Meeting accountable care initiatives under the healthcare law is presenting challenges for its accountable care organization (ACO) participants.
Even though the Centers for Medicare & Medicaid Services relaxed the final performance measures from a proposed 65 to 33, meeting those performance measures is no small feat.
The federal program might not be easy for its Pioneers, who have long been fueled by health plans, noted. The new approach will require utilization management functions, such as disease management, complex case management, preauthorization services, specialty referral management and other analytic tools, Lynn Dong, a principal consulting actuary with Milliman, explained.
Sharp HealthCare, one of the 32 federal Pioneer ACOs, said it already has experience in providing coordinated care and population-based payments, but the San Deigo-based health system--like other Medicare ACOs--faces the challenge of consumer choice.
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