New Survey Reveals 2014 Wellness Trends

BioIQ, a health improvement technology company, revealed yesterday the results of its fourth annual Wellness Trends survey. BioIQ announced that 92 percent of respondents said their employees would benefit from better coordination between their wellness program and Accountable Care Organization (ACO) networks. Another result was that nearly 21 percent of those surveyed said they currently encourage their employees to engage with an Accountable Care Organization. 

“Our research reveals a growing interest in the ACO model as a way to monitor and improve the health of a covered population,” said Justin Bellante, CEO at BioIQ.

The 2014 Wellness Trends webinar, during which BioIQ discussed these and other timely topics, is now available on demand.

Intel Adopts Narrow Network to Better Manage Care

Dissatisfied with previous cost and quality efforts, computer chip giant Intel Corp. has entered an unusual direct contract with Presbyterian Healthcare Services for a narrow-network, accountable care-style arrangement for its employees in New Mexico, according to Modern Healthcare.

The arrangement, which started in January, covers about 5,400 individuals at Intel's manufacturing plant in Rio Rancho, NM. The California-based software developer and computer chip maker, which is self-insured, decided to contract directly with a single provider system rather than working with a national commercial health insurer this year to administer its benefits for some of its eight health plans options. Intel declined to name the insurer. The deal offers Intel employees a narrow network of Presbyterian providers as two of four health plan options.

Presbyterian, which now operates a clinic at Intel's Rio Rancho plant, will receive a bonus if it meets quality goals and Intel's employee healthcare costs stay under a set target. It also agreed to accept a financial penalty if costs exceed that target. Presbyterian has its own insurance arm, eight New Mexico hospitals and a medical group with more than 400 physicians.

Brian DeVore, director of healthcare strategy and ecosystem at Intel, is a confirmed speaker at NBCH's upcoming Annual Conference November 18-20, 2013.

New Tool for Tracking Accountable Care at State Level

A number of states are at the forefront of efforts to design and implement innovative payment and delivery approaches that advance accountability in health care delivery.

Encouraged by state legislative mandates, as well as provisions in the Affordable Care Act to reorient federal health spending to promote accountable care, these states are developing a variety of initiatives to achieve better health outcomes at lower costs.

With the support of The Commonwealth Fund, the National Academy for State Health Policy (NASHP) is tracking state activity to promote accountable care on its interactive State Accountable Care Activity map. NASHP has defined "accountable care" models as organizations or structures that:

• assume responsibility for a defined population of patients across a continuum of care; 
• are held accountable through payments linked to value and reliable performance measurements; 
• demonstrate that savings are achieved in conjunction with improvements in care.

Coalitions are invited to check out the activities in their states and examine whether there are ways for employers to be involved in these state-level efforts.

Providers Offering Price Guarantees to Insurers to Stabilize Employer Health Costs

According to Forbes, one of the Midwest’s largest providers of medical care is bringing a price guarantee to a new concept being pushed by the Obama administration that rewards doctors and hospitals for working together to improve quality.

Milwaukee-based Aurora HealthCare has formed an Accountable Care Organization (ACO) that is working with Aetna Inc. and Wellpoint subsidiary Anthem Blue Cross and Blue Shield in Wisconsin that are packaging commercial health insurance products using Aurora doctors and hospitals that offer small and mid-sized businesses a “price guarantee.”

The concept relies on the cost savings an ACO is expected to achieve through greater care coordination and care management. If the providers in the ACO achieve cost savings through improved care, they share money saved with the health plans. Aurora executives say they can promise the stable rates in what employers spend on health care “as a result of improved patient outcomes and efficiencies.”

Aurora’s commitment is that the employer’s costs won’t go up by a certain amount for three years. To get the guarantee, the employer has to sign a three-year contract with either Aetna or Anthem. Costs savings will vary depending on the employer’s past cost increases and “claims experience,” but rates could potentially drop 10 percent, Aurora says.

Few ACOs Ready to Accept Financial Risk for Patient Management

Few hospitals interested in becoming accountable care organizations are ready to take on financial risk, according to a survey released by The Commonwealth Fund. There are already 154 Medicare Shared Savings Program ACOs serving nearly 2.4 million Medicare beneficiaries, and dozens more ACOs are involved in partnerships with private insurers. But so far, the majority of ACOs are pursuing models that allow them to share in any savings they achieve without losing money if they fail to cut costs. In other words, there’s a lot of carrot but not much stick.

The Commonwealth Fund report suggests that’s likely to continue, though hospitals are making advances in how they manage patient care, specifically related to use of data and electronic medical records. The nationwide survey of nearly 1,700 hospitals measured hospitals’ readiness to participate in ACOs. It was conducted in September 2011, before the federal government released final rules for the Medicare Shared Savings Program.

Only thirteen percent of respondents reported that they were either already participating in an ACO, or planning to participate in the next year.

The results show that hospitals already involved with ACOs are improving the coordination of patient care and doing a better job of ensuring safe transitions among care settings—both hallmarks of the ACO model. At the same time, it’s clear that hospitals will need to strengthen their capacity to undertake population-based care and to fully assume financial risk for the patient population for which they are accountable. The survey results indicate that the use of data analytics and electronic medical records are an integral part of successful population health management.

Insurers Plan Expansions of ACOs

According to Health Leaders Media, Cigna, Aetna, and Blue Shield of California are stepping up efforts to develop their own Accountable Care Organization (ACO) models for their commercial populations.

While government ACO programs focus on physicians and hospitals providing coordinated care to improve quality and lower the cost of care for beneficiaries, insurance company versions of the comercial ACO are insurer-physician partnerships that provide coordinated care to improve quality and contain healthcare costs across commercial and Medicare Advantage books of business.

Leavitt Partners, a Salt Lake City–based health intelligence business estimates that there are currently nearly 200 commercial ACOs or ACO-like organizations at some stage of development.

Cigna has accelerated the development of its collaborative accountable care (CAC) program, which is their variation on the ACO program created as part of federal healthcare reform.

Like Cigna’s efforts, Aetna’s ACO program is in its infancy but has plans for significant growth. It has 10 ACO agreements in place and expects to have 20 under contract by the end of 2012. It plans to develop a national ACO network over the next five years.

Employers, both fully insured and self-insured, who work with these companies may be hearing more about commercial ACOs in the near future.  One possible option for employers is to offer an ACO product as one of an employee's health plan options; another place commercial ACOs may appear is in private exchanges.  

Pros and Cons of the Accountable Care Organization Model

The current issue of Mayo Clinic Proceedings contains a collection of commentaries from six leading health care organizations explaining why they did or did not choose to participate in the CMS ACO program. For example, representatives from St. Louis-based SSM Health Care cited lack of beneficiary engagement as a serious design flaw and a reason not to participate. In contrast, two of Ascension Health's sites in Texas chose to participate to gain experience in medical management and financial risk management, as well as to identify novel strategies for engaging physicians around shared values and shared business objectives. The commentary authors write not only about ACOs but, more broadly, about the challenges of reducing health care costs while improving health care quality.  

RWJF Call for Proposals: Testing the Impact of ACOs

The Robert Wood Johnson Foundation (the Foundation) has released a call for proposals to support case studies of Accountable Care Organizations (ACOs) in the private market. The case studies will also lead to predictions about the potential effects of the ACOs on a variety of outcomes including clinical quality, cost, patient experience, disparities, and the impact on vulnerable populations.

The Foundation will award up to three $400,000 projects for up to 24 months and anticipates that this will be the first in a series of two calls for proposals about ACOs. The Foundation may give preference to applicants that are either public entities or nonprofit organizations that are tax-exempt under Section 501(c)(3) of the Internal Revenue Code and are not private foundations or Type III supporting organizations.

Brief proposals are due September 5, 2012. If invited to apply, full proposals are due November 6, 2012. The Foundation will host applicant webinars on August 15 and 16, 2012. More information is on the Foundation website.

Senate Committee Discusses Health Care Delivery System Reforms

On May 23, the Senate Finance Committee held a hearing, Progress in Health Care Delivery: Innovations from the Field, to hear testimony on new developments in health care delivery system reform in the wake of the Patient Protection and Affordable Care Act (PPACA).

Committee Chairman Max Baucus (D-MT), in his introductory statement, said that the hearing would examine the ways in which delivery system innovation helps to reduce health care costs and improve health care quality. “The private sector has always been at the forefront creating innovative ideas,” Baucus said, though he noted that “the private sector cannot do it alone, nor can Medicare and Medicaid. The only path forward is through partnerships between the public and private sectors.” Baucus cited the Center for Medicare and Medicaid Services (CMS) Innovation Center – which identifies, develops, supports, and evaluates innovative models of payment and care service delivery for Medicare and Medicaid– as a positive step initiated by PPACA.

The committee’s ranking Republican member, Orrin Hatch (R-UT), in his opening statement, criticized PPACA in general and the CMS Innovation Center specifically, noting that the program “has an enormous budget and very little accountability.” He also noted that the standard fee-for-service payment system “provides little financial incentive to manage care properly. Instead, the incentive is to increase the volume of services. Reducing costs will require that patients receive the right care, in the right place, at the right time. Increasingly, it is private payers — on behalf of employers — who pressure providers to reduce costs, providing better care and better health outcomes.”

The committee heard testimony from the following private-sector health care insurer and provider representatives:

• Dr. Richard Migliori, executive vice president of health services at UnitedHealth Group, recounted his organization’s efforts to increase access to high-quality, affordable care by embracing wellness and prevention programs, providing individuals with tools and transparency to make better decisions, and instituting payment reform to better align incentives with quality outcomes. “public-private collaboration on delivery system reform will produce better results for the American people,” he said.
• Dr. Lee Sacks, chief medical officer for Advocate Health Care and CEO for Advocate Physician Partners (Oak Brook, IL), described his organization’s Clinical Integration Program, an accountable care organization (ACO) that allows payers, patients, physicians and hospitals to collaborate on health care efforts. Such collaborations “have the ability to …drive significant improvements in health outcomes and the patient experience while also reducing costs,” he said.
• Marc Malloy, president and CEO of Renaissance Medical Management Company (Wayne, PA), talked about his organization’s experience as a “pioneer” ACO selected by the CMS Innovation Center. He cited three primary areas of focus for improving quality and lowering costs: prevention and wellness efforts, screening and intervention for health risk factors and coordinated, evidence-based care by a physician team.
• Paul Diaz, president and CEO of Kindred Healthcare, Inc. (Louisville, KY), discussed his organization’s efforts to provide clinical integration between acute and post-acute care and between post-acute providers. He also emphasized “the need for collaboration, trust and teamwork between providers, payers, and policymakers to achieve delivery system reform,” noting that the ability to achieve immediate results “will depend critically on some measure of payment stability and confidence in the short-term and incremental reform of our current payment system.”

Employers Should Incorporate ACO Concepts into Worksite Medical Care

The American College of Occupational and Environmental Medicine is encouraging workplace health programs to adopt elements of accountable care organizations and patient-centered medical homes in a position statement that appears in the April issue of the Journal of Occupational and Environmental Medicine.

"By extending the well-conceived integrative concepts of the PCMH model and ACOs into the workforce via occupational and environmental medicine physicians, the power of these concepts would be significantly enhanced," write the physician authors of the official statement, including lead author and former ACOEM President Robert K. McLellan, MD.

The authors argue OEM provides an infrastructure to achieve PCMH and ACO goals. Since many people spend most of their day at work, the workplace should be a key component of an integrated healthcare delivery model. OEM physicians will need to develop innovative solutions that address primary care, workers' compensation and disability management within PCMH and ACO models, according to the authors of the article.

ACO Final Rule

ACO Final Rule Addresses Perceived Barriers To Participation
The Centers for Medicare and Medicaid Services today released the long-awaited final rule on the Medicare Shared Savings Prorgram, which sets standards for the creation of accountable care organizations. ACOs are designed to encourage physicians, hospitals, and other providers to coordinate with each other and provide better quality care more efficiently.

Value-Based Payment, Accountable Care, And The ACO Final Rule: Are We Making Progress?
With the Final Rule, CMS again has made a significant contribution to the national dialogue on accountable care and the important role ACOs can have in helping to achieve the Triple Aim. Moreover, while all stakeholders may not agree with every revision made in the Final Rule, CMS clearly has responded carefully and thoughtfully to the over 1,300 comments received by stakeholders on the Proposed Rule. At the very least, this represents a healthy public-private dialogue on an important topic, which is how rulemaking is supposed to work.

Employers look to ACOs to help increase value, keep health costs in check

A new report from human resources consulting firm Aon Hewitt and healthcare consulting firm Polakoff Boland says employer interest in accountable care organizations is ramping up as they seek new ways to continue offering healthcare benefits to employees.

“Seventy-seven percent of employers are unlikely to exit healthcare management when health insurance exchanges become available starting in 2014,” the study authors noted. “This finding indicates that employers intend to remain ‘in the game’ of offering healthcare benefits for the foreseeable future. Sixty-five percent of respondents have expressed interest in exploring the use of ACOs as an option for providing healthcare benefits to their workforce.” Read the full article...

New Approaches In A New World, Starting With ACOs

By Debra Ness and William Kramer

If it’s time to discard the old ways of doing business, there’s no better place to start than with Accountable Care Organizations, or ACOs. At the very heart of the philosophy that underlies health reform, and with a history of support from both Republicans and Democrats, ACOs are a model of care that incentivizes medical groups and hospitals to reduce costs while providing high-quality care.

An ACO is a network of health providers – hospitals, primary care doctors, specialists, advanced practice nurses, physician’s assistants, home health care providers and others. Some are private; others are public. Under the terms of the Affordable Care Act, an ACO contracts to meet the health care needs of at least 5,000 Medicare beneficiaries for a minimum of three years. Read the full post...