Wait and See on ACO
At first glance, Atrius Health looks like a great candidate to become an accountable care organization, the newly developed model of shared risk and savings being launched by Medicare.
At first glance, Atrius Health looks like a great candidate to become an accountable care organization, the newly developed model of shared risk and savings being launched by Medicare. Atrius consists of five independent medical groups encompassing 80 physicians across 36 sites in the Boston area. It is fully deployed on an EHR, from Epic, which facilitates communications across specialties—one of the characteristics of an ACO. Moreover, the EHR has enabled Atrius to “function as one large contracting entity,” said Gene Lindsey, M.D., its CEO, who spoke at the World Congress Leadership Summit on ACOs this week in Vienna, Va. About half of the group’s 700,000 patients are treated under global payments arrangements, Lindsey noted.
But Atrius is in no hurry to sign up for the federal ACO program, which kicks off next January and is still awaiting final rules. Reason for the caution? The current ACO proposed regulations, all 498 pages of them, contain too many problematic areas for the practice to move ahead. The draft regulations, which will be released in final form later this year, contain too many quality measures that physicians would have to uphold, and worse, the metrics for how the measures would be calculated are unclear, Lindsey said. He was among a chorus of Summit participants who described the proposed regulations as unworkable.
But Lindsey does not see the impetus for ACOs going away any time soon, citing rising costs and the expansion of patients with expensive conditions both occurring in an era of stunted economic growth nationally. “There will be much less money in the health system regardless of whether we take advantage of the program or not,” he said.
Or, as panelist Paul Markovich, the chief operating officer of Blue Shield California, put it, “the status quo is going to kill us.” He cited runaway health costs in California, that if left unchecked, would result in annual HMO premiums of nearly $40,000 by the end of the decade. The Blues plan has three ACO-like efforts underway now, and has already seen some modest benefits, Markovich noted. By altering the discharge process to assure medication reconciliation and follow-up physician visits, the effort reduced inpatient readmissions by nearly 15 percent in one group of 42,000 members participating. The effort shares risk among Catholic Healthcare West, Hill Physicians and Blue Shield.
To succeed, the ACO model needs clear, measurable goals with clinical and financial data transparency on all sides of the equation, he said.
--Gary Baldwin
But Atrius is in no hurry to sign up for the federal ACO program, which kicks off next January and is still awaiting final rules. Reason for the caution? The current ACO proposed regulations, all 498 pages of them, contain too many problematic areas for the practice to move ahead. The draft regulations, which will be released in final form later this year, contain too many quality measures that physicians would have to uphold, and worse, the metrics for how the measures would be calculated are unclear, Lindsey said. He was among a chorus of Summit participants who described the proposed regulations as unworkable.
But Lindsey does not see the impetus for ACOs going away any time soon, citing rising costs and the expansion of patients with expensive conditions both occurring in an era of stunted economic growth nationally. “There will be much less money in the health system regardless of whether we take advantage of the program or not,” he said.
Or, as panelist Paul Markovich, the chief operating officer of Blue Shield California, put it, “the status quo is going to kill us.” He cited runaway health costs in California, that if left unchecked, would result in annual HMO premiums of nearly $40,000 by the end of the decade. The Blues plan has three ACO-like efforts underway now, and has already seen some modest benefits, Markovich noted. By altering the discharge process to assure medication reconciliation and follow-up physician visits, the effort reduced inpatient readmissions by nearly 15 percent in one group of 42,000 members participating. The effort shares risk among Catholic Healthcare West, Hill Physicians and Blue Shield.
To succeed, the ACO model needs clear, measurable goals with clinical and financial data transparency on all sides of the equation, he said.
--Gary Baldwin