Managed Care - August 2012 - (Page 23)

Health Plans Won’t Sit Out While Docs, Hospitals Dance As providers scramble to form accountable care organizations, insurers take steps to either participate, or limit ACO market power is 100 ACOs by 2014. In July 2012, it announced six new contracts from Maine to California, bringing its total to 32. Aetna has announced several new ACOs including, in June, a contract with Inova ospitals, physicians, and insurers suddenly Health System announcing an ACO and private find themselves in a furious round of corpohealth plan aimed at serving 1.1 million residents in Virginia. rate speed-dating as these major stakeholders explore realignments and forge new alliances in Insurers aren’t the only wary ones. There is conthe face of health care reform. The hospital/physisiderable concern that providers lack many of the cian realignment is something we’ve documented capabilities to function as ACOs or to manage the for a while ( It’s the provider/ health of populations. For example, they do not health plan dance that’s added a few steps. have the types of data systems to identify gaps in Still, both categories of realignment — provider care, a core component of population health manwith provider, provider with insurer — change how agement. plans relate to providers. On one hand they offer Another Health Affairs article (“Early Lessons opportunities to improve quality, control costs, From Accountable Care Models in the Private Secand change financial arrangements. It is a cliché tor: Partnerships Between Health Plans and Providto say that opportunity means risk, but we’ll say it ers,” September 2011), meanwhile, points out that anyway. History is on our side. many of the necessary ACO tools and skill sets do At least one widely publicized report (“Unnot exist in provider organizations. It says, though, checked Provider Clout in California that payers are providing technical asForeshadows Challenges to Health sistance to providers in four areas: disReform,” by the Center for Studyease and case management, population ing Health System Change) contends health management, administrative that health plans did not have effecdata sharing, and managing costs or tive counter-strategies for the past financial risk. hospital-physician alignment initiaHealth plans have realized that they tives and providers gained costly necan ensure the operational success of gotiating leverage over them. And at ACOs and also develop a more collableast one article (“Accountable Care orative relationship by providing these Organizations: The Case for Flexible “We are working with both forms of technical assistance. hospital-centric and physicianPartnerships Between Health Plans and Aetna has adopted this strategy. “We Providers,” in Health Affairs in January centric ACOs,” says Aetna’s Charles are working with both hospital-centric Kennedy, MD. 2011) argues that there is potential for and physician-centric ACOs,” says ACOs, the latest form of provider alignCharles Kennedy, MD, CEO of Aetna Accountable Care Solutions. ment, to shift costs to private insurers if they lead He says Aetna does not prefer one type over the to market concentration. In response to expanding provider realignment, other. “It is less a question of structure than of health plans are now taking a page from the hospiwhether or not there is strong forward-thinking tal playbook and are pursuing their own realignleadership to bring about change. We look at the ment initiatives with providers. Insurers are very reasons for hospital and physician integration and aggressive in forming ACOs. Cigna has said its goal are interested in working with those organizations By Thomas Reinke Contributing Editor H AUGUST 2012 / MANAGED CARE 23

Table of Contents for the Digital Edition of Managed Care - August 2012

Managed Care - August 2012
Editor’s Memo
Legislation & Regulation
News & Commentary
Medication Management
Evidence Review
Compensation Monitor
Private Exchanges: Practice Makes Perfect
Hospitals and Providers Ganging Up on Plans?
Q&A: Kaiser Permanente’s Sharon Levine, MD
God Save the Health Care System!
Future Points to Greater PBM/Plan Cooperation
Formulary Files
Plan Watch
Tomorrow’s Medicine

Managed Care - August 2012