ACOs slow to make progress on risk-based con­tracts

Most ACOs still largely fo­cus on “first wave” care-de­liv­ery changes such as pre­vent­ing read­mis­sions, emer­gency depart­ment use and chronic care man­age­ment, ac­cord­ing to the re­port.

Modern Healthcare - - NEWS - By Maria Castel­lucci

While ac­count­able care or­ga­ni­za­tions are grav­i­tat­ing to­ward risk-based con­tracts, they are still largely fo­cused on the low-hang­ing fruit when it comes to sav­ing money and im­prov­ing qual­ity, ac­cord­ing to a new anal­y­sis.

Roughly 50% of ACOs are in­volved in at least one down­side risk con­tract, such as shared sav­ings and cap­i­ta­tion con­tracts, ac­cord­ing to a Leav­itt Part­ners and Na­tional As­so­ci­a­tion of ACOs re­port re­cently pub­lished in Health Af­fairs. About 47% of ACOs plan to par­tic­i­pate in shared-sav­ings, risk-based con­tracts in the next year or so.

“Even though ACO providers say they are pre­par­ing for and as­sum­ing risk, the care de­liv­ery sys­tem is not ad­vanc­ing as quickly as the pay­ment sys­tem re­forms,” said Kate de Lisle, an au­thor of the study and a se­nior an­a­lyst at Leav­itt Part­ners. “In or­der for th­ese pay­ment mod­els to be suc­cess­ful, providers need to change the way they de­liver care.”

Most ACOs still largely fo­cus on “first wave” care-de­liv­ery changes such as pre­vent­ing read­mis­sions, emer­gency depart­ment use and chronic care man­age­ment, ac­cord­ing to the re­port. ACOs haven’t tapped into other re­forms that will also help them pre­pare for down­side risk like be­hav­ioral health in­te­gra­tion and med­i­ca­tion op­ti­miza­tion and man­age­ment.

Ap­prox­i­mately one-fourth of all ACOs, or 240, re­sponded to the sur­vey. The re­spon­dents ranged from ur­ban to ru­ral ACOs as well as physi­cian-led, hospi­tal-led and in­te­grated ACOs.

About 48% of hospi­tal-led ACOs said they cur­rently had a risk-based con­tract, com­pared with 28% of physi­cian-led ACOs. Physi­cian-led ACOs might have stalled be­cause they have fewer re­sources than large health sys­tems to se­cure the cap­i­tal needed to par­tic­i­pate in risk-based con­tracts, de Lisle said.

Pre­vi­ous re­search has shown that physi­cian-led ACOs are more likely to be suc­cess­ful in the model be­cause they have a deeper un­der­stand­ing of their pa­tient pop­u­la­tions, she added.

But de­liv­ery sys­tem re­form hasn’t kept pace with pay­ment re­form. The CMS and other pay­ers haven’t of­fered providers much of a road map for adopt­ing changes to care man­age­ment. As a re­sult, physi­cians are try­ing many dif­fer­ent tac­tics all at once to see what does and doesn’t work, de Lisle said.

That hasn’t stopped providers with sev­eral years of ACO ex­pe­ri­ence from gen­er­at­ing sav­ings. A re­cent study from HHS’ Of­fice of In­spec­tor Gen­eral found that the 423 ACOs par­tic­i­pat­ing in the CMS’ Medi­care Shared Sav­ings Pro­gram re­duced spend­ing by about $1 bil­lion in three years.

The ACO model is by the far the most pop­u­lar in the push to value-based care. As of the first quar­ter of 2017, 923 pri­vate and pub­lic ACOs were in op­er­a­tion, cover­ing more than 32 mil­lion pa­tients, ac­cord­ing to a June 2017 post in Health Af­fairs by Leav­itt Part­ners.

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