How an Accountable Care Organization Helps Transform Care

This cross-site comparison of the early experience of four provider organizations participating in the Brookings-Dartmouth Accountable Care Organization Collaborative identifies factors that sites perceived as enablers of successful ACO formation and performance. The four pilots varied in size, with between 7,000 and 50,000 attributed patients and 90 to 2,700 participating physicians. The sites had varying degrees of experience with performance-based payments; however, all formed collaborative new relationships with payers and created shared savings agreements linked to performance on quality measures. Each organization devoted major efforts to physician engagement. Policy makers now need to consider how to support and provide incentives for the successful formation of multipayer ACOs, and how to align private-sector and CMS performance measures. Linking providers to learning networks where payers and providers can address common technical issues could help. These sites' transitions to the new payment model constitutes an ongoing journey that will require continual adaptation in the structure of contracts and organizational attributes.

International Journal of Environmental Research and Public Health

Accountable Care Organizations (ACOs) seek sustainable innovation through the testing of new care delivery methods that promote shared goals among value-based health care collaborators. The Morehouse Choice Accountable Care Organization and Education System (MCACO-ES), or (M-ACO) is a physician led integrated delivery model participating in the Medicare Shared Savings Program (MSSP) offered through the Centers for Medicare and Medicaid Services (CMS) Innovation Center. The MSSP establishes incentivized, performance-based payment models for qualifying health care organizations serving traditional Medicare beneficiaries that promote collaborative efficiency models designed to mitigate fragmented and insufficient access to health care, reduce unnecessary cost, and improve clinical outcomes. The M-ACO integration model is administered through participant organizations that include a multi-site community based academic practice, independent physician practices, and federally qualified he...

Circulation, 2015

Journal of general internal medicine, 2014

H ealth care, like electricity, is an instrumental good, a means to an end. We don't want kilowatt hours; we want hot showers and cold beer. We don't want to trek to the physician's office, we want health. How markets are structured determines how people behave. Energy policies have begun to reward utility companies for keeping people warm at the least possible cost, for example, through home insulation programs. Similarly, payment reforms in health care have begun to move away from those that reward volume to alternative approaches intended to improve the value of care. Patient-centered medical homes (PCMHs) were an important step, as fee-for-service payment provided no direct support for many key functions of primary care. Accountable care organizations (ACOs) were another advance, as they encourage collaboration across providers to improve care and lower costs. As we approach the fifth anniversary of the passage of the Affordable Care Act, it is a good time to reflect on how we are doing in payment policy-and how we might do better.

Health Affairs, 2013

Rural policy brief, 2014

Accountable Care Organizations (ACOs) are groups of providers (generally physicians and/or hospitals) that may receive financial rewards by maintaining or improving care quality for a group of patients while reducing the cost of care for those patients. The Patient Protection and Affordable Care Act of 2010 (ACA) established a Medicare Shared Savings Program (MSSP) and accompanying Medicare ACOs to “facilitate coordination and cooperation among providers to improve the quality of care for Medicare fee-for-service (FFS) beneficiaries and reduce unnecessary costs.” The MSSP now includes 343 ACOs; an additional 23 ACOs participate in the Medicare Pioneer ACO demonstration program, and there are approximately 240 private ACOs. Based on our analysis, among the Medicare ACOs 119 operate in both rural and urban counties and seven operate exclusively in rural counties. A little over 24 percent of non-metropolitan counties are included in Medicare ACOs. To assist rural providers considering ...

Health policy (Amsterdam, Netherlands), 2014

A historically fragmented U.S. health care system, where care has been delivered by multiple providers with little or no coordination, has led to increasing issues with access, cost, and quality. The Affordable Care Act included provisions to use Medicare, the U.S. near universal public coverage program for older adults, to broadly implement Accountable Care Organization (ACO) models with a triple aim of improving the experience of care, the health of populations, and reducing per capita costs. Private payers in the U.S. are also embracing ACO models. Various European countries are experimenting with similar reforms, particularly those in which coordinated (or integrated) care from a network of providers is reimbursed with bundled payments and/or shared savings. The challenges for these reforms remain formidable and include: (1) overcoming incentives for ACOs to engage in rationing and denial of care and taking on too much financial risk, (2) collecting meaningful data that capture ...

Pediatrics, 2015

Accountable care organizations (ACOs) are responsible for costs and quality across a defined population. To succeed, the ACO must improve value by reducing costs while either maintaining or improving the quality of care. We examined changes from 2008 through 2013 in the cost and quality of care for Partners for Kids (PFK), a pediatric ACO serving an Ohio Medicaid population. We measured the historical cost of care for PFK and gathered comparison statewide Ohio Medicaid fee-for-service (FFS) and managed care (MC) cost histories. Changes in quality of care measures were assessed by using 15 Agency for Healthcare Research and Quality Pediatric Quality Indicators and 4 indicators targeted by PFK. PFK per-member-per-month costs were lower in 2008 than either FFS or MC (P < .001) costs and grew at a rate of $2.40 per year compared with FFS increases of $16.15 per year (P < .001) and MC increases of $6.47 per year (P < .121) with ∼3.5 million member-months each year. The quality o...

Journal of Healthcare Management, 2016

Oregon's coordinated care organizations (CCOs) are an integral part of a massive statewide reform that brings accountable care to Medicaid. CCOs are regional collaboratives among health plans, providers, county public health, and communitybased organizations that administer a single global budget covering physical, mental, and dental healthcare for low-income Oregonians. CCOs have been given freedom within the global budget to implement reforms that might capture efficiencies in cost and quality. For this study-fielded between 2012 and 2015-we traced the path of the global budget through the interior structures of two of Oregon's most promising CCOs. Using document review and in-depth qualitative interviews, we synthesized and summarized descriptive narrative data to produce case studies of the financial models in each CCO. We found that the CCOs feature substantially different market contexts, governance models, organizational structures, and financial systems.

Health Affairs, 2012

Patient-centered, accountable care has garnered increased attention with the passage of the Affordable Care Act and new Medicare regulations. This case study examines a care model jointly developed by a provider and a payer that approximates an accountable care organization for a Medicare Advantage population. The collaboration between Aetna and NovaHealth, an independent physician association based in Portland, Maine, focused on shared data, financial incentives, and care management to improve health outcomes for approximately 750 Medicare Advantage members. The patient population in the pilot program had 50 percent fewer hospital days per 1,000 patients, 45 percent fewer admissions, and 56 percent fewer readmissions than statewide unmanaged Medicare populations. NovaHealth's total per member per month costs across all cost categories for its Aetna Medicare Advantage members were 16.5 percent to 33 percent lower than costs for members not in this provider organization. Clinical quality metrics for diabetes, ischemic vascular disease, annual office visits, and postdischarge followup for patients in the program were consistently high. The experience of developing and implementing this collaborative care model suggests that several components are key, including robust data sharing and information systems that support it, analytical support, care management and coordination, and joint strategic planning with close provider-payer collaboration.