CMSA Today - Issue 3, 2018 - 18

ACOS

ACCOUNTABLE CARE
ORGANIZATIONS AND THE

IMPACT ON
CARE MANAGEMENT
BY CONNIE PHILLIPS-JONES, RN, MSN, CCM, CPHQ

I

n 2011, the U.S. Department of
Health and Human Services (HHS)
released new rules under the
Affordable Care Act (ACA), aimed at
helping doctors, hospitals and other
providers better coordinate care by way of
accountable care organizations, or ACOs.
ACOs provide a framework for rewarding
providers financially - in both the public and
private sectors - for ensuring that patients,
especially the chronically ill, get the right care
at the right time, while avoiding unnecessary duplication of services and preventing
medical errors.
Since then, the number of ACOs has
grown dramatically.
Under the Centers for Medicare &
Medicaid Services (CMS), ACOs agree to
manage all the healthcare needs for a minimum of 5,000 Medicare beneficiaries for at
least three years. For ACO guidelines, CMS
established 33 quality measures focused on
care coordination and patient safety, the
appropriate use of preventive health services,
strengthening care management for at-risk
populations and improving the experience
of care for patients and caregivers. Savings
from this initiative are expected to be millions of dollars.
18

CMSA TODAY

In the beginning, ACOs were paid bonuses
for reporting on quality metrics, but in
2013 the program transitioned from payfor-reporting to pay-for-performance. The
Medicare Shared Savings Program (MSSP),
designed for organizations new to risk-based
reimbursement, rewards ACOs that lower
growth in healthcare costs while meeting
performance standards on clinical quality
and patient-centered care. To date, there
are more than 200 ACOs participating in
the MSSP.

"In the past, there was intuitive
acknowledgement that care
managers made a positive
difference for improved care and
cost, but now, the data allows
for more than intuition. With
the data and analytics available
today, care management is
evaluated on outcomes as well
as process."

Issue 3 * 2018 * DIGITAL

As CMS-sponsored plans were developed,
commercial healthcare insurers also began
offering risk-based contracts to providers.
Most commercial risk contracts include
similar combinations of quality incentives,
shared savings, full capitation and small budget adjustments for medical inflation, but
variety in these contracts has been identified. This variety includes partial capitation
(also known as bundled payments), retainer
agreements, in-kind services and subsidies
provided by payers, or have limited themselves to upside-only pay-for-performance
incentives.
Many ACOs simultaneously contract with
both private payers and CMS. Additionally,
many state Medicaid programs, offered
directly through a state Medicaid office
or Medicaid managed care plan, are also
negotiating accountable care agreements
with providers.
So, what does this mean for care
managers?
There has never been a better time to be
a case/care manager. Care coordination is
the very hallmark of accountable care and
ACOs. The change from volume to value
requires care management and coordination.
Care managers are the glue that keeps this



Table of Contents for the Digital Edition of CMSA Today - Issue 3, 2018

President’s Letter
Association News
CMSACorporate Partners
The Opioid Epidemic: Understanding the History and Confronting the Impact Today
Accountable Care Organizations and the Impact on Care Management
Case Management in Primary Care Makes a Difference
Past Presidents Corner
The Integrated Case Management Program: Essential for Today’s Case Manager
Index of Advertisers
CMSA Today - Issue 3, 2018 - Intro
CMSA Today - Issue 3, 2018 - cover1
CMSA Today - Issue 3, 2018 - cover2
CMSA Today - Issue 3, 2018 - 3
CMSA Today - Issue 3, 2018 - 4
CMSA Today - Issue 3, 2018 - 5
CMSA Today - Issue 3, 2018 - 6
CMSA Today - Issue 3, 2018 - President’s Letter
CMSA Today - Issue 3, 2018 - Association News
CMSA Today - Issue 3, 2018 - 9
CMSA Today - Issue 3, 2018 - 10
CMSA Today - Issue 3, 2018 - CMSACorporate Partners
CMSA Today - Issue 3, 2018 - The Opioid Epidemic: Understanding the History and Confronting the Impact Today
CMSA Today - Issue 3, 2018 - 13
CMSA Today - Issue 3, 2018 - 14
CMSA Today - Issue 3, 2018 - 15
CMSA Today - Issue 3, 2018 - 16
CMSA Today - Issue 3, 2018 - 17
CMSA Today - Issue 3, 2018 - Accountable Care Organizations and the Impact on Care Management
CMSA Today - Issue 3, 2018 - 19
CMSA Today - Issue 3, 2018 - Case Management in Primary Care Makes a Difference
CMSA Today - Issue 3, 2018 - 21
CMSA Today - Issue 3, 2018 - 22
CMSA Today - Issue 3, 2018 - Past Presidents Corner
CMSA Today - Issue 3, 2018 - 24
CMSA Today - Issue 3, 2018 - 25
CMSA Today - Issue 3, 2018 - The Integrated Case Management Program: Essential for Today’s Case Manager
CMSA Today - Issue 3, 2018 - 27
CMSA Today - Issue 3, 2018 - 28
CMSA Today - Issue 3, 2018 - 29
CMSA Today - Issue 3, 2018 - Index of Advertisers
CMSA Today - Issue 3, 2018 - cover3
CMSA Today - Issue 3, 2018 - cover4
http://www.nxtbook.com/naylor/CMSQ/CMSQ1118
http://www.nxtbook.com/naylor/CMSQ/CMSQ0417
http://www.nxtbook.com/naylor/CMSQ/CMSQ1417
http://www.nxtbook.com/naylor/CMSQ/CMSQ0317
http://www.nxtbook.com/naylor/CMSQ/CMSQ1317
http://www.nxtbook.com/naylor/CMSQ/CMSQ0217
http://www.nxtbook.com/naylor/CMSQ/CMSQ1217
http://www.nxtbook.com/naylor/CMSQ/CMSQ0117
http://www.nxtbook.com/naylor/CMSQ/CMSQ1117
http://www.nxtbook.com/naylor/CMSQ/CMSQ0416
http://www.nxtbook.com/naylor/CMSQ/CMSQ1416
http://www.nxtbook.com/naylor/CMSQ/CMSQ0316
http://www.nxtbook.com/naylor/CMSQ/CMSQ1316
http://www.nxtbook.com/naylor/CMSQ/CMSQ0216
http://www.nxtbook.com/naylor/CMSQ/CMSQ1216
http://www.nxtbook.com/naylor/CMSQ/CMSQ0116
http://www.nxtbook.com/naylor/CMSQ/CMSQ1116
http://www.nxtbook.com/naylor/CMSQ/CMSQ0415
http://www.nxtbook.com/naylor/CMSQ/CMSQ1415
http://www.nxtbook.com/naylor/CMSQ/CMSQ0315
http://www.nxtbook.com/naylor/CMSQ/CMSQ1315
http://www.nxtbook.com/naylor/CMSQ/CMSQ0215
http://www.nxtbook.com/naylor/CMSQ/CMSQ1215
http://www.nxtbook.com/naylor/CMSQ/CMSQ0115
http://www.nxtbook.com/naylor/CMSQ/CMSQ1115
http://www.nxtbook.com/naylor/CMSQ/CMSQ0414
http://www.nxtbook.com/naylor/CMSQ/CMSQ1414
http://www.nxtbook.com/naylor/CMSQ/CMSQ0314
http://www.nxtbook.com/naylor/CMSQ/CMSQ1314
http://www.nxtbook.com/naylor/CMSQ/CMSQ0214
http://www.nxtbook.com/naylor/CMSQ/CMSQ1214
http://www.nxtbook.com/naylor/CMSQ/CMSQ0114
http://www.nxtbook.com/naylor/CMSQ/CMSQ1114
http://www.nxtbook.com/naylor/CMSQ/CMSQ0413
http://www.nxtbook.com/naylor/CMSQ/CMSQ1413
http://www.nxtbook.com/naylor/CMSQ/CMSQ0313
http://www.nxtbook.com/naylor/CMSQ/CMSQ1313
http://www.nxtbook.com/naylor/CMSQ/CMSQ0213
http://www.nxtbook.com/naylor/CMSQ/CMSQ1213
http://www.nxtbook.com/naylor/CMSQ/CMSQ0113
http://www.nxtbook.com/naylor/CMSQ/CMSQ1113
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0412
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1412
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0312
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1312
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0212
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1212
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0112
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1112
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0411
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1411
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0311
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1311
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0211
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1211
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0111
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1111
http://www.nxtbookMEDIA.com