With the prohibitive and rising cost of healthcare, there has never been a greater need for accountable care organizations (ACO's), according to Mark McClellan, MD, former administrator for the Centers for Medicare and Medicaid Services under President George W. Bush.
McClellan's comments, according to Healthcare Payer News came by way of a plenary speech given Monday at the National Health IT and Delivery System Transformation Summit, held in conjunction with Second Annual National Accountable Care Organization Summit in Washington, D.C.
The challenge of achieving better care at lower costs has never been more important or more urgent, he said within the speech, and the serious challenges of getting from here to there have never been more daunting.
McClellan, now director of the Engelberg Center for Health Care Reform at the Brookings Institution, said during the past year the Centers for Medicare and Medicaid Services has identified many challenges faced by providers when starting an ACO – and there are now some successful ACOs from which to draw experience.
"ACOs are about fundamental changes," he said. "The main emphasis is to get away from fee-for-service payment structures," thus creating more efficient health care payment models that de-emphasize quantity and move toward a quality focus.
McClellan added that "ACOs are not going to be an immediate solution to all (U.S. healthcare) problems, but neither is anything else. The time is now" for ACO's, McClellan concluded.
For a more detailed analysis of ACO's go to this Robert Wood Johnson Foundation policy brief on Accountable Care Organizations and the Medicare pilots authorized under the PPACA.
Here are some details from the linked report above:
The Senate version that was enacted into law focused instead on one model that is now able to become a part of Medicare, not just a pilot program. The model embodies a few basic features proposed by some policy analysts:
- • invisible enrollment. Patients who receive most of their care from ACO-affiliated providers would be treated as “assigned” to the ACO.
- • performance measurement. Over some period of time, payers would collect data on utilization and costs for the ACO population and on measures of quality of care and population health.
- • shared savings. Spending for the population of patients in a particular ACO could be compared to targets based on past experience for the same patients, or to spending for similar patients in the community who were not assigned to the ACO.
- • evolution toward stronger incentives. In the beginning, there would be no downside risk: The ACO would not share in the losses if treatment of its patients cost more than expected, though this could change over time.
Despite the difficulties faced in launching ACOs, McClellan said they "aren't going away." Over time, the rules and provider incentives will be improved.
ACOs are part of the PPACA, a comprehensive strategy to get better care at a lower cost. "They are not a bunch of reforms we're throwing up against the wall to see what sticks," he said.
In a March 31 article published in the New England Journal of Medicine, Donald Berwick, current CMS administrator in the Obama administration, said the purpose of ACOs will be to foster change in patient care so as to accelerate progress toward a three-part aim: better care for individuals, better health for populations, and slower growth in costs through improvements in care.
The regulation does not as yet specify how much incentives providers will earn participating in the voluntary program. If this effort proves successful, hopefully it will move far beyond the "voluntary" aspect and be something that physician's and health care providers feel compelled to do in remaining competitive.
ACO's Defined
ACOs create incentives for healthcare providers to work together to treat an individual patient across care settings, according to HHS Secretary Kathleen Sebelius. Medicare Advantage plans will not be included in the ACO program.
Some of the difficulties cited by stakeholders are cost, physician buy-in and interoperability.
McClellan predicted the final ACO rule, expected out this summer, should have "a lot of changes" compared to the March proposal. Given McClellan's statement its obvios that ACO's do enjoy broad, bi-partisan support as a posiotive reform effort.
Department of Health and Human Services Secretary Kathleen Sebelius, who also spoke at the conference's opening session, said HHS has "listened" and weighed the interest of stakeholders after proposing the ACO rule in March. Since then, HHS has received 1,200 comments, she said.
HHS is looking for ways "to find the best balance" between stabilizing costs and protecting patients. The ACO model will reward physicians for keeping their patients healthy in the first place, she said.
