NOVEMBER 27, 2012

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

The ACO Surprise
A new report from the Oliver Wyman consulting firm finds that 10 percent of the population is already being treated by providers participating in ACOs of some kind. While not all of the ACOs are fully accountable yet, rapid ACO growth suggests that success in some of the experiments could bring swift change to how care is delivered and paid for. The report's authors see little or no prospect for immediate savings, but they predict that a combination of technology and experience will make it easier and cheaper for more health care groups to both join and succeed with the ACO model. (Oliver Wyman, 2012)

Within the Next 12 Months, 49 Percent of Surveyed Primary Care Physicians and 53 Percent of Surveyed Endocrinologists Expect to Participate in an Accountable Care Organization
A new study by Decision Resources, a leading research and advisory firm on healthcare and pharmaceutical issues, finds that nearly one fifth of all clinicians participate in an accountable care organization (ACO) and that within the next twelve months 49% of all surveyed primary care physicians expect to be participating in an ACO. Decision Resources Product Manager Roy Moore said, "The expected growth of ACOs is quite staggering as both MCOs and physicians appear to be buying into the core concepts of ACOs and, in many ways, we're just now seeing the tip of the iceberg for ACOs. The emergence of ACOs is now upon us and these entities will present challenges and opportunities for the drug industry. A focus on costs and generic prescribing targets could harm branded therapies, but a push for drug compliance and screenings may increase the number of patients taking specific medications." (Business Wire, October 30, 2012)

Gilfillan Details CMMI Program Expansions, Sees ACOs Doubling
Richard Gilfillan, MD, Director of the CMS Center for Medicare and Medicaid Innovation (CMMI), speaking at recent National Business Coalition, said, "If we have roughly 150 ACOs now, we are looking at somewhere between 200-300 this coming year." This increase will include Advanced Payment ACOs, where physicians can apply for a grant to receive the funding necessary to start an ACO. (Inside Health Policy, November 14, 2012)

5 Ways ACOs Will Save Money and Benefit Patients
Organizations need to move from the "how" to the "what" of accountable care, advise consultants from Warbird Consulting in this article. "In many places around the country, healthcare providers are more worried about the structure and mechanics of ACOs over the function itself. There's a big difference between the two." The firm suggests these five focus areas in ACOs that both save money and benefit the patient: 1) implementation of practice, 2) chronic care management, 3) reduce administrative processes, 4) improve access, and 5) an all care focus. (Healthcare Finance News, October 11, 2012)

How ACOs Will Affect Physician Recruitment
A recent survey by The Medicus Firm found that over 73% of healthcare executives are adapting recruitment plans to respond to the impact of accountable care organizations. The survey identified several traits beneficial in physicians functioning in an ACO environment: more team-oriented (78%), motivated by quality incentives (68.3%), more technologically savvy (65.9%), more evidence-based in their approach (61%), and more comfortable working with PAs and NPs (53.7%). Only 2.4% of respondents reported that all of their current physician staff meet these criteria. (Becker's Hospital Review, October 19, 2012)

Health Plans Embracing ACOs, Boosting IT, Study Shows
"While health plans have been preparing for a changing marketplace for a few years, the pace and clarity of their plans are ramping, and their technology needs are expanding," said Ellen Donahue-Dalton of Medecision. The Firm's analysis shows that health plans are headed toward 100 percent participation in accountable care organizations; 78% of respondents are already participating in an ACO and the remaining 22% reported plans to participate. (Healthcare IT News, October 26, 2012)

Hybrid Concierge Model Uses Best of ACOs, Medical Homes
The medical home and the accountable care organization are delivery models that appear unable to coexist within a single practice. The medical home "...is all about the doctor and practice handling more of the soft services that have been fading from many primary-care practices -- things like TLC, advocacy, advising, coaching, managing, and coordinating care." The ACO speaks of quality but its focus is cost. This blogger, Wayne Lipton, suggests that the two can be effectively mixed by using a "hybrid concierge" model of care. While this model closely resembles the medical home, "...it is funded by the patient. It is voluntary, not universal, and does not negatively affect the cost analysis of an ACO. In fact, it may actually help to reduce costs." (Physicians Practice blog requires free registration to view articles.) (Physicians Practice, November 22, 2012)

Hospital Operators on ACOs: Lay the Groundwork, or Wait and See?
This article summarizes the position of several leading for-profit health systems on the accountable care model. Concerns revolve around the length of time for savings to be documented and subsequently distributed. Vanguard's Executive Vice President Tim Petriken, said, "We may not realize savings, but there's not an option to sit back and protect the status quo. I don't really know that there's a choice but to pursue lowering the cost of healthcare." (Becker's Hospital Review, November 9, 2012)

What Doctors Should Ask Insurers before Joining ACOs or Medical Homes
American Medical News provides here an analysis distilled from interviews of how physicians should evaluate ACO or Medical Home participation. The article provides a range of questions suggesting that first "...physicians need to ask about responsibilities and independence. What exactly must a practice do to participate? If a practice has to follow particular care guidelines, are the physicians comfortable with what is called for? Do they have flexibility that takes clinical judgment into account? If a program calls for patients to have same-day appointments or access to a physician or another clinician outside of usual office hours, how will that be done? If other practice redesigns are necessary, can they be accomplished?" Additional questions are offered around subjects such as amount of clinical independence, fees to be paid, downside risks, etc. (amednews.com, November 12, 2012)

Accountable Care Organizations

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Lessons Learned from Private Sector ACOs

Lee B. Sacks, MD
CEO, Advocate Physician Partners, EVP Chief Medical Officer, Advocate Health Care, Oak Brook, IL