Patients pose challenges in provider-payer ACOs

Representing a national provider-payer trend, physician organizations and health plans are actively partnering in coordinating care--specifically in California--for cost-effective management, according to an Integrated Healthcare Association white paper released today.

With the accountable care partnerships, though, come some challenges. For example, it may be difficult to link patients to physician organizations, as patients seek care from physicians within the insurer's network, including doctors outside of the ACO. Communicating with patients also may be complex as ACOs try to engage patients in the care process, including wellness and disease prevention.

In addition, there are challenges in clinical and administrative data exchange. ACO providers and health plans must be prompt and thorough in coordinating patient data across the organizations.

Nevertheless, even with these patient challenges, ACOs can be a high-value opportunity in healthcare, according to the white paper.

"ACOs represent the opportunity to forge a middle ground between the traditional HMO product, which controls cost at the expense of consumer choice, and the traditional PPO product, which preserves choice at the expense of cost control," said report author James C. Robinson, Kaiser Permanente professor of health economics in Berkeley, Calif. "It is now time to overcome the challenges and fulfill the opportunities presented by the principles of ACOs."

For more information:
- read the press release
- check out the white paper (.pdf)

Related Articles:
Advanced Payment Model to lure critical access hospitals, rural providers
Modern provider-payer accountable care not a repeat of 90s
ICD-10 fluency means provider, payer collaboration
Guest commentary: Changing relationship dynamics of payers and providers in 2011