The forum “The State of Accountable Care: Evidence to Date and Next Steps” hosted on October 20th by the Engelberg Center for Health Care Reform at Brookings www.brookings.edu/about/centers/health examined the challenges and successes that Accountable Care Organizations (ACO) are facing in today’s health and medical environment.
Mark B. McClellan, MD, PhD, Director for the Health Care Innovation and Value Initiative at Brookings, pointed out, “ACOs are rapidly growing throughout the U.S and offering the promise of coordinated patient care at a lower cost resulting in many physician-led groups moving to the new payment coordinated care model.
According to McClellan, the growth in ACOs can be found in smaller ACOs led by physician groups consisting of primary care physicians and mostly practices with 20 to 30 doctors not affiliated with a hospital. These newer physician-led ACOs, realize greater financial benefits when they are able to reduce costs.
According to keynote speaker Sean Cavanaugh, Deputy Administrator and Director of the Center for Medicare at CMS, “Major regulatory changes are anticipated in the coming months that will impact accountable care programs in Medicare as well as in the private sector. CMS in the near future intends to release a “Notice of Proposed Rulemaking” to establish rules for participation in the Medicare ACO program.
The new proposed regulations will affect ACO capability and help transform smaller practices into ACOs especially in rural areas. The plan is to publish the proposed rule and then solicit comments from the public. After reviewing the comments from the public, the final rule is expected to be ready early 2015.
As reported, there are now more than 335 ACOs participating in the Medicare Shared Savings Program (MSSP) www.cms.hhs.gov in 47 states, D.C., and Puerto Rico. MSSP providers are paid more by CMS if they are able to keep costs down while meeting agreed upon standards for quality care.
Early results show that while most Medicare ACOs are succeeding at meeting their quality benchmarks, but only a quarter of MSSP participants have been able to reduce their spending below the projected financial targets to qualify for shared savings. While these results are encouraging, they also suggest that more work is needed from both CMS and providers to ensure continued sustainability of the MSSP ACOs.
Morey Menacker, DO, President and CEO of the Hackensack Alliance ACO www.hackensackumc.org and Vice Chair of Medicine at Hackensack University Medical Center reported on how their Medicare Shared Savings ACO is developing new tools. One program uses ten tablet computers provided to patients that frequently use emergency rooms due to their difficulty in managing chronic conditions.
The tablets are given to patients who are alert enough to use the tablets and have the dexterity to handle them. They receive notices through a web-based application on when they need to take their medications, and how to monitor their weight, blood pressure, and blood sugar levels. If a patient doesn’t log in that they have taken their medications or if a test comes back with troubling results, a notice is sent directly via cell phone to the care coordinator for the ACO.
Also, when ACO patients are discharged, they receive all their medications with the needed information and ae required to see their doctors within 48 hours. This is done to eliminate confusion over taking their medications which may very well end up requiring the patient to be readmitted to the hospital.
The Pioneer ACO Model http://innovation.cms.gov/initiatives/Pioneer-ACO-Model allows provider groups to move more rapidly from a shared savings payment model to a population-based payment model consistent with but separate from the MSSP program.
CMS reports that the Pioneer Program saved $96 million in its second year. CMS also reports that the Pioneer ACO Program was able to improve quality scores by 19 percent and increased performance on 28 of 33 measures between performance year one and year two.
Marcus Zachary MS, DO, Senior Medical Director for Quality and Population Health at Brown & Toland Medical Group www.brownandtoland.com described how his organization was able to not only generate savings but also improve quality for their Medicare’s Pioneer ACO. Currently, Zachary reports that close to 190 doctors in the medical group are providing care for 16,000 Medicare beneficiaries in the Brown & Toland’s Pioneer ACO and has helped Medicare save $4.6 million.