Making The Move To ACOs

Compiled by Ken Congdon, editor in chief, Health IT Outcomes

ACO (Accountable Care Organization). It's the hottest new buzzword in healthcare, and it's got healthcare institutions throughout the U.S. scrambling to modify their processes to survive in a reimbursement environment based upon accountable care as opposed to the traditional pay-for-service model. While the delivery of care via ACOs seems imminent in the near future, much is still unknown about exactly how an ACO should be structured and how the distinct stakeholders in an ACO will ultimately be paid by both government programs and private insurers. Health IT Outcomes recently had the opportunity to speak with key executives at healthcare facilities that have proven to be pioneers in the area of ACOs. Their ACO strategies and experiences to date may provide you with some tips on how to construct your own ACO game plan.

Q: WHAT ARE YOUR BIGGEST CONCERNS REGARDING THE ACO CONCEPT?

Morrison: As a CIO, my biggest concern is juggling the ACO transition in line with all the other huge IT initiatives (e.g. EHR meaningful use, ICD-10 and HIPAA 5010 conversions, etc.) that are currently on my plate. All of these initiatives have some fairly significant implications over the next year or two and need to be prioritized appropriately.

Outside of that, the next biggest concern is deciding what type of ACO model we're going to follow. There are a myriad of ACO models out there — there's a bundled payment model, there's a pay-for-quality model, there's a shared savings model, there's a model that incorporates elements of capitation, etc. The ways you're reimbursed under each model is slightly different, as is the path you need to follow in order to be successful.

For example, Medicare has proposed a shared savings model that facilities can begin to participate in beginning in January 2012. Medicare's model is focused on utilization management. In the Medicare world, providers have historically been paid based on the procedures or services they perform, and everyone is paid the same. The Medicare shared savings model now incentivizes providers to do less while ensuring the quality of patient care doesn't suffer. There are 65 quality metrics that to be met in order to qualify for the reimbursement payment. Currently, this is the model we are leaning toward at Concord Hospital.

Other models focus less on utilization and more on pay-for-performance. This is the way many private payer ACO models have been structured. This model can potentially introduce an added layer of complexity. Furthermore, Medicare doesn't have much of the historical data that would be necessary to measure performance. Access This Content To Read This Article In Its Entirety.