ACO Update: Accountable Care Partnerships in September
By - Accountable Care Organizations (ACOs) are designed to reduce costs while leveraging care coordination and improving patient outcomes. Moreover, the Centers for Medicare & Medicaid Services (CMS) recently showed that ACOs qualified for $445 million in shared payments while bringing $372 million in total program savings for Medicare.
But just how popular are ACOs? RevCycleIntelligence.com decided to round up a few of the recently announced ACOs and see what different organizations are doing to improve patient care while also keeping costs down.
Aetna and Hartford HealthCare
Aetna and Hartford HealthCare (HCC) announced at the end of September that the two organizations had a new, multiyear network agreement that would begin Jan. 1, 2015. Moreover, they will offer new value-based, accountable care arrangements in Connecticut starting in 2015.
According to an Aetna statement, the agreement builds on an existing collaboration between Aetna, HHC and ICP for HHC employees. The three entities exchange data to help identify, engage and help people with chronic conditions like diabetes and chronic obstructive pulmonary disorder (COPD). Additionally they work together to improve care coordination for employees being discharged from one of the acute-care five hospitals in the HHC system.
The agreement is good news for patients, employers and providers in the system, said Dr. James Cardon, executive vice president and chief clinical integration officer for HHC.
“Together, we will work to improve quality, provide more access to health services and programs and lower the overall cost of care,” Cardon said.
Aetna Launches ACO in Colorado
On Sept. 29, Aetna announced an ACO with Banner Network Colorado, Colorado Health Neighborhoods, New West Physicians and Physician Health Partners. Additionally, Aetna introduced the Aetna Whole HealthSM product in Colorado.
Paul Kellogg, senior director for managed care in Banner Health’s Western Region, said in a statement that his organization is pleased it was selected by Aetna.
“The arrangement between Aetna and BNC is designed to enhance care and control costs through an emphasis on wellness and close coordination of care for members,” Kellogg said. “Banner Health Network’s program with Aetna and its Aetna Whole Health product in Arizona has shown tremendous success for its members, and we’re confident we will see the same successful outcomes in northern Colorado.”
The agreement will feature a new payment model, Aetna explained, will reward providers when they meet quality, efficiency and patient satisfaction measures. These include reductions in avoidable hospital readmission rates and reduction in emergency room visits. Additionally, providers will be rated on how they improve “better management of patients with chronic conditions such as diabetes and heart failure” and “the percentage of Aetna members who get recommended preventive care and screenings.”
Aetna and Weill Cornell Physicians
On Sept. 9, Aetna announced that it formed a new ACO with Cornell University’s physician group, the Weill Cornell Physicians. Under the agreement, Aetna will recognize the Weill Cornell Physicians Organization for achieving quality and efficiency benchmarks. Moreover, the ACO will help Weill Cornell expand its care-management program and add health information technology that will benefit Aetna members.
“This collaboration will add to the effort of aligning our Weill Cornell faculty with the Triple Aim of improving quality, lowering costs, and performing population-health management,” Michael Wolk, MD, MACC, chair of the Weill Cornell Physicians’ Managed Care Committee, said in a statement.
Medicare members often have complex healthcare needs that go undetected, according to Terry Golash, M.D., senior medical director, Aetna, New York. However, with providers and insurers working together in a collaborative model, Golash explained that information and resources can be shared to improve care and direct outreach.
In the Aetna and Weill Cornell collaboration, Aetna nurse case managers will work closely with the Weill Cornell Physicians to identify, coordinate and improve the care of members. The two groups will also ensure they adhere to best practices and treatment plans.
Aetna, Hill Physicians Medical Group, Inc. and Dignity Health
Aetna announced another ACO toward the end of September, this time with Hill Physicians Medical Group, Inc., Dignity Health Medical Foundation and Dignity Health hospitals. The move also includes the introduction of the Aetna Whole HealthSM product to the Northern California-based health systems.
“In a marketplace as dynamic as ours, it’s important to be innovative,” David Joyner, COO of Hill Physicians, said in a statement. “We’re very pleased that Aetna chose Hill Physicians and Dignity for the launch of its Whole Health product in northern California.”
The ACO will feature a new model of healthcare delivery that is designed to offer cost savings to employees who use providers in the accountable care network. Additionally, it will have a more coordinated and personalized experience for patients, as well as better healthcare outcomes.
“Aetna is excited to collaborate with Hill Physicians and Dignity Health to transform patient care and build a more effective, sustainable health care delivery model in Northern California,” said Mark Reynolds, Aetna’s president for Northern California. “Our accountable care agreement with these two organizations will ensure that our members receive the care that they need to help them live healthier, more productive lives.”
Humana and Iora Health
An ACO arrangement and population health management partnership was created between Humana Inc. and Iora Health in the middle of September. The two organizations explained in a statement that the move will open four new primary care practices – two in Phoenix and two in Seattle – under the Iora Primary Care brand.
“The partnership with Humana allows Iora to help improve the lives of seniors in Phoenix and Seattle,” Rushika Fernandopulle, M.D., M.P.P., CEO and Co-Founder of Iora Health, said in a statement. “Seniors deserve care matched to their specific needs. Iora’s people-first primary care operating system helps do just that. We’re thrilled to partner with Humana to continue to restore humanity to health care.”
Value-based incentives will be included in the partnership, and are expected to improve patient care coordination, be more cost effective, and ensure quality care. The move will also offer more personalized care and population management tools, including predictive analytics and chronic care, disease management and wellness programs, the organizations explained.
Anthem Blue Cross and Blue Shield, Mount Carmel Health Partners
Ohio received a new ACO when the state’s Anthem Blue Cross and Blue Shield and Mount Carmel Health Partners announced on Sept. 9 that they were joining together to improve patient care.
According to a Mount Carmel statement, the group’s primary care physicians already participate in Anthem’s Enhanced Personal Health Care program. Under that arrangement, Mount Carmel delivers patient-centered care for Anthem members, while the insurer compensates and rewards the medical group for care coordination and shares cost savings – when accompanied by high-quality care.
“This is an exciting time for our two organizations and for the state,” Claus von Zychlin, President and Chief Executive Officer of Mount Carmel Health System, said in a statement. “This agreement with Anthem will enable our clinically integrated network to expand its focus on increasing value to patients through improved quality and slowing the rate of healthcare cost increases, which over time will result in more affordable health care for central Ohioans.”
As part of the arrangement, both organizations will collect and analyze data on quality, costs, and utilization. This enables them to identify opportunities to improve care and keep care affordable for patients and employers in Ohio.
Cigna and ChoiceHealth
Cigna Corp. and ChoiceHealth announced a collaborative care organization on Sept. 23. Cigna’s Collaborative Care initiative is very similar to an ACO, as it aims to lower healthcare costs and improve overall value though such collaboration.
The program with ChoiceHealth will go into effect on Oct. 1 and members will receive treatment from over 35 primary care doctors who are part of ChoiceHealth in Virginia, according to a statement.
“The Cigna Collaborative Care program only further supports what Novant Health is doing to create a new level of care coordination,” Melissa Robson, president, Novant Health northern Virginia market, said in a statement. “This program aligns with our system’s desire to provide better care for individuals and populations while lowering the overall cost of care.”
ChoiceHealth will be compensated by Cigna for the medical and care coordination services they and their physicians provide. Moreover, when physicians meet targets for improving quality and lowering medical costs, they may be rewarded through a “pay for value,” Cigna explained.
Registered nurse clinical care coordinators, who are employed by ChoiceHealth, are critical aspects of the collaborative. They are aligned with Cigna case managers, ensuring a high degree of collaboration between ChoiceHealth physicians and Cigna.
UnitedHealthcare, Advocate Heath Care and Illinois Health Partners
UnitedHealthcare announced on Sept. 24 it had established ACOs with Advocate Heath Care and Illinois Health Partners, which is comprised of physicians affiliated with DuPage Medical Group and Edward-Elmhurst Healthcare.
With the partnership, UnitedHealthcare will share data and incentives with Advocate Health Care and Illinois Health Partners, according to a UnitedHealthcare statement. Moreover, it is a priority to close the gaps in care and ensure that beneficiaries receive the needed care at the right time and in the best setting. The health systems will also share in any savings that come from the high-quality, better-managed care.
“We know the existing fee-for-service system is not sustainable in the long term,” said Lee McGrath, president of Illinois Health Partners. “This new model of enhanced collaboration between care providers and health plans is an important step toward delivering evidence-based, higher-quality care while bringing down costs. We appreciate UnitedHealthcare’s efforts to work with us closely to create a customized model that helps facilitate optimal care for our patients.”
Those already enrolled in UnitedHealthcare Medicare Advantage plans – who currently receive care from providers affiliated with Advocate Health Care and Illinois Health Partners – are not required to do anything differently to receive the benefits of the new collaborations.
