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NYC value-based joint venture chalks up savings

In an NEJM Catalyst article headlined “Success in Hospital-Integrated Accountable Care Organization,” the authors write:

“Conventional wisdom holds that urban academic medical centers are ill-suited for value-based care initiatives such as the Medicare Shared Savings Program (MSSP). Nevertheless, NewYork Quality Care, the MSSP Accountable Care Organization (ACO) established in 2015 as a joint venture between NewYork-Presbyterian, Columbia University Vagelos College of Physicians and Surgeons, and Weill Cornell Medicine, achieved savings in each of its 3 performance years by implementing a range of operational, financial, and analytical initiatives.”

“The creation of NewYork Quality Care has established a blueprint for collaboration that has increased alignment among our three institutions. Looking ahead, our plan is to potentially expand NewYork Quality Care to include additional clinicians and their attributed beneficiaries. We also plan to leverage the care redesign and analytics capabilities that we have developed to inform other such efforts across our three institutions.”

To read the whole article, please hit this link.

How huge NYC safety-net system made its ACO a success

Headquarters of NYC Health + Hospitals.

A Health Affairs blog entry looks at how the  huge safety-net system NYC Health +Hospitals has built a highly successful Accountable Care Organization   since 2012 to participate in the Medicare Shared Savings Program (MSSP). Indeed, the authors report that NYC Health + Hospitals’ ACO has cut costs to Medicare by more than $31 million and generated $14 million in shared savings payments. The organization has cut costs by  4-12 percent  each year compared to benchmarks, and, they write, is New York City’s   only ACO to earn shared savings each year in MSSP.

To help achieve this success,  it collected  claims data to track the histories of 12,000 Medicare patients, many of whom are dual-eligible with Medicaid. It then used that information to chart future  care.

The data  suggested that the ACO should  focus on the chronically ill needing complex care, and less on overuse of healthcare services.

The  ACO  integrated clinicians into the initiative,  and sought to develop physician leaders for it. Clinicians got wide  autonomy to shape the program to fit patient needs within a shared  goals

The authors wrote that  NYC Health + Hospitals  is applying the lessons learned to other populations,  particularly Medicaid and uninsured patients.

To read more, please hit this link.


Big churn seen of physicians and patients in a Medicare Pioneer ACO


“Chaos,” by George Frederick Watts.

An article in Health Affairs reports:

“Alternative payment models, such as accountable care organizations (ACOs), attempt to stimulate improvements in care delivery by better alignment of payer and provider incentives. However, limited attention has been paid to the physicians who actually deliver the care. In a large Medicare Pioneer ACO, we found that the number of beneficiaries per physician was low (median of seventy beneficiaries per physician, or less than 5 percent of a typical panel). We also found substantial physician turnover: More than half of physicians either joined (41 percent) or left (18 percent) the ACO during the 2012–14 contract period studied. When physicians left the ACO, most of their attributed beneficiaries also left the ACO. Conversely, about half of the growth in the beneficiary population was because of new physicians affiliating with the ACO; the remainder joined after switching physicians. These findings may help explain the muted financial impact ACOs have had overall, and they raise the possibility of future gaming on the part of ACOs to artificially control spending. Policy refinements include coordinated and standardized risk-sharing parameters across payers to prevent any dilution of the payment incentives or confusion from a cacophony of incentives across payers.”

To read more, please hit this link.


ACA repeal could kill innovative programs at hospitals


The Republicans’ promise to repeal the Affordable Care Act not only threatens to deprive millions of people of their health insurance; it could drive many hospitals deep into debt and destroy innovative programs created by the ACA aimed at  improving patient care.

Timothy Ferris, M.D., an internist and medical director of the Mass General Physicians Organization, told FierceHealthcare that he worries that the “progress we’ve made over the past five years would be threatened.”

He said that  includes programs through the Accountable Care Organization (ACO) at Massachusetts General Hospital, including experiments with video consultations and home hospitalization.

Dennis Keefe, head of Care New England, in Rhode Island, told NPR that he is concerned about the future for Integra, an ACO that includes primary- care physicians, specialists, urgent-care and after-hour providers, clinics, laboratories and inpatient facilities.

Hospitals and healthcare systems that have spent the last six years trying to create new value-based, patient-centered models as part of the ACA.  And so 120 organizations sent a letter to President  Trump and Vice President Pence urging them to not roll back progress they have made.

To read more, please hit this link.

Money seems to triumph over an ACO’s good intentions


Creating Accountable Care Organizations is meant to improve care and help cut the costs of the world’s most expensive healthcare system. But such attempts run into a huge barrier caused by the fact that  U.S. physicians, who are used to making far more money than their equivalents in the rest of the world, and hospital executives strive to stick to the fee-for-service approach that has made them so affluent.

Consider Cornerstone Health Care, a large physician group in North Carolina, that made a big bet a few years ago when it turned itself into an ACO.

It seemed to work for a while. But then began an exodus of physicians seeking the more money they could get from working directly for hospitals.

As a New York Times story noted:

“Cornerstone’s experience illuminates just how tough it can be to overhaul the way medical care is delivered, even when the change is a priority for doctors and the government. As Cornerstone learned, hospitals and doctors frequently fight the changes, because they believe they can make the most money under a fee-for-service model.”

To read The Times’s piece, please hit this link.

UnitedHealthcare is launching a national ACO

UnitedHealth Group‘s UnitedHealthcare unit,   America’s largest health insurer, will launch a nationally branded Accountable Care Organization as part of its push to value-based care aimed at luring self-funded employers.

UnitedHealthcare’s NexusACO will be available in 2017 in 15 markets to self-funded employers with 100 or more workers during this fall’s open enrollment period. The company said that NexusACO already has a dozen employers signed on, but  it wouldn’t disclose  names, Forbes reported.

“This (ACO) will have a much more national view with consistency across how the product is designed,” Jeff Alter, UnitedHealth’s CEO for employer and individual coverage,  told Forbes.  “It’s sold as a product that happens to have a unique network attached to it.”

The NexusACO has a national network of UnitedHealthcare’s “tier1” physicians who, UnitedHealth says, are already meeting the insurer’s quality and efficiency measures.

UnitedHealthcare said NexusACO is different from regional ACOs, which generally have contracts with providers only in certain markets. UnitedHealthcare, for example, already has contracts with more than 800 ACOs across  America —  double what it had two years ago.

Forbes noted that UnitedHealthcare’s rivals are also expanding arrangements with ACOs. Aetna, for example, has increased its ACO agreements to 275 since 2011, and that figure is expected to grow even more in the next year as the company shifts 50 percent of what it pays providers from fee-for-service  to value-based arrangements.

To read the Forbes article, please hit this link.

Feds give preliminary OK to Vt. ‘all-payer’ plan


The Vermont State House, in Montpelier, the nation’s smallest state capital.

VTDigger reports that the federal government and Vermont have drafted a preliminary agreement to implement an “all-payer” healthcare payment system.

Under the model, payments to physicians from commercial insurers, Medicare and Medicaid would be based on monthly fees instead of  fee-for-service. Physicians would operate under an Accountable Care Organization — either OneCare Vermont or Vermont Care Organization — which would accept the payments. The ACO would then pay physicians based on quality of care.

The deal would make Vermont the first state to implement an all-payer system for all providers. Maryland now has the only U.S. all-payer system, but  just for hospital services.

The Vermont model aims to keep certain costs paid by Medicare, Medicaid and commercial insurance from growing more than 3.5 percent a year for five years,  starting in 2018.

The state aims to have about 30 percent of primary-care providers under the model by Jan. 1, 2018, with 80 percent  over a five-year period. If OneCare ACO decides to join the all-payer model, the state would reach the initial 30 percent goal.

The Green Mountain Care Board would regulate the ACO. Gov. Peter Shumlin said the all-payer model could save Vermont about $10 billion over  10 years.

To read the VTDigger story, please hit this link.

Wis. ACO laying off 40% of employees


The Milwaukee Business Journal reports that Integrated Health Network {IHN} of Wisconsin, an Accountable Care Organization based in Brookfield, has laid off 21 employees (40 percent of its employees) as  part of shifting some functions from ACO administrators to participating healthcare organizations.

“IHN is in the process of adjusting operations and staffing across the organization to most efficiently and effectively meet the network’s evolving strategic needs,” Kathy Allen, IHN’s vice president for  marketing and communications, told the publication.

The job cuts followed   strategic planning sessions with the ACO’s board of managers.

“It was determined that owner-member health systems and health plans now have the capabilities to absorb many functions IHN provides as they continue the transition to value-based care,” Ms. Allen said. Health systems can perform some of these functions. Some of these systems run their own health plans and population-health management programs.

Ms. Allen said that many of the employees being fired are being considered for jobs within health systems that are members of the ACO.

To read the Milwaukee Business Journal article, please hit this link.

Dartmouth discusses its ACO woes


Dartmouth-Hitchcock Medical Center.

Healthcare leaders at the Geisel School of Medicine at Dartmouth College and the affiliated Dartmouth-Hitchcock Medical Center have been busily explaining to the national news media their decision to scrap their Accountable Care Organization — a  model mostly invented at Dartmouth.

A New York Times story said that Dartmouth’s ACO cut Medicare costs on hospital stays, tests, imaging and other procedures. But although it met its goal for quality of care, the Feds still penalized Dartmouth’s ACO  for not reaching cost-savings benchmarks, which prompted it to exit the program last fall.

Robert A. Greene, M.D., an executive vice president in the Dartmouth-Hitchcock Health System, told  The New York Times that  that the cost-cutting, in combination with federal penalties, was not sustainable for the system. Elliot S. Fisher, M.D., director of Dartmouth Institute for Health Policy and Clinical Practice and one of the designers of the ACO model, noted the disappointment of himself and his colleagues.

“It’s hard to achieve savings if, like Dartmouth, you are a low-cost provider to begin with,” Dr. Fisher told The Times.

A Health Affairs blog post said that  the Centers for Medicare & Medicaid Services  data suggest that while more ACOs are finding success,  financial performance and health outcomes can vary widely across America. In late August, CMS reported that that fewer than a third of ACOs qualified for Medicare bonuses.

To read a FierceHealthcare report on ACO issues, please hit this link.

To read a Health Affairs post on ACO performance, please hit this link.

To read The New York Times’s story on this, please hit this link.

IRS ruling whacks some ACOs

The New York Times reports that an Internal Revenue Service  ruling creates a significant obstacle to many Accountable Care Organizations. The Obama administration has promoted ACOs as a way to provide better care at lower cost.

The Times reported the  IRS  denied a tax exemption sought by an ACO that coordinates care for people with commercial insurance  since, the agency said, it  didn’t meet the test for tax-exempt status “because it was not operated exclusively for charitable purposes and it provided private benefits to some doctors in its network.”

The  name and location of the ACO,  formed by a nonprofit healthcare system, weren’t disclosed. The ruling  doesn’t affect ACOs formed solely to participate in Medicare, but it could affect similar entities serving privately insured patients, the newspaper reported. Many ACOs coordinate care for both Medicare beneficiaries and privately insured patients.

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