2013 as ACOs get their footing and do more experimentation with various models. “In different markets, we see different speeds that the market is moving from fee-for-service to pay-for-value,” explains Jerry Penso, MD, MBA, the chief medical and quality officer of the American Medical Group Association. For example, California has a robust pay-for-performance model established, while other states and other markets are not quite as far along and are moving slower in that direction.
Banner’s accountable care payment models run the gamut from fee-for-service with an aspect of risk to capitated payments to bundled payments. “It depends on the payor and the system’s capabilities,” Mr. Lehn explains, so its payment models may evolve as capabilities on both sides increase.
Even though Banner and its partners have not settled on one way to pay, Mr. Lehn is sure of one thing. “I don’t see us going back to just doing fee-for-service episodic [payment],” he says.
As a payor, Aetna is currently relying on a modified fee-for-service payment model, according to Dr. Kennedy. In its ACO payment model, Aetna establishes targets based on quality and efficiency targets and shares the savings achieved with the provider. As providers gain more experience managing populations and overall cost of care, Aetna’s models shift to put more of the payments at risk.
While Aetna is currently focused on modified fee for service, Dr. Kennedy says it has not settled on that model as a permanent solution. “We are keeping our eye on bundled payment methodologies as they are rolled out and proven,” Dr. Kennedy says. “They could become a component [of our program].”
Commercial ACO payment models are still evolving in different markets, but it seems as though organizations across the country will continue to move away from straight fee-for-service in favor of reimbursement models that link payment to care quality. “They are trying…to figure out a compensation model that aligns physicians with ACO objectives,” Dr. Penso says.
Continually improving care quality
ACOs are continually working to improve the quality of care they provide as part of meeting the quality and patient outcomes aspects of the triple aim. Quality measures have been set with payors that guide the organizations, and providers are now getting innovative in how to further improve quality through care coordination and population health management.
“The area we’re hearing strongest about from ACOs [is] the move to care coordination,” says Dr. Penso on the future direction of ACOs. “That’s where [organizations] want to apply more of their human and information technology resources.”