Em­brac­ing ACOs

Pri­vate in­sur­ers forge string of provider deals for ac­count­able care

Modern Healthcare - - THE WEEK IN HEALTHCARE - Me­lanie Evans

In a grow­ing num­ber of con­tracts with providers, pri­vate health in­sur­ers are em­brac­ing ac­count­able care, a pay­ment model that holds hos­pi­tals and doc­tors jointly re­spon­si­ble for con­trol­ling costs and im­prov­ing pa­tient out­comes.

Com­mer­cial in­sur­ers re­cently an­nounced the lat­est in a string of new ac­count­able care con­tracts. Aetna, Hart­ford, Conn., said the in­surer reached ac­count­able care deals with five Maine health sys­tems or med­i­cal groups, while Unit­edHealth­care an­nounced an ACO deal with Mount Carmel Health Part­ners, Colum­bus, Ohio. Both in­sur­ers said more such deals would fol­low.

Aetna is in talks for an­other 200 ACO deals, said Robert Downs, head of the in­surer’s North­ern New Eng­land mar­ket. Aetna’s new Maine agree­ments are its first with hos­pi­tals in that state, which brings the in­surer’s to­tal num­ber of ACO con­tracts to 27.

Unit­edHealth­care said in a news re­lease last month that by 2017, its ac­count­able care con­tracts would ac­count for $50 bil­lion in pay­ments to providers, up from the cur­rent $20 bil­lion.

Aetna and other pri­vate and pub­lic in­sur­ers have moved to en­ter ac­count­able care pay­ment con­tracts fol­low­ing the 2010 health­care re­form law’s in­clu­sion of ACO tests un­der Medi­care. ACO pro­po­nents say the model will im­prove care and slow health spend­ing by es­tab­lish­ing joint fi­nan­cial in­cen­tives for hos­pi­tals, physi­cians and other providers to man­age pa­tients’ health.

Unit­edHealth­care said in a news re­lease last month that by 2017, its ac­count­able care con­tracts would ac­count for $50 bil­lion in pay­ments to providers, up from the cur­rent $20 bil­lion.

But few hos­pi­tals and doc­tors have ex­pe­ri­ence with ac­count­able care and early re­sults have been mixed.

Some provider sys­tems are more en­thu­si­as­tic about pri­vate-sec­tor ACOs than Medi­care ACOs. Un­like Medi­care, pri­vate in­sur­ers and em­ploy­ers have the lee­way to de­sign ben­e­fits with fi­nan­cial in­cen­tives for plan mem­bers to use net­work providers. Some Medi­care ACOs have com­plained that Medi­care does not al­low them to use fi­nan­cial sticks to keep ben­e­fi­cia­ries in their net­works, mak­ing it harder for them to con­trol costs and qual­ity.

Maine hos­pi­tals and med­i­cal groups that en­tered into the Aetna deals are: In­terMed, a Port­land-based pri­mary-care prac­tice; Mercy Health Sys­tem, Port­land; Maine-Health, an eight-hos­pi­tal sys­tem in Port­land; Martin’s Point Health Care, a health plan and clinic op­er­a­tor in five Maine coun­ties; and Maine-Gen­eral Health, a mul­ti­spe­cialty prac­tice in Au­gusta.

The ACO ar­range­ments fol­lowed Aetna’s suc­cess­ful bid to cover Maine state em­ploy­ees. The in­surer agreed to en­ter into ACO deals within 12 to 24 months. Maine’s state em­ploy­ees will have fi­nan­cial in­cen­tives to se­lect providers that have ACO con­tracts, Downs said.

Un­der the Aetna con­tracts, hos­pi­tals and med­i­cal groups that meet qual­ity and spend­ing tar­gets keep a share of what they save. Qual­ity tar­gets mir­ror those used by Medi­care in more than 200 ACO agree­ments and in­cor­po­rate mea­sures used by an ex­ist­ing col­lab­o­ra­tive within the Maine health­care mar­ket, Downs said.

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