Private insurer-led ACOs continue to evolve, study says

Accountable care organizations (ACOs) run by private insurers have matured in their efforts to boost quality and lower costs, but shared risk plays an increasing role in changes to reimbursement models, according to an analysis from the American Journal of Managed Care.

All 28 health plans that responded to a survey conducted by AJMC had ACO contracts in effect, and these contracts were present in 43 states and spanned commercial, Medicaid and Medicare Advantage product lines. In addition, an analysis of new, qualitative data from eight plans featured in a previous AJMC study showed that each reported improvements in both quality and cost, including:

  • Improved performance on clinical quality measures for specific conditions such as diabetes
  • Reduced admission rates and reduced emergency department visits
  • Increased lower-cost drug prescriptions

About 69 percent of private payer ACO contracts use a shared savings plan and 56 percent include a downside risk component, but only 7 percent of Medicare Shared Savings Program contracts incorporate downside risk, according to an article from Healthcare Payer News. Insurers must learn how to manage risk when joining ACOs, the article adds, and providers also must think about the terms of the partnerships and the arrangement of the financial model.

Wellmark Blue Cross Blue Shield is one example of a successful private health plans that has joined an ACO, as it recently revealed that it has leveraged its ACO to cut healthcare spending and improve quality of care. Aetna, meanwhile, has some 60 commercial ACO agreements, with two-thirds featuring risk-sharing agreements.

"One of the reasons providers had difficulty bearing risk before, they had no access to real-time data, to know what was going on so they could manage the risk," Freeborn & Peters attorney Deborah Dorman-Rodriguez tells Healthcare Payer News. "Now real-time data is available."

To learn more:
- here is the AJMC analysis
- read the Healthcare Payer News article

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