Posts tagged ‘ACOs’

What’s in a (business) name? Gold.


Selecting a business name is important. As MedSpan Research and our client learned, it is worth the time and investment to carefully consider alternatives.

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Continue Reading September 29, 2015 at 4:26 PM Leave a comment

Medspan’s Tri-Weekly Newsletter–See What We Have Learned and You Should Know


In May 2015, the Center for Medicare and Medicaid Services (CMS) released a 653-page rule that is likely to create the largest changes in managed Medicaid in over ten years. Read the full blog to learn more.

Continue Reading June 23, 2015 at 9:32 AM Leave a comment

2015 Started Out With 89 New ACOs Joining the Medicare Shared Savings Program


89 new ACOs joined the Medicare Shared Savings Program starting January 2015, increasing the total participating ACOs to 424; including the Innovation Center’s 19 Pioneer ACOs. The 89 new Shared Services ACOs added 23,000 additional physicians and other providers to the Medicare Shared Savings Program’s provider network. The Share Services ACOs combined with the Innovation Center’s 19 Pioneer ACOs will serve over 7.8 million beneficiaries.

Continue Reading March 25, 2015 at 2:20 PM Leave a comment

Covered Lives Under ACOs as well as the Number of ACOs is Growing


The number of ACOs rose from Q4 2010 to Q4 2013 from 41 to 606. During that time frame, the number of ACOs’ covered lives grew from 0.2 million to 18.1 million. Will the numbers continue to increase?

Continue Reading March 24, 2015 at 4:30 PM Leave a comment

How will private ACOs impact your business?


As healthcare reform shifts from traditional fee-for-service to alternative provider compensation models, such as shared savings/risk-sharing arrangements, provider organizations that aren’t already on the ACO bandwagon are closely watching the performance of ACOs around the country to see if they should get in the game. Last week, a private California ACO reported early success.

Continue Reading June 16, 2014 at 10:43 AM Leave a comment

What are Accountable Care Organizations (ACOs)?


Hello again!

Since our last blog post, the leaves have turned green, the summer months have passed, and we have just begun to enjoy the crisp autumn air.

Lately there has been much debate surrounding the launch of Accountable Care Organizations (ACOs) under President Obama’s Patient Protection and Affordable Care Act. ACOs are one of the key provisions in the 2010 health reform law designed to help reduce the cost of medical care. There is so much talk about this concept, but what exactly are ACOs?

An ACO is a network of providers and hospitals that share responsibility for delivering healthcare to a minimum of 5,000 Medicare beneficiaries for at least three years. It is based on the idea that hospitals, doctors, and other health care providers should work together to coordinate care for their patients. By coordinating care, the ACO will reduce costs by avoiding unnecessary tests and procedures. Those organizations that produce better outcomes will be rewarded, and for those that don’t, financial penalties will be incurred. In a recent study of ours, we found that with the development of ACOs, providers will take on responsibility for not only delivering actual medical care, but also providing some level of medical management between appointments.

Sounds like a great idea however, a lot skepticism has surrounded the development and launching of ACOs. First, there are very few providers that truly understand the ACO concept. In a recent survey conducted by Beacon Partners, only 15% of 200 provider organizations are “very familiar” with ACOs. Of those 200 surveyed, 92% are in the development stages for an ACO, and nearly all respondents’ budgets are not yet established.

Second, the Centers for Medicare and Medicaid (CMS) have yet to issue the final rules, which will affect the application process that prospective participants have to go through. Prospective participants will need to review the final rules before entering the application process in order to demonstrate their ability to comply with the eligibility requirements. Then, CMS will need to review all applications and offer contracts before the January 2012 launch deadline.

Lastly, the systems that were considered to be the models for a new health care delivery system, namely the Mayo Clinic, the Cleveland Clinic, Geisinger Health System and Intermountain Healthcare, have all declined to apply for the ACO program. Hospital and physician groups complained that the program created more financial risks than rewards and imposed burdensome reporting requirements.

Given the series of events surrounding the development of ACOs, it is no wonder that there is skepticism and doubt. Too much confusion and too many barriers surround the development of ACOs, including high start-up costs and regulatory issues. Add to that the refusal by health system role models to apply to the ACO program and you have a complicated situation.

Referring to our last post, this is one way to reduce the cost of care, a much needed move in our unstable economy. As prices for healthcare keep increasing over the year (health insurance is expected to rise 5.4% in 2012), patients deserve access to affordable healthcare. We urge ACO development leaders to address the barriers that health systems are encountering in order to aid in launching a successful ACO program.

Author:  Nicole Victoria

Editors:  Ken Chiang and Robert Kaminksy

 

October 26, 2011 at 3:52 PM Leave a comment


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