APMA News - May 2012 - (Page 40)

ACO Update: Are Commercial ACOs Getting a Leg Up on their Medicare Brethren? FROM THE APMA HEALTH SYSTEMS COMMITTEE T here has been a great deal of angst and concern over the implementation of the CMS Medicare Shared Savings Accountable Care Organizations (ACO). This concern has led health care-focused organizations, such as APMA, to follow closely the various iterations of the ACO proposed and final rules, as well as the CMS implementation timelines. Those who were tracking these entities all along realized that there may be much better opportunities for success on the commercial side, with models developed by hospitals and insurers. The greatest concern with these commercial models As APMA has reported previously, the ACO final rule as promulgated by CMS allows for inclusion of DPMs for participation and for sharing in savings as “ACO participants” in the CMS model. What remains to be seen is how our members fit into the commercial models. is that they are not necessarily subject to the rules and regulations that apply to CMS ACOs. APMA, through its Heath Policy and Health Systems committees, is tracking commercial ACOs as well as the CMS traditional model to determine how widely these models apply to DPMs and how our member physicians are best positioned to participate. As APMA has reported previously, the ACO final rule as promulgated by CMS allows for inclusion of DPMs for participation and for sharing in savings as “ACO participants” in the CMS model. What remains to be seen is how our members fit into the commercial models. The relatively strict guidelines and infrastructure requirements suggest that there will be relatively few Medicare ACOs, at least initially (CMS estimates 75–150 nationwide). What remain to be seen are the adoption rates of commercial ACOs as well as how these models would look. In many cases, it’s just simpler for providers looking to establish a commercial ACO to build off of existing payer relationships. In Massachu40 APMA News May 2012 setts, commercial ACOs have taken on the form of the AQC, or Alternative Quality Contract, offered by Blue Cross Blue Shield (BCBS) of Massachusetts to providers enrolled in its HMO Blue plan. In fall 2010, Advocate Health Care signed a three-year agreement with BCBS of Illinois to hold doctors and hospitals accountable for performance and quality service. Advocate, which operates 10 hospitals around Chicago, agreed to limit the rate increases it negotiates from the insurance company. Physicians and hospitals must meet performance targets in quality, safety, and efficiencies. Advocate makes money by getting a share of dollars saved under the arrangement (financial terms and rate increases were not disclosed). Similar efforts have been undertaken by: Cigna in New Jersey: a “collaborative accountable care organization” with East Brunswick-based Partners In Care; Blue Shield of California: Greater Newport Physicians, an individual practice association of more than 500 doctors; and Hoag Memorial Hospital Presbyterian in Newport Beach, CA: a three-year accountable care initiative to provide integrated, cost-efficient care to approximately 11,000 Blue Shield HMO members in Orange County. • • • In a number of these cases, the providers and payer involved will share clinical and case management information, coordinate health-care services, and align their incentive structures to improve health-care quality and patient service while reducing costs. These developments have led many to conclude that the potential for success for ACOs is greater in the commercial population than in the Medicare population. Health-care veterans question whether or not the commercial ACO is really new. More than a few health-care leaders have remarked that the ACO is a rebranded and refined model of pay-for-performance (P4P) and capitation. While there is some truth to this statement, the biggest difference between P4P/capitation and the ACO model is the joining of all stakeholders at the table (the physicians, the hospitals, and the payers) to share data to guide better outcomes. In contrast, lack of alignment from these stakeholders in the 1990s likely contributed to the near demise of the capitated model. Ultimately, the commercial ACO contains elements of capitation and P4P, and most hospitals and health systems nationwide are already working on quality and safety initiatives. Coordination among stakeholders may be the factor that eventually drives their success. n

Table of Contents for the Digital Edition of APMA News - May 2012

APMA News - May 2012
President’s Message
Contents
92nd House of Delegates: Advancing Education and the Profession
Special Section: APMA Educational Foundation
Being a Residency Director: What’s in it for You?
DPM versus MD: Letters to the Editor
JCRSB Update: May 2012
ACO Update: Are Commercial ACOs Getting a Leg Up on their Medicare Brethren?
APMA By the Decade: 1952–1961
Profiles in Progress: Medical Staff Leadership
2011 Podiatric Practice Survey: Determination of Income/Salary for Employed Professionals
Master Your Practice at the National
Annual Scientific Meeting Preliminary Program
Annual Scientific Meeting Registration Form
Annual Scientific Meeting Sponsors
Reimbursement
Federal Advocacy Forum
APMAPAC Chair Report
IT Consultant
Website Wisdom
Technofile
Small Business 101
Awards Nominations
APMA All Stars
In Short
Worthy of Note
Affiliates Corner
New Members
Death Notices
List of Affiliated Organizations
Insurance Advisor
APMAPAC Update
Development Update
Classified Advertising
Dates to Remember
Advertising Index
10 Questions
Your APMA

APMA News - May 2012