With fears that the accountable care organization (ACO) experiment will repeat the history of HMOs, industry experts and hospitals alike are trying to figure out how successful ACOs will be in patient outcomes and costs savings, if any. But as Thomson Reuters noted in its report yesterday, no one really knows how ACOs will slow healthcare spending.
Thomson Reuters, however, did offer four metrics that serve as ACOs' financial predictors, it said. According to the report, success hinges on the number of attributed members, current member in-network and out-of network utilization and payments, opportunities to reduce utilization and costs and the baseline costs and payer financial terms.
For instance, if diabetics make up 5.5 percent of 10,000-member ACO--that is, 550 patients--each participating primary care physician might only care for a handful of diabetic patients, making it difficult to accurately justify significant changes, the report noted.
"Those of us with long memories recall the promise of Health Maintenance Organizations in the '80s and '90s, and we recognize that a healthcare concept is ultimately only as good as its implementation," Bob Kelley, senior vice president of healthcare analytics at Thomson Reuters, said in a company announcement yesterday. "For hospitals and other large healthcare organizations, success will depend on access to accurate information on the characteristics of population health and utilization of services."
Even with the work necessary to gather accurate data, Thomson Reuters noted that better data is available today than the days of HMOs.
For more information:
- see the company announcement
- download the report (registration required)
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