By Gregg A. Masters, MPH
So one view holds, ‘the more things change, the more they stay the same’ (i.e., it’s deja vu all over again), while the present day, ‘enlightened’ [or perhaps event horizon naive] view suggests, ‘no this time, things really are/can be different’. Just enter the key enabler: [ _________ ] e.g, technology, ubiquitous internet/device access, healthcare costs are now threatening countries, not just industries, patient empowerment, better ‘skin-in-the-game’ plan design, pure desperation, you name it, etc.
Even at this late stage in the early implementation of the Patient Protection and Affordable Care Act (ACA) we still find ourselves in a muddled and often confusing if not selectively implemented [or waived] regulatory market with respect to the ability of the Act to achieve its ends via the proscribed means. Yet, ACA is the law and most of us ‘on the ground’ [or closely following the action] are either muddling though and/or boldly going forward amidst a vague and ambitious yet mandatory journey – enabling the ‘triple aim‘.
One large moving part of the ACA that disproportionately bears the burden of the Act’s efficacy, that is mission critical and must be interstitially infused inside delivery system [and financing/risk sharing if not assumption] transformational efforts is ‘the ACO’ – including it’s many non Federal derivatives operating in the commercial space.
Unfortunately once you’ve seen an ACO, well, you’ve seen one ACO
[NOTE: For some context see ‘More or Less Confusion in ACO World: Who Really ‘Certifies’ ACOs?, ‘Accountable Care: In Search of Anchor Business Model(s) for the ‘All In’ Healthcare Eco-system’, and ‘IPA 2.0 the Preferred ACO Chassis?’].
Other then some broad brush guidance in the ACA and the regulatory follow-up via rules implementation, there is much room for variation on how the ‘Ark’ is to be built, governed and operated. Ergo the continuing conversation around one key pillar in the launch of a viable ACO, i.e., physician alignment with enterprise and market goals, or by proxy achieving the underlying clinical integration essential to seamless, coordinated, efficient and appropriate delivery of evidenced based care.
While there is much to learn, there are principles in evidence on which to build, i.e., successes in the market. If you want to learn more from an eclectic mix of players in the space, consider attending the ACO Alignment Summit.
Details of the panel session on alignment are here:
I am pleased to say that I will be moderating the Keynote Panel Discussion:
‘Drive Towards the Development of Tomorrow’s Accountable Health Care Delivery System’ with some talented colleagues from different markets around the country.
Joining me in this deep dive are: Nicole Bradberry, Chief Executive Officer, Florida Association of ACOs, President and Co-Founder, Citra Health Solutions; President, MZI Healthcare, Diwen Chen, Executive Director, Payment Innovation and Accountable Care, Dignity Health, and Bruce Miller, FACHE, Vice President, Network Development, Baylor Quality Alliance, Baylor Scott and White.
This is a unique blend of talented thought leaders and host business models from three different domestic U.S. markets all with distinctly different geo-political healthcare footprints. Nicole sits atop a member based association of ACOs in Florida (in addition to her leadership role at MZI Healthcare a vendor, consultant and health IT infrastructure play), while Diwen hails from a progressive institutionally managed integrated delivery system with hospital DNA Dignity Health, and Bruce stewards Network and Quality Management issues for an integrated group medical practice/IDN Scott and White that recently merged with the flagship Baylor Health System to combine two trophy properties (with distinctly different cultures, imj) in the Lonestar state.
This will be a ‘roll up your sleeves’ exchange on lessons learned in ACO alignment as well insights into the ‘how do I navigate the white waters of clinical integration’ given the local market considerations I face?
We continue to wait for the midterms to be over to get a view of the new ACO regulations. The most recent announcement of 114 Million to rural ACOs now operating over the past years gives us cause to believe the future for ACO development and expansion is bright yet the alignment of resources still leaves many confused. The potential for technology to SUPPORT a successful ACO exists and is happening however we have clients who readily admit they did not do a good job of evaluating their current software and hardware GAPs so they are either overpaying for services and data they already have or are disappointed the the technology does not all connect with their legacy system to produce the reports required by CMS .
Two very big points I will speak about in the opening remarks for the World Congress on Network Development and Contracting on October 28th and 29th in Washington DC.
First of all the digital industry realizes that the perfect system does not exist. We have been trying to build systems that offer in depth clinical reporting and link it to financial outcomes analysis for years. Many of the larger health care systems are aligning data because the realize they have large holes in their data bank or, by themselves, are not big enough to really measure outcomes consistently with a benchmark of outcomes that makes clinical and financial sense so many are buying in to temporary systems and or outsourcing this to a third party until the systems are scale-able and have enough data to reveal clear and meaningful data.
Second is the false goal of meeting minimum reporting standards for CMS as an ACO to get the bonus. This begs the question are there going to be more standards? YES, are there going to be changes in benchmarks ? YES . Are we treating ONLY the ACO assigned patients with these measures or all of our populations are 65 plus. HOPEFULLY YES. so this is more than meeting minimum quality and financial standards this is moving your entire physicians network or hospital to a risk based reimbursement based upon overall performance.
We know this because the measure of success for the Medicare segment, the HMO segment, the Fee for services segment and the Medicaid segment is Per member Per month. PMPM. that means that the end result will be cost per head or a capitated calculation.
This means we are looking at a system wide investment in data gathering and tracking the likes of which have never been seen but have been needed in health care for years. To get at this as an investment in the future of the physician network or physicians hospital network is an answer that will eventually bring down the costs of Information technology as an enterprise wide investment .
What this means is the CMS estimates for the number of ACO covered lives is vastly understated by 4 to 5 times . This also means ACO savings for medicare alone are probably understated by 4 fold as well . ACOs are the future aligned launching pad for commerce in the next 20 years. There is no going back and many health plans are moving quickly to global capitation or bundling to put hospitals and physician in a risk relationship with one another . The enablers are there but the true alignment starts with the physicians because it is physician leadership that will make the difference in being successful in population management and risk management .
Hard to not factor politics in the geo-political landscape associated with ‘managed competition’ writ large. We shall see. I don’t think the repeal and replace crowd have tempered their intentions much to date.
Thanks for a very thoughtful comment!
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