MAY 30, 2012

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

Aetna Aims for National ACO Network
Aetna is interested in developing a national network of ACOs over the next five years. The plan is being built around three principal approaches: 1) support for clinical integration, 2) defined population management, and 3) private label health plans. This project is being pursued in support of their efforts to shift relationships with providers from rate-based to value-based. (HealthLeaders Media, May 14, 2012)

How Rivals Built an ACO
Two competing health Systems in Minnesota, HealthPartners and Allina Health, formed Northwest Metro Alliance, a functioning ACO meant to serve the needs of 27,000 high-risk patients. This pilot project is intended to be scaled ultimately to meet the needs of their more than 300,000 combined patients. The initial focus has been on using generic drugs, reducing elective inducements before 39 weeks, reducing ER use through expanded urgent care options and enhancing assistance for chronic care patients. These efforts have produced an estimated savings of $1 million. (HealthLeaders Media, May 23, 2012)

ACO Blueprints: Options in Accountability
Drawing in part from the HealthPartners--Allina collaboration reported in the above story, HealthLeaders Media provides an excellent analysis of several developing options for organizing and delivering successful accountable care. (Health Leaders Media, May 14, 2012)

Banner Health, Aetna Reach for ACO Gold
InformationWeek reports that Banner and Aetna are partnering to provide the technological support for facilitating the transition to an ACO (Banner is one of the 32 Pioneer ACOs) for Banner's more than 200,000 patients. This is Aetna's largest implementation of provider and patient technologies to date. (InformationWeek, May 17, 2012)

Early Lessons from a Shared Risk, Integrated Care Organization Serving a Commercial Population
In this Health Affairs Blog interview, representatives from a successful ACO-like collaboration in Sacramento, CA, including CalPERS (California's public employee benefit group), Hill Physicians Medical Group and Dignity Health (formerly Catholic Healthcare West), discuss their efforts to achieve year-one successes in quality and satisfaction improvements, reductions in readmissions and inpatient utilization and savings of approximately $20 million. (Health Affairs Blog, May 15, 2012)

Special Considerations for Creating Medicaid Accountable Care Organizations (ACOs)
The Patient Protection and Affordable Care Act (PPACA) authorized Medicaid to experiment with models similar to those developed for Medicare and to provide incentives for providers to collaborate in the formation of ACOs. Several states (e.g., Colorado, Connecticut, Florida, and Utah) have taken actions to promote aspects of accountable care. While similar, there are important differences and this article explores them. (Ignite, May 16, 2012)

ACO Model May Improve Populations-based Outcomes for Pain Management
Tufts University's Daniel Carr, MD, said in his keynote speech at the recent American Pain Society Annual Scientific Meeting that he believes pain management, one of the healthcare systems most prevalent and costly conditions, will benefit from alignment with ACOs. "The upbeat news for the pain care community is that the intent of the Affordable Care Act is to focus on population-based health management, which for pain care means addressing the complex, multifaceted components of chronic pain." (News Medical, May 18, 2012)

Senate Panel Looks at Innovative Health Care Strategies
This Kaiser Health News story reports on a Senate Health, Education, Labor and Pensions Committee hearing in which Coastal Medical, Inc., Rhode Island's largest primary care group, describes results of their continuing efforts to produce accountable results. Positive results were also reported by Humana and Louisville's Norton Healthcare System. (Kaiser Health News, May 17, 2012)

Florida Blue Launches Oncology ACO
Florida Blue, Florida's largest insurer, has announced its plan to create a specialty ACO focused on oncology services. Partnering with Baptist Health South Florida and Advanced Medical Specialties of Miami (AMS), Florida Blue is targeting oncology in this innovative approach because cancer represents a large portion of the State's specialty service costs. This effort is the first in Florida and is one of the first of its kind in the country. (Health Leaders Media, May 14, 2012)

Six Strategic Variables in Predicting the Impact of Accountable Care
This article reviews the six variables likely to influence the financial results from implementing an accountable care initiative. These variables are the halo effect, the number of enrollees, the cost of creating and operating the ACO, the ability to blend the cost curve, various organizational structure considerations and the adaptability of the participants. (Health Affairs Blog, May 22, 2012)

Milliman Provides ACO Guide
Milliman, the actuarial firm, has published a tool to guide stakeholders through participation in Medicare's Shared Savings Program (MSSP) and Medicare's Pioneer ACO Program. Included are estimated benchmarks for high-cost and low-cost areas for both MSSP and Pioneer participants. (Milliman Healthcare Briefing Paper, May 2012)

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Creating Systems of Care and Fostering Better Care Coordination

Susan Dentzer, MA
Editor-in-Chief, Health Affairs, Washington, DC