According to year-over-year ACO metrics published in 2015 Healthcare Benchmarks: Accountable Care Organizations, the percentage of healthcare organizations in ACOs has climbed from 14 to 50 percent in the last four years.
Leadership of ACOs by payor-provider co-ops or health plans has slowed to a trickle during this period, while the percentage of physician-hospital organization (PHOs) firmly grasping administration reins has nearly doubled—from 15 percent in 2011 to 28 percent among 2015 respondents.
ACO Staffs Support Healthcare Integration
The ACO staff has become more diverse, boasting more specialists, health coaches and clinical psychologists to support integration of behavioral health and primary care, the ‘sweet spot’ of patient-centered medicine. Watchwords are care coordination and care management, according to 2015 respondents who shared ACO success stories.
Staffing within ACOs has swelled as well: 29 percent of 2015 survey respondents support 500-1,000 physicians within its ACO, nearly double the 17 percent reporting this staffing ratio in 2011.
The average ACO is also busier than ever, with 61 percent encompassing 10,000 covered lives or more, up from 42 percent in 2011, perhaps reflecting consolidation occurring across the healthcare landscape.
Today, healthcare organizations are more conservative about time required to adequately frame an ACO, with 20 percent of 2015 respondents reporting that two years or more was needed, up from 4 percent in 2011, while the percentage requiring 12 to 18 months for ACO creation dropped from 50 percent in 2011 to 37 percent this year.
Reimbursement Shifts from Volume- to Value-Based
The retrospective data supports the industry's transition from the traditional fee for service payment environment to the value-based reimbursement structure favored today, with 45 percent of 2015 respondents favoring a FFS + care coordination + shared savings payment model, up from 15 percent in 2012. (Note: 2011 respondents were not surveyed on reimbursement models).
This handwriting is on CMS’s wall, in the form of its pledge to move half of Medicare payments into value-based payment models by 2018. More than half of 2015 respondents—54 percent—expressed faith in the federal payor's ability to meet this financial goal.
Despite the latest benchmarks, operational ACOs insist no two accountable care organizations are alike. In the experience of Steward Health Care Network, a top-performing Medicare Pioneer ACO, “When you’ve seen one ACO, you ‘ve really seen...one ACO.” Having ended Pioneer performance year two with gross savings of $19.2 million, Steward still must scale the perennial hurdles of physician engagement, performance improvement and care management, explained Kelly Clements, Steward’s Pioneer program director.
This year’s ACO survey benchmarks bear this out. Clinical integration, which can only succeed with the support of an engaged physician population, is still the biggest barrier to ACO formation, say 17 percent of 2015 survey respondents with no plans for accountable care.