ACOs for everyone

Karen Cheung-Larivee

 Karen Cheung-Larivee

What's in a name? "Accountable care organization" is the catch phrase of 2012. But the term describes just about any type of pay-for-performance, quality care-coordination, IT-focused, right-time right-place, cross provider-payer, value-based system change that the country is clamoring for.

Even those reluctant to sign up with the Center for Medicare and Medicaid Innovation are drinking the accountable care Kool-Aid.

As hospitals wind down the year, they're looking ahead to 2013 plans--and accountable care is sure to be a part of their strategic decisions.

With the U.S. Supreme Court upholding most of the Affordable Care Act, the reelection of Obama and Medicare penalties taking effect this year, hospitals are undoubtedly pressured to focus their attention on quality and not quantity.

There's something for everyone on the ACO menu, as Medicare called it--the Pioneer model for the ambitious, Shared Savings for those hopping on the bandwagon or Advanced Payment ACOs for the IT-lacking rural providers. They now total more than 150 in the United States.

But Medicare is only one "onramp" to accountable care, according to Robert Williams, national medical director at Deloitte Life Healthcare Sciences Consulting, based in McLean, Va.

According to last week's report by Salt Lake City-based healthcare intelligence firm Leavitt Partners and Orem, Utah-based KLAS Research in their analysis of Medicare ACOs and commercial ACOs outside of the government , 65 percent of the accountable care organizations are "mainstream," with Medicare Shared Savings or commercial payer arrangements. A fifth are "toe-dippers," which are just getting started and unsure of a long-term strategy. And 15 percent are forerunners that were functioning before ACOs even were defined.

But what was once a pie-in-the-sky idea is now taking hold across the United States, with particular concentrations in Massachusetts, California and Florida. Other sparse spots, including the upper Midwest, are expected to start in 2013, with rumors already of forth-coming ACOs next year. Williams also predicts more activity in the West and Southwest.

Aside from the reimbursements that reward quality care, hospitals and other providers and payers are partly joining the ACO movement to build their skills. Providers are integrating clinically, focused on evidence-based medicine and technology, and assuming more risk.

"The same skill sets in the Medicare program are needed in other populations," Williams told FierceHealthcare. "It'll improve patient satisfaction if ACOs if can execute effectively," he added.

There's still time for the late bloomers, according to Williams, who says there's no "one-size-fits-all" model.

"What we're calling 'accountable care' right now--in five years, we may be calling it something else."

Value-based reimbursement will always be a part of it, he said. - Karen (@FierceHealth)