AJMC Session Traces Evolution of ACO Growth, Mental Health Delivery Models

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How do ACOs reach the point of delivering both savings and better care? The recent online session of the ACO and Emerging Healthcare Delivery Coalition, sponsored by The American Journal of Managed Care, covered how ACOs evolve, how that process applies to oncology care, and how managed care can benefit from a better model for mental health delivery.

AJMC Session Traces Evolution of ACO Growth, Mental Health Delivery Models


PLAINSBORO, NJ — Accountable care organizations (ACOs), created by the Affordable Care Act to tie payment to the quality of care, go through distinct phases from their formation until they can deliver the “triple aim” of population health, patient satisfaction, and savings.

Applying the lessons of the triple aim to oncology care and bringing better delivery models to mental health care were also on the agenda at the recent WebEx session for the ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care.

Better Models for Mental Health Delivery


Lori Raney, MD, of Collaborative Care Consulting, addressed how behavioral health is finding its way into quality measures. While depression screening may be the only measure included in the 33 ACO measures from CMS, other behavioral health metrics exist. It is slowly being realized that in healthcare, a segmented approach to mental health makes little sense medically, and patients whose needs go unaddressed end up driving up costs elsewhere in the form of visits to the emergency department and other high-cost interventions. Nevertheless, most ACOs are still providing behavioral health services in a separate setting, she said.

Models used to integrate behavioral health services into primary care fall along a continuum, DrRaney explained.

  • Psychiatrists may act as consultants to a practice; they are paid for a few hours a week and do not see patients directly, but discuss cases with the primary care physician (PCP).
  • Behavioral health services may co-locate within the same physical space as the PCP.
  • Fully embedded services place the psychiatrist or other behavioral health specialist within the PCP practice, providing both consultations and in some cases, one-on-one appointments, depending on the nature of the arrangement.
  • In reverse integration, basic treatment of chronic diseases, such as diabetes or cardiovascular disease, is provided to patients with serious mental health problems in the psychiatrist’s office.

Dr Raney specifically discussed the value of collaborative care, an embedded service model that increases the likelihood that patients will receive the right care and be on the right medication. The TEAMCare approach, pioneered by the University of Washington, was found to save $600 to $1100 per patient, and has led to better outcomes in both depression scores and cardiometabolic results.

Evolution of ACO Growth

This session covered the distinct steps of ACO evolution. Dave Escalante, senior vice president for OneKey and Marketing, identified 4 distinct phases of integrated health system growth:

  • Expansion of services, which involve acquisitions and direct employment of physicians.
  • Health information technology (HIT) upgrades, which create the ability to track and measure progress.
  • Standardization of care, which focus on cost-effectiveness through the use of metrics, as well as protocols and pathways.
  • Quality outcomes and cost reduction, as ACOs form, the most sophisticated groups assume financial risk for episodes of care.

Escalante said the direct employment of physicians, in contrast with affiliate relationships, was a “critical variable” in the ability of the ACO to achieve triple aim. “The networks that employ physicians seem to be operating at a much more efficient rate, and are evolving through that maturity spectrum at a much quicker rate than those institutions that choose a traditional affiliate relationship,” he said.

Oncology Delivery

Ira Klein, MD, MBA, FACP, of Aetna, discussed how the insurer has developed an oncology delivery model that employs value-based principles within an ACO framework. The arrival of value-based principles has been essential, he said, to uncover the $800 million of waste in the system and redeploy it to deliver better care. By developing and testing hypotheses, he said, Aetna has been able to identify 5 steps for making this transition: modeling, development of clinical analytics, value creation planning, delivery, and ongoing collaboration.

“Getting the metrics right is really difficult,” in developing value-based programs in oncology, Dr Klein said. It’s taken Aetna almost 4 years, although the insurer believes it now has the model correct. Once it’s all up and running, however, payers and practices get data that allow them to make changes in the short-term. “You get a better system. Patients like it better. Outcomes are better. Providers like it better,” he said. “Technology acts as the lubricant to make it easy.”

About the ACO Coalition

As ACOs and other emerging delivery and payment models evolve and move away from traditional fee-for-service system models toward cost-effective and value-based care, the need to understand how these models will evolve is critical to building long-term strategic solutions. The mission of the ACO Coalition is to bring together a diverse group of key stakeholders, including ACO providers and leaders, payers, IDNs, specialty pharmacy, and pharmaceutical manufacturers to work collaboratively to build value and improve the quality and overall outcomes of patient care. Coalition members share ideas and best practices through live meetings, Web-based interactive sessions, and conference calls. Distinguishing features are the Coalition’s access to leading experts and its small workshops that allow creative problem-solving. To learn more, click here.

CONTACT: Nicole Beagin (609) 716-7777 x 131