Tuesday, January 18, 2011

ACO Conference Notes

The Disease Management Care Blog is broadcasting tonight from Austin, Texas, where it is attending the Opal Events Summit on ACOs.

Some important takeaways:

Power Reform: While you may have been astonished at the degree of power granted to the Secretary of HHS under the Affordable Care Act, it’s worse than that. It was really a conscious decision by Congress to move power on health care from the Legislative to the Executive branch.

ACO Wannabes: There is no shortage of varying provider, hospital, commercial insurer and Medicaid arrangements, partnerships, collaborations and contacting relationships that already involve an array of risk transfer arrangements. This means there are a large host of entities that believe they can step up and be ACOs tomorrow. Once the regulations come out, the DMCB suspects many will be tempted to participate.

Shared Services Model: As the DMCB has suspected, many of the ACO wannabes have invested quite heavily in non-physician led care management that is external to the primary care sites.

Accountable Care Organizations Are Only the Beginning. They’re a “transitional” model of care because, if they work out as planned, many of the easy to implement system changes will result in one-time and short-term savings. In the meantime, the performance baseline will be reset every one to three years. Developing a long-term business model will take “creativity” will be ultimately based on providers assuming real insurance risk.

ACO Marketing: Since patients couldn’t care less about health care policy, how about “We’re accountable, we’re current and we measure.” The DMCB’s suggested brand tag line: “We care, we’re the best and we have results.” You get the idea.

Actuaries! If you’re hoping that ACOs make money, you’ll probably prefer that the projected cost performance baseline is based on a “concurrent” methodology (using this year’s cost modeling) versus a “prospective” methodology (using a projection of last year’s cost modeling).

Whither “concierge practices?" The DMCB thinks that they’ll act as an alternative to the ACO’s patient centered medical homes. If many take root in an ACO service area, that will be an indication that the ACO is failing to adequately meet patient expectations.

A Profession of Faith: If you believe in ACOs, you also believe 1) health care costs are too high, 2) in collaboration between physicians and non-physicians is good, 3) collaboration between physicians and health plans has potential, 4) in data and 5) the eventual assumption of risk by providers.

Should Health Plans Whiter On the Vine? No, because they bring 1) care management experience, 2) a financial back stop and 3) access to other people’s money i.e., capital.

Leveraging: Physicians may be able to hold out for the best deal from competing ACOs with overlapping service areas.

End of Life Care: How does a risk bearing health insurer institute a potentially creepy program that promotes hospice and saves money by reducing hospital stays? By not telling anyone about it.

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