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12 Trends on the ACO Frontier

Posted by Matthew Smith on May 9, 2014 11:36:00 AM

ACO, Accountable Care, Health DirectionsThe accountable care organization (ACO) movement continues to heat up. In fact, looking ahead, there is a greater number of ACOs in the wings than one year ago.

Forty-four percent of developing ACOs will be helmed by physician-hospital organizations, according to a new infographic from the Healthcare Intelligence Network.

This HINfographic examines 12 emerging ACO trends at 138 healthcare organizations and delivers tactics from a top performing Pioneer ACO, Monarch HealthCare.

Infographic source: Healthcare Intelligence Network

ACO, Accountable Care Organization, Health Directions, Infographic

MSSP, Medicare Shared Savings Program, ACO, Accountable Care

Topics: Accountable Care, ACO, Accountable Care Organizations, Pioneer ACO, PHO

Infographic: 12 Trends on the ACO Frontier for 2014

Posted by Matthew Smith on Nov 6, 2013 1:19:00 PM

ACO, Accountable Care, Pioneer ACOThe accountable care organization (ACO) movement shows no signs of slowing. In fact, looking ahead, there is a greater number of ACOs in the wings than one year ago.

Forty-four percent of developing ACOs will be helmed by physician-hospital organizations, according to a new infographic from the Healthcare Intelligence Network.

This HINfographic examines 12 emerging ACO trends at 138 healthcare organizations and delivers tactics from a top performing Pioneer ACO, Monarch HealthCare.

Infographic source: Healthcare Intelligence Network

ACO, Accountable Care Organizations

 

Topics: Accountable Care, ACO, Accountable Care Organizations, Pioneer ACO, PHO

100% of Pioneer ACOs Improved Patient Quality; 56% Lowered Costs

Posted by Matthew Smith on Jul 16, 2013 12:42:00 PM

ACO, Pioneer ACO, Accountable Care OrganizationNOTE: This article originally appeared at Project Millennial, a site focusing on American health policy. 

After a slew of disheartening press releases from the Center for Medicare and Medicaid Services (CMS) about the Affordable Care Act’s growing pains, the Obama administration is probably quite happy to see the initial results of one of the law’s most important provisions: Accountable Care Organizations (ACOs). You should be too.

But the framing of the results may give the typical reader a false impression of what’s actually transpired. From an article by Melinda Beck in the Wall Street Journal titled “Mixed Results in Health Pilot Plan”:

All of the 32 health systems in the so-called Pioneer Accountable Care Organization program improved patient care on quality measures such as cancer screenings and controlling blood pressure, according to data to be released Tuesday by the Centers for Medicare and Medicaid Services. But only 18 of the 32 managed to lower costs for the Medicare patients they treated — a major goal of the effort. Two hospitals lost money on the program in the first year. ”

Does that sound mixed to you? Let’s restate it a bit: All of the 32 health systems in the so-called Pioneer Accountable Care Organization (PACO) program improved patient care on quality measures such as cancer screenings and controlling blood pressure. Eighteen (56% of PACOs) managed to lower costs for the Medicare patients they treated, saving $140 million in costs. Of that, they’ll receive $76 million, and $33 million will be returned to the Medicare Trust Fund. Only two of the 32 PACOs lost money in the first year.

Or, in charts:

Put that way, the program sounds a bit more successful, right?

Partners Healthcare, the Boston-area hospital conglomerate, was one of the winners, and will get a check for $7 million from CMS. Of the two PACOs to lose money, one did so, its executive director said, because its cost baseline was artificially low. It will cut a check to CMS for $2 million. Even so, it isn’t one of the nine that are reported to be leaving the program — it’s sticking around.

Make no mistake: These aren’t mixed results. These are unambiguously positive results for one of the most important provisions in the Affordable Care Act.

Should we have expected all 32 PACOs to save money in the first year of a nascent program? Probably not. And they didn’t — 44% either failed to reduce costs or lost money on the program. But, as the director of CMS’s Innovation Center put it, we shouldn’t have expected all 32 to improve patient care, either: “It’s very rare that 100% of the participants outperform benchmarks.” And they did.

This is only the first year of a program that is reinventing the way the American health care system operates. And it worked. Full stop.

Three-quarters stop, actually: It’s important to keep in mind that the PACOs are, well, weird. For starters, they are Pioneer ACOs because they already had ACO-like qualities, so they have a head start on other hospital systems and are perhaps uniquely qualified to initially succeed. Then there’s the fact that they self-selected into a brand-new program that could cost them millions in missed Medicare reimbursements. Their finance departments crunched the numbers and guessed that they could make money (or at least wouldn’t lose money). Most were right. And PACOs operate under slightly different rules than the average ACO will, starting in 2014. For the first two years, for example, PACOs are playing under the old fee-for-service rules, then will move to global payments, and only PACOs have two-sided risk — they can share in savings and losses, while typical Medicare ACOs will only share in savings.

In other words, PACOs aren’t “average” health systems, and they aren’t “average” ACOs, so it’s obviously premature to say that all ACOs will work.

Still, that doesn’t invalidate these results, and it doesn’t invalidate the hope that ACOs are one policy innovation that can help bend the cost curve in a real, significant way.

Topics: Accountable Care, ACO, Accountable Care Organization, Obamacare, Pioneer ACO

60 ACOs Launch National Association of Accountable Care Organizations

Posted by Matthew Smith on Feb 12, 2013 1:17:00 PM

ACO, Accountable Care Organization, NAACOSixty accountable care organizations are charter members of the new National Association of ACOs and seek more members.

The group recently formed and presently is governed by an interim board until elections in June. The Washington-based association will focus on fostering growth of ACOs, influencing development of public policy, developing uniform quality and performance measures, engaging the vendor community and educating the public.

The Centers for Medicare and Medicaid Services recently recognized 258 ACOs working with Medicare and/or Medicaid, and there are numerous other ACOs across the nation working with commercial insurers. Annual membership fees in the new association range from $3,500 to $10,000, depending the size of the ACO. The first annual conference of the association is scheduled for March 19-21 in Baltimore, by which time the group hopes to have more than 100 members.

Vendors also are encouraged to participate in the association as business partners. An annual “supporting membership” fee of $5,000 includes complimentary exhibit space at the March conference, the option to attend other meetings, a listing on the association Web site, and the ability to send emails to the member list twice annually.

More information for ACOs and vendors is available at naacos.com.

Topics: Accountable Care, ACO, Accountable Care Organizations, Population Health Management, Pioneer ACO, NAACOS

Map of 2012 Medicare Accountable Care Organizations

Posted by Matthew Smith on Nov 26, 2012 10:33:00 AM

While it's easy to view a list of ACOs, it's always interesting to see where these ACOs are in relation to one another. This new map from CMS provides a quick snapshot of Pioneer ACOs, Advance Payment ACOs, and Medicare Shared Savings ACOs throughout the United States.

Visual courtesy of CMS.

Topics: Accountable Care, ACO, Accountable Care Organizations, Population Health Management, Pioneer ACO

Top 25 Diagnoses for Pioneer ACOs

Posted by Matthew Smith on Sep 18, 2012 2:21:00 PM

green caduceus icon green clipart 83380669 resized 600The following information pertains to the first 32 CMS Pioneer Accountable Care Organizations in 2011. Data was provided by Stratasan and published in a Jarrard Phillips Cate & Hancock blog post. 

There were a total of 15,245,067 admissions in this time period out of the 75,104,205 people who lived in the geographical coverage area of the ACOs in 2011. These are the top 25 primary ICD-9 diagnoses with the respective number of inpatient visits. 

1. Supplementary classifications — 2,150,629

2. Disease of the circulatory system — 1,271,469

3. Females with deliveries — 947,421

4. Heart disease — 816,933

5. Disease of the digestive system — 811,833

6. Diseases of the respiratory system — 797,652 

7. Injury and poisoning — 689,136

8. Disease of the musculoskeletal system and connective tissue — 510,330

9. Disease of the genitourinary system — 457,144

10. Mental disorders — 454,974

11. Endocrine, nutritional and metabolic disease and immunity disorders — 421,046

12. Neoplasms — 391,270

13. Psychoses — 323,919

14. Malignant neoplasms — 301,355

15. Infectious and parasitic diseases — 262,760

16. Pneumonia — 253,413

17. Fractures, all site — 244, 254

18. Disease of the nervous system and sense organs — 228,021

19. Congestive heart failure — 223,144

20. Certain complications of surgical and medical care — 216,035

21. Osteoarthritis and allied disorders — 215,351

22. Cerebrovascular disease — 202,253 

23. Disease of the skin and subcutaneous tissue — 177,758

24. Cardiac dsyrhythmias — 164,243

25. Coronary atherosclerosis — 157,930

Topics: Accountable Care, ACO, Clinical Integration, Clinically Integrated Care, Accountable Care Organizations, Pioneer ACO

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