Employers understand what accountable care organizations are, but they need a better understanding of how they deliver value better than the market, explained Brian Marcotte, president and CEO of the National Business Group on Health
Employers understand what accountable care organizations are, but they need a better understanding of how they deliver value better than the market, explained Brian Marcotte, president and CEO of the National Business Group on Health
Transcript (slightly modified)
How well do employers currently understand what accountable care organizations are and what they offer?
I think that employers understand the concept of ACOs. ACOs are providers coming together in a delivery system to take on responsibility for the care and the cost of a defined population. So, they get that. I think where employers struggle is understanding how they deliver value better than the market. If I have a health plan coming into me and I have a relationship with a national health plan, and they have 150 ACOs that they can deploy across my population because I’m in every state. I don’t know how to react to that as an employer. How do I differentiate the value that those ACOs are providing, from what I have in place today from a cost, a quality, and a consumer experience perspective?
Is there an education process the National Business Group on Health provides to help employers better understand what ACOs offer?
What we’ve done is we’ve put health plans, healthcare providers, even ACO providers, and employers together to see if we can all agree on what the market expectations of ACOs are. What are the key domains? What are the core competencies that an ACO must have? How do those competencies evolve over time, from an early stage to a much more mature stage? The goal here is to give employers the confidence to recognize: What’s the ask? What am I looking for from an ACO? But also, for a health plan to be able to bring in to an employer, with confidence themselves, as to how ACOs differentiate in the market from what they offer today. It also provides a road map for ACOs of: Where do I need to be from an employer perspective if I want an employer to engage with me? So, it’s trying to get everyone to speak the same language, and to talk about things in the same way, and to recognize what the tipping point from a value perspective is to move forward.
Increasing Lp(a) Awareness for Better Cardiovascular Health: Dr Mary McGowan
March 24th 2024For Lp(a) Awareness Day, Mary McGowan, MD, FNLA, chief medical officer of the Family Heart Foundation, highlights how most people with elevated Lp(a) are completely unaware that they have this increased risk and calls for increased testing.
Read More
Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
Listen
Covered Preventive Services at Risk: V-BID Summit Breaks Down the Braidwood v Becerra Case
March 20th 2024For more than a decade, certain high-value preventive care services have been covered at no cost to patients under the Affordable Care Act, but a current legal challenge has the coverage at risk.
Read More
Reducing Low-Value Care Is Hard, but What About Just Not Paying for It?
March 14th 2024After years of efforts to reduce low-value care, panelists at the 2024 Value-Based Insurance Design Summit proposed a new strategy: drawing a line in the sand that payers will not be on the hook for these services.
Read More
Evolution of HDHPs With VBID Components Can Improve Care for Chronic Disease
March 14th 2024Over the course of the last 20 years, high-deductible health plans (HDHPs) have undergone an evolution. Today’s plans, with more high-value services covered predeductible, can improve care for people with chronic diseases, said panelists at the 2024 Value-Based Insurance Design (V-BID) Summit.
Read More