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ACOs (Accountable Care Organizations)

Posted on August 28, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

ACO’s Built Around Primary Care Not Payers
It’s always quite interesting when a non-healthcare journalist covers healthcare. The above title comes from this article on NJBiz.com. In the article they offer the following interesting ACO stats (as of Sep 2011):

-51% of all ACOs are buist as joint ventures between doctors and hospitals
-20% of ACOs are physician led
-18% of ACOs are hospital led
-75% of hospitals surveyed were not planning on participating in ACOs
-13% of hospitals are already participating in ACOs


Then, the article offers this insight into the ACO battle between payers, physicians and hospitals:

The report also noted that hospital- and physician-led ACOs tend to focus more on primary care than acute care, but Horizon Blue Cross Blue Shield’s partnership with Optimus is set up to promote primary care based on patient-centered medical home models, according to spokesman Tom Vincz.

“Horizon ACO arrangements include incentive payments to support improved patient care coordination and fund other activities to further transform offices into patient-centered practices,” said Horizon in a statement from Vincz. “Entities that Horizon collaborates with are given other valuable resources, such as timely, population-based data, to help them deliver more effective and efficient care to their patients.”

Since I consider myself a physician advocate, it seems appropriate for me to add in a quote from a blog post Kerry A. Willis, MD did on KevinMD:

During the PHO debacle a few years ago, I reminded our physicians that the letters should represent the ownership and direction that these organizations should take as they developed. I frequently offered that they were really pHO’s with Big hospitals and Big organizations with little physician control over the direction and quality that was important to us.

I fear that the same is true with ACOs. If we are not vigilant in their formation and direction, then they will become AcOs with physicians being a small part of their governance but very accountable to their owners. They will be dependent on the revenue streams that spring from them. I see scenarios where physicians will profit but then be caught in a spider’s web of their own design where they will be told how to practice and what kind and amount of care they can provide. I guess you could claim that I don’t trust insurance companies and you would be wrong. I do trust them. I trust them to do what is best for the corporate profits and the nonprofit executives’ with bonus clauses at the end of a successful year.

I fear that when it comes to ACOs many physicians are sitting on the sideline. We saw what happened with EHR incentive money and meaningful use when more doctors weren’t involved in the process. There were requirements that didn’t make any clinical sense. I can see the same thing happening with ACOs if doctors don’t get involved.

It’s a rapidly changing ACO environment, and my hope is that many smart physicians will add their voice to the mix. Otherwise, the shift to hospital owned practices will continue and doctors won’t have much of a choice but to be beholden to a big company.

Commercial Insurance Implementing Meaningful Use

Posted on August 17, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The HITECH Law Blog had a post recently titled “Commercial Payors Implementing EHR Meaningful Use Criteria in P4P Programs.” Here’s a short excerpt:

On August 5, 2010, four major commercial health insurance payors participated in the Health Industry Forum in Washington, D.C., to discuss private industry collaboration with the United States Health & Human Services Department (HHS) to support providers in the adoption of certified electronic health records (EHRs). Leading the Forum’s panel discussion was David Blumenthal, M.D., Chief of the Office of National Coordinator of HIT. All four payors will include the Meaningful Use criteria in their pay for performance (P4P) programs.

The 4 insurance groups identified are Aetna, Inc and its subsidiary, ActiveHealth Managent, United Health Group (UHG), Wellpoint, Inc, and Highmark, Inc. (Blue Cross Blue Shield).

The author of the blog also asserts that now that the government has created the final meaningful use rule, it will clear the way for the commercial payors to implement it as well. The press releases from the 4 companies about this change are really vague and so it’s hard to say exactly how these companies will implement the meaningful use criteria.

In fact, this almost feels like it’s a little warning shot from the commercial payors. It seems like they’re testing the waters to see how doctors and practices will react to this type of announcement. Plus, I’ll be surprised if we see any major implementation of meaningful use by commercial payors until we see the first physicians showing meaningful use to the government. That way the commercial payors can sit back and watch the impact on physicians of having to show meaningful use to the government. If it goes poorly (like the bad PQRI incentives), then I can see commercial payors backing off the meaningful use bandwagon.

The theme I did read in all the press releases is that it’s valuable for commercial payors to have information from an EHR. Now I think the payors are just trying to figure out the best way to achieve that outcome. Will it be meaningful use? Will it be some other method? They don’t really care. They’re just concerned with their outcomes.

If commercial payors do require meaningful use, I think it’s going to be a really ugly outcome.