Commercial health plans have “dramatically shifted” in how they pay hospitals and physicians, with 40 percent of all payments reflecting value over volume, but 60 percent of payments remain tied to the traditional fee-for-service model, according to the nonprofit Catalyst for Payment Reform.
Proposed legislation introduced in the U.S. House calls for Medicare to pilot a reimbursement mechanism for accountable care organizations based on outcomes and encourages ACO use of telehealth and remote patient monitoring services.
Rep. Diane Black (R-TN), a registered nurse for 40 years, sponsors The ACO Improvement Act (H.R. 5558) along with Rep. Peter Welch (D-VT). Both serve on powerful committees--Black on Ways & Means and Welch on Energy & Commerce.
Aetna (NYSE: AET) today announced an accountable care collaboration with Banner Network Colorado, Colorado Health Neighborhoods, New West Physicians and Physician Health Partners, along with the introduction of the Aetna Whole HealthSM product in Colorado.
Interoperability and technology costs cited as challenges
The ability of accountable care organizations to meet the goals of improving care and lowering costs may be hindered by health IT obstacles suggests a new analysis.
Of the 62 ACOs polled by Premier healthcare alliance this past summer, 88 percent report "significant obstacles" in integrating data from disparate sources; 83 percent say they have a hard time fitting analytics tools into their workflow; and 90 percent say IT costs and a lack of return on investment are key roadblocks to more effective implementation of health IT.
Two lawmakers have introduced a bill (HR 5558) that aims to improve the accountable care organization model in part by allowing ACOs to expand telehealth services, Becker's Hospital Review's "Health IT & CIO Review" reports
Bill Details
The ACO Improvement Act was introduced by Reps. Diane Black (R-Tenn.) and Peter Welch (D-Vt.) (Gregg, "Health IT & CIO Review," Becker's Hospital Review, 9/24).
Quality varied widely among Medicare accountable care organizations during their first year, with a few earning millions of dollars in bonuses but scoring below average on all but a handful of quality measures.
On Sept. 23, federal officials posted the first published quality results for more than 200 ACOs with one year of results in Medicare's Shared Savings Program. The organizations are among the first to accept new Medicare incentives under the health reform law that reward hospitals and medical groups if they treat patients at less expense while meeting quality targets.
Three more accountable care organizations dropped out of Medicare's Pioneer program, which was designed to test the payment and delivery model with a small group of elite providers deemed best prepared to handle the operational demands and financial risks.
The Franciscan Alliance, Genesys PHO and Renaissance Health Network have exited the program, which is now in its third year. In August, Sharp HealthCare, San Diego, announced its decision to pull out after determining “the model was financially detrimental” despite the ACO's performance managing quality and healthcare use.
Universal American Corp. (NYSE:UAM) announced today that the Accountable Care Organizations (ACOs) it formed in partnership with primary care physicians generated $57 million in total program savings for the Centers for Medicare & Medicaid Services (CMS) as part of the Medicare Shared Savings Program for program years 2012 and 2013.
Many accountable care organizations are struggling with advanced IT functions and interoperability, a survey of 62 ACOs conducted in July and August 2014 by Premier and the eHealth Initiative shows.
“Most ACOs are still at the stage of basic care-coordination capabilities,” said Bryan Bowles, Premier's vice president of population health solution management, Wednesday on a call discussing the survey. “The challenges of blending disparate data have hindered uptake of more advanced functions.”
The CMS for the first time publicly released individual performance data for Medicare accountable care organizations on 33 measures of healthcare quality.
The results for 220 of the participants (PDF) in the Medicare Shared Savings Program reveal how ACOs performed on measures (PDF) of patient experience and preventive care and disease management for some of the leading causes of death among U.S. elderly, including heart disease, cancer and diabetes.
