Accountable Care, ACO, Triple Aim

Leavitt Partners Weigh in on Medicare, APMs and Provider Readiness for Pivot

by Gregg A. Masters, MPH

It’s been busy since our re-launch at This Week in Accountable Care primarily due to the heavy lifting support from National ACO co-founders, Andre Berger MD, CEO, and Alex Foxman, MD, President and Chief Medical Officer, respectively.

While I moderate the series, Drs. Berger and Foxman serve as co-hosts and subject matter experts as we engage thought leaders and best-in-class ACO operators in focused conversation around local or regional market challenges including headwinds, tailwinds, lessons learned and emerging best practices.

Recently we’ve chatted with top national talent including: Don Crane, CEO, of CAPG, Hal Sadowy, the IPA Association of America, Jay Parkinson, MD, Founder and CEO of Sherpaa Health and author, consultant and futurist Ian Morrison.

Our all-star line-up continues in October with David Muhlestein, PhD, JD, Chief Research Officer, Leavitt Partners on Tuesday October 3rd, Farzad Mostashari, MD, Founder & CEO of Aledade on October 17th, and the rock-star advocate to fix the Affordable Care Act and former Acting Administrator of the Centers for Medicare and Medicaid Administration (CMS), Andy Slavitt on October 31st.

For our chat with David Muhlestein, PhD, JD, Leavitt Partners, Chief Research Officer you may want to read: Medicare Alternative Payment Models: Not Every Provider Has a Path Forward.

An informative Whitepaper that lays out the range of challenges most health systems, IDNs, physicians whether in groups or not face in the pivot to a value based (alternative payment models – APMs).

From the Whitepaper:

The Centers for Medicare and Medicaid Services (CMS) has shown significant support for the development of Alternative Payment Models (APMs).

CMS’ development and testing of 45 payment models has led to the adoption of similar models by other payers. Initial reports indicate that APMs could be key to producing the health care delivery reform necessary to decrease health care costs and increase delivery quality.

However, these models are only available to select provider types, and some providers, such as emergency physicians and audiologists, have no Medicare APMs in which they can participate. To realize the full benefits of APMs, additional collaboration between CMS leadership and providers is needed to develop new models for providers who do not currently have access to them.

Be sure to join us October 3rd at 5PM Pacific/8PM Eastern for a conversation with David Muhlestein on This Week in Accountable Care with Andre Berger, MD and Alex Foxman, MD. co-founders of National ACO.

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Accountable Care, ACO, Affordable Care Act

Leavitt Partners on ACO Growth and Dispersion: An Update

By Gregg A. Masters, MPH

Per Leavitt Partners:

A ‘Growth and Dispersion of Accountable Care Organizations: August 2013 Update.’

The Leavitt Partners Center for Accountable Care Intelligence releases new white paper entitled “Growth and Dispersion of Accountable Care Organizations: August 2013 Update”Growth and Dispersion of ACOs August 2013.Screen shot 2013-08-15 at 12.09.40 PM

Salt Lake City, August 15, 2013 — Drawing from an ongoing study by Leavitt Partners, The Center for Accountable Care Intelligence has released an ‘August 2013 Update’ to the previously acclaimed white paper: Growth and Dispersion of Accountable Care Organizations.

The report details how the growth and proliferation of accountable care initiatives has unabatedly continued over the last twelve months. The broad adoption of accountable care paired with the emergence of preliminary results has provided some clarity to the overall accountable care movement.

Analysis of the current accountable care landscape highlights three significant findings:

The number of accountable care entities is increasing. Leavitt Partners is currently tracking 488 accountable care entities through the end of July 2013, more than double the number from June 2012.

Medicare ACOs are growing faster than non-Medicare ACOs. Medicare ACOs now comprise more than half of all accountable care contracts nationwide.

There are many different models of accountable care. No single model has emerged as most successful and as accountable care expands, we continue to see variety in organization and execution.

About Leavitt Partners

Leavitt Partners is a health care intelligence business. The firm delivers collaborative, high-value intelligence that helps clients transition to new models of care. Through its member-based collaboration called Health Intelligence Partners™ and direct services to clients, the consulting firm provides the best available window to the future of American health care. For more information visit LeavittPartners.com or call (801) 538-5082.

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Update: Growth and Dispersion of Accountable Care Organizations – Leavitt Partners

By Gregg A. Masters, MPH

While Attending the Third National ACO Summit in Washington, DC last week I  had the opportunity to cross paths with Thomas Merrill my liaison with Leavitt Partners (LP) responsible for our interview on ‘This Week in Accountable Care‘ discussing LP’s initial release of their report ‘Growth and Dispersion of Accountable Care Organizations.’ Thomas informed me of an impending update to their landmark issue in November 2011. That update is now available via the Leavitt Partners website here.

In summary, the update reveals the following key metrics and contextual guidance:

The last eight months have seen considerable growth in the number of health care entities commencing accountable care payment arrangements. Despite large variation in models used, this growth is evidence of the increasingly common belief that health care should be more than simply providing and billing for services.

Leavitt Partners has utilized both public and private sources to track the activity of 221 accountable care organizations through the end of May 2012.

Growth is concentrated in larger population centers though it has expanded to 45 different states. Care coordination and payment models continue to vary depending on the organization leading the initiative, the organizations involved in the ACO and the region or market in which the entity serves. While the various Medicare ACO programs seem to be influencing the direction of accountable care models, the government’s role in leading the growth of accountable care is unclear.

Well said, though a clearly hedged future. I might add that irrespective of the outcome of the SCOTUS decision, the competitive ‘horse is out of the barn.’ As witnessed by United HealthGroup’s statement earlier this week of their intention to carry forward certain provisions of the Patient Protection and Affordable Care Act (ACA), if the decision is to deem the individual mandate (and perhaps more) unconstitutional. Irrespective of the legal shackles that may be placed on CMS, the commercial market is steaming forward implementing the very spirit of the Act via ACOs and derivative efforts to achieve the triple aim.

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The Incidence of ACOs: The Leavitt Report

By Gregg A. Masters, MPH

We’re seeing a flurry of reports on ACOs quoting the Leavitt Partners report ‘Growth and Dispersion of Accountable Care Organizations‘ published last year, see previous post for access here.

Meanwhile we chatted with report authors Andrew Croshaw and Thomas Merrill who provided additional context and insight into their findings on ‘This Week in Accountable Care.’ To listen, click radio show image to the left.

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ACO or vACe aka virtual Accountable Care enterprise?

By Gregg A. Masters, MPH (inspired by Vince Kuraitis)

e/n/t/e/r/p/r/i/s/e/A business (also known as enterprise or firm) is an organization engaged in the trade of goods, services, or both to consumers… The etymology of “business” relates to the state of being busy either as an individual or society as a whole, doing commercially viable and profitable work. – WikiPedia

Yesterday I had the pleasure of chatting with Andrew Croshack and Thomas Merrill of Leavitt Partners, aka @LeavittPartners, the consulting firm founded by former Bush Administration Secretary of HHS and EPA Administrator, Michael O. Leavitt. We discussed their recent report ‘Growth and Dispersion of Accountable Care Organizations‘.

Upon review of the document, and perhaps due to my UCLA forged public health genealogy, I instinctively substituted common epidemiology notions of ‘incidence and prevalence’ v. the growth and dispersion of ACO’s characterization. Not sure why, just an autonomic reponse (thanks professor/dean Detels). I suppose it remains to be seen whether the neo-clinical and underlying public health pathology implied will in fact materialize as de facto business or enterprise equivalents akin to the rise and fall of the physician practice management company industry (PPMC).

None-the-less, Croshaw posits as motivation to conduct the survey the absence of empirical data on the growth of the industry. Their reported results by ‘sponsor’ are summarized as follows:

Of the 164 identified ACOs, the sponsoring entities included hospital systems, physician groups and insurers with a market presence in 41 states but less than half of all HRRs. Of these entities, 99 were primarily sponsored by hospital systems, 38 by physician groups and 27 by insurers.

Yet following a review of their report and our conversation, noted industry observer and talented consultant Vince Kuraitis further opined on their methodology, specifically questioning their omission to distinguish between ACOs and ‘accountable care’ per se. Kuraitis offers the following:

Are the Findings Accurate?

I’ve written before about the critical distinction between “accountable care” and ACOs — they’re not the same thing. If there is one suggestion I would offer the Leavitt researchers, it’s that the next census should better distinguish between formal ACOs and other accountable care-like (AC-Like) activities.

A formal ACO organization is a legal entity formed by care providers — it is incorporated, has a Board, holds meetings, is registered with the Secretary of State.

Informal, AC-Like initiatives can be created through contracts. The parties simply get together and agree to develop an initiative. They might choose to announce or not to announce their initiative publicly. Commercial payers are much more likely to be involved in AC-Like activities — in many cases even leading the charge.

How accurate is the Leavitt census of ACO activity? I can see that it has potential both to overstate and understate accountable care initiatives.

Kudos to both Vince and Andrew et al for kicking off this conversation, and comments are most welcome here and there as well. Yes, there is little empirical data available and for good reasons noted in both narratives. I highly recommend you read both the Leavitt Partners report, and Vince’s follow-up thoughts to further develop your own perspective.

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Leavitt Partners Report: ACOs, Their Growth and Dispersion

On the Wednesday, November 30th, 2011 broadcast at 11AM PT / 2PM ET my special guests include two principal co-authors of the recently released Leavitt Partners study titled: Growth and Dispersion of Accountable Care Organizations‘. For an extract and link to download the full report, click here.

More about the guests:

Andrew Croshaw is Managing Director, Health Care Practice, at Leavitt Partners. Founded by former U.S. Health and Human Services Secretary and EPA Administrator Michael O. Leavitt, the partnership advises clients in the health care and food safety sectors. As Managing Director of the Health Care Practice, Croshaw helps clients enter new markets, enhance the value of their products, navigate dynamic regulatory and reimbursement systems and improve health conditions around the world.

Thomas Merrill is a strategic analyst at Leavitt Partners. As a member of the knowledge development team, Merrill collaborates with others to analyze and research issues associated with health reform and more specifically, emerging care models and the various factors that influence the modern health care landscape.

We’ll discuss the key findings and implications of their report. To listen live or via archived replay, click here.