2011 eventually may be more known for the explosion of Accountable Care Organizations (ACO's), rather than the first full year of Affordable Care Act implementation.
Across the U.S. dozens of ACO pilots are popping up as the industry seeks to bend its cost curve and reign in health care expenditures.
CIGNA
According to Dick Salmon, CIGNA's national medical director for performance measurement, CIGNA expects to have implemented or be in the active planning stage with approximately 30 Accountable Care initiatives by the end of the year, up from the eight CIGNA-only programs and four multi-payer pilots in which CIGNA now participates.
On its website, CIGNA states that it is running eight accountable care programs throughout the country and participating in four multi-payer pilots.
Salmon indicates the goal is to achieve the “triple aim” of improved quality, lower medical costs and improved patient satisfaction by creating a care model anchored in the principles of the patient-centered medical home that also builds in accountability by rewarding physicians for results.
A key element of CIGNA's programs is the sharing of “gaps in care” data with a care coordinator at the physician practice. The care coordinator schedules follow-up appointments, prescriptions are filled or additional medical tests are completed. In the case of Dartmouth-Hitchcock, this type of collaboration has resulted in a 10 percent improvement in the practice’s overall closure rate for gaps in care compared to other physician practices in the market where patient care isn’t coordinated. For hypertension, Dartmouth-Hitchcock shows a 16 percent gap closure improvement compared to the market, and for diabetes an eight percent improvement.
At Cigna Medical Group, the Phoenix-based multi-specialty medical group practice division of CIGNA HealthCare of Arizona, a strong focus on the patient and improved care coordination has resulted in average annual savings per patient of $336. The cost of ambulatory surgery is down 11 percent, while preventive care visits are up three percent overall - and up 12 percent for adults.
CIGNA is now engaged in 12 patient-centered initiatives in 11 states, encompassing 100,000 CIGNA customers and 1,800 physicians. These programs include multi-payer pilots in Colorado, New Hampshire, Pennsylvania, and Vermont, as well as CIGNA-only collaborative accountable care initiatives in Arizona, Connecticut, Georgia, Maine, Missouri, New Hampshire, Tennessee and Texas. CIGNA has been a member of the Patient-Centered Primary Care Collaborative since October 2007.
Vermont's ACO Effort
Since 2009 the Vermont Health Care Reform Commission (HCRC) has been charged with investigating how ACOs might be incorporated into the state’s comprehensive health reform program. Three Vermont provider organizations are now in various stages of creating an ACO, with the objective of implementing the first site in 2011 as part of a national ACO Learning Network.
Key Vermont stakeholders in the ACO pilot program have included the state’s three major commercial insurers, four hospitals, the state hospital association, the state medical society, the business community, state health reform staff, the Vermont Department of Health, the Department of Banking, Insurance, Securities, and Health Care Administration, and the legislature.
United Healthcare
UnitedHealthcare is also jumping into the ACO business full throttle. 'United' will help fund a new accountable care organization in 2011 at Tucson (Ariz.) Medical Center. CMS also plans to fund the ACO, which was designed by the Brookings Institution and the Dartmouth Institute for Health Policy and Clinical Practice. Here Benton Davis, CEO for the Western States for UnitedHealthcare, explains the ACO's origins and how it will function.
Primary care physicians at Tucson Medical Center receive a monthly fee covering the cost of coordinating care for each patient enrolled in the program. Physicians can also collect a performance bonus based on clinical quality factors such as positive cholesterol and blood pressure patient outcomes. Results of the pilot are still not complete, but so far, necessary ED visits for the medical-home group are 4.5 percent lower and unnecessary ED visits are 22.5 percent lower than visits for other patients.
Humana
In 2010 Humana launched its region's first commercial Accountable Care Organization. The Louisville pilot ACO, one of five such Humana sites in the nation, was selected by the Engelberg Center for Health Care Reform at the Brookings Institution.Humana is partnering with Norton Healthcare in the Brookings-Dartmouth ACO Pilot Project and "we feel this is a tremendous opportunity to participate in an alternative model for health reform," said Steve Hester, MD, Norton Healthcare CMO. "Our progress toward a system-wide integrated electronic medical record; and our large base of employed primary- and specialty-care physicians, Norton Healthcare was the logical choice in our region to be an ACO pilot participant," according to Hester.
Anthem Blue Cross
Not to be outdone, Anthem is not sitting on the ACO sidelines. Anthem is participating in an accountable care organization (ACO) pilot with two southern California medical groups/independent practice associations (IPAs): Irvine-based Monarch HealthCare and Torrance-based HealthCare Partners.
"The current fragmented healthcare system does not result in the best care possible," Anthem spokeswoman Peggy Hinz tells FierceHealthPayer. "ACOs financially incent healthcare professionals to deliver superior quality care to patients by encouraging greater collaboration among physicians, hospitals and health insurers and, more importantly, by paying for superior health outcomes. Anthem Blue Cross and ... WellPoint are honored to be at the forefront of the ACO movement."
Summary
The ACO is a promising financial incentive model that could support the development of a community health system. These pilots are an essential process. Successful ACOs will require participation of public payers, particularly Medicare, in a common multipayer framework to realize their potential.
Cartoon courtesy of © Phil Hands, cartoonist.
