Aetna, Cigna and the Blues sprang out of the gate in just the first two weeks of the year with announcements of newly formed accountable care organizations and expansions of existing ones, adding more scale and breadth to testing of value-based models to deliver better care at lower cost.
The number of public and private ACOs is mounting with an estimated 500 such initiatives and expectations that they will double by the end of 2014, according to a recent Premier Inc. report.
Cigna has started an ACO program with Core Physicians in New Hampshire for its plan members who receive care from the 120 primary care physicians and specialists in the group. It is Cigna's fourth ACO in the state.
Similar to other ACOs, care coordinators employed by Core and aligned with Cigna will focus on patients with chronic conditions, such as identifying those being discharged from the hospital, who might be at risk for readmission and making sure that these patients get follow-up care and receive screenings and medications.
Cigna also launched two more ACOs in Connecticut for a total of six, the latest with two Fairfield County physician groups, PriMed and Greenwich Physicians Association Inc.
Aetna will introduce fully insured plans in April that will use Valley Preferred, a preferred provider organization aligned with Lehigh Valley Health Network, in a program to create more coordinated care and reduced costs for employers and employees using the ACO network of physicians in the Allentown, Pa., region.
Horizon Blue Cross Blue Shield of New Jersey established a collaboration with Partners in Care, an independent physician association and healthcare management company based in East Brunswick, with 51 primary care practices throughout the state participating.
And Capital BlueCross and PinnacleHealth System have created CareConnect Point of Service, an extension of their two-year old ACO arrangement and a patient-centered medical home for high risk and rising risk patients.
In an analysis of one- and two-year old accountable care programs, data analytics firm Treo Solutions has found measurable improvements among its clients who are early adopters. These clients had reduced spending 2.5 percent in the first year and decreased inpatient admissions by 5 percent while showing an increase in outpatient services of 7.4 percent and professional services, 2.6 percent.
The accountable care organizations and patient-centered medical home programs also showed a 13.2 percent drop in potentially preventable initial admissions and a 9.7 percent decline in readmissions.
The new models "are clearly trending in the right direction," said Carole Cusack, Treo's vice president of consulting, in a news release.
However, one challenge is that most of the hundreds of ACOs and medical homes across the country are located in more densely populated areas, she noted. Providers in less densely populated and rural areas face the same pressures to reduce costs and improve health outcomes as those in urban and suburban areas.
"I call this the 'urban conundrum,'" Cusack said in a release. That is, keeping care local to the community, whenever possible." A great deal of outmigration occurs to large systems or providers for services that can be offered locally.
Providers and payers in these areas may also need to look at new models for strengthening relationships with primary care physicians and providing incentives for patients to get treatment locally.
The Treo analysis has suggested developing a regional ACO or patient-centered medical home and building a system hub, such as for high cost diagnostic and specialty services.