Physicians offer strategies to balance accountable and fee-for-service payment models

stethoscope, coins and calculator
Clinicians who treat ACO patients are likely to run into incompatible financial incentives, experts say. (Getty/mckare)

Accountable care organizations are beginning to show positive results, but there are challenges inherent for providers that have one foot in the value-based payment world and the other in fee-for-service reimbursement.

There are steps that health systems can take to address these challenges and ease the transition to value-based care, wrote Ishani Ganguli, M.D., a physician at Brigham and Women's Hospital, and Timothy G. Ferris, M.D., the senior vice president of population health management at Partners HealthCare, in a piece for the Journal of the American Medical Association. 

For instance, physicians who treat ACO patients often run into conflicting financial incentives, they wrote. This is especially common for specialists, who may hesitate to adopt new technologies common in ACOs, such as telemedicine, because many of their patients remain in fee-for-service plans. 


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Health systems can address this issue by communicating with specialists and encouraging them to work alongside ACO primary doctors on care coordination and case management. 

RELATED: 3 traits of the most successful ACOs—A focus on internal culture, population health and continuous improvement 

Disparate performance measures is another challenge. Ganguli and Ferris suggested that providers take advantage of technology to align these measures and that future iterations of the ACO model should take a look at which measures are the most meaningful. Hiring outside staff for data entry can reduce the burden on ACO clinicians, according to the article. 

Population health management is central to the ACO, but engaging patients in programs that may benefit them also poses a challenge, as they may not be aware they're in an ACO at all, according to the article. Clinicians may also be uncomfortable treating ACO patients differently than others when it comes to population health. 

The model as a whole is promising as a driver in the transition toward value-based care, but addressing issues like this can help ACOs better reach their goals, Ganguli and Ferris said. 

"In the process, some tensions may be inevitable," they wrote. "But if these efforts result in better care for patients, they will be worth the trouble." 

RELATED: A global look at accountable care organizations 

ACOs may generate sluggish savings, but even as the Centers for Medicare & Medicaid Services take a new approach to some alternative payment approaches—including bundled payments—it seems committed to making the ACO model work. 

After several years of shaky financial reports, the major ACO programs have turned a corner and are now saving millions in healthcare costs. The Medicare Shared Savings Program saved Medicare $652 million last year, and Pioneer and Next Generation ACOs also reported millions in savings

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