In another step towards advancing models of care that reward value over volume, HHS recently announced the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, a new initiative designed to move an increasing percentage of Medicare payments into models that support value-based care, and which supports a number of tools including telehealth and post-discharge home services.
With their built-in cadre of healthcare providers, multi-specialty physician groups (referred to here as physician groups), which comprised about a tenth of survey respondents to the Healthcare Intelligence Network's third annual Accountable Care Organization survey administered in 2013, would seem ideally placed to transition to accountable care organizations. Percentage-wise, this sector has the highest rate of existing ACOs (57 percent participating in ACOs versus 34 percent of overall respondents) and twice the rate of participants in the CMS Pioneer ACO program (25 percent versus 13 percent).
Other characteristics of this sector follow.
In other deviations from the norm, twice the number of physician group-reported ACOs favor the hybrid FFS + care coordination + shared savings payment model (75 percent of physician-group ACOs versus 37 percent of overall respondents).
More than half of ACOs in this sector are administered by independent physician associations (IPAs), and most are smaller than the hospital-sized ACOs reported above, with three-quarters reporting a physician staff of less than 100. These ACOs benefit from having specialists on board in greater numbers to help with care coordination of the chronically ill (100 percent include specialists, versus 71 percent overall).
They also unanimously include nurse practitioners (versus 90 percent of overall respondents) and with 50 percent including clinical psychologists in the ACO (versus 42 percent overall), are a little further along on the path of integrating behavioral health into the accountable care initiative.
Cognizant of the full care continuum, these IPA-led ACOs are almost twice as likely as overall respondents to include skilled nursing facilities (50 percent versus 29 percent overall) and hospice (75 percent versus 42 percent overall) in their ACOs.
Perhaps because their organizational structure lends itself to the ACO model, the majority of this sector—75 percent—needed less than year to launch its accountable care organization (versus 29 percent of overall respondents, whose comfort level was between 18 months and two years).
These ACOs seem to have all the clinical pieces in place, reporting near-unanimous usage of evidence-based care, case management, care transition management and population health management. They are also unanimous in the review of clinical outcomes as an ACO success measurement, and much more likely than their counterparts to consider provider satisfaction in program evaluation (50 percent of physician group-led ACOs, versus 32 percent of overall respondents).
Technology-wise, however, there’s some catch-up to be done here: only three-fourths of responding physician groups report the use of EHRs and patient portals, versus near-global usage levels reported in other sectors. This could explain why this sector was three times more likely to report technology as a barrier to ACO creation
Source: 2013 Healthcare Benchmarks: Accountable Care Organizations
2013 Healthcare Benchmarks: Accountable Care Organizations documents the numerous ways in which accountable care is transforming healthcare delivery, particularly in the area of care coordination, where the ACO model has had the greatest impact for this year's respondents.