There are signs that private insurers may not follow the template for accountable care organizations set out in federal proposed regulations for Medicare ACOs, according to a report by AISHealth.
While the major private insurers like Cigna are not yet revealing their responses to the proposed regulations, released on March 31, consultants are already weighing in on whether insurers would follow key elements of the proposal, such as reporting 65 quality measures and using a shared savings model.
One consultant noted that most commercial payors already have direct contractual relationships with primary care physicians that they could use to incentivize additional care management of patients, thus avoiding a relationship with a risk-bearing entity like an ACO.
In markets that already embrace capitation, some insurers are introducing models that involve full-risk rather than shared savings. Blue Shield of California, for example, recently announced plans to form two full-risk ACOs with five major health care providers. A Blue Shield official said the federal ACO regulations would "not change our approach to contracting with providers as we build virtually integrated ACOs for our commercial business."
On the other hand, another consultant argued that commercial insurers would need to adopt Medicare standards for ACOs in order to benefit from protections under the proposed regulations from antitrust and fraud and abuse scrutiny.
Read the AISHealth report on ACOs.
Read more coverage of private payor ACOs:
- CalPERS ACO Pilot May Produce $15.5M Savings
- Cigna ACO Pilots Show Improved Quality, Costs
- 10 ACOs Recently Formed by Hospitals and Health Systems
While the major private insurers like Cigna are not yet revealing their responses to the proposed regulations, released on March 31, consultants are already weighing in on whether insurers would follow key elements of the proposal, such as reporting 65 quality measures and using a shared savings model.
One consultant noted that most commercial payors already have direct contractual relationships with primary care physicians that they could use to incentivize additional care management of patients, thus avoiding a relationship with a risk-bearing entity like an ACO.
In markets that already embrace capitation, some insurers are introducing models that involve full-risk rather than shared savings. Blue Shield of California, for example, recently announced plans to form two full-risk ACOs with five major health care providers. A Blue Shield official said the federal ACO regulations would "not change our approach to contracting with providers as we build virtually integrated ACOs for our commercial business."
On the other hand, another consultant argued that commercial insurers would need to adopt Medicare standards for ACOs in order to benefit from protections under the proposed regulations from antitrust and fraud and abuse scrutiny.
Read the AISHealth report on ACOs.
Read more coverage of private payor ACOs:
- CalPERS ACO Pilot May Produce $15.5M Savings
- Cigna ACO Pilots Show Improved Quality, Costs
- 10 ACOs Recently Formed by Hospitals and Health Systems