Last updated July 27, 2022 More data is required for ACOs, now that Alternative Payment Models have moved to high gear. In this article we’ll take the mystery out of how to realistically gauge your data needs and scale up data, so that your ACO can be successful. We’ll show you how to identify the […]
New ACO Playbook: How ACOs Can Transform Clinical Care for Diabetes
An illuminating article about ACOs, featuring current and former MedPAC chairs’ perspectives, argues that savings have been constrained because too much is beyond ACOs’ purview to manage. Examples include both external restrictions (the exclusion of prescription drugs and provider fee payments from ACO control) and internal cultural or economic barriers (conflicts of interest that make […]
New ACO Playbook: To Show Standout Performance, ACOs Must Rethink Quality
The health care media are full of articles asserting that ACOs have proven their mettle in delivering health care of highest quality. Citing ACO quality reporting results, CMS and advocates point to the majority of ACOs passing CMS quality standards, and that ACOs are improving their results on quality measures over time. The vast majority […]
New ACO Playbook: Three Touchstones for ACO Viability
Some believe that an ACO’s leadership structure predicts its success. They point to differing savings results for physician-led versus hospital-led ACO shared savings models (MSSPs) to make their case. In particular, they make the argument that future Value-Based Care (VBC) policies should benefit the growth of successful physician-led ACOs, protecting them from policies that force […]
New ACO Playbook: Can Coordination of Care Save Enough Money to Save ACOs?
Central to the controversy about ACOs’ potential for Value-Based Care is whether they actually save enough money and reduce costs fast enough. Researchers and advocates have produced various independent studies of ACO savings, the most generous estimating $1.8 billion in cumulative savings over the first three years of the program, almost double CMS estimates. Many […]
Why ACOs Need a New Playbook
A lot has happened in health care since 2012, when final rules permitted provider-organized ACOs to be the driving force of Value-Based Care under the 2010 Affordable Care Act (ACA). As we pass the ACA’s eleventh anniversary, a dwindling number of Medicare Shared Savings Program (MSSP) ACOs are entering a new phase marked by higher […]
5 Value-Based Behavioral Health Strategies for ACOs and Medical Group Models
For ACOs and Direct Contracting Medical Groups adopting value-based payment models, behavioral health is often overlooked. But your patients’ unmet behavioral health issues are a big cost driver for emergency care and inpatient admissions, and they compound risk factors in disease. They also influence your patients’ adherence to treatment plans. You may believe this is […]
With Competing Payment Models on Hold, What’s the Future for ACOs?
When CMS first announced new primary care payment models in April 2019, ACOs understood that their future might be threatened by competition for both physicians and patients. If medical groups could independently contract with Medicare under these models, they would have the advantage of greater control over their physician network, referral arrangements, and clinical decisions. […]
Why Health Equity Will Be Measured in Value-Based Health Care
After the first wave of COVID-19 case numbers and deaths in Spring 2020, it was Mayor Lori Lightfoot of Chicago who broke the story of how the virus was distinctly ravaging Black and brown communities with higher hospitalizations and deaths. In Chicago, alone, Black residents were dying from COVID-19 at six times the rate of […]
7 New Value-Based Health Care Directions You’ll See in 2021
Everyone who’s reeling from 2020 is hoping for light in 2021. Health care, especially—systems, hospitals, clinical practices and their providers—wants the pain to stop. What might lie ahead for health care next year? Here’s what we’re thinking about the near future, and what you should watch for in 2021. 1. Health care providers will be […]