Private Accountable Care Organizations (ACOs) Gaining Traction

Mixed Results

The results of the initial Pioneer ACOs are mixed at best – and suggest that ACOs will need to place more emphasis on establishing interoperability among desperate information systems and meaningful performance monitoring, measurement and management reporting systems.

At the start of 2013, medical groups around the country began joining private ACOs with an emphasis on shared responsibility among provider groups for a defined pool of patients. Almost a year later, few medical groups have enough data to suggest whether their varied approaches to managing patient populations will lead to better quality care that’s also more affordable.

Private ACOs

Pioneer ACOs model incentives are stronger than Medicare Shared Savings Program (MSSP) ACOs because the groups assumed more risk early-on. If MSSP ACOs want to do better than the 3-4% savings results achieved by some Pioneer ACOs, they will require an information platform that is payment reform compliant – and that helps them to acquire, process and stream information between multiple partner systems. This is the only way that ACOs will be able to fully implement optimal cost, revenue and provider incentive models that improve health outcomes and contain patient cost.

Private ACOs account for roughly half of all ACOs, a trend driven by their ability to experiment with different approaches and more easily track costs through clearly defined patient populations. The groups assume more risk, and in return are more rewarded if they meet quality of care and shared savings benchmarks. While some ACO partners require relatively few changes in how they operate, others will need to dramatically rethink how they provide care.

Healthcare experts may differ regarding which ACO models and reform components are likely to make the biggest long-term impact. However, it is clear that ACOs must go beyond the simple review of historical expenditure and utilization patterns, and begin to apply predictive analytics that support care optimization, reduced operational costs, and improved patient health outcomes.

ACO Working Group

Patriot Labs is launching the ‘ACO Performance Management Working Group’ to address the challenges of designing, developing and deploying an optimal ACO integrated information management system. For more details, contact Ron Garnett.