Health Affairs: Are ACOs ready for prime time?
An article published in the September edition of Health Affairs highlighted lessons from accountable care organization (ACO) models where the authors concluded that not all providers are equally ready to enter into these arrangements with health plans, thereby suggesting that flexibility be built into the design of these arrangements.
Aparna Higgins, vice president, private innovations, America’s Health Insurance Plans (AHIP) in Washington, D.C., and colleagues identified 22 health plans with approximately 30 accountable care arrangements that were in place or in development. The researchers selected eight health plans for study and used structured telephone interviews to address accountable care model program goals, criteria for provider selection, performance metrics, payment methods, technical assistance and any lessons or challenges.
Higgins and colleagues admitted the limitation of their study in that the results might not be able to be generalized across the health plan industry due to a focus on eight insurers that were members of AHIP.
The scope of the accountable care models varied among the health plans, the authors added. Some health plans were implementing these arrangements with specific employer accounts (with fewer than 100,000 members), while others were working with providers in multiple geographic areas that included most of their commercial populations.
“[The] providers’ ability to be successful in these new accountable care arrangements will depend on their capacity to organize their delivery of care to achieve performance and accountability requirement,” wrote Higgins and colleagues. “Health plan representatives interviewed in this study agreed that an assessment of this capacity is needed to ensure that providers are ready to enter into these arrangements. Also, providers must be able to implement the types of changes within their organizations required to ensure sustainable care delivery in the long term.”
However, although much of the debate on accountable care arrangements has focused on the role of providers in helping achieve the three-part aim, there is also growing recognition of the patient’s role in attaining better health and reducing cost, the researchers noted. They identified three patient-focused incentives or benefit design approaches under the accountable care arrangements:
A comparison of the common elements from private-sector programs with the Medicare Shared Savings Program Proposed Rule showed some similarities but also notable differences, the authors found. These included data sharing and availability, the level of technical assistance needed, performance standards, exclusivity of primary care providers and the opportunity for beneficiaries to “opt out” of having health data shared within the accountable care organization for population health activities.
“The ability to scale up these models and enable diffusion of best practices requires strong evidence of the models’ effectiveness,” the study concluded. “Some of the health plans in this study reported approximately 10 percent improvements in quality, a 15 percent decrease in readmissions and total patient days in a hospital, as well as annual savings of $336 per patient.”
According to the authors, formal evaluation studies will be needed to ascertain the effectiveness of these models and to identify causal relationships between specific model elements and improvements in quality and efficiency.
Aparna Higgins, vice president, private innovations, America’s Health Insurance Plans (AHIP) in Washington, D.C., and colleagues identified 22 health plans with approximately 30 accountable care arrangements that were in place or in development. The researchers selected eight health plans for study and used structured telephone interviews to address accountable care model program goals, criteria for provider selection, performance metrics, payment methods, technical assistance and any lessons or challenges.
Higgins and colleagues admitted the limitation of their study in that the results might not be able to be generalized across the health plan industry due to a focus on eight insurers that were members of AHIP.
The scope of the accountable care models varied among the health plans, the authors added. Some health plans were implementing these arrangements with specific employer accounts (with fewer than 100,000 members), while others were working with providers in multiple geographic areas that included most of their commercial populations.
“[The] providers’ ability to be successful in these new accountable care arrangements will depend on their capacity to organize their delivery of care to achieve performance and accountability requirement,” wrote Higgins and colleagues. “Health plan representatives interviewed in this study agreed that an assessment of this capacity is needed to ensure that providers are ready to enter into these arrangements. Also, providers must be able to implement the types of changes within their organizations required to ensure sustainable care delivery in the long term.”
However, although much of the debate on accountable care arrangements has focused on the role of providers in helping achieve the three-part aim, there is also growing recognition of the patient’s role in attaining better health and reducing cost, the researchers noted. They identified three patient-focused incentives or benefit design approaches under the accountable care arrangements:
- Reduced premiums
- Stand-alone product—“The key features of such a product are lower premiums, because care under this product is coordinated and better managed; a narrower network of providers; and typically richer member benefits, such as lower copayments or coinsurance,” the authors clarified.
- Tiered networks - Performance measurement in the context of accountable care models includes two components. The first is the selection and implementation of measures, and the second relates to the establishment of quality and cost targets for the participating providers. “Measure selection was typically driven by commonly used criteria, such as the existence of a robust evidence base for the measure; whether or not the measure had been endorsed by the National Quality Forum or by specialty societies; use of the measure in other ongoing incentive programs; or whether use of the measure would help ensure a focus on the needs of the specific patient populations, such as management of patients with advanced illnesses,” the authors noted.
A comparison of the common elements from private-sector programs with the Medicare Shared Savings Program Proposed Rule showed some similarities but also notable differences, the authors found. These included data sharing and availability, the level of technical assistance needed, performance standards, exclusivity of primary care providers and the opportunity for beneficiaries to “opt out” of having health data shared within the accountable care organization for population health activities.
“The ability to scale up these models and enable diffusion of best practices requires strong evidence of the models’ effectiveness,” the study concluded. “Some of the health plans in this study reported approximately 10 percent improvements in quality, a 15 percent decrease in readmissions and total patient days in a hospital, as well as annual savings of $336 per patient.”
According to the authors, formal evaluation studies will be needed to ascertain the effectiveness of these models and to identify causal relationships between specific model elements and improvements in quality and efficiency.