MARCH 30, 2012

Welcome to the Accountable Care Update eNewsletter
This issue is sponsored by ACO Summit

California Glitch Spurs Additional CMS Oversight of ACO Provider Lists
CMS asked all Pioneer Accountable Care Organization participants to review their provider lists and submit a final, correct list to the agency by mid-February following an incident in which two California participants sent letters to Medicare patients of several providers who had not agreed to join the ACO, according to documents obtained byInside Health Policy. CMS Acting Administrator Marilyn Tavenner, in a letter to several House lawmakers who had queried her about the glitch, said the ACOs that made the error were asked to provide a Corrective Action Plan, and she stressed that CMS will continue to keep an eye on the situation. (insidehealthpolicy.com, March 8, 2012)

Private-Sector Insurers Tap Health IT to Support Accountable Care
Accountable care has been an important topic of conversation lately. But even before the federal government launched several accountable care organization programs, ACO-style payment arrangements already had been adopted by private insurers. Health plans and large employers have tried for some time to direct patients to preferred providers as a way to control costs. (iHealthBeat, March 8, 2012)

Quality Missing from ACO Equation?
The term ACO is most readily associated with the Medicare Shared Savings Program or the Pioneer Accountable Care Organization but it actually stretches beyond these programs, as there are many others which fall outside of the federal sphere. Some people have voiced concerns that the term has of late been used too liberally, citing the recent announcement regarding the success of the "largest commercial ACO" of Advocate Health Care and major health insurer Blue Cross Blue Shield of Illinois (BCBSIL) called AdvocateCare. (Fierce Healthcare, March 13, 2012)

ACOs Changing Economics
The Congressional Budget Office made a major revision to its 10-year Medicare spending projection by decreasing estimates by $69 billion, Paul Ginsburg and Chapin White at the Center for Studying Health System Change, in Washington, D.C., wrote in the New England of Journal of Medicine last week. "[W]e do not believe that the recent slowdown in Medicare spending growth is a fluke," they wrote. "There has been a long-term trend toward tighter Medicare payment policy, and policy changes that began in the middle of the 2000s have continued that tightening." (Fierce Healthcare, March 14, 2012)

Reporter's Notebook: ACOs and the Gingrich Connection
After being close to disowning it last year, the American Medical Group Association was back to touting its role in the creation of accountable care organizations at its annual conference last weekend in San Diego, and it even provided a little more context and back story -- which included giving credit to a somewhat unlikely catalyst. What George Roman, AMGA senior director of health policy, said and former AMGA Vice President of Public Policy Chet Speed later confirmed, was that, essentially, the ACO-creating provision might never have been included in the Patient Protection and Affordable Care Act if it weren't for former U.S. House Speaker Newt Gingrich. (Modern Healthcare, March 14, 2012)

Boston Healthcare Market Moves Rapidly toward Global Payments
HealthLeaders-InterStudy reports that the Boston healthcare market is moving rapidly toward global payments. This movement is led by Blue Cross Blue Shield of Massachusetts' (BCBSMA) Alternative Quality Contract (AQC), according to the recently published Boston Market Overview. AQC is a new contract model combining a per-patient global budget with significant performance incentives based on quality measures, according to BCBSMA. (Market Watch, March 14, 2012)

JAMA: Target Wasteful Spending, Not Care
While striving to provide the most innovative and valuable care to patients is the overarching goal of healthcare, the costs associated with this care are astronomical. Several strategies have been implemented into practice to curb these high expenditures, yet current healthcare costs are nearly 18 percent of the gross domestic product. Donald M. Berwick, MD, and Andrew D. Hackbarth, MPhil, say cut waste, not care. (Health Imaging, March 15, 2012)

Cigna CEO Cordani Says Court Won't Derail Health-Care Shift
Cigna Corp.'s chief executive officer, David Cordani, believes that the forthcoming Supreme Court decision on whether the health care law is constitutional shouldn't affect the expected change to how American's receive their medical care. According to Mr. Cordani, employees are being moved into plans where they are more accountable for their healthcare by their employers. (Bloomberg, March 15, 2012)

ACO Planned in New York
Westmed Medical Group, a multispecialty group medical practice based in Purchase, N.Y., said it is collaborating with UnitedHealth Group to form an accountable care organization. Westmed will work with UnitedHealthcare and Optum, the insurance and health information technology services businesses of Minnetonka, Minn.-based UnitedHealth Group, to form the Westmed ACO, according to a news release. Westmed has 220 physicians at nine locations in New York's Westchester County. (Modern Healthcare, March 20, 2012)

Don't Fear the Payor: Why Hospitals Should Begin ACO Talks With Insurers
Care team Connect recently held a webinar which broached the idea that hospitals should be involved in the discussions with payors to find solutions to bring down costs and boost quality as health plans are seeking partners for care coordination. The payors' perspectives on care coordination were presented by Jay Meyers, Care Team Connect's vice president of business development. (Becker's Hospital Review, March 22, 2012)

ACO Deep Dive Session at this Year's Health Datapalooza
As part of the HHS Health Data Initiative, The Health Datapalooza will be held this year on June 5th and 6th in Washington, DC. This event is being put on by the Health Data Consortium, a group of organizations that joined together with the aims of promoting new data, making existing data more accessible by consumers and developers, and encouraging the development of products and services that improve health and health care. The Department of Health and Human Services (HHS) is a member of the Consortium. (HDIForum.org, March 2012)

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Organizing for Risk

Jeff Goldsmith, PhD
President, Health Futures, Inc.; Associate Professor of Public Health Sciences, University of Virginia, Charlottesville, VA