Try as you might, it’s hard to ignore the buzz surrounding accountable care organizations (ACOs) these days. You’ll find articles about ACOs in nearly any publication you open and presentations on ACOs at nearly any conference you attend.
So—as Emily Litella of Saturday Night Live fame would say—what’s all this fuss about ACOs?
Shared savings, shared risk
When you sort through all of the rhetoric and regulation, an ACO is a network of doctors, hospitals and health plans that shares responsibility for providing care to patients. ACOs—both public and private networks—offer incentives for providers that cooperate and save money while meeting specific quality metrics. In other words, they get bonuses for keeping patients healthy and out of the hospital. On the other side of the coin, providers will be responsible for additional costs if they cannot effectively treat the patient.
While some experts debate whether or not ACOs will completely replace the current fee-for-service approach, they predict that some flavor of ACO will gain prominence in the marketplace.
PCPs and smaller practices will be critical to ACO success
Smaller practices find themselves in a challenging situation. It’s likely that large provider groups (such as independent physician associations), hospitals, health systems and payers will drive the development of most ACOs. But they will be highly dependent upon “family docs,” primary care providers (PCPs) and small specialty practices to deliver the well care, preventive services and disease management critical to meeting the access/quality/cost conundrum.
New model requires technology, communication
It’s to your advantage to explore whether or not it would be beneficial to participate in an ACO. You’ll be asked to enter into contractual relationships with other providers in your service area, of course, as well as implement health information technology (HIT) solutions like electronic health records (EHRs) to facilitate data sharing and collaboration if you have not done so already.
It also means you’ll need to communicate with patients about your involvement. The Medicare Shared Savings Program mandates that PCPs tell patients they are part of an ACO—and when they’re referring these patients to hospitals or specialists within the network. Patients, of course, can select other providers if they prefer.
Yet another option: the Comprehensive Primary Care Initiative
Here’s another twist: the Centers for Medicare and Medicaid Services (CMS) has created a model similar to ACOs specifically for PCPs—the Comprehensive Primary Care Initiative, also funded by healthcare reform. Through the program Medicare will coordinate with private and state health plans to pay bonuses to PCPs who improve care coordination for their patients. Even better, Medicare will offer PCPs additional resources to participate in the program. After two years, Medicare will give participants a chance to share in any savings they generate.
Consider all your options
Without a doubt, there will be no shortage of options for you to consider. And you’ll be able to respond in whichever way you feel most appropriate for your practice.
There’s only one reaction your partners at Emdeon advise against: Don’t take your cue from Emily Litella and simply say, “Never mind.” These changes are coming—and PCPs and small practices will be right in the middle of any new model. You’d be wise to keep abreast of what is occurring on the national scale, as well as right in your own backyard.
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So, what's all the fuss about ACOs?
