I didn’t write any of the following, it is from the Health Affairs Blog. However, I thought you might find all this interesting. If you are an employer, here is the next “in thing” coming at you from your consultants; right behind the private exchanges they are selling you.
If you are an employee get ready for the next round of “solutions” to your employer’s health care cost problem; not to be confused with other “solutions” you have experienced such as wellness and consumer-driven, high deductible health plans.
Has anyone noticed that nothing seems to work? Another curious state is that while the Administration takes credit for moderating health care costs, while Medicare premiums are not rising in 2015, employers are “eager, if not desperate, for solutions to contain the costs of health care …”
Here is a tip I have mentioned before. How will we ever manage the cost of health care if our major systems all pay a different amount for the same service? Take a basic MRI for example; Medicare will pay one amount, Medicaid another, and any number of private insurers yet more different amounts and meanwhile nobody knows what it should actually cost. Every payer should be paying the same fair price.
Then there is the real question; do you actually need that MRI, or the second one?
As you read the words below, think to yourself; how the heck are employers going to do that? You know, like: “requiring that the ACO select providers based on quality and efficiency,” “Insist on outcomes measures,” “provide cost and quality information to patients.” We throw that word “quality” around quite easily … define it‼️
A growing number of large employers are piloting accountable care organizations (ACOs), working through their health plan; in some cases they are doing so directly with provider systems, such as the new Boeing arrangement with Providence Health and Services, Swedish Health Services, and University of Washington Medicine and Intel’s contracting efforts in Albuquerque, New Mexico and Portland, Oregon. The large employers and other health care purchasers with whom we work — eager, if not desperate, for solutions to contain the costs of health care and improve its quality — are watching these first movers carefully to see if ACOs prove to be a viable strategy for improving population health and bending the cost trend.
These leading purchasers intend to set the bar high. They cannot make the investment to pursue these ACO relationships if they are not assured that their populations will see meaningful, measurable gains in their health care and its affordability, as well as their health. That often means contractual commitments to lowering total costs of care and showing improved patient outcomes for targeted populations — like high risk, medically complex patients. Our purchaser colleagues who have been among the early adopters of ACO arrangements have begun to identify the features critical to successful ACOs; these are the elements other purchasers will look for when deciding if it’s worth proceeding.
Lessons For Purchasers Considering ACOs
Catalyst for Payment Reform (CPR) and the Pacific Business Group on Health (PBGH) have captured these elements in a recently released Accountable Care Organization Toolkit for purchasers. The Toolkit contains a questionnaire for health plans about their efforts, and model contract language for health care providers wanting to serve as ACOs. Providers, health plan leaders, and other health care experts may find these lessons useful as well.
Not just any network will do. When creating or entering into an ACO, employers should be choosy about the provider network, requiring that the ACO select providers based on quality and efficiency.
Insist on outcomes measures. The whole point of trying an ACO strategy is to improve quality and reduce costs. An ACO must be able to generate outcomes measures that assess its impact on quality and costs.
Patient-centered, coordinated care is critical. ACOs promise to improve care quality, in large part through better care coordination. A purchaser shouldn’t work with any provider system that can’t support targeted care management; physician engagement in shared decision making with patients is a key piece as well.
Transparency is key for patients, providers, and purchasers. Part of the appeal of an ACO is that it is next generation health care. As such, it should provide cost and quality information to patients, preferably at the individual provider level. The same information can help providers gauge and improve their performance. And purchasers must absolutely insist on transparency regarding the spending, savings, and the savings distribution within the ACO.
Information technology helps with all of the above, and then some. Online data administration is essential to help track care management and performance.
The ACO movement will largely negate its own goals if it stifles competition. ACOs should not use contract exclusivity and/or provisions that prohibit transparency, thereby reducing competition within the market. Rather, ACO development and growth should advance competition among providers in the market.
Finally, and perhaps most importantly, providers should have some financial “skin in the game.” To assess cost savings, ACOs should apply a prospective patient attribution model. As a result, the ACO will have a defined patient population for cost and quality measurement and targeted care coordination strategies. Ideally, ACOs will be subject to a shared-risk payment arrangement in which any savings will be distributed based on meeting medical cost and quality goals. Furthermore, ACOs should promote payment for value not volume, such that the performance incentives are passed through to primary and specialty care providers.
via The Payment Reform Landscape: Accountable Care Organizations – Health Affairs Blog.
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