ACO

While participation in Medicare accountable care organizations (ACOs) continues to grow—9 million Medicare beneficiaries are currently attributed to Medicare Shared Savings Program (MSSP) ACOs alone, up 1.3 million since 2016—controversy swirls around their impact as analysts disagree about the success of the model.

Six medical groups participating in Anthem Blue Cross’ Accountable Care Organization (ACO) program were able to save $7.9 million in just one year by focusing on improving population health management for patients suffering multiple chronic diseases, according to an Anthem press release. 

The Enhanced Personal Care Program helps primary care providers leverage clinical analytics and big data as they offer team-based, personalized care and robust chronic disease management for patients at risk of suffering from highly fragmented services or insufficient support.

There are few things that healthcare regulators like more than a good acronym. With alphabet soup like PCMH, ACO, MSSP, VBR, and FFS, it can sometimes be difficult to tell what the real differences are between the various quality and value-based reform options available to providers.

After understanding what the patient-centered medical home is and how it’s structured, the next question to ask is how the PCMH model stacks up against another familiar initiative: the accountable care organization (ACO). [practicetransform]

The CMS is planning major changes to the financial incentives for Medicare accountable care organizations in a revamp aimed at preventing hospitals and medical groups from dropping out of the initiative. A proposed rule issued late Monday (PDF)would alter the structure of the Medicare Shared Savings Program, an attempt launched in 2012 under the Patient Protection and Affordable Care Act to reduce U.S. health spending with new incentives that seek to improve the quality and efficiency of healthcare. 

The healthcare breakthrough of the 21st century may not come in the form of a miracle drug from the pharmaceutical industry. Rather, it's more likely to emerge from the ways caregivers interact and motivate patients.

Characterizing patients as non-compliant has long been an excuse for physicians not fully engaging people, but that needs to change, according to Bruce Bagley, MD, CEO of TransforMED, an organization devoted to helping medical practices transition to the patient-centered medical home model.

Collaborative care models like accountable care organizations are the "tip of the iceberg" helping insurers deliver population health to consumers, says Harriet Wallsh, a clinical program director with Cigna Collaborative Care.

"We're in the informative stages of where I think we could be going," Wallsh said of the healthcare industry in an interview with RevCycle Intelligence. "We can do great things over time if we can connect and really coordinate care."

The Centers for Medicare and Medicaid Services (CMS) recently released more detailed ACO-level data for participants in first two years of the Pioneer ACO Model. The program, which is designed for health systems with more experience assuming financial risk for patient populations, has generated savings and improvements in quality measures, but has also struggled to retain participants. The program began with 32 provider organizations; following a series of recent announcements there are now 19 total participants.

The CMS published for the first time the quality and financial performance for individual Pioneer accountable care organizations, a small, select group enlisted for Medicare's most ambitious test of the payment model. First year financial results show health spending slowed as much as 7% (PDF) among some ACOs and accelerated as much as 5% for others. In the second year, health spending slowed as much as 5.4% among those that reduced patients' medical bills and accelerated as much as 5.6% where costs escalated.

As we approach the one-year anniversary of Obamacare’s launch, the pundits continue to argue over whether or not it’s working. Meanwhile, something much bigger is happening. Whatever you think of its merits, the Affordable Care Act is re-shaping American healthcare, radically altering business models that hadn’t changed in decades.

Medicaid has offered an attractive venue for states and the federal government to pursue patient-centered medical home (PCMH) innovation experiments, but one state initiative that launched before PCMH certification even began offered potential lessons before it was curtailed for budget reasons, according to a recent study.