Commercial and public payers and providers toiled in the trenches putting accountable care organizations (ACOs) and other new models of payment and delivery to work this year to determine if they in reality could improve quality and cost.
Most new models achieved some quality improvement measures, but the financial results have been mixed.
Medicare ACOs reported uneven performance. A year into the Pioneer ACOs program, the Centers for Medicare & Medicaid Services reported last summer that all 32 improved quality of care, with 25 able to generate lower risk-adjusted hospital readmission rates, but only 13 were able to lower the cost of that care enough to share in the savings.
Seven of the Pioneer ACOs decided to move to programs within the Medicare Shared Savings Program, which involved less financial risk. Two decided to leave Medicare accountable care altogether.
Ken Perez, former director of healthcare policy at MedAnalytics, said that the Pioneer ACOs program is challenging because it “just doesn’t generate the quick hits, the quick returns that folks would really like to have.” Preventive care screenings are “good solid pillars of population health management, but they show the benefits three, four, five years down the road,” he said.
Regardless of the iffy results of ACOs, like those in the Pioneer program, a number of payers have made the establishment of ACOs a major strategy. With more than 300 agreements under their belts, commercial payers account for more than half of all the nearly 500 ACOs.
For example, UnitedHealthcare in July said it will double its number of accountable care contracts over the next five years, representing $50 billion of reimbursements by 2017.
While the effectiveness of these new models is being tested now, as time passes, the experience that payers and providers gain in these new delivery and payment relationships will lead to some industry standards. In the meantime, those that have been participating in ACOs or ACO-like organizations can offer some lessons to those coming along.
For example, Fairview Medical Group in Minneapolis moved rapidly to avoid a long interim period between fee-for-service and value-based models, said Patrick Herson, MD, Fairview senior executive medical director.
Early on, Fairview shared risk with a local Medicare Advantage plan and later entered into an ACO contract for shared savings with commercial payer Medico. Then Fairview negotiated similar agreements with other area payers. In 2012, it became a Pioneer ACO member.
It was important to stop straddling different payment models so that the clinical model really could be built on population health, Herson said.
“By having the payer partners involved, once we got contracts and different kinds of financial arrangements, it became imperative that our operations realign their work and make sure it got done in a way that would be profitable for our payer partners and for Fairview Health Services as a whole,” he said.
Other best practices that are becoming evident include providers and payers sharing objectives and expectations, like sharing claims data and how physicians will use it; establishing clear strategic goals among the executive team; identifying the way the organization can build a culture to engage the workforce in substantial change; and building measurement systems to evaluate work processes and skill sets across the continuum of care.