Critics of accountable care organizations (ACOs) have been quick to proclaim the demise of the aggressive healthcare delivery reform after the Center for Medicare & Medicaid Services (CMS) released some rather checkered results in mid-July for the first year of the Pioneer ACO program. Although 13 of the 32 Pioneers were successful, generating some shared savings, seven of the ACOs opted to step down to the less-risky Medicare Shared Savings Program (MSSP), and two decided to no longer be any kind of Medicare ACO (Pioneer or MSSP). The remaining 10 Pioneers chose to stay in the program even though they did not have a successful first year.
One should not be alarmed by the spotty results, as they are reminiscent of what happened with the Physician Group Practice (PGP) Demonstration Project, a precursor to the current Medicare ACO programs, in which only two of 10 participating ACOs succeeded in the first year. The encouraging news is that the participants in the PGP Demonstration Project improved their overall performance during the following years, so the 23 Pioneers still in the program have reason to expect their performance will improve in the years ahead.
There was good reason to believe the mixed marks would deter provider organizations from signing up as Medicare ACOs, but in the past three months, eight health systems have all entered into agreements to be involved in MSSP ACOs: Frederick Regional Health System, Meritus Health, Orlando Health, PinnacleHealth System, Robert Wood Johnson Health System, Rutgers University, Scottsdale Healthcare, Susquehanna Health, and Western Maryland Health System.
The momentum of commercial payer-led ACOs is even greater. According to a recent survey by HealthEdge, a technology provider for healthcare payers, 61 percent of commercial payers want to participate in the ACO model. From August through October, the following provider organizations joined commercial ACOs, which are largely led by Aetna, Cigna, and Blues plans: Alta Bates Medical Group, Barnabas Health, Brown & Toland Physicians, Facey Medical Foundation, Facey Medical Group, Humboldt-Del Norte Independent Practice Association, InterMed, Jefferson Health System, Maine General Health, MaineHealth, Martin’s Point Health Care, Medical College of Wisconsin, Memorial Hermann, Mercy Health System, Mount Carmel Health Partners, New Hanover Regional Medical Center, Prevea Health, Providence Health & Services, Quality Health Solutions, Saint Francis HealthCare Partners, Santa Clara County IPA, Scottsdale Healthcare Partners, UCLA Medical Group, WellSpan Health, and Wilmington Health.
As of this writing, the problems of HealthCare.gov and the sending of policy cancellation notices to small businesses and individuals who buy their own insurance are dominating the newspaper headlines and talk-radio airwaves. So quietly, yet relentlessly, the accountable care movement—despite the mixed results of the first year of the Pioneer program—continues its march to reform the delivery of health care in America.
Ken Perez, healthcare IT marketing and policy consultant, Menlo Park, Calif.
Publication Date: Monday, November 04, 2013