NAACOS: National Association of ACOs

Money, stethoscope, and calculator on health claims form | Image Credit: © Nadzeya - stock.adobe.com

Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.

During the second plenary at the National Association of ACOs fall meeting, Meridith Seife, deputy regional inspector general, Office of Evaluation and Inspections in the HHS Office of the Inspector General, presented results from a government report identifying strategies of high-performing accountable care organizations that had improved care quality while cutting costs.

Joann Sciandra, RN, BSN, CCM, associate vice president of healthcare management, Geisinger Health System, discusses how the role of case management has evolved with increased attention being paid to social determinants of health and if she thinks the role will continue to evolve in the future.

Transforming a practice to become proactive in delivering care, rather than reactive, will be crucial in improving patient care and reducing costs, said Thomas Graf, MD, president, Ascension Medical Group, at the spring session of the National Association of Accountable Care Organizations, held April 24-26 in Baltimore, Maryland.

There has always been interest in bundled payments, and now the industry is moving toward implementing more, explained Scott Hewitt, vice president, payment strategy and innovation, UnitedHealthcare.

There is a lot involved if an accountable care organization (ACO) decides to switch from Medicare Shared Savings (MSSP) to Medicare Advantage, but Medicare Advantage offers more benefit design flexibility, explained Kim Kauffman, MPH, vice president of value-based care at Summit Medical Group.

The Institute for Accountable Care has a massive database to understand which accountable care organizations (ACOs) are successful and why, as well as how best to implement accountable care programs, explained Rob Mechanic, MBA, senior fellow at the Heller School of Social Policy and Management at Brandeis University and executive director of the Institute for Accountable Care.

As CMS prepares to implement its new Pathways to Success program (formerly Medicare Shared Savings Program) for accountable care organizations (ACOs), some ACOs may consider Medicare Advantage a more beneficial arrangement, explained Kim Kauffman, MPH, vice president of value-based care at Summit Medical Group.

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