Major Healthcare Payers, Providers Say Financial Implications, Agreement On Quality, Cost/Efficiency Are Top Challenges In Forming Commercial ACOs
Groups detail key areas of consensus, disagreement in MedeAnalytics research
Senior executives at two dozen of the nation's top payer and provider organizations agree that the Medicare Shared Savings Program (Medicare accountable care organization (ACO) provision within health reform) and competition—not pressure from employers—are driving the formation of commercial ACOs.
These findings are contained in a third-party market research report commissioned by MedeAnalytics, a leading provider of healthcare performance management solutions.
Commercial ACOs, which have been described in a variety of ways, are distinct from Medicare ACOs in that a commercial payer, rather than Medicare, is the entity providing the financial incentives to the provider organizations for quality and cost performance.
The study also revealed that payers believe the top two challenges to starting an ACO are: 1) the financial implications (risks, model for shared savings), and 2) gaining agreement on quality and cost/efficiency measures.
Both groups agreed electronic medical records (EMRs), with the capability to share data between providers, along with a strong base of primary care physicians (PCPs), are the essential components or competencies for a successful ACO. Click here to download a white paper on meaningful use of EMRs.
Areas of agreement: The ACO research identified the following areas of consistency and agreement between payers and providers:
- Factors driving the formation of commercial ACOs (i.e.. Medicare ACOs and competitive pressures)
- The top challenges to starting an ACO (financial implications and gaining agreement on quality and cost/efficiency measures)
- Some of the top key performance indicators for cost/efficiency (admissions, length of stay and utilization)
- The necessity of an EMR for the success of the ACO
- The need for improved reporting and clinical data exchange capabilities to make an ACO model work
Differing perspectives: Payers and providers had, in general, different views in these areas:
- Who should develop quality measures for the ACO? In contrast with the payers—a solid majority of which favored a collaborative approach involving all three parties (payer, hospital, physicians)—a third of the providers surveyed felt that hospitals alone should develop quality KPIs, equal to the number who supported a collaborative approach.
- KPIs for quality: Not surprisingly, payers identified the National Center for Quality Assurance's Healthcare Effectiveness Data and Information Set (HEDIS) as a preferred umbrella measure set, which the vast majority of them use currently. In contrast, providers specified CMS core measures, hospital-acquired infections, readmissions, mortality and patient satisfaction.
Researchers spoke to senior executives from integrated delivery networks, physician practices and commercial payers which were already involved in commercial ACOs or planning to do so within a year. The overall objectives of the research were to assess perceptions, drivers, challenges and the developing needs related to creating or participating in a commercial ACO. The actual research was conducted in December 2010.
About MedeAnalytics
Founded in 1994, MedeAnalytics delivers performance management solutions across the healthcare system—including hospitals, physician practices and payers—to ensure accountability and improve financial, operational and clinical outcomes. For more information, visit www.medeanalytics.com.
SOURCE: MedeAnalytics