Full ahead for ACO pro­gram /

ACOS al­ready in place gain mo­men­tum

Modern Healthcare - - FRONT PAGE - Me­lanie Evans

Un­cer­tainty did not stop health sys­tems from rac­ing ahead with ac­count­able care as the U.S. Supreme Court de­bated the health­care re­form law that launched Medi­care’s ef­forts to en­cour­age the emerg­ing model.

Now that the law sur­vived largely in­tact, the in­dus­try’s ac­count­able care ex­per­i­men­ta­tion will give ef­forts struc­ture and mo­men­tum, ex­ec­u­tives said.

“We are pleased that the Supreme Court has re­leased their de­ci­sion be­cause now we know the con­text in which we move for­ward,” Chuck Mooty, in­terim CEO for Min­neapo­lis-based Fairview Health Ser­vices, said in a state­ment.

“We’ve had great suc­cess work­ing with lo­cal pay­ers in our mar­ket to sup­port changes in care de­liv­ery and pay­ment, and we in­tend to con­tinue those ef­forts,” Mooty said. “As one of the 32 Medi­care Pi­o­neer ac­count­able care or­ga­ni­za­tions, our on­go­ing work also will in­clude de­liv­er­ing greater value to Medi­care ben­e­fi­cia­ries. Th­ese are just a few ex­am­ples of how we are and will re­main en­gaged in health re­form.”

Mon­te­fiore Med­i­cal Cen­ter, also se­lected by Medi­care as one of the ACOs to launch in Jan­uary, did not de­fer in­vest­ments as the court de­bated the law, said Dr. Steven Safyer, pres­i­dent and CEO of the New York-based, 1,491-bed hos­pi­tal.

“There was risk,” but the risk paid off, Safyer said. “That’s why I’m happy.”

The law, a mash-up of health pol­icy, in­cludes new in­surance reg­u­la­tion, in­surance sub­si­dies and ex­pan­sion, qual­ity in­cen­tives and other pro­vi­sions, in­clud­ing one four-page pro­vi­sion to create ACOs un­der Medi­care. An­other pro­vi­sion cre­ated the Cen­ter for Medi­care & Med­i­caid In­no­va­tion with the au­thor­ity to launch pay­ment ex­per­i­ments such as ac­count­able care.

The po­lit­i­cal and le­gal de­bate sur­round­ing the law has cen­tered on its in­surance ex­pan­sion pro­vi­sions, but a de­ci­sion from the Supreme Court on those points threat­ened to bring down the en­tire law.

Yet health­care or­ga­ni­za­tions were pur­su­ing new ac­count­able care con­tracts un­der Medi­care even in the weeks and days lead­ing up to the court’s de­ci­sion.

In Milwaukee, Aurora Health Care went ahead as the le­gal chal­lenge brewed and ap­plied to be among the Medi­care ac­count­able care or­ga­ni­za­tions to be named in com­ing weeks.

Dr. Nick Turkal, the sys­tem’s pres­i­dent and CEO, said he was pleased that ex­panded cov­er­age and pro­vi­sions to over­haul health­care de­liv­ery, such as ac­count­able care, sur­vived, though “the law falls short of re­ally re­form­ing health­care in our coun­try.”

New York City’s pub­lic health sys­tem told Medi­care of­fi­cials of plans to ap­ply to join the Medi­care shared-sav­ings pro­gram for ACOs start­ing in 2013.

Alan Aviles, pres­i­dent and CEO of the New York City Health and Hos­pi­tals Corp., said the out­come would give fo­cus and mo­men­tum to ef­forts to re­vamp health­care de­liv­ery “and result, hope­fully, in im­prove­ment in ef­fi­ciency and qual­ity that re­main the cen­tral chal­lenge be­fore us.”

Aviles said ac­count­able care, as an ap­proach to re­vamp­ing in­cen­tives to pro­mote qual­ity and re­duce costs, has gained “a fair amount of mo­men­tum,” and Medi­care’s move toward the model is con­sis­tent with the di­rec­tion of the in­dus­try and the sys­tem.

In­deed, ex­ec­u­tives en­gaged in ACOs said the ef­forts would have con­tin­ued, re­gard­less of the de­ci­sion.

“The em­pha­sis on a higher value, more-or­ga­nized, bet­ter co­or­di­nated health­care sys­tem that pro­vides bet­ter qual­ity and fo­cuses a great deal on pro­vid­ing bet­ter qual­ity has started, and that’s not go­ing to stop,” said Jeff Squier, ex­ec­u­tive direc­tor for Bellin ThedaCare Health­care Part­ners, an­other Pi­o­neer ACO.

Catholic Med­i­cal Part­ners op­er­ates eight ac­count­able care con­tracts, in­clud­ing pri­vatemar­ket ACOs and a Medi­care ACO that cov­ers 30,000 and stands to gen­er­ate $260 mil­lion of rev­enue for the Buf­falo, N.Y.-based provider.

“We’re do­ing this any­way,” Den­nis Hor­ri­gan, pres­i­dent and CEO of Catholic Med­i­cal Part­ners, one of 27 or­ga­ni­za­tions to win some of the first Medi­care ac­count­able care con­tracts made pos­si­ble by the Pa­tient Pro­tec­tion and Af­ford­able Care Act.

Health­care spend­ing can­not con­tinue to grow unchecked, and providers face pres­sure from em­ploy­ers, house­holds and gov­ern­ments to curb spend­ing, said Chuck Lehn, CEO of the Ban­ner Health Net­work, which over­sees the health sys­tem’s ACO. “Prac­ti­cally speak­ing, the un­der­ly­ing prob­lem does not go away.”

Hos­pi­tals, med­i­cal groups and com­mer­cial in­sur­ers will con­tinue with ef­forts, such as ac­count­able care, that seek to bet­ter co­or­di­nate med­i­cal care and im­prove the qual­ity of medicine, he said. “Every­body’s got their head down work­ing on it,” Lehn said.

Ban­ner Health launched its Medi­care ACO in Jan­uary un­der the Cen­ter for Medi­care & Med­i­caid In­no­va­tion. The Phoenix-based sys­tem, which owns or op­er­ates 22 hos­pi­tals, has roughly 52,000 se­niors in its Medi­care ACO.

John Hens­ing, Ban­ner’s ex­ec­u­tive vice pres­i­dent and chief med­i­cal of­fi­cer, said an ag­ing pop­u­la­tion and ris­ing health spend­ing are cre­at­ing de­mand for greater ef­fi­ciency, more col­lab­o­ra­tion and new in­cen­tives that re­ward hos­pi­tals and doc­tors that keep peo­ple healthy “al­most re­gard­less of what the Supreme Court said.” The rul­ing, he said, “doesn’t change that ac­tiv­ity, and we’ll con­tinue to pursue it.”

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