黑料正能量 Note: While ACOs are currently just practicing to assist persons with Medicare in NYS, several states and NY are planning to shift the model to one that accounts for those in Medicaid. The enhanced network comes with greater risks but the potential for significant dividends, not only through financial bonuses but potentially greater health benefits for all involved. In NY, Health Homes were established based on an ACO model, but without the incentives and stringent requirements. The DSRIP proposal to distribute $8b in reinvestment funds to accountable networks would also be a similarly rigorous and integrated approach, and one that would necessarily have more success in involving hospital networks in improving systems of care. While these models continue to grow, it鈥檚 necessary to consider what gaps (regional, cultural, economic, practice model) its optional implementation could engender.
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About 60% of Physician Practices Avoiding ACOs, Study Finds
Modern Healthcare; Melanie Evans, 3/17/2014
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The majority of physician practices have not joined an and don’t plan to anytime soon, a new study has found. These reluctant medical groups are also less likely to have the resources鈥, care coordinators, formal quality improvement initiatives鈥攖o effectively manage the costs and care for chronically ill patients, the study said.
The results, , show that roughly 6 of 10 physician groups have so far avoided accountable care, a proliferating payment model that rewards and penalizes hospitals and doctors based on their ability to meet cost and quality targets. Medicare accountable care efforts, launched in 2012 under the , now include more than 350 organizations. Private insurers have entered into more than 600 accountable care contracts, according to estimates by healthcare consultant Leavitt Partners.
When measured against an index of 25 measures of care management, patient engagement and quality, the practices with no plans to join an ACO scored lowest, the study said. Medical groups already under accountable care contracts ranked highest.
One-quarter of survey respondents were in ACOs. The survey included roughly 1,180 medical groups that researchers adjusted to reflect a nationally representative sample. Another 15% planned to join an ACO soon.
鈥淚t would have been surprising and extremely disappointing if those already in ACOs had the least capabilities,鈥 Stephen Shortell, a University of California at Berkeley professor of health policy and management and one of the study鈥檚 authors, said in an interview.
But that gap in readiness and resources between those that eschew and those that embrace accountable care suggest that widespread and rapid adoption of the payment model is unlikely, Shortell said. 鈥淲e鈥檙e not on the scale … where that鈥檚 going to occur,鈥 he said. Too many medical groups lack the necessary capacity to manage the financial risk of accountable care.
That lack of capacity among such a large segment of physician groups is discouraging if accountable care succeeds at slowing health spending while improving quality, Shortell said.
It鈥檚 too soon to tell if that鈥檚 the case. Medicare ACOs met rudimentary quality goals for the first year, but were not required to show progress. Meanwhile, ACOs achieved mixed results on efforts to control health spending.
Shortell and co-authors Sean McClellan, Patricia Ramsay, Lawrence Casalino, Andrew Ryan and Kennon Copeland said success among early adopters could help encourage groups not in ACOs to invest and prepare for the change. The demands on ACOs are significant.
鈥淓arly formative evaluations of pilot sites highlight the challenges of building capabilities in electronic health-record functionality, predictive analytics, data collection reporting and analysis, care management, physician and patient engagement, and the key roles played by culture and leadership,鈥 they said.
ACOs also face a dilemma in , an unrelated commentary in the Journal of the American Medical Association recently noted.
Doctors may exit ACOs that fail to account for physicians鈥 contributions and challenges toward meeting ACO goals, the authors wrote.
The Shortell study found other differences between physician practices inside and outside ACOs.
Medical groups already in accountable care were more likely to have 100 or more doctors and were less likely to be owned by a hospital. That may be because of financial incentives under accountable care to reduce, when possible, costly hospital admissions, the study said. 鈥淥ur findings also suggest that those practices owned by hospital and health systems may be reluctant participants given that the new value-based payment models are likely to adversely affect hospital admissions and financial viability.鈥
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