Pay­ers and Pur­chasers

Modern Healthcare - - 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.”

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