Archive for the ‘Physician-Hospital Organizations’ Category

2017 ACO Snapshot: As Adoption Swells, Social Determinants of Health High on Accountable Care Agenda

June 29th, 2017 by Patricia Donovan

Nearly two-thirds of 2017 ACO Survey respondents attribute a reduction in hospital readmissions to accountable care activity.

Healthcare organizations may have been wary back in 2011, when the Department of Health and Human Services (HHS) first introduced the accountable care organization (ACO) model. The HHS viewed the ACO framework as a tool to contain skyrocketing healthcare costs.

Fast-forward six years, and most resistance to ACOs appears to have dissipated. According to 2017 ACO metrics from the Healthcare Intelligence Network (HIN), ACO adoption more than doubled from 2013 to 2017, with the number of healthcare organizations participating in ACOs rising from 34 to 71 percent.

During that same period, the percentage of ACOs using shared savings models to reimburse its providers increased from 22 to 33 percent, HIN’s fourth comprehensive ACO snapshot found.

And in the spirit of delivering patient-centered, value-based care, ACOs have embraced a whole-person approach. In new ACO benchmarks identified this year, 37 percent of ACOs assess members for social determinants of health (SDOH). In support of that trend, the 2017 survey also found that one-third of responding ACOs include behavioral health providers.

Since that first accountable care foray by HHS, the number of ACO models has proliferated. The May 2017 HIN survey found that, of current ACO initiatives, the Medicare Shared Savings Program (MSSP) from the Centers for Medicare and Medicaid Services (CMS) remains the front runner, with MSSP participation hovering near the same 66 percent level attained in HIN’s 2013 ACO snapshot.

Looking ahead to ACO models launching in 2018, 24 percent of respondents will embrace the Medicare ACO Track 1+ Model, a payment design that incorporates more limited downside risk.

This 2017 accountable care snapshot, which reflects feedback from 104 hospitals, health systems, payors, physician practices and others, also captured the following trends:

  • More than half—57 percent—participate in the Medicare Chronic Care Management program;
  • Cost and provider reimbursement are the top ACO challenges for 18 percent of 2017 respondents;
  • Clinical outcomes are the most telling measure of ACO success, say 83 percent of responding ACOs;
  • Twenty-nine percent of respondents not currently administering an ACO expect to launch an accountable care organization in the coming year;
  • 75 percent expect CMS to try and proactively assign Medicare beneficiaries to physician ACO panels to boost patient and provider participation.

Download HIN’s latest white paper, “Accountable Care Organizations in 2017: ACO Adoption Doubles in 4 Years As Shared Savings Gain Favor,” for a summary of May 2017 feedback from 104 hospitals and health systems, multi-specialty physician practices, health plans, and others on ACO activity.

Providers, Patients Outline Healthcare Priorities to New HHS Secretary

February 16th, 2017 by Patricia Donovan

As HHS secretary Tom Price begins his tenure, the ACA and physician reimbursement are on constituents' minds.

As HHS secretary Tom Price begins his tenure, the ACA and physician reimbursement are on constituents’ minds.

As Rep. Tom Price settles into his new role as secretary of the Department of Health and Human Services (HHS), organizations representing physician practices, nurses, patient groups and actuaries are making their healthcare priorities known to the newly confirmed administrator.

Concerns range from the future of the Affordable Care Act, which President Trump pledged to repeal in a January 2017 executive order, to specifics of new physician reimbursement programs resulting from MACRA (Medicare Access and CHIP Reauthorization Act of 2015).

In a news release from the American Association of Nurse Practitioners, America’s leading nursing organizations called on the Trump administration and Congress to prioritize patient health and the patient-provider relationship in any health reform proposals. Representing over 3.5 million nurses, the organizations affirmed their shared commitment to advancing patient-centered healthcare and healthcare policies that reflect five key areas ranging from ensuring patients access to healthcare with affordable coverage options regardless of preexisting conditions to creating greater efficiency in the Medicare system.

On the patient side, I Am Essential, a coalition of more than 200 patient groups, asked Price to preserve key ObamaCare protections, including one that guarantees coverage for those with pre-existing conditions.

In its letter, the coalition said certain ObamaCare provisions have provided improved access to care to millions living with chronic and serious health conditions.

“While it is not a perfect law,” the letter stated, “The ACA has provided health coverage and improved access to care for tens of millions of Americans living with chronic and serious health conditions, many of whom were previously uninsured or underinsured. If they lose access and coverage for even one day, their health and well-being can be immediately jeopardized.”

The letter concluded with the following statement: “As you make any changes, we urge you not to go back on the promise of affordable and quality care and treatment for everyone, especially those living with chronic and serious health conditions.”

Meanwhile, a letter from the Medical Group Management Association (MGMA), which represents more than 18,000 U.S. healthcare organizations in which 385,000 physicians practice, asked the new administrator to “significantly reduce the regulatory burden on physician practices and improve the quality and efficiency of healthcare delivery in this country.”

Focused on the federal payor’s new Quality Payment Program resulting from MACRA, the MGMA requested the following from Price, who worked in private practice as an orthopedic surgeon for nearly twenty years prior to launching his political career:

  • A reduction in the cost and reporting burden of the Merit-Based Incentive Payment System (MIPS);
  • A careful review of the eligible Advanced Alternate Payment Program (APM) risk standard and contend there is significant inherent risk in moving from fee-for-service to risk-bearing arrangements, including substantial investment and operational costs, as well as misaligned financial incentives between the payment systems; and
  • Legislative relief from the Federal Physician Self-Referral Law, which MGMA referred to as “a regulatory monster of mind-numbing complexity.”

MGMA represents physician groups of all sizes, types, structures and specialties, and has members in every major healthcare system in the nation.

And finally, the American Academy of Actuaries released three new issue briefs examining a number of key public policy considerations policymakers should weigh when evaluating specific proposals for reforming or replacing the Affordable Care Act.

The three papers, which address high-risk pools, selling health insurance across state lines, and association health plans, are available on the academy’s site.

“Differences in a reform’s structure can have wide implications for stakeholders and for how it interacts with other reforms that have been or may be adopted,” said Academy Senior Health Fellow Cori Uccello. “For example, high-risk pools can be structured in different ways, with different implications for access to coverage, premiums, and government spending. Further, how regulatory authority is defined for both cross-state insurance sales and association health plans affects whether insurers would compete on a level playing field.”

Infographic: Overcoming 5 Data Challenges Preventing Effective Physician Alignment

November 14th, 2016 by Melanie Matthews

Achieving physician alignment, critical to the success of health systems, requires a view into physician activity and referrals, according to a new infographic by Evariant.

Claims data is the best source of information to help analyze and identify referral patterns to move toward achieving physician alignment, but analyzing this information does not come without its own unique set of challenges. The infographic examines five data challenges preventing effective physician alignment and how to overcome them.

Overcoming 5 Data Challenges Preventing Effective Physician Alignment

6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability In today’s value-based healthcare sphere, providers must not only shoulder more responsibility for healthcare outcomes, cost and quality but also align with emerging compensation models rewarding these efforts—models that often seem confusing or contradictory. The challenges for payors and partners in creating a common value-based vision are sizing the reimbursement model to the provider organization and engaging physicians’ skills, knowledge and behaviors to foster program success.

6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability examines a set of provider compensation models across the collaboration continuum, advising adopters on potential pitfalls and suggesting strategies to survive implementation bumps.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Infographic: Building a Million-Dollar Physician Relationship

August 1st, 2016 by Melanie Matthews

In today’s competitive healthcare environment, hospitals and health systems are looking to drive patient volume and attract and retain physicians, according to a new infographic by Evariant.

According to Evariant, the financial results of physician relationship management are compelling: A single physician, whether in primary care or a specialty, can generate more than $1.5 million in revenue each year, so it’s a heavy price when referrals and procedures are lost to competitors.

The infographic drills down on how to build an effective physician relationship management strategy.

A profitable by-product of CMS’s aggressive pursuit of value-based healthcare delivery is a menu of revenue opportunities associated with care management of the Medicare population.

Physician Reimbursement in 2016: 4 Billable Medicare Events to Maximize Care Management Revenue and Results details the ways in which Bon Secours Medical Group (BSMG) leverages a team-based care approach, expanded care access and technology to capitalize on four Medicare billing events: transitional care management, chronic care management, Medicare annual wellness visits and advance care planning.

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Have an infographic you’d like featured on our site? Click here for submission guidelines.

Guest Post: 5 ACO Competencies to Create Value-Based Change

May 3rd, 2016 by Bob Wadsworth, Client Executive, Freed Associates

Only when an accountable care organization (ACO) succeeds in both delivering high-quality care and spending healthcare dollars wisely will it share in savings it achieves from its efforts. In this guest post, Bob Wadsworth, Client Executive with Freed Associates, suggests five steps for organizations to consider as they think critically about ACO development.

Step 1: Set Holistic Quality Goals

In care management, simpler is often better, especially if the same program can be used across numerous payor-specific ACOs. Some program capabilities are needed to address unique and specific line-of-business needs; others work across multiple insurance lines. If several ACO contracts delegate medical management, healthcare delivery organizations have the opportunity to set up across-the-board quality and cost/utilization management programs to achieve steadily improving quality, resource efficiency, and patient satisfaction improvements.

To prevent assumptions about the burden of illness in attributed populations, get smart on their risk profiles. Find the target populations for risk/care management, and match them to specific programs. Better-performing ACOs have high-cost stratification in place for common episode treatment groups (ETGs) with high incidence rates and uncommon ETGs with lower incidence rates, allowing them to proactively address care coordination needs for an all-encompassing set of expensive chronic episodes.

Integrated care management efforts require clinical staff to re-think and remodel their care approach, from a physician-only care delivery model to one involving team-based care across the medical, behavioral health, and social services continuum. It requires empowerment of care team members, and ensuring all roles are operating at the “top of their license” with clear delineation of who’s coordinating what across a range of medical and non-medical services.

Step 2: Emphasize Financial and Organizational Goals

Your board and physician leadership need to be aligned with your long-term plan for reimbursement mix changes. Establish how you plan to grow at-risk lives over your planning time horizon, specify percentage shifts in fee-for-service (FFS) and at-risk revenues. Given the increasing exposure to downside insurance risk in shared risk and capitation contracts, this is a difficult, yet essential, dialogue. This value-based transformation should be led by your CEO, CFO, and clinical leadership in visible ways.

Be clear about the financial impact of the value-based ACO model and the individual contributions required of clinicians and administrative staff to reach sustained financial viability under new reimbursement models. Align financial incentives, such as individual physician bonus programs, with the new ACO financial contract structure.

As second-generation ACOs gain steam, they get smarter on their end-to-end risk/care management models. Many ACOs build up internal HIT knowledge and secure objective, third-party input on enterprise-wide HIT strategies. These strategies will address overall enterprise needs and narrow the unique line of business needs. The objective of this effort should be to align senior staff on a multi-year, holistic vision of the organization and its operations. It can pay for itself by identifying technology rationalization opportunities (latent or un-identified by staff who could be wedded to a particular solution/vendor because of convenience or other subjective criteria).

Step 3: Involve People and Roles

Aligning the roles of patient care delivery staff to support an ACO model is a cultural and operational shift. First, educate clinical and administrative staff on management expectations for their departments and how individual roles might change. The dual focus on both quality and cost efficiency can be a difficult transition. Provide real examples and proof points, such as showing how reduced utilization through use of evidenced-based medicine guidelines (and joint physician/patient decision-making) can benefit the patient, curb medical cost inflation, and increase patient satisfaction.

As you examine roles in a new ACO world, there may be duplicative roles across your organization and others, particularly payor medical management and inpatient case management. Remind staff that moving along the ACO ‘change curve’ will require a series of steps, with changes happening incrementally inside and outside the organization. Management’s goal is to orchestrate these changes in ways that incremental quality, cost, and patient satisfaction improvements can be readily seen as “waypoints” toward the desired future state of the enterprise.

Step 4: Create and Maintain Sustainable Processes

Process orientation and management is becoming a valuable competency in most ACOs. First, develop a process to identify the right group of patients for care coordination. If you don’t have the patient “risk score” data needed in-house, collaborate with your payors; they’re likely rich with the information needed to make informed decisions about areas of focus. Staff the care coordination of higher risk patients accordingly, using conservative case load benchmarks in the beginning, so case managers/care coordinators are not initially overwhelmed by productivity expectations. Work intelligently to determine the location of care coordination roles and their work activity —those that should be situated centrally or at physician offices. Measure results and continuously modify and improve processes.

Being process-oriented means being “performance tracking”-oriented. Develop measurement capability so leaders can be informed by dashboards that tell them the health of the processes along with results. Inform and engage physicians continuously during the change process, so they can effectively champion the improvements.

Step 5: Connect with the Right Technology

One area of potential long-term financial gain is making better use of existing technologies, or replacing them with simpler, cheaper, and more effective technologies. Your organization may have purchased a veritable hodgepodge of niche technologies. But are they all working together to your utmost advantage? Might a narrower set of existing and new solutions be far better than, say, six disparate systems? As your ACO begins accepting more financial risk, the need to enhance IT systems increases, so people and processes supporting ‘risk management’ can be sufficiently supported.

In an ACO world, it’s essential that technology be placed within the natural workflow of clinical staff. If they’re taking a lot of extra time training and re-training themselves to use a particular technology, they’ll be relieved when provided with a less time-consuming, superior solution in one or a few, easy-to-use software applications.

Be sure your technologies meet multi-payor needs, so that a simpler technological footprint can be realized, which has speed and cost-to-market benefits when trying to improve overall operations. A simpler and easy-to-use technology portfolio will likely yield improved patient service and quality, and provide the benefit of higher staff satisfaction with their work environment.

Bob Wadsworth joined Freed Associates in 2015 as a Client Executive. He has significant experience in deploying technology for cost, quality, and service improvement in both payor and provider operational settings. Prior to this position, Bob was a senior vice president of healthcare delivery networks with an integrated care management software company. He also has held executive positions at a large health plan and leadership positions in other health care technology companies, in addition to his management consulting experience.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

CMS Postpones LOI Deadline to May 2, Readies for Next Wave of ‘Next Generation ACO’ Participants

March 10th, 2016 by Patricia Donovan

Update: On March 11, 2016, the Centers for Medicare and Medicaid Services (CMS) pushed back the deadline for letters of intent for 2017 Next Generation ACO participation to May 2, 2016.

ACO

April 1 is the deadline to submit a letter of intent to participate in the Next Generation ACO Model in 2017.

Letters of intent from healthcare organizations interested in applying to the Next Generation ACO Model for the January 1, 2017 start date must be submitted by April 1, 2016, according to an update from the Centers for Medicare and Medicaid Services.

The letter of intent (LOI) as well as more information about CMS’s newest accountable care organization model, including dates and times for Application Open Door Forums, can be found on the Next Generation ACO Model web page.

Only organizations that submit an LOI will be able to complete an application. Even applicants that submitted an application previously but are not participating in the Next Generation ACO Model for 2016 must complete and submit an LOI if they wish to apply to participate in the Next Generation ACO Model beginning in 2017, CMS stated.

Subsequent to the organization’s LOI, applications for 2017 Next Generation ACOs will be due in two parts:

  • The narrative portion is due May 25, 2016; and
  • The Participating Provider list is due June 3, 2016.

If an organization plans to submit more than one LOI, it should use a different email address for the primary contact listed on each LOI submission, CMS said in its Next Generation ACO LOI and application FAQs.

In 2016, there are currently 21 ACOs participating in the Next Generation ACO Model, an initiative for ACOs that are experienced in coordinating care for populations of patients. The Next Generation ACO model allows these provider groups to assume higher levels of financial risk and reward than are available under the current Pioneer and Shared Savings Program (MSSP) models. The goal of the Next Generation ACO model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for Original Medicare fee-for-service (FFS) beneficiaries.

2015 metrics from the Healthcare Intelligence Network (HIN) found that one-fifth of healthcare organizations expect to participate in CMS’ new ‘Next Generation’ ACO Model in the future.

View an infographic on the Next Generation ACO model.

An April 5th webinar hosted by the Healthcare Intelligence Network will provide a value-based, risk contract roadmap to determine organizational readiness for participation in the Next Generation ACO Model in particular and in risk-based contracts in general. Click here for more details.

ACO Trends for Hospitals & Health Systems: 9 Metrics to Know

September 24th, 2015 by Patricia Donovan

Of all healthcare sectors, hospitals and health systems are the most engaged in ACO activity, with 72 percent belonging to an accountable care organization (ACO), versus 50 percent of overall respondents to the 2015 Accountable Care Organizations survey by the Healthcare Intelligence Network.

Hospitals and health systems made a strong showing in HIN's fourth annual ACO activity and trends snapshot.

Moreover, respondents in this sector are united on many ACO fronts, reporting 100 percent commitment to the following: use of electronic health records (EHRs); inclusion of population health management and care coordination in their ACOs; adoption of NCQA guidelines for ACO recognition; review of clinical outcomes, health claims and health utilization data to measure ACO success; and designation of program rollout as the chief challenge of ACO creation.

And while not unanimous, hospital ACOs are almost twice as likely to be administered by a physician-hospital organization (60 percent, versus 28 percent overall); and to incorporate telehealth into their ACO framework (60 percent versus 34 percent overall).

This fourth comprehensive accountable care snapshot by the Healthcare Intelligence Network also found that ACOs within the hospital/health system sector, which comprised 11 percent of 2015 survey respondents, are twice as likely to employ 100 to 500 physicians (a metric reported by 60 percent of hospitals and health systems, versus 29 percent overall).

Also, hospitals have the largest number of pending ACOs, with half of those not already in an ACO expecting to be part of an ACO launch in the next twelve months, as compared to 25 percent overall.

Additionally, 40 percent of hospital-reported ACOs say they will participate in the Next Generation ACO Model, the latest Medicare Accountable Care Organization introduced by CMS, as compared to 21 percent of overall respondents, the survey found.

On the payment front, the hospital sector reports the highest use of a “fee for service + care coordination + shared savings” reimbursement model within their ACOs (60 percent versus 45 percent overall), the survey found.

Return on investment for hospital ACOs also tended to be healthier, with responding hospitals almost four times more likely to report ACO ROI between 3:1 and 4:1 (20 percent of hospitals versus 5 percent overall).

Finally, despite robust value-based activity, this sector expressed the most skepticism over CMS’s ability to shift half of Medicare payments to value-based models, with 71 percent doubting Medicare would meet this 2018 goal, versus 46 percent of responding healthcare organizations overall.

Source: 2015 Healthcare Benchmarks: Accountable Care Organizations

ACO Evolution from 2011-2015: 8 Year-Over-Year Trends

July 21st, 2015 by Patricia Donovan

ACO Trends 2011-2015

Today's ACOs are larger, busier and better staffed than they were four years ago, according to a HIN year-over-year analysis.

Adoption of accountable care organizations (ACO) has more than tripled in four years and clinical integration continues to challenge non-adopters, according to a Healthcare Intelligence Network analysis of accountable care organization benchmarks from 2011 to 2015.

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.

Source: 2015 Healthcare Benchmarks: Accountable Care Organizations

Integrated Networks Trigger Rise in Post-Acute Care Accountability

June 25th, 2015 by Patricia Donovan

Healthcare is examining new post-acute care (PAC) delivery and reimbursement models.

As physician-hospital associations (PHOs) and clinically integrated networks increasingly monitor referrals and where patients go once they leave the office or hospital setting, the post-acute care market will be held more accountable for the quality and cost of care they provide and their ability to manage readmissions, predicts Travis Ansel, senior manager with the Healthcare Strategy Group. Here, Ansel suggests how PHOs might prepare for the eventual inclusion of post-acute care in their networks.

Healthcare Strategy Group did a lot of work in Arkansas in 2011 and 2012. As providers started being held accountable for what happened once their patients left the hospital, post-acute care became very relevant in the Arkansas market. This was due to the impact on the providers, and on the physicians of the hospitals in that market. Almost immediately upon the announcement of the models, the hospital started bringing in different post-acute care organizations, saying, These are our incentives. We’re trying to manage patients who have been assigned these diagnosis-related groups (DRGs). We’re trying to manage these factors for those patients. Either you’re going to be the one to help us to do it, or we’ve going to find someone else in the market to do it.

My general expectation would be that as hospitals and physicians get together and start talking more about how post-acute care affects them, we’ll see them bringing in post-acute care to have that discussion: either help us with what we’re being held accountable for, or we will find someone else who can.

The natural market reaction to that is post-acute care organizations will either compete to respond to those requirements, because there will be some opportunity to grow market share or grow reimbursement if they’re effective in responding to those things.

We’ve already seen a tremendous amount of consolidation in the post-acute care world over the last five to ten years. To me, that would signal a lot more consolidation, the same as we’ve seen with the provider market. They’re going to look for a capital infusion and build competencies that will help them respond to PHOs’ requests.

Note: Have more thoughts on the rise of accountability for post-acute care? Answer 10 Questions on Post-Acute Care Trends.

Source: Physician-Hospital Organizations: Framework for Clinical Integration and Value-Based Reimbursement

Travis Ansel, MBA, is a Manager, Strategic Services with Healthcare Strategy Group, LLC, with a primary focus on hospital strategic planning, physician alignment planning and clinical integration.

Are Multi-Specialty Physician Groups ‘Next Generation’ to Transition to ACOs?

March 26th, 2015 by Cheryl Miller

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

http://hin.3dcartstores.com/2014-Healthcare-Benchmarks-Embedded-Case-Management-_p_4985.html

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.