By Gregg A. Masters, MPH
For those of you following this blog you know I write about ACOs and the emerging accountable care zeitgeist. My lens has been forged by decades of experience in the ‘managed competition’ experiment. For an earlier piece see: ‘Some Context and Perspective on Standing Up the ACO.’
The managed competition industry – perhaps more widely known as ‘managed [though more accurately mangled] care’ – can be traced back to it’s regulatory oversight origins via an office in the predecessor agency to CMS, the Health Care Financing Administration (HCFA) titled the ‘Office of Alternative Delivery Systems’ (OADS).
The mission of the OADS was to monitor the then emerging (‘disruptive’) players in the HMO domain but also this little known but ‘HMO lite’ mutation dubbed ‘preferred provider organizations’ (PPOs). The alternative delivery system domain was typically populated by those operators who compensated their contracted network of physicians, hospitals and ancillary providers via other than routine fee for services based payment. Alternative compensation ranged from mere discounts of standard fee schedules to full or partial capitation for physician or even hospital services, thus ADS operators could be arrayed across a continuum of risk assumption.
It is interesting to note that what was then considered ‘alternative’ to prevailing or normalized healthcare financing and delivery is now the new ‘normal’. Yet, we hear more reference to ‘alternative delivery systems’ today as representative by such new age/zeigeist disruptors the likes of certain ACOs, medical homes or even the tapestry of direct, membership, retainer or even ‘concierge’ models of delivery – including hybrids (OneMedical).
So in a way, the first phase of the ‘integration 1.0’ cycle is complete and we’re now embarking on ‘integration 2.0’ using the same terms albeit applied to different vehicles. Instead of HMOs or PPOs, we’re talking about ACOs, medical homes or other care delivery innovations.
Clearly technology – both enterprise and consumer facing – are central to the complex deliverable of the sustainable healthcare ecosystem, yet the preferred ‘chassis’ onto which to stitch if not graft the organizational, governance and operational best practices remain somewhat elusive. To many digital or mhealth enabled solutions seems to represent a fair amount of rational promise to emerging ACOs.
At the 5th Annual mhealth Summit in a session titled: ‘Mobile Enabling the ACO‘ we’ll here from:
- Shelley Price, Director, Payer and Life Sciences HIMSS
- Edward Connors, President Innovative Educational Resources LLC; and
- Drew Palin, Medical Innovation Officer Preventice
…on the state of the merger between promising digital health technologies and ACO operational fulfillment of certain ACA performance requirements .
The session description and schedule is pasted below: