An Accountable Care Organization (ACO) is a voluntary coalition of healthcare providers characterized by a care delivery and reimbursement model tying provider payments to quality metrics and patient care outcomes. The goal of the ACO model is to reduce total care costs for a specific patient population. Each ACO has a defined patient population for…
As the healthcare industry continues the march toward value-based care, CMS has turned a critical eye on one-sided ACO contracts for driving up costs and making little progress toward value. “These ACOs are actually increasing Medicare spending, and the presence of these ‘upside-only’ tracks may be encouraging consolidation in the marketplace, reducing competition and choice…
Ann Morse Abdella was all in when the Medicare Shared Savings Program started in 2012. She helped launch a rural accountable care organization in western New York, serving roughly 7,000 Medicare beneficiaries. Six turbulent years later, Chautauqua Region Associated Medical Partners is heading for the exit. The constantly evolving program and its increasing pressure to…
Medicare accountable care organizations (ACOs) are likely to face an imminent overhaul, according to former leaders of the program. Nancy-Ann DeParle, partner with Consonance Capital and formerly acting administrator of the predecessor agency to the Centers for Medicare & Medicaid Services (CMS) before serving as an Obama White House senior healthcare adviser, said CMS is…
If any vignette defines the provider experience in a Medicare accountable care organization (ACO), it is probably the anxious waiting, digesting, and analyzing of the Centers for Medicare and Medicaid Services (CMS) quarterly reports of ACO performance against its benchmark. In offices across the United States, ACO executive directors and analytics teams pore over tables…
Medical professionals and other healthcare industry stakeholders need to develop strategies that allow clinicians to address the social determinants of health without adding to administrative burden and provider burnout, according to a recent report from Leavitt Partners. The whitepaper, informed by a survey of 621 clinicians across the country, contended that the increased focus on…
High quality health plan customer service is critical for payers who want to create meaningful, positive beneficiary interactions. Customer service plays several important roles for health plans. In addition to the stand-alone goal of leaving members with a satisfactory experience, the quality of customer relations is included in NCQA’s HEDIS measures, one of the most…
Earlier this week, CMS (the Centers for Medicare & Medicaid Services) Administrator Seema Verma remarked that “upside-only” ACOs (accountable care organizations) that do not take on downside risk have not generated enough results to date. Now, Healthcare Informatics has learned that a CMS rule is forthcoming that could shorten the duration ACOs can stay in…
Specialty care is a thorny cost and political issue for ACOs and physicians alike. No ACO can provide good or comprehensive patient care without specialists. But if ACOs are to produce savings, they will almost certainly need to address how, when and at what cost those specialists will be used. The degree of concern about…
It’s clear that healthcare providers are increasingly recognizing and accepting that value-based payment is here to stay. The tremendous growth in Accountable Care Organization (ACO) arrangements is a testament to this fact. When properly managed, ACOs present hospitals with the single greatest pathway to operational and financial success. Yet, some new ACOs have found that…