Payers finding their footing in ACOs

The number of accountable care organizations is rapidly increasing among private payers and with it some best practices are emerging as the new models significantly alter payer-provider relationships.
With more than 300 ACO agreements under their belts, commercial payers account for more than half of the ACOs, according to KLAS enterprise research analyst Mark Allphin, who examined early strategies of major payers, including Aetna, Cigna, Humana and UnitedHealthcare, and providers who have entered into 21 of the commercial ACO payer arrangements.
Each payer has its own approach for helping providers in their ACOs, like supplying health IT, and each provider has different needs, often depending on the populations that they serve and resources available.
"It's very important to have objectives and expectations in place up front so that payer and provider organizations working together know what to expect and what they are working towards," Allphin said. "Those expectations and objectives help to form the whole working relationship."
When expectations and objectives are set, it then makes sense to start talking about areas like sharing payer claims data and specifications about how that data is used by the providers.
Health plans offer an incredible amount of flexibility to meet the needs of providers at various levels of readiness, said Clare Krusing, a spokeswoman for America's Health Insurance Plans (AHIP). "The biggest one is helping to manage financial risk, and designing payment arrangements that give those providers the flexibility and encourage participation in ways that they want to with a different partner," she said. Payers have been working with risk and risk analysis for years.
New payment models offer an opportunity to organize care delivery in a way that rewards good care and is much more focused on the patient, but the goal is for care to be more affordable, said Susan Pisano, AHIP vice president of communications.
"You always have quality trumping cost, but in today's environment there is a concerted focus on the issue of affordability," she said. "Some things you do in a delivery system will achieve savings, and other things may not. So the things that both deliver better care and achieve savings - that's great. Things that only improve quality but do it more affordably - that's great, too."
According to Allphin's conversations with providers, payers help in different ways. "On a continuum of operational involvement, Cigna provides the most day-to-day hand-holding by retaining analytics and guiding local care coordinators with tactical reports," he said in his report. "Aetna and UnitedHealth occupy the other end, with tools and consulting geared to make providers self-sufficient. Humana falls in the middle, expanding cooperation in longtime relationships but headed down the transformation path."
Based on Allphin's research, he found that insurers offer a slew of payer-agnostic tools and services. All four payers studied offer access to claims data and care guidance reports. Aetna, Cigna and Humana can supply care coordinators; Aetna, UnitedHealthcare and Humana offer plan administration; Aetna and UnitedHealthcare can provide care management, patient portal apps, performance management, data exchange and aggregation and health information exchange. Humana also offers data and health information exchange.
Allphin said he expects to see more ACOs announced each quarter. Currently, Cigna has the most ACO contracts with 66 at the time of his study. UnitedHealthcare announced in July that it would double the number of its accountable care contracts over the next five years, representing more than $50 billion of reimbursements by 2017.
While there may be more variability currently in payer-provider relationships, over time, Allphin said, "I think there will be some kind of standard mode of operation for relationships, some kind of standard agreement or approach."