At the Becker's Annual CEO Strategy Roundtable, held Nov. 14 in Chicago, a panel of healthcare experts discussed the pilot accountable care organization program.
The panel consisted of Dan Shellenbarger, partner, Health and Life Sciences; Jen Johnson, CFA, Partner, VMG Health; Randall E. Williams, MD, CEO, Pharos Innovations; Miles Snowden, MD, MPH, CEBS, chief medical officer of Optum.
During the first pilot year, Ms. Johnson was most surprised with the time and money spent on data tracking and talking about data and infrastructure. She emphasized that health systems need to carefully track exactly where their shared savings dollars are going back to so the Office of the Inspector General can be sure physicians who did not contribute to savings are not benefiting from them.
She was also not surprised that the pilot ACOs saw improved quality and cost savings because they were all integrated delivery networks with low costs from the start. However, she said, "It may look more grim going forward." This is because CMS may not pay for reporting and instead move to outcomes-based payments, raising the bar on the quality piece. She said this format may be frustrating for some systems.
What most emerged from the first ACO year, Dr. Williams said, was collaboration among previously adversarial groups — payers, physicians, executives and patients. "This is an enormous breadth of people formerly antagonistically aligned that are now all getting together," he said. His big takeaway was that the healthcare industry hasn't learned much from the past.
"At the end of the day, an ACO or any other change is about adaptive leadership," he said. "We will either make this work by being adaptive leaders or we will fail."
Dr. Snowden said it's too early to tell whether the pilot program truly met its goals. However, either way CMS gave a big wake up call to the industry. Fundamentally, ACOs are not only about shared savings but also about the need to move portions of the population to this model.
"I think pioneer is a success, not because of the metrics, but because of the revolution it started to incite," Dr. Snowden said.
The pilot program had many winners — the consumers who had improved quality and CMS that saved money — but the providers did not win because the program was structured wrong, he said. Year one should've been pay for performance without regard for the cost.
"You cannot uniformly achieve quality measures on a population of people without raising your costs," Dr. Snowden said.
In the future, the challenge will be for ACOs to continue to reduce costs. Improving quality will always be easier than reducing costs, Dr. Williams said. Also, the feedback cycle needs to improve.
"The only way to get shared savings is when data needed to get back in the hands of people is timely enough for them to make decisions and execute rapid cycle improvement," Dr. Williams said.