Accountable Care Organization Model Gains Momentum Despite Risks

Among the many delivery models that have been discussed in the midst of healthcare reform is Accountable Care Organizations (ACOs). The general idea behind the ACO model is to provide something that is currently missing from our healthcare system: an incentive in the form of shared savings for organizations to constrain resources while maintaining (or even improving) quality.

Among the many delivery models that have been discussed in the midst of healthcare reform is Accountable Care Organizations (ACOs). The general idea behind the ACO model is to provide something that is currently missing from our healthcare system: an incentive in the form of shared savings for organizations to constrain resources while maintaining (or even improving) quality. In the newly proposed Medicare model, if ACOs are simultaneously able to reduce cost and improve quality, then the savings that are yielded will be shared with the providers.

The challenge with the ACO model is that organizations also take on a fair amount of risk. According to one report published earlier this year, providers, for the most part, lack the infrastructure required to take on and manage risk successfully. The report goes on to say that “providers will need more data and analytic capabilities to manage the patient populations for which they take on financial risk and to negotiate appropriate risk-sharing arrangements with payers.” For now, organizations that are contemplating an ACO model need to consider specific steps toward a solid infrastructure. Among those steps are assessing the personnel and technology infrastructure. Being as prepared as possible will ensure the best chance of success and will minimize risk.

As David Blumenthal, Samuel O. Thier Professor of Medicine and Professor of Health Care Policy at Massachusetts General Hospital/Partners HealthCare System and Harvard Medical School, recently stated in an interview with healthsharetv, “the timing of the accountable care organization process and new incentive system remains to be worked out, but at least [the US healthcare system] has gotten started.” Some organizations in particular that have gotten started are Tufts Medical Center and Vanguard Health Systems; Blue Cross and Blue Shield of North Carolina and Key Physicians; and Methodist Le Bonheur Healthcare and BlueCross BlueShield of Tennessee.

Dr. David Blumenthal discusses the evolution of ACOs in the United States

The fact is that integrated care provided through ACOs is rapidly becoming a reality; to read more about how this healthcare delivery model continues to evolve, as well as how organizations should prepare, please access the resources below.

Around the Web

Promising Payment Reform: Risk-Sharing with Accountable Care Organizations [The Commonwealth Fund]

5 steps to solid infrastructure for ACO goals [Healthcare Finance News]

Medicaid ACOs are risky testing ground [Fierce Healthcare]