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Dr Katherine Schneider on Handling Variability in ACO Contracts

Contracts for accountable care organizations (ACOs) can be very different depending on who the payer is, according to Katherine Schneider, MD, MPhil, FAAFP, president and CEO of Delaware Valley ACO.

Contracts for accountable care organizations (ACOs) can be very different depending on who the payer is, according to Katherine Schneider, MD, MPhil, FAAFP, president and CEO of Delaware Valley ACO.


What has been your experience with commercial contracts vs Medicare Shared Savings Program (MSSP)?

We are an ACO of about a quarter million lives and a third of our lives are in MSSP Track 1, about a third are in 3 private payer relationships, and a third are our own employees, actually, across our large joint venture health system enterprise. And, I think the biggest difference is the ability of us to have a face-to-face relationship and partner with the payers.

All of these contracts are different, we have the opportunity to negotiate, obviously, and that’s not just around favorable contract terms, around who gets more of a dollar, but it’s also understanding our local market and our ACO and our providers and being able to customize the programming and the clinical partnerships to where we are in our journey in care transformation. I think the biggest difference is that ability to partner with the payers locally.

How can ACOs participating in MSSP and commercial contracts, or just multiple commercial contracts, accommodate variability in these contracts?

The variability can be behind the scenes, in which case I don’t think it’s of huge concern or impact, but where it gets very complicated is where there’s variability at the point of care. So, things like quality metrics being all over the map or, worse yet, quality metrics that kind of overlap but not quite—different definitions, different specs, different ability to submit supplemental data, just as one example.

I think our job as an ACO is to protect our providers from that noise and chaos and allow them to focus on the care of the patient regardless of whose card they’re carrying in their pocket. The more that we can do that, we can’t always get everything perfectly and aligned and we know that, but the more that we can sort of keep that stuff in the background and allow our caregivers to just provide the highest level of care, great care experience, and bend the trend, obviously, is our goal.

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