Becker's Hospital Review

ACOs 14 Speaking from the payor side, Mr. Thomas says Aetna's ACOs involve opportunities for hospitals and health systems to tap into new sources of revenue. "For example, many of the ones Aetna is involved with include jointly marketed health plan products, giving health systems and provider organizations an additional way to improve the health of their communities while at the same time grow their patient base," he says. 5. ACOs take healthcare back to the 1990s. Healthcare leaders have a hard time forgetting the 1990s and emergence of integrated delivery networks. These memories leave many in the industry pointing to ACOs and calling the model déjà vu. Physician-hospital organizations and management service organizations were designed to coordinate care through capitated risk contracts, but overall, they were regarded as ineffective in improving care quality or lowering costs. Those disappointments still linger for some cynics. There has have also been consistent comparisons between ACOs and HMOs. For instance, some critics say ACOs should allow patients to partake in cost savings. This participation could take different forms, such as patients paying smaller copayments if they choose a physician who is in an ACO. If ACOs make it more expensive for patients to receive care elsewhere — as a strategy to keep patients in the ACO — then it may resemble an unfavorable, network HMO. Oddly, even HMOs received less flak when they were rolled out. Dr. Bard says the emergence of HMOs in the 1990s did not stir as much controversy as ACOs, largely because HMOs were not as mainstream. "The HMO was an alternative movement. It was voluntary and always a bit of the fringe, whereas managed care was more mainstream," he says. One of the most significant differences between ACOs and delivery networks in the 1990s is today's role of health information technology, data analytics and clinical decision support. But these tools alone will not make ACOs infallible, according to a 2012 study published in Health Affairs, which suggested that information technology is necessary but insufficient to improve outcomes in an ACO. Rather, the study found ACOs will fare best if they are not oversold as silver bullets and if structured to target specific populations. Survey: Majority of Physicians Unfamiliar With ACOs, PCMHs By Heather Punke  J ust one in three of the nation's physicians reported they were familiar with accountable care organizations, episode-based payments and patient-centered medical homes, according to the Deloitte 2013 Survey of U.S. Physicians. Last year, more than 50 percent of physicians were familiar with those programs, according to the survey. The survey's findings are based off of 613 responses from primary care physicians, surgical specialists, non-surgical specialists and other physicians. n What will prove ACOs? The healthcare industry is still in a waiting game as far as ACOs' results. Although a few mature ACOs like AdvocateCare (and it's important to keep in mind that the term "mature" means that ACO is only about three years old) have reported hopeful results from their first years; other newly launched ACOs are not yet able to disclose results. For Medicare savings, the industry has its eye on the Pioneer ACOs, and results from those 32 organizations are expected this summer. Either way, whether in regards to commercial or Medicare results, Dr. Bard says people shouldn't expect dramatic results or a sudden wave of ACO acceptance and implementation. "What I look for is evidence that as we invest in and improve systemness, with everyone working as a team, playing as far north in their licenses as possible and delivering patient-centered care, outcomes improve. I think it will be a slow, steady momentum." Dr. Bard and Mr. Lockman both noted that ACOs have already made changes to the healthcare industry, particularly for providers. Dr. Bard says ACOs have restored a level of professionalism across the industry that has been well-received and healthy, as ACOs have enabled the broader range of healthcare providers — nurses, physicians, dieticians, pharmacologists, social workers and more — to feel needed in the care continuum. "That's what was lost in the 1990s: dignity and care and all those things that matter so much to those people," he says. Mr. Lockman says although it will take time for ACOs to gain broader acceptance, he's observed a change in the provider-patient relationships within Michigan Pioneer ACO. As more providers begin to notice ACOs' positive effects and promotion of patient-centered care, Mr. Lockman says the model is likely to catch on. "One of the things that gives us gratitude is some of the individual experiences patients have in terms of working with care managers and providing the kinds of care transitions that the fee-for-service, episodic care system in a fragmented environment does not provide. When we see patients being grateful for having care manager and providing care transitions — every one of those voices adds to support of program," he says. n Medicare ACO Results Expected Soon By Molly Gamble  R ichard Gilfillan, MD,  director of the Center for Medicare and Medicaid Innovation, said more "telling evidence" about CMMI models, including accountable care organizations, would be available this summer. Dr. Gilfillan offered some early evidence that other pilot programs like bundled payments and patient-centered medical homes may be helping to lower healthcare costs. In the final quarter of last year, hospital readmissions for Medicare beneficiaries decreased to slightly below the threshold of 18.5 percent to 19.5 percent, which is where the readmission rate had sat for the past five years, according to the report. Dr. Gilfillan also said there is data suggesting CMMI's medical home program in Vermont is slowing the growth of healthcare costs, according to the report. n

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