Sur­vival tips for pi­o­neer­ing ACO'S

ACO Pi­o­neers mak­ing ten­ta­tive plans

Modern Healthcare - - FRONT PAGE - Melanie Evans

Medi­care’s first ex­per­i­ment with ac­count­able care started with the New Year. But for the hos­pi­tals and doc­tors that agreed to closely man­age med­i­cal care and spend­ing for 860,000 se­niors, it’s too soon to tell what new in­vest­ments the ini­tia­tive will re­quire, ex­ec­u­tives say. The 32 med­i­cal groups, health sys­tems and hos­pi­tals named last month by the CMS as ac­count­able care “Pi­o­neers” were se­lected, in part, for their readi­ness and re­sources. But much of providers’ plan­ning will de­pend on what type of care pa­tients need. That in­for­ma­tion is con­tained in data hos­pi­tals and doc­tors won’t get un­til af­ter pa­tients are no­ti­fied and given a chance to opt out, they said. Pioneer ACOS will be­gin to re­ceive data this month or early in Fe­bru­ary, ac­cord­ing to the CMS.

The CMS an­nounced the Pi­o­neers in the fi­nal weeks of last year and touted the ef­fort as a money-sav­ing push to im­prove pa­tient care. Pi­o­neers are pro­jected to save Medi­care up to $1.1 bil­lion over five years, fed­eral of­fi­cials said. The pay­ment model, how­ever, is largely untested. Un­der ac­count­able care, hos­pi­tals and doc­tors agree to meet qual­ity and cost-con­trol tar­gets and re­ceive a share of sav­ings, if suc­cess­ful.

The CMS will test ac­count­able care more broadly in the com­ing year un­der the Medi­care shared sav­ings pro­gram. In both pro­grams, fi­nan­cial in­cen­tives are based on a per­cent­age of how much providers can re­duce Medi­care spend­ing com­pared with what it might other­wise be. How­ever, hos­pi­tals and doc­tors must also meet cer­tain qual­ity per­for­mance tar­gets be­fore they can earn bonuses.

Un­der the shared sav­ings pro­gram, how­ever, providers face less po­ten­tial risk or no risk at all, but will see smaller pos­si­ble bonuses. The CMS en­vi­sions that pro­gram as draw­ing a broader range of providers per­haps less pre­pared for the ex­per­i­ment out of the gate.

Some in­vest­ments, such as tech­nol­ogy, were al­ready un­der way but will be ac­cel­er­ated for the pro­gram, ex­ec­u­tives with Pioneer ACOS said. Oth­ers are en­tirely new. Irvine, Calif.-based Monarch Health­care, for ex­am­ple, added a vice pres­i­dent of ac­count­able care.

Dr. Jay Co­hen, ex­ec­u­tive chair­man of Monarch Health­care, an independent prac­tice as­so­ci­a­tion, said the new se­nior po­si­tion was cre­ated as a re­sult of work on com­mer­cial ac­count­able care and pre­lim­i­nary prepa­ra­tion for Medi­care’s ini­tia­tive. Other newly cre­ated jobs— co­or­di­na­tors to help pa­tients nav­i­gate the sys­tem, a data an­a­lyst, and likely an­other job in in­for­ma­tion tech­nol­ogy—will fol­low, he said.

Keith Pugliese, vice pres­i­dent of ac­count­able care and pub­lic pol­icy for Brown & Toland Physi­cians, an independent prac­tice as­so­ci­a­tion in San Fran­cisco, said prior tech­nol­ogy in­vest­ments and ex­ist­ing chronic dis­ease pro­grams would sup­port its Medi­care ac­count­able care ef­fort. The physi­cian group may ex­pand its staff to meet the need of 17,500 Medi­care en­rollees ex­pected to re­ceive care from the ACO, he said. “We’re pre­pared,” Pugliese said.

Many de­ci­sions will be driven by data the CMS pro­vides re­gard­ing Medi­care ben­e­fi­cia­ries as­signed to each ACO, and Pioneer ex­ec­u­tives say that un­til that data can be an­a­lyzed, doc­tors and hos­pi­tals will draw on assumptions, ex­pe­ri­ence with com­mer­cial ac­count­able care and Medi­care man­aged care to make ten­ta­tive plans about where to hire peo­ple and how to in­vest cap­i­tal.

“If we need to add, we will,” said Mike Mur­phy, pres­i­dent and CEO at Sharp Health­care, of po­ten­tial de­mand for more care­givers to ex­pand pro­grams to man­age heart dis­ease, di­a­betes and other chronic con­di­tions out­side the hos­pi­tal. The Cal­i­for­nia health sys­tem is ex­pected to en­roll 33,000 se­niors un­der a new ac­count­able care con­tract with Medi­care.

Sharp, based in San Diego, will en­ter the new Medi­care con­tract with some re­cent ex­pe­ri­ence and in­vest­ments that will ben­e­fit the fed­eral ini­tia­tive, Mur­phy said. The sys­tem al­ready plans to in­vest to ex­pand its data ware­house for two pri­vate ac­count­able care con­tracts with com­mer­cial in­sur­ers An­them and Aetna.

About 100 miles up the Cal­i­for­nia coast­line from Sharp, Tor­rance, Calif.-based Health­care Part­ners Med­i­cal Group said the med­i­cal group and independent prac­tice as­so­ci­a­tion plans to hire con­sul­tants to help an­a­lyze data and de­velop plans based on the find­ings. Health­care Part­ners, one of the largest Pi­o­neers with about 115,000 se­niors to be en­rolled un­der the Medi­care ac­count­able care con­tract, also has some ex­pe­ri­ence with com­mer­cial ACO ef­forts that has pre­pared its in­for­ma­tion tech­nol­ogy staff for the work ahead, said Dr. Wil­liam Chin, ex­ec­u­tive med­i­cal di­rec­tor.

Chin said he ex­pects Health­care Part­ners to hire care man­agers as the or­ga­ni­za­tion “can bet­ter iden­tify the need” us­ing the data even­tu­ally pro­vided by the CMS. He said it is too early to know what ex­penses will be re­quired for the ef­fort. “Un­til we see what is hap­pen­ing in our com­mu­nity with the data, we’re just sit­ting on pins and nee­dles,” Chin said. That does not mean that med­i­cal lead­ers

Pi­o­neers give fed­eral of­fi­cials the op­por­tu­nity to eval­u­ate the pro­gram’s ef­fec­tive­ness at a lo­cal level, says Dr. Richard Gil­fil­lan, di­rec­tor of CMS’ Cen­ter for Medi­care and Med­i­caid In­no­va­tion.

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