Posted in Accountable Care, ACO, Affordable Care Act

Accountable Care Round Up

by Gregg A. Masters, MPH

One of the ongoing challenges in ‘new media’ is to effectively discern the content ‘signal to noise’ ratio given the ease of publishing these days. Everyone is a potential publisher and not all curation is of equal value nor newsworthy per se.

As heard at a Health 2.0 meeting some time ago, ‘there’s no such thing as information overload, only filter failure’. I’m not sure if I entirely agree, but I’m in there trying.

Meanwhile if this blog can contribute to the accountable care or more broadly cast quest triple aim conversation via a recap of  ‘must read’ articles, videos or podcasts posted elsewhere then so be it. What follows is week one of a round-up series that you might appreciate:

Managed Care Contract Negotiations Morph Under PPACA

In ‘Managed Care Contract Negotiations Morph Under PPACA‘  HealthLeaders author Greg Freeman points out that:

Negotiating a managed care contract is not the same as it was even a few years ago. Now all of the power providers have in managed care negotiations is in their ability to prove that they can manage quality and cost more effectively than the next guy, says one expert.

In it’s purest form the entire managed care industry experience comes down to an opaque mosh-pit of filing cabinets stuffed with ‘proprietary contracts rates and terms’ as well as the underlying ‘secret sauce’ business models to enable the contractual obligations assumed. One could make an equally plausible argument that the entire accountable care et al sequelae industry will reduce itself to a similar albeit virtual version of this opaque storage of a complex tapestry of provider/payor relationships – not much of a contribution towards transparency here.

One big difference in the mix today thanks mostly to the emergence of enabling health information technology but also ‘new and improved’ sets of performance indices is the more effective (at least in the view of some) measurement of the actual quality of healthcare delivered.

Just remember, ACOs are not gatekeeper entities that traffic patients (members) to their preferred contract network of providers. They must attract and have attributed to their ‘risk pools’ (or share savings budgets) their membership. In this ‘vote with your feet’ environment, a more friendly consumer facing image and experience of care AND better documented quality outcomes (improved population health) will no doubt be a material competitive advantage.

There’s more to the story but one I suggest you read in its entirety.

A risky future? Two-thirds of ACOs want rules to change

Over at The Advisory Board (always an excellent independent source of market intelligence) Chas Roades, Chief Research Officer vets the signal from the ACO community to CMS overlords with – you guessed it – more risk pushback: A risky future? Two-thirds of ACOs want rules to change Citing a recent survey from the National Association of ACOs (NAACOs):

  • About 67% of program participants say they are unlikely to adopt a two-sided risk model in the next round of contracts;
  • 46% of its members are “very unlikely” to accept two-sided risk in the next round; and
  • 21% are “somewhat unlikely” to take on greater risk.

So the dance between the regulators and the regulated continues. Whether this NPRM public/private mechanism to source, develop and issue industry ground rules can succeed in crafting a new paradigm of healthcare delivery and finance – short of single payer – that doesn’t bankrupt the country remains to be seen.

Court Rejects ProMedica Merger Opposed by FTC 

Court Rejects ProMedica Merger Opposed by FTCOne of the ‘counseled’ potential market risks via the ‘Notice of Proposed Rule Making’ process (NPRM) associated with the implementation of the Affordable Care Act and the provisions specific to enabling the formation of Accountable Care Organizations (ACOs) is provider asset concentration in markets to consolidate power, grow share and leverage price. Ergo, the recent unanimous decision via a three-judge panel in the U.S. 6th Circuit Court of Appeals in Cincinnati to deny ProMedica’s petition to overturn a 2011 FTC ruling that ProMedica’s bid to merge with Toledo-area St. Luke’s was anticompetitive is worth a read. Whether the judges can adjudicate pro-market equilibrium also remains to be seen.

DaVita lowers earnings forecast as medical group unit underperforms

Consider this next story as more narrative in the vetting of business models that might work in an ‘ACA implementation quiver’ portfolio of sorts. DaVita lowers earnings forecast as medical group unit underperforms

In today’s murky and mostly transitional but assuredly disruptive operating environment, layered with conflicting financial incentives and nominal to no effective alignment between health systems and their physician ‘partners’ the pursuit of ‘successor’ managed competition models is no sure thing. Sourcing and grafting clinically integrated (both virtual and otherwise) models into local footprints that can legitimately enable the sometimes mutually exclusive (or seemingly so) objectives of the triple aim (better experience of care, better outcomes at lower per capita costs), the acquisition by renal care center operator DaVita of Healthcare Partners and thus entry into the integrated medical group operational theater is one to watch and dissect for clues.

The investor call is well worth the listen, including the entire Q & A from the usual institutional suspects following the industry.

(NOTE: though obviously very smart and knowledgeable you might want to caveat analyst engagement of DaVita/Healthcare Partners leadership with the history of due diligence applied during the vetting of the PPMC industry – a Ponzi scheme that sold many into serfdom while broker/dealers and underwriters pocketed millions).

The rather clever but telling ‘formula’ articulated by Kent Thiry (beginning at the 00:18:50 mark), DaVita’s talented and straight talking CEO is revealing. He nets it out as follows, then articulates the company’s performance on across it’s two principal verticals:

effective rate (OI) – expense x volume x execution risk = performance 

The net for aggregate medical group operations of Healthcare Partners:

down/more down than up/unit growth very promising/legacy solid, new ventures poor

Again, the investor call is well worth a listen if you want a deeper dive into the nexus between strategy and the challenging real world of implementation.

FTC Examining Health Care Competition Workshop: Panel 3: Advancements in Healthcare Technology

 Examining Health Care Competition Workshop - Part 3 The FTC’s ambitious and timely exploration of ‘consumer facing issues’ albeit not in sound byte fashion is a rather compelling and insightful journey into the status of health information technology as enablers [or obstacles] of the integration vision (care management, coordination, de-siloing the silos of American sick care) albeit from a central or more accurately distributed ‘IT’ spine perspective.

The ‘Panel 3: Advancements in Health Information Technology (HealthIT)‘ session focused on the competitive considerations that FTC should incorporate into their process as they catch up with market changes.

This is a MUST watch series for all but especially e-patients and healthIT professionals. The eloquent exploration of industry issues and observations proffered by both former ONC Director Farzad Mostashari, MD and AthenaHealth VP for Government & Regulatory Affairs, Dan Haley are worth the effort of watching the entire clip. As an alternative you can scroll through the transcript of the session pasted here.

There’s more to share, but we’ll roll them into the next Round-Up.

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