Accountable Care Trends, Strategies and Best Practice Compliance

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EMPLOYERS SEEKING HEALTHCARE BEST PRACTICES

According to a national survey3 published just prior to the issuance of the Final Rule, employers are gaining interest in accountable care. If companies seek entry into an ACO plan, the obvious result is their ability to be a driver of where employees are eligible to seek care, which would impact the patient load of providers weighing their own future benefit of practicing within an accountable care community.

The survey included 674 respondents providing healthcare coverage to more than 5 million employees and dependents. It found that 77 percent are likely to remain in employee healthcare management when external health insurance exchange options become available in 2014 as planned. Sixty-five percent expressed interest in the use of an ACO for providing healthcare benefits.

When factoring the importance of accountable care goals, more than 80 percent listed quality of care and the ability to manage care costs as top ACO factors. Those surveyed were largely evenly split on who should share in the cost of an ACO among health plans (21 percent), hospitals (22 percent), medical groups (23 percent), employees (15 percent) and employers (18 percent). That result speaks to the necessity for multiple payors or flexibility within the ACO structure.

Employers may also look for their own flexibility in a coordinated care community structure by seeking to create their own ACO or pursuing a corporate on-site clinic. Another option would be direct contracting with a provider group within an existing or forming ACO, or accessing an ACO through a private health insurer.

PUTTING YOUR BEST PRACTICES TO WORK

It is clear from the assembled information that a new healthcare community paradigm based on evidence-based, preventive medicine within a coordinated provider structure that includes elements of payment reform is gaining widespread acceptance. The historic existence of public and private “P4P" or quality reporting programs has shown that incentive-driven programs can work. At the same time, health information technology has advanced and innovated to the point where there is confidence it can produce, share and categorize the needed data to coordinate care.

As coordinated care models continue to emerge from multiple resources and options, they are striving to put best practices to work and to create a smarter, more sustainable healthcare system. The Final Rule has furthered the possibilities by broadening the scope of providers and institutions that can partake of shared savings, and by broadening the programmatic pathways to pursue accountable care. For providers and healthcare organizations, there is much to consider. Prior to the issuance of the Final Rule, CMS’ Pioneer Model, Bundled Payments for Care Improvement Initiative, Primary Care Initiative, and Final Rule all offer additional routes and choices for the pursuit of incentivized care coordination – and even allow for some dual participations as a further incentive.

As commercial payors, employers and health plans are increasingly entering the conversation and shaping other forms of accountable care models, the time has come to determine which model being discussed or planned in your region fits with your best practices. Engaging your peers and seeking out informational gatherings that are assuredly taking place is a starting point toward inclusion into these new models of healthcare delivery and payment.

Justin Barnes is a vice president with Greenway Medical Technologies and also serves as co-chairman of the national Accountable Care Community of Practice (ACCoP), in addition to chairman emeritus of the HIMSS Electronic Health Record Association (EHR Association). Barnes has formally addressed and/or testified before Congress as well as the last two presidential administrations on 15 occasions between 2005 and 2011, with statements relating to accountable care, ACOs, EHR meaningful use, health IT innovation, interoperability, health information exchange (HIE), patient safety and quality.

References

1. Federal Trade Commission, Bureau of Competition, Health Care Division: TriState Health Partners Inc. Advisory Opinion, April 13, 2009

2. Centers for Medicare and Medicaid Services (Online) https://www.cms.gov/NationalHealthExpendData/downloads/proj2010.pdf

3. 2011 Employer Driven Accountable Care Organizations Survey Report; Aon Hewitt and Polakoff Boland, authors.

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