AUGUST 14, 2012

Welcome to the Accountable Care Update eNewsletter
Editor: Philip L. Ronning
This issue is sponsored by the ACO Congress

Accountable Care Organizations: Testing Their Impact
The Robert Wood Johnson Foundation (RWJF) has called for proposals to compete for three $400,000 grants for case studies which will help identify the facilitators and barriers to success for ACOs. The foundation is most interested in ACOs developed among safety net providers. Proposals are due September 5, 2012. Applicant webinars are scheduled for Wednesday and Thursday of this week. (Robert Wood Johnson Foundation, 2012)

Cigna Plans Aggressive Expansion for ACO-like Program
Cigna has announced plans to expand its Collaborative Care (CAC) program. This is a variation on the accountable care organization called for by the Affordable Care Act (ACA) in order for providers to participate in Medicare's Shared Savings Program. The CAC is an insurer-physician partnership providing coordinated care that improves quality and reduces costs for Cigna's commercial and Medicare Advantage insureds. Aetna and other major insurers are planning similar expansions. (HealthLeaders Media, August 9, 2012)

New Health Practice Leading to Better Patient Care?
AdvocateCare, an ACO established by Advocate Healthcare in January of this year, is reporting lower readmission rates. Advocate Healthcare is a Chicago-based system of 10 acute care hospitals and more than 250 sites. AdvocateCare now provides services to 380,000 Blue Cross Blue Shield of Illinois enrollees and is one of the nation's oldest and largest ACOs. (Chicago Sun Times, August 3, 2012)

CAP Proposal on Self Referrals Signals Dems Willing to Ease Barriers to ACOs
The Center for American Progress (CAP) created a panel of health policy experts who have acknowledged that physician self-referrals cannot be banned in organizations like ACOs. This is seen as an indication that a relaxation of some Stark-like regulations is appropriate for organizations moving away from the fee-for-service model. (Health Policy News, August 8, 2012)

Health Care Systems Explain Why They Did Not Participate in CMS ACO Program
The current issue of Mayo Clinic Proceedings includes comments from six leading healthcare systems who explain their decisions not to participate in forming Accountable Care Organizations in order to participate in Medicare's Shared Savings Program. Arguments against participation include, for example, lack of beneficiary engagement. Several relevant articles, including the one referenced, can be found in the August issue at http://www.mayoclinicproceedings.org/current. (News-medial.net, August 3, 2012)

Mobile Tech Is a Natural Fit for ACOs, Experts Say
Tricia Nguyen, MD, the Chief Medical Officer for Banner Health, a pioneer ACO program, advocates mobile health (or mHealth) because patients become more engaged to support wellness. While most mobile health applications are currently focused on helping sick patients interact with their providers, the applications will evolve to put devices in the hands of healthy members of the population to encourage them to seek care earlier and thus keep themselves healthy. (searchhealthit.com, August 3, 2012)

Park Nicollet in Minnesota Forms ACO with Non-profit Insurer Medica
Medica, a non-profit insurer, is teaming up with Minnesota's Park Nicollet Health Services to create an accountable care organization (ACO) to be called Park Nicollet First with Medica. Patients covered by the ACO will be able to access Park Nicollet's 20 primary care clinics, affiliated specialists and centers as well as Parke Nicollet Methodist Hospital. (Becker's Hospital Review, July 31, 2012)

Accountable Care Organizations Aim to Cut Costs, Increase Quality
"Hospitals controlling and running ACOs -- that makes our members very nervous. It's absolutely important that ACOs are physician lead. The ACO model can be a very good thing, but it needs to be done carefully as a collaborative effort," said Francisco Silva, Vice President and General Counsel for the California Medical Association based in Sacramento. He added, "It's absolutely important that ACOs are physician led...The ACO model can be a very good thing, but it needs to be done carefully as a collaborative effort." David Muhlestein of Leavitt Partners LLC, says, "Right now I'd say there is a growing consensus that accountable care is the future of healthcare." Yet he adds that there is no clear definition of an ACO. For another example see http://www.healthycal.org/archives/9289. (healthycal.org, July 18, 2012)

Pharmaceuticals Play Key Role in Achieving ACO Quality, Cost Goals
Pharmaceuticals are an important area for provider organizations to consider as they evaluate ways to improves quality and reduced overall costs of care for ACOs and value-based providers. The National Pharmaceutical Council (NPC), the American Medical Group Association (AGMA) and Premier have teamed with seven provider organizations to form the Working Group on Optimizing Medication Therapy in Value-Based Healthcare. In the July 2012 issue of Journal of Managed Care, the group's framework for achieving success in value-based organizations with pharmaceuticals is discussed. (MarketWatch, July 18, 2012)

This Modern Healthcare Interactive Map Provides Details for Each of the Pioneer ACOs

- click map for larger, interactive version -
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National Trends in Health Care Reform

Elliott Fisher, MD, MPH
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH

Mark McClellan, MD, PhD
The Brookings Institution, Washington, DC

Susan Dentzer, MA
Health Affairs, Washington, DC