Commercial accountable care organizations are continually popping up across the country, and Medicare ACOs are not far behind. At the time of this article's publication, CMS had yet to announce its first group of ACOs under the Medicare Shared Savings Program, missing its previous deadline of March 16 for the announcement. However, to be sure, many systems are developing ACOs to participate in CMS' program.
And while we don't yet have a comprehensive picture of the Medicare ACO landscape, a number of commercial ACOs have been announced this year. Some of the arrangements involve payors, hospitals and physician groups, while others involve only one of the latter two. Also, health insurers have been swift and steady in unveiling new payment models for providers that reward quality care — a model that functions similarly to the ACO. Despite these developments, however, there remains some uncertainty and ill-preparedness among both providers and payors. Here's an 11-point briefing on commercial ACOs so far in 2012.
The following ACOs have been announced since January 1.
• Westmed Medical Group — a multi-specialty practice based in Purchase, N.Y., which includes more than 220 physicians — launched an ACO with UnitedHealthcare and Optum. Westmed has also received level-3 recognition for its patient-centered medical home from the National Committee for Quality Assurance.
• Minneapolis-based Fairview Health Services, which includes 350 clinics and seven hospitals, launched a collaborative with Minneapolis-based insurer Medica that functions as an ACO. The plan will go into effect April 1. Fairview was also named one of the first 32 Pioneer ACOs by the Centers for Medicare and Medicaid Services in December.
• Tucson (Ariz.) Medical Center joined with more than 150 physicians and three community health centers to form an ACO called Arizona Connected Care. The ACO will begin treating approximately 15,000 to 20,000 Medicare patients in April as part of the Medicare Shared Savings Program.
• Newport, Calif.-based Hoag Memorial Hospital Presbyterian formed an accountable care organization with Blue Shield of California and Greater Newport Physicians Medical Group. The ACO, which will go into effect July 1, will be Blue Shield of California's sixth commercial ACO in California.
• Cigna launched an accountable care initiative with Weill Cornell Physician Organization in New York, which includes roughly 71 primary care physicians. The arrangement is the first patient-centered accountable care organization in New York City between a payor and a physician organization.
While some ACOs are still in formation, 2012 marks the second year in operation for others.
• One of those is AdvocateCare, the three-year pilot ACO between Oak Brook, Ill.-based Advocate Health Care and Blue Cross Blue Shield of Illinois. The ACO, which went into effect in 2011, recently released findings from its first six months in operation. Hospital admissions per ACO member decreased by 10.6 percent and emergency department visits fell by 5.4 percent. To date, AdvocateCare has 250,000 HMO and 125,000 PPO members.
Though not formal ACOs, payors are still expressing interest in accountable care initiatives and rewarding high-quality, efficient care.
• In January, WellPoint announced plans to increase its regular reimbursement to primary care physicians — paying them up to 50 percent more if they maintain or improve quality.
• In February, UnitedHealth Group unveiled plans for new value-based contracts for hospitals and physicians, under which providers will be rewarded for high-quality, efficient care and payments can be withheld if certain standards aren't met.
• Cigna recently said it plans to have one million people enrolled in accountable care organizations by 2014.
Despite the drive towards provider coordinated care, a significant portion of the healthcare industry remains wary of the ACO model.
• A December 2011 survey from Optum Institute for Sustainable Health found 46 percent of specialists and primary care physicians were unsure about plans for their practice to join an ACO.
• Another December 2011 survey, this one sponsored by HealthEdge, found a similar division in opinion among payors. Fifty-five percent of health insurers said they plan to participate in an ACO over the next three years, with a majority saying they lacked the technology necessary for pay-for-performance models.
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And while we don't yet have a comprehensive picture of the Medicare ACO landscape, a number of commercial ACOs have been announced this year. Some of the arrangements involve payors, hospitals and physician groups, while others involve only one of the latter two. Also, health insurers have been swift and steady in unveiling new payment models for providers that reward quality care — a model that functions similarly to the ACO. Despite these developments, however, there remains some uncertainty and ill-preparedness among both providers and payors. Here's an 11-point briefing on commercial ACOs so far in 2012.
The following ACOs have been announced since January 1.
• Westmed Medical Group — a multi-specialty practice based in Purchase, N.Y., which includes more than 220 physicians — launched an ACO with UnitedHealthcare and Optum. Westmed has also received level-3 recognition for its patient-centered medical home from the National Committee for Quality Assurance.
• Minneapolis-based Fairview Health Services, which includes 350 clinics and seven hospitals, launched a collaborative with Minneapolis-based insurer Medica that functions as an ACO. The plan will go into effect April 1. Fairview was also named one of the first 32 Pioneer ACOs by the Centers for Medicare and Medicaid Services in December.
• Tucson (Ariz.) Medical Center joined with more than 150 physicians and three community health centers to form an ACO called Arizona Connected Care. The ACO will begin treating approximately 15,000 to 20,000 Medicare patients in April as part of the Medicare Shared Savings Program.
• Newport, Calif.-based Hoag Memorial Hospital Presbyterian formed an accountable care organization with Blue Shield of California and Greater Newport Physicians Medical Group. The ACO, which will go into effect July 1, will be Blue Shield of California's sixth commercial ACO in California.
• Cigna launched an accountable care initiative with Weill Cornell Physician Organization in New York, which includes roughly 71 primary care physicians. The arrangement is the first patient-centered accountable care organization in New York City between a payor and a physician organization.
While some ACOs are still in formation, 2012 marks the second year in operation for others.
• One of those is AdvocateCare, the three-year pilot ACO between Oak Brook, Ill.-based Advocate Health Care and Blue Cross Blue Shield of Illinois. The ACO, which went into effect in 2011, recently released findings from its first six months in operation. Hospital admissions per ACO member decreased by 10.6 percent and emergency department visits fell by 5.4 percent. To date, AdvocateCare has 250,000 HMO and 125,000 PPO members.
Though not formal ACOs, payors are still expressing interest in accountable care initiatives and rewarding high-quality, efficient care.
• In January, WellPoint announced plans to increase its regular reimbursement to primary care physicians — paying them up to 50 percent more if they maintain or improve quality.
• In February, UnitedHealth Group unveiled plans for new value-based contracts for hospitals and physicians, under which providers will be rewarded for high-quality, efficient care and payments can be withheld if certain standards aren't met.
• Cigna recently said it plans to have one million people enrolled in accountable care organizations by 2014.
Despite the drive towards provider coordinated care, a significant portion of the healthcare industry remains wary of the ACO model.
• A December 2011 survey from Optum Institute for Sustainable Health found 46 percent of specialists and primary care physicians were unsure about plans for their practice to join an ACO.
• Another December 2011 survey, this one sponsored by HealthEdge, found a similar division in opinion among payors. Fifty-five percent of health insurers said they plan to participate in an ACO over the next three years, with a majority saying they lacked the technology necessary for pay-for-performance models.
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