As the federal government prepares to launch accountable care organizations in Jan. 2012, private payors are already setting up limited ACO pilots in preparation for launching their own ACOs.
These preparations are causing some anxiety in the provider community, says Richard E. Wesslund, chairman of BDC Advisors in Miami, which has been assisting hospitals and health plans in setting up ACO arrangements.
"Right now in many parts of the healthcare community there is a bit of a competition about who's going to control the ACO, the physicians, the health plans or the hospitals," Mr. Wesslund says. "If a health plan says, 'We want to reach out to physicians, hospitals see the implication as, 'They're going to marginalize us.' "
Mr. Wesslund says health plans will likely decide how payments will be formulated based on the landscape of each healthcare market. For example, in Los Angeles, where there is no dominant health system, physician groups will probably run ACOs, he says, but down the road in San Diego, where there are powerful health systems like Sharp and Scripps, systems will probably take the baton.
Private payors begin pilots
Health plans are already starting to work on such decisions as they begin to set up a host of pilots for ACO payments across the country, he says. Mr. Wesslund reports that every major plan and many state Blues plans have ACO pilots that are starting or about to start. These pilots involve specific patient populations, such as employees of the health plan.
Mr. Wesslund says UnitedHealthcare has pilots in Nevada and Arizona. Humana has started a pilot with Norton Healthcare in Louisville, enrolling employees from both organizations. In Minneapolis, Healthcare Partners is working with Allina on a pilot. And Blue Cross Blue Shield of Massachusetts has begun offering its Alternative Quality Contract to providers in Massachusetts. Mr. Wesslund says BDC has been involved in the latter three projects.
New companies help providers set up ACOs
"One lesson we learned from the managed care boom of the 1990s was that providers did not have an adequate infrastructure to manage risk," Mr. Wesslund says. "Back then, a lot of train wrecks were caused by a lack of financing in the administrative system."
To avert another train wreck, some health plans have created companies to assist providers in building ACOs. For example, UnitedHealthcare's OptumHealth Care Solutions offers tools and methodologies to accept and manage insurance risk. Third party administrators are also developing risk management infrastructure that they will offer to providers, he says. In the same vein, BDC and Advocate Physician Partners in the Chicago area have partnered to offer CI-Now.
Perhaps the biggest challenge for ACOs will be creating an atmosphere of trust and mutual cooperation, Mr. Wesslund says. "They will need to develop a paradigm, away of thinking about the relationship of physicians an preventive services," he says. "There has been so much history, so much bad history between providers. People have to willing to experiment and take risk."
Learn more about BDC Advisors.
These preparations are causing some anxiety in the provider community, says Richard E. Wesslund, chairman of BDC Advisors in Miami, which has been assisting hospitals and health plans in setting up ACO arrangements.
"Right now in many parts of the healthcare community there is a bit of a competition about who's going to control the ACO, the physicians, the health plans or the hospitals," Mr. Wesslund says. "If a health plan says, 'We want to reach out to physicians, hospitals see the implication as, 'They're going to marginalize us.' "
Mr. Wesslund says health plans will likely decide how payments will be formulated based on the landscape of each healthcare market. For example, in Los Angeles, where there is no dominant health system, physician groups will probably run ACOs, he says, but down the road in San Diego, where there are powerful health systems like Sharp and Scripps, systems will probably take the baton.
Private payors begin pilots
Health plans are already starting to work on such decisions as they begin to set up a host of pilots for ACO payments across the country, he says. Mr. Wesslund reports that every major plan and many state Blues plans have ACO pilots that are starting or about to start. These pilots involve specific patient populations, such as employees of the health plan.
Mr. Wesslund says UnitedHealthcare has pilots in Nevada and Arizona. Humana has started a pilot with Norton Healthcare in Louisville, enrolling employees from both organizations. In Minneapolis, Healthcare Partners is working with Allina on a pilot. And Blue Cross Blue Shield of Massachusetts has begun offering its Alternative Quality Contract to providers in Massachusetts. Mr. Wesslund says BDC has been involved in the latter three projects.
New companies help providers set up ACOs
"One lesson we learned from the managed care boom of the 1990s was that providers did not have an adequate infrastructure to manage risk," Mr. Wesslund says. "Back then, a lot of train wrecks were caused by a lack of financing in the administrative system."
To avert another train wreck, some health plans have created companies to assist providers in building ACOs. For example, UnitedHealthcare's OptumHealth Care Solutions offers tools and methodologies to accept and manage insurance risk. Third party administrators are also developing risk management infrastructure that they will offer to providers, he says. In the same vein, BDC and Advocate Physician Partners in the Chicago area have partnered to offer CI-Now.
Perhaps the biggest challenge for ACOs will be creating an atmosphere of trust and mutual cooperation, Mr. Wesslund says. "They will need to develop a paradigm, away of thinking about the relationship of physicians an preventive services," he says. "There has been so much history, so much bad history between providers. People have to willing to experiment and take risk."
Learn more about BDC Advisors.