Payers and Purchasers
to improve, he says. “An ACO is not an HMO,” James says.
More quality measures will be added to the accountable care pilot during the second year, which began in July, Hester says, although the Dartmouth and Brookings policy experts won’t select them. Norton and Humana will identify measures where the partners see an opportunity for improvement. Second-year efforts will also target health spending growth, he says.
James says the partners will share first-year results with area employers in an effort to recruit more patients into the pilot.
For Norton, work to develop and operate the private-market ACO helped as the health system completed the Center for Medicare and Medicaid Innovation application to test various ACO models, Hester says.
The CMS declined to say how many applied for the Innovation Center experiment—the plans are known as Pioneer ACOs—which policymakers proposed as an alternative to more-restrictive plans for accountable care under draft Medicare rules. Congress outlined criteria for Medicare accountable care in the 2010 health reform law, but allowed for further experiments under the Innovation Center.
Norton gained experience identifying ACO patients and transferring data during the Dartmouth-Brookings pilot that proved useful for its Innovation Center application, Hester says. But the Medicare pilot will also present new challenges, including patients who are older than commercially insured patients. For example, that could mean more congestive heart failure patients, a condition more common among the elderly. Providers would need to develop new interventions for heart failure patients. Meanwhile, diabetes is more common among commercially insured patients.
Hester says Norton officials won’t rule out other proposed reform models and must settle unanswered questions before committing as an accountable care Pioneer. Ultimately, that did not prevent Norton from applying to participate. It’s unclear where health reform is going, Hester says. “Being involved in the process is better than waiting.”