Kaiser Health News reports from the Associated Press, that big players in the health industry are seeing the cost benefits of nabbing problems before they start. That hot lunch delivered to your door? Your health insurer might pick up the tab. The cleaning crew that fixed up your apartment while you recovered from a stroke? The hospital staff helped set that up.
Some insurers are paying for rides to fitness centers and checking in with customers to help ward off loneliness. Hospital networks are hiring more workers to visit people at home and learn about their lives, not just their illnesses.
The health care system is becoming more focused on keeping patients healthy instead of waiting to treat them once they become sick or wind up in the hospital. This isn’t a new concept, but it’s growing. Insurers are expanding what they pay for to confront rising costs, realizing that a person’s health depends mostly on what happens outside a doctor’s visit.
Read MoreIn a recent article in the Health Affairs blog, the NYC Health + Hospitals ACO (NYCHH ACO) reduced costs by 4–12 percent annually compared to benchmark, while continually improving quality in its first four years. It is the only ACO in New York State to achieve shared savings in all four Medicare SSP performance years. Overall costs to Medicare have been reduced by more than $31 million, generating shared savings incentive payments of nearly $14 million.
Read MoreThe Department of Health & Human Services (HHS) finalized a new payment system for Medicare clinicians that will continue to reform how the health care system pays for care. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program, which replaces the Sustainable Growth Rate (SGR), is designed to consolidate the SGR, Meaningful Use, and the Value Modifier into a single alternative payment system. According to the HHS press release, the Administration is building a system that delivers better care, one in which clinicians work together and have a full understanding of patients’ needs, Medicare pays for what works and spends taxpayer money more wisely, and patients are in the center of their care, resulting in a healthier country.
Read MoreThe Centers for Medicare & Medicaid Services’ (CMS) Innovation Center is accepting the second and final round of applications for its Next Generation Accountable Care Organization (ACO) model, which will begin its second performance year on Jan. 1, 2017.
The Next Generation ACO Model is an initiative for ACOs that are experienced in coordinating care for populations of patients and allows doctors and hospitals to assume higher levels of financial risk and reward than are available under the current Pioneer Model and Shared Savings Program (MSSP). The goal of the Model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for Original Medicare fee-for-service (FFS) beneficiaries.
Read MoreAccording to a Commonwealth Fund study, a multipayer medical home program piloted in Colorado led to a sustained reduction in emergency department use and costs over three years, although there were no overall cost savings for practices or patients. Primary care visits also decreased. The impact on quality was mixed: cervical cancer screening rates improved, yet colon cancer screenings and hemoglobin testing for diabetes patients decreased.
The goal of Patient Centered Medical Homes (PCMH) are to deliver primary care services in a proactive, coordinated manner and improve quality of care, including patient health outcomes– particularly those with multiple or complex care needs. In addition, the PCMH goal is to lower by reducing the need for expensive hospital stays and emergency department visits.
The Commonwealth Fund research evaluated a pilot program involving 15 PCMH practices in Colorado serving approximately 98,000 patients both prior to the program’s launch and then again at two and three years.
Read MoreCMS announced the participants for the Comprehensive ESRD Care Model, a new accountable care organization model for Medicare patients with end-stage renal disease (ESRD). The model brings together dialysis facilities, nephrologists and other providers to form ESRD Seamless Care Organizations (ESCOs) to coordinate care for ESRD beneficiaries and reduce costs. The ESCOs will be financially accountable for quality outcomes and Medicare Part A and B spending for ESRD beneficiaries, including all spending for dialysis services.
Read MoreAccording to a blog post by Patrick Conway, MD, Deputy Administrator for Innovation and Quality and Chief Medical Office, Centers for Medicare and Medicaid Services (CMS), CMS is unveiling its next generation Accountable Care Organization model, which it hopes will provide an attractive alternate for providers not yet participating in the ACO program.
How the new model works
The new model uses a combination of fee-for-service and capitation. It creates four payment systems and two risk tracks for its participants, including one with almost full risk.
According to Conway, the Next Generation ACO Model sets more predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality of care. Key features of the new model include:
Read MoreAccording to a Centers for Medicare & Medicaid Services (CMS) press release, Medicare Accountable Care Organizations (ACO) continue to improve the quality of care for Medicare beneficiaries while generating financial savings.
In Medicare's detailed results, the 20 ACOs in the Pioneer ACO Model and 333 Medicare Shared Shavings Program ACOs generated more than $411 million in total savings in 2014, which includes all ACOs’ savings and losses. At the same time, 97 ACOs qualified for shared savings payments of more than $422 million by meeting quality standards and their savings threshold. The results also show that ACOs with more experience in the program tend to perform better over time.
Read MoreA recent article from Hospitals and Health Networks highlights the growing use of virtual medical huddles to help coordinate care across the care team.
Communication is critical to successfully implementing new models of care to reduce costs and keep patients from making return trips to the hospital. But communicating across care teams can be a big hurdle for accountable care organizations.
One such organization using virtual huddles is Meritage Medical Network based in Novato, Calif. The physician-led, Medicare Shared Savings ACO includes numerous physician practices and a hospital with disparate records systems, covering a 26,000 square-mile region.
Read MoreA precursor program similar to the ACO model generated some Medicare savings, especially among dual-eligible beneficiaries, according to a study in the Journal of the American Medical Association.
Read MoreThirteen percent of hospitals are currently participating in an Accountable Care Organization or plan to do so within the next year, according to report by the Commonwealth Fund.
Read MoreAs of July 1, 2012, 89 new Accountable Care Organizations (ACOs) have begun participating in the The Medicare Shared Savings Program, according to a press release.
Read MoreThe Centers for Medicare and Medicaid Services will be launching a third group of Advance Payment Model ACOs on January 1, 2013, according to The Commonwealth Fund.
Read MoreUnder the new Medicare Shared Savings Program, 27 Accountable Care Organizations (ACOs) have entered into agreements with CMS, taking responsibility for the quality of care furnished to people with Medicare in return for the opportunity to share in savings realized through improved care, according to a press release.
Read MoreTwo former health and public policy advisers in the Obama administration predict that by 2020, insurance companies will be replaced by Accountable Care Organizations, in an opinion article in the New York Times.
Read MoreThe Commonwealth Fund has released a report highlighting findings and lessons from case studies of four health care organizations participating in the Brookings–Dartmouth ACO Pilot Program, launched in 2009 to support the formation accountable care organizations.
Read MoreThe American Hospital Association sent a letter to the Centers for Medicare and Medicaid Services expressing concern over CMS’s announcement that it plans to narrow legal definitions regarding fraud and abuse waivers for ACOs in the future, according to Modern Healthcare.
Read MoreAs part of the Affordable Care Act, thirty two organizations from across the country will participate in the Pioneer Accountable Care Organizations (ACOs) initiative, according to a press release by the U.S. Department of Health and Human Services.
Read MoreAn increasing number of patients are seeing Physician Assistants or Advanced Nurse Practitioners in hospital outpatient departments, according to an National Center for Health Statistics data brief.
Read MoreIn conjunction with the Centers for Medicare and Medicaid Services final rules for Accountable Care Organizations, The Federal Trade Commission and Antitrust Division of the Department of Justice has issued their final “Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program”, according to AHA News Now.
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