Num­ber of ACOs nearly dou­ble with lat­est ex­pan­sion

Third and largest ex­pan­sion sees 106 or­ga­ni­za­tions added to pro­gram

Modern Healthcare - - NEWS - Me­lanie Evans

Medi­care en­tered year two of its ac­count­able care ex­per­i­ment with a sig­nif­i­cant ex­pan­sion, even as a top of­fi­cial said it was too soon to re­lease early re­sults. The CMS an­nounced last week 106 new ac­count­able care or­ga­ni­za­tions un­der Medi­care, the third and largest ex­pan­sion of a pro­gram cre­ated by the Pa­tient Pro­tec­tion and Af­ford­able Care Act and launched last April. The lat­est crop of ACOs nearly dou­bled Medi­care’s shared-sav­ings pro­gram and in­cluded the drug­store gi­ant Wal­green Co.

Medi­care of­fers ACOs fi­nan­cial in­cen­tives to meet qual­ity and cost-con­trol tar­gets, and as many as 4 mil­lion en­rollees re­ceive care from doc­tors un­der such con­tracts, or one out of 10 en­rollees not en­rolled in Medi­care man­aged-care plans.

Jonathan Blum, the CMS’ act­ing prin­ci­pal deputy ad­min­is­tra­tor and di­rec­tor of the cen­ter for Medi­care, told re­porters af­ter an­nounc­ing the ex­pan­sion that the agency was op­ti­mistic it would re­duce costs but said it would be too early to re­lease re­sults from 116 ACOs launched last year or an­other 32 ACOs op­er­at­ing for the past year un­der the Cen­ter for Medi­care and Med­i­caid In­no­va­tion’s Pioneer model.

The health­care re­form law, which seeks to sig­nif­i­cantly re­duce the num­ber of unin­sured cov­er­age through Med­i­caid and pri­vate-

mar­ket in­surance ex­pan­sion, in­cluded ACOs among a lim­ited num­ber of ini­tia­tives that seek to curb U.S. health spend­ing.

Medi­care spend­ing in­creased 6.2% in 2011 to $554.3 bil­lion, a growth rate faster than the 4.3% growth in 2010, CMS of­fi­cials said last week. The CMS es­ti­mates ACOs will save Medi­care $940 mil­lion over four years.

Hos­pi­tals and doc­tors in Medi­care’s shared-sav­ings pro­gram may se­lect from two in­cen­tive op­tions, in­clud­ing one with greater in­cen­tives but that also car­ries the risk of po­ten­tial losses. So far, eight shared-sav­ings ACOs have se­lected this op­tion. The other shared-sav­ings op­tion of­fers no risk of losses and smaller bonuses. Pioneer ac­count­able care con­tracts re­quire all par­tic­i­pat­ing hos­pi­tals and doc­tors to be at risk for losses start­ing this year.

Dr. David Pate, pres­i­dent and CEO of St. Luke’s Health Sys­tem in Boise, Idaho, which was among the newly named Medi­care ACOs, said his or­ga­ni­za­tion se­lected the bonus-only op­tion but con­sid­ers the ACOs an op­por­tu­nity to pre­pare for pay­ment models that in­clude greater fi­nan­cial risk.

St. Luke’s has in­vested in pre­dic­tive mod­el­ing soft­ware to iden­tify pa­tients at great­est risk for costly care that could per­haps be pre­vented with more co­or­di­nated ef­forts to im­prove the health of chron­i­cally ill pa­tients, he said. Medi­care will sup­ply pa­tient data not pre­vi­ously avail­able to St. Luke’s, he said. “We’re really hun­gry for this data,” he said.

The CMS said half of ACOs are physi­cian­led and care for fewer than 10,000 Medi­care en­rollees, but Wal­green’s en­try un­der­scores an in­ter­est in ACOs across the in­dus­try. Wal­green fol­lows Uni­ver­sal Amer­i­can, a pub­licly traded Medi­care Ad­van­tage and sup­ple­men­tal in­surance provider, which also con­tracted with hospi­tal and med­i­cal groups to win mul­ti­ple Medi­care ACO con­tracts last year.

Stephen Short­ell, a pro­fes­sor of health pol­icy and man­age­ment and dean of the school of pub­lic health at the Univer­sity of Cal­i­for­nia Berke­ley School of Pub­lic Health, said he was not sur­prised by Wal­green’s en­try into the ACO mar­ket, be­cause bet­ter man­age­ment of med­i­ca­tions could im­prove care for chron­i­cally ill pa­tients.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.