Accountable care organizations (ACO) have the potential to shift the healthcare industry toward payment reform and improved care, as long as they successfully coordinate the complete spectrum of care across different delivery sites, according to an article published in the Journal of the American Medical Association.
ACOs also must use electronic medical records, adhere to cost-effective guidelines for diagnosis and treatment and monitor clinical and financial performance.
The authors contend that payers have the necessary operational infrastructure, including access to capital, depth of professional management, expertise in managing financial risk and IT systems, to create and manage fruitful ACOs.
Indeed, many payers already have stepped up to the plate, contributing to the 38 percent increase in ACOs in the past six months, as they create ACOs with hospitals, physician groups, medical clinics and other providers in the hopes of lowering costs and improving care. Of the more than 200 ACOs that intelligence business firm Leavitt Partners identified in its report this week, 6 percent are insurer-provider ACOs.
Here's a summary of the payer-driven ACOs created since November 2011.
Aetna established an ACO with Banner Health Network in which aetna members have access to Banner Health's providers in Arizona. Aetna offers Banner Health rewards based on quality, efficiency and patient satisfaction measures.
Blue Shield of California-Hoag Memorial Hospital Presbyterian, Greater Newport Physicians
Blue Shield of California set up an ACO with Hoag Memorial Hospital Presbyterian and Greater Newport Physicians to provide integrated, cost-efficient healthcare. The three organizations will collaborate and share information with each other to provide comprehensive healthcare service.
Blue Shield of California-John Muir Health
Blue Shield of California and John Muir Health created an ACO to provide coordinated care for 16,000 Blue Shield HMO members.
Blue Cross Blue Shield of Michigan-Trinity Health
Blue Cross Blue Shield of Michigan and Trinity Health developed an ACO in which Blue Cross aims to improve information systems at Trinity's 12 hospitals and health facilities.
Cigna-Granite Healthcare Network
Cigna expanded its network of ACOs to include the Granite Healthcare Network, a group of five clinical groups: Concord Hospital, Elliot Health System, LRGHealthcare, Southern New Hampshire Health System and Wentworth-Douglass Hospital. The ACO, which marks the first time Cigna is collaborating with a multi-hospital system, aims to provide greater access to healthcare for patients, improve care coordination and increase patient satisfaction.
Cigna also expanded its ACO program with 10 new initiatives in seven states--Colorado, Maine, New York, North Carolina, Tennessee, Texas and Virginia--to improve quality, affordability and patient satisfaction, focusing particularly on patients with chronic conditions such as diabetes and heart disease.
Cigna-Weill Cornell Physician Organization
Cigna and the Weill Cornell Physician Organization created an ACO in New York, in which nurses act as coordinators identifying and reaching out to patients at risk for hospital readmission, overdue for important health screenings or have skipped a prescription refill.
Cigna-Fairfax Family Practice Centers
Cigna and Fairfax Family Practice Centers in Virginia founded an ACO that intends to reform financial incentives for doctors toward accountable care.
Florida Blue-Baptist Health South Florida, Advanced Medical Specialties
Florida Blue, Baptist Health South Florida and Advanced Medical Specialties formed an ACO to decrease health costs and change care delivery.
Wellmark-Genesis Health System
Wellmark Blue Cross Blue Shield of Iowa and Genesis Health System launched an ACO that aims to provide improved quality care for all its members, improve members' all-around experience in areas such as making appointments, scheduling follow-ups and coordinated visits with multiple doctors.
Wellmark Blue Cross Blue Shield of Iowa launched the state's first ACO with Iowa Health, the state's largest hospital system. Although participating providers will continue to receive traditional fee-for-service payments, they will be eligible to share in savings from delivering higher-quality care.
To learn more:
- read the JAMA article