Meeting the Challenges of Transitioning to Accountable Care


Accountable Care Organizations have been attracting a lot of attention lately, with the recent article in The New York Times and Don Berwick reportedly advising some Pioneer ACOs in their dispute with CMS about how to measure quality. Here on the TJU campus, Jonathan M. Niloff, MD, spoke at the JSPH Forum on ACOs and ways of achieving organizational alignment and management through healthcare transformation. Dr. Niloff, Chief Medical Officer for MedVentive, is responsible for the strategic development of population health analytics and solutions.

ACOs take up only seven pages of the new health law yet have become one of the most talked about provisions. This latest model for delivering services offers doctors and hospitals financial incentives to provide good quality care to Medicare beneficiaries while keeping down costs. An ACO is a network of doctors and hospitals that shares responsibility for providing care to patients. In the new law, an ACO would agree to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years.

During his talk at the May 9 JSPH Forum, Dr. Niloff described the often difficult realities of making an ACO work. A successful ACO implies less revenue per patient – a scary proposition for any health system. In an environment of less revenue per patient, it is crucial to keep the patients that were going out of the system, within the system. Growing the network is also vital. “Ultimately, it’s about aligning more physicians, gaining the allegiance of more physicians to your program to drive better coordination of care.” A successful ACO also requires a population health approach to managing healthcare by identifying patients most at risk and putting programs in place that captures those patients and drives specific programs focused on improving quality and coordination of care.

One health provider that seems to have this figured out is Advocate Health Care, based in Oak Brook, Ill. Described in The New York Times piece as an innovator in the accountable care approach, Advocate Health Care has seen hospital admissions decline nearly 9 percent. The average length of stay has declined, and many other measures show them providing less care, too. Under Advocate’s deal with Blue Cross Blue Shield, certain patients are assigned to the accountable care framework – about 380,000 – and their health costs are projected. If Advocate achieves savings below that amount while meeting explicit quality targets, it splits the money with the insurer. If not, its revenue is at risk.

The Affordable Care Act has helped encourage a shift to Advocate’s payment model – an estimated 428 accountable-care organizations now cover four million Medicare enrollees and millions more people with private insurance.

Still, many remain skeptical that we have arrived at the right set of measures to allow us to declare one ACO a success and another a failure. Perhaps what is needed is a set of definitive measures, beyond readmission rates and average length of stay, that can tell us how a specific population is doing.

I’m sure that by now, many of you have had experience with ACOs. What are your thoughts? Are ACOs part of the answer to alleviating Washington’s long-term deficit problems? Feel free to weigh in on this issue in the comment field below.

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