ACOs: It’s Not Just About Medicare [shared savings]

By Gregg A. Masters, MPH

A recent report attached to a Tweet posted by Brian Ahier caught my attention in the blitzkreig of ACOs postings this past week.

 @ahier Building #ACO‘s & OUtcome Based Contracting in the Commercial Market

The complete title of the attached report is ‘Building ACOs and Outcome Based Contracting in the Commercial Market: Provider and Payor Perspectives‘.

This immediately caught my attention as for the better part of 30 years in the healthcare industry I spent a considerable amount of time in the managed care contracting business negotiating and signing my share of upstream (payor) as well as (downstream) hospital, physician and network agreements. From full risk, global capitated network deals to discounted fee for services to specialty care subcontracting and essential re-insurance backstops, I lived and breathed c/o/n/t/r/a/c/t/i/n/g.

Since the release of the proposed rule to implement the ACO provisions in the Affordable Care Act, most of the mainstream discussion has been about the ‘Medicare Shared Savings Program’, and considerably less attention has been paid to the activities delegated to the Center for Medicare and Medicaid Innovation (CMMI).

This report may change that singular focus since it broadens the loop and recognizes the market shift which is and has been rather active since the passage of the Act in March of 2010.

Call it ‘managed care 2.0, or 3.0’ or whatever you choose, the fix in healthcare, i.e., bending the cost curve. demonstrating the value proposition and improving access while reducing the rate medical inflation, if not lowering the cost of care, is rather well known: integration (legal, financial and operational) of medical practices under a banner of patient centered and coordinated (v. solo-ed or fragmented) care, enabled by information networks linked and seamlessly integrated across the continuum of care.

This was the same mission in the 70s and 80s when primarily HMO’s and to a lesser degree PPO’s were the mantra, yet the pain points did not exist as they do today, nor did the enabling technologies. The difference today is our house of cards sick care system is in the ICU on life support, and no one is defending the more is better, fee for services paradigm that drove our ‘healthcare borg’ to these heights of inefficiency and diminishing returns. Yet technology along with a determined shift in consciousness if not the sober recognition that ‘business as usual’ is not an option, gives us a materially different palette on which to collaborate towards a changed paradigm.

Check out this report and see what is already happening below the radar. You might be surprised. There is enough here to parse out over several posts and perhaps even invite the authors into a conversation on ‘ACO Watch: A Mid-Week Review’.