Accountable Care Organizations

Transcription

1 Healthcare Association of New York State

2 Accountable Care Organizations In 2011, in an effort to contain spiraling health care costs, HHS released new rules under the ACA aimed at helping doctors, hospitals, and other providers better coordinate care through Accountable Care Organizations, or ACOs. ACOs provide a framework for rewarding providers financially in both the public and private sectors for ensuring that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. Since HHS introduction of this reimbursement model, the number of ACOs has grown dramatically. As of February 2013, there were an estimated 428 ACOs in 49 states, more than double the number from the start of Leavitt Partners. (2013, February 20). Accountable Care Organizations have more than doubled since Available at: care organizations have more thandoubled since 2011/. See more at: hub/aco/acos.php#sthash.y9mungdk.dpuf Healthcare Association of New York State

3 Shared Savings Program Under a new program developed by CMS, ACOs agree to manage all of the healthcare needs for a minimum of 5,000 Medicare beneficiaries, for at least three years. In 2011, the first 32 Medicare ACOs, called Pioneer ACOs, were announced. Those selected for the program were healthcare organizations already operating with coordinated care principles. In 2013, Pioneer ACOs were scheduled to transition from pay forreporting to pay for performance, but requested extra time to reexamine the terms under which they would be evaluated. The Medicare Shared Savings Program, designed for organizations new to risk based reimbursement, rewards ACOs that lower growth in healthcare costs while meeting performance standards on clinical quality and patient centered care. To date, the federal government has approved nearly 260 ACOs to participate in the MSSP. Healthcare Association of New York State

4 Shared Savings Program Participants in NYS Accountable Care Coalition of the North Country, LLC Rochester General Health System ACO Accountable Care Coalition of Syracuse, LLC Adirondack ACO Catholic Medical Partners Accountable Care Coalition of Greater New York Chautauqua Region Associated Medical Partners, LLC Asian American ACO Balance ACO Independent Physicians ACO Mount Sinai Care, LLC Pioneer ACO 12 Phase 1 12 Phase Bon Secours Good Helpcare, LLC Crystal Run Healthcare ACO, LLC Accountable Care Coalition of Mt. Kisco, LLC WESTMED Medical Group, PC Beacon Health Partners, LLP Montefiore ACO Healthcare Provider ACO, Inc. HHC ACO Chinese Community ACO Healthcare Association of New York State FamilyHealth ACO Primary PartnerCare Associates, IPA ProHEALTH Accountable Care Medical Group, PLLC NYS Elite ACO

5 Commercial ACOs Alongside the CMS backed plans, commercial healthcare insurers also began offering risk based contracts to providers. One such program, established long before the CMS initiatives, was the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract (AQC), which ultimately served as a model for payment reform. Most commercial risk contracts include similar combinations of quality incentives, shared savings, full capitation, and small budget adjustments for medical inflation. Some contracts have moved to partial capitation (also known as bundled payments). Additionally, many state Medicaid programs, offered directly through a state Medicaid office or Medicaid managed care plan, are also negotiating Accountable Care agreements with providers. New York is currently underway developing regulations for state based ACOs. Healthcare Association of New York State

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