The rise of private insurer-led accountable care organizations across the country comes with several challenges, including applying various quality measures, managing different provider requirements and recruiting independent providers to join, reported California Healthline.
Many of the 600 public and private ACOs are run by private insurers, including Aetna, Anthem Blue Cross and Blue Shield of California. Insurers say their ability to track patient data and evaluate care can lead to ACO success.
"ACO arrangements with commercial plans can be more flexible and customized to the organization's particular circumstances, assets and needs," Farzad Mostashari, a visiting fellow at the Brookings Institution and former National Coordinator for Health IT, told California Healthline.
Payer-led ACOs like the ones operated by Humana are flexible enough to allow for slow and steady growth. The Louisville, Ky.-based insurer recognized the need to marry providers' clinical expertise with Humana's business views to drive integrated care, Humana Chief Medical Officer Roy Beveridge, M.D., told FierceHealthPayer in an exclusive interview.
The problem is commercial ACOs aren't held to the same quality standards as publicly-run versions. Mostashari agreed, at least in part, that ACOs run by private insurers have greater variability in payment models and more difficulty managing different requirements for providers. What's more, some industry analysts worry that private ACOs aren't recruiting enough independent doctors to round out the type of providers participating in the programs.
Despite these challenges, many industry experts believe ACOs will continue to thrive. "With continued government support ... and considerable growth in the number of organizations becoming ACOs, the prospect of ACOs becoming the dominant model in care delivery seems very real," said David Muhlestein, director of research at Leavitt Partners, according to California Healthline.
To learn more:
- read the California Healthline article