Slideshow Top Trends in ACO Payment Models

  • March 21 2013, 5:44pm EDT
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Top Trends in ACO Payment Models

MedeAnalytics recently released a research report analyzing top metrics in play in accountable care organizations across the country. Based on interviews, literature review and published reports, the analysis reveals current trends in ACO payment models and offers insight into the differences between Medicare and commercial efforts. Report highlights follow.

Growing Numbers

According to MedeAnalytics, there are some 300 commercial ACOs and more than 250 Medicare ACOs in operation. Growth is uneven, with more ACOs in California, Texas, New England and Floriday than in the Mid-West, says the report, written by Michelle Marge, director of provider solutions at MedeAnalytics.

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Common Denominators

ACO metrics fall under six main categories, says MedeAnalytics. These are: 1. Pediatric; 2. Ambulatory; 3. Prevention; 4. Acute care; 5. Outcome; and 6. Utilization. In the ACO model, reimbursement will be pegged to various performance measures within the categories.

Commercial ACOs

MedeAnalytics found over 300 metrics in play among commercial ACOs and assigned them to one of the 6 large categories. Among commercial efforts, ambulatory metrics appeared most commonly encompassing 28% of all metrics. Ambulatory metrics are typically the responsibility of a primary care physician, and included such measures as blood testing for diabetic patients. Service utilization metrics ranked a close second, representing 27% of all metrics. This metric includes such activities as avoidable ED visits or utilization of high-cost imaging tests.

Medicare ACOs

In contrast to commercial ACOs, prevention metrics ranked highest among Medicare ACOs, accounting for 42% of all metrics. Prevention measures include breast cancer screening and presence of pneumonia vaccinations for example. Utilization of services, among the most common commercial ACO measures, accounted for only 3% of Medicare metrics.

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Among commercial ACOs, breast cancer screening was the most frequently counted metric, followed by hemoglobin testing and nephropathy screening for diabetics. Colorectal cancer screening came in fourth.

Leveraging Data

A number of metrics do overlap between widely used commercial and Medicare metrics, setting the stage for a multi-payer ACO, MedeAnalytics says. “Leveraging data will be integral for ACO operational success,” the report says. EHRs, health information exchanges and analytics packages will help pave the way to more metric standardization. Without some standardization, measuring performance will become difficult and stand as a roadblock to the model’s expansion. “By identifying commonly used ACO metrics at the outset, providers can select metrics most applicable across a larger population.”
Source: MedeAnalytics.