Accountable Care Organizations (ACOs) are increasing in the state and half are smaller physician-driven organizations serving fewer than 10,000 beneficiaries.
Recently, the Centers for Medicare & Medicaid Services (CMS) announced 89 new ACOs in the nation; three are in Indiana:
- Franciscan American Health Network Mishawaka
- IU Health
- Deaconess Care Integration
|What are Accountable Care Organizations?
Accountable care organizations (ACOs) are mechanisms for participating in the Medicare Shared Savings Program created through federal health care reform, the Patient Protection and Affordable Care Act. Health care providers collectively create separate entities, called ACOs, that can collect a portion of the funds they save Medicare by yielding higher quality, lower cost services for defined populations of Medicare patients. Participation in ACOs is voluntary, but some physicians’ choices may be dictated by their affiliations with hospital systems.
“The whole ACO concept is physician centered. Physicians are the center of this whole movement,” commented ISMA Past President Vidya Kora, M.D., chair of the ISMA ACO Task Force.
“I think as physicians become more comfortable with ACOs, they will become more involved.”
ACOs represent a new payment model that rewards physician groups for improving patient outcomes by proactively coordinating patients’ total health care needs. The addition of the latest ACOs brings the total number to 154 nationwide and 400 more are slated for confirmation in January 2013.
The Deaconess ACO, which involves 323 physicians, will reach Medicare beneficiaries in Illinois, Indiana and Kentucky. At this time, participants are all within Deaconess Health System, including:
- Employed physicians
- One rural health clinic
- Deaconess Hospital
- The Heart Hospital
Future plans include adding affiliated physicians, in both individual and group practices.
|David Christeson, M.D.
“Physician participation is inevitable,” commented David Christeson, M.D., executive director of the Deaconess Care Integration ACO in Evansville. “The key is that physicians need to be the leaders in the effort to create better coordinated care and to be rewarded for doing so. Right now, fee-for-service reimbursement doesn’t give them enough incentive or reasons to take on this role,” said Dr. Christeson.
The Franciscan American Health Network (AHN) ACO in Mishawaka is the second such organization formed by the Franciscan Alliance and the first for AHN. It is expected to reach an estimated 28,000 Medicare patients.
|Ben Park, M.D.
“This is the future of health care. No one likes everything in the Affordable Care Act, but I think they got some things right,” said Ben Park, M.D., AHN president and CEO. “Physicians should be rewarded for outcomes.”
Goals of the Franciscan AHN ACO include:
- Improved care coordination
- Chronic disease management
- Internal process improvements
- Point-of-care reminders and best practices through health information technology and electronic medical record data-sharing
Find additional resources about ACOs on the ISMA ACO page.
|ISMA seminar will help you learn more about ACOs
Your future will likely involve participation in an integrated health care delivery system where you and hospitals are held accountable for the overall cost and quality of care. To help you learn what options are available to you, the ISMA will host a continuing medical education (CME) seminar Friday, Sept. 14, at the JW Marriott Indianapolis, in conjunction with the annual convention.
AMA Senior Attorney Wes Cleveland will present “ACOs, Co-ops and Other Options: A ‘How To’ for Physicians Navigating a Post-Health Reform World.” The session will provide a detailed overview of the changing health care environment, including the benefits and challenges associated with establishing or participating in physician and other health care provider collaboratives.
For information and to register, go here.