‘Too early to tell’

Full im­pact of ACOs on qual­ity un­known

Modern Healthcare - - COVER STORY - Me­lanie Evans

Though early adopters are gain­ing ex­pe­ri­ence with ac­count­able care or­ga­ni­za­tions, ev­i­dence of their im­pact on qual­ity re­mains limited. The untested pay­ment model gained fa­vor with pri­vate pay­ers and Medi­care af­ter pol­i­cy­mak­ers in­cluded pilot pro­grams in the 2010 health­care re­form law. Medi­care has steadily ex­panded its reach to 250 or­ga­ni­za­tions, up from the orig­i­nal 32 in­volved in the pro­gram. Ma­jor in­sur­ers such as Cigna Corp. and Aetna also have jumped on the ac­count­able care band­wagon.

Hos­pi­tals and med­i­cal groups un­der an ac­count­able care con­tract can earn a share of the money they save by meet­ing qual­ity per­for­mance tar­gets and by low­er­ing the over­all cost of the pa­tient panels en­rolled in the pro­gram. The ve­hi­cle is de­signed to neu­tral­ize the in­cen­tives to de­liver high-vol­ume care as­so­ci­ated with fee-for-ser­vice medicine. Pol­i­cy­mak­ers be­lieve si­mul­ta­ne­ously pay­ing for qual­ity and cost con­trol will im­prove out­comes and not risk stint­ing on care.

But whether ac­count­able care will work as de­signed is still an open ques­tion. “It’s too early to tell,” said Kavita Pa­tel, a fel­low in the Eco­nomic Stud­ies pro­gram and man­ag­ing di­rec­tor for clin­i­cal trans­for­ma­tion and de­liv­ery at the En­gel­berg Cen­ter for Health Care Re­form. The En­gel- berg Cen­ter and Dart­mouth In­sti­tute for Health Pol­icy & Clin­i­cal Prac­tice were early ad­vo­cates of ac­count­able care in pub­lic pol­icy and pri­vate mar­kets and helped to launch four ac­count­able care pi­lots in late 2010 and early 2011.

The ev­i­dence from the field is mixed. In Louisville, Ky., Nor­ton Health­care’s ac­count­able care con­tract with in­sur­ance gi­ant Hu­mana has made dif­fer­ences in some qual­ity mea­sures but no mark in oth­ers in its first two years.

In Sacra­mento, Calif., an ACO among Dig­nity Health, Hill Physi­cians and Blue Shield of Cal­i­for­nia curbed the num­ber of pa­tients who leave the hos­pi­tal only to re­turn within a month, which usu­ally means those pa­tients did not get the needed care to keep them home. Re­duc­ing read­mis­sions can keep providers from get­ting pe­nal­ized by Medi­care, which now low­ers over­all pay­ments by up to 2% if read­mis­sion rates are high.

Of­fi­cials at the sys­tems in Louisville and Sacra­mento say more can be done to ex­pand on ad­mit­tedly limited ini­tial qual­ity mea­sures.

Fu­ture ef­forts at Nor­ton will likely fo­cus on more so­phis­ti­cated track­ing of qual­ity mea­sures through wider adop­tion and bet­ter use of elec­tronic health records, said Mar­cia James, di­rec­tor of provider en­gage­ment for Hu­mana. Nor­ton’s out­pa­tient lo­ca­tions fully adopted EHRs last Au­gust and its hos­pi­tals in March.

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