What ACOs should consider when building partnerships with independent physicians

The core premise of Accountable Care Organizations (ACOs) is to “assign responsibility for a population of patients to health care providers, with payments depending on the cost and quality outcomes for that population,” as described by Managed Care. Participating in an ACO is voluntary for providers; however, the Centers for Medicare & Medicaid Services (CMS) has identified savings programs in which ACOs can share.

An ACO is formed by a group of independent providers. The ACO may find, though, that it needs to find new partners to fill a gap in medical service capabilities. When building partnerships with independent physicians, an ACO should consider a number of factors. While ACOs offer incentives for quality healthcare, they must “recognize the needs of their assigned populations and work to provide comprehensive care management across the spectrum of provider types.”

Recent research published in Managed Care suggests that “ACOs need a framework for evaluating potential partners that will help risk-bearing providers establish the partnerships that will enable them to achieve their goals.” That framework includes seven “high-value” elements to look for in potential partners:

  • Patient-centeredness
  • A culture that emphasizes value
  • Accountability
  • A team-based approach
  • High-functioning health information technology systems
  • A quality assurance system
  • Financial preparedness for value-based care

The research involved interviews with ACO representatives as well as entities representing several different types of healthcare providers. Additionally, an expert panel was convened to “evaluate the framework and help prioritize provider types to evaluate.”

Managing care appropriately and in line with the move toward value-based care requires coordination across providers of different types and specialties. An ACO that can build effective partnerships with independent physicians based on the framework identified in the research “may allow providers to expand their influence throughout the delivery system as they begin to work across locations and episodes of care to manage population health.”

Prabhat Dhar
April 11, 2018

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Learning more about physician-only ACOs

The Centers for Medicare & Medicaid Services (CMS) defines Accountable Care Organizations (ACOs) as “groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.” The goal of an ACO is to coordinate care, “avoiding unnecessary duplication of services and preventing medical errors.”

There are currently 171 physicians-only groups that make up 30% of the total ACOs. That number has increased from 134 in 2016. Physicians have also joined with hospitals and other facilities to form 324 ACOs, or 58% of the total.

The American Medical Association (AMA) reports that “Of the 432 MSSP ACOs operating in 2016, 31 percent generated shared savings with 45 percent of physician-only ACOs generating shared-savings, compared to only 23 percent of the 226 hospital-based ACOs.” In addition, CMS has launched a new Advanced Alternative Payment Model (APM) for physicians, which “limits downside risk for participating practices while also allowing them to collect a lump-sum bonus previously available only to those who assumed more risk.”

AMA also notes that “Physician-only accountable care organizations (ACO) … have significant flexibility to contract with allied providers to build the ACO’s network as a new enterprise.” The association points out some key takeaways regarding physician-only ACOs, including:

  • Physician-only ACOs have obtained management, information technology, care coordination, and compliance infrastructure thanks to third party vendors accepting contingent payment from a portion of potential shared savings.
  • Health insurers and private equity funded management companies have recognized that a properly supported physician ACO can achieve improved quality and lower costs than independent physicians or mere contracting networks.
  • Experienced ACOs have seen success in early detection/early intervention by developing a stable of allied providers to steer patients to the appropriate sites of care.

Physician-only ACO numbers are on the rise, as independent physicians participating in ACOs are realizing greater benefits in terms of shared savings, improved quality of care, and lower costs.

Prabhat Dhar
March 29, 2018

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Elation launches new care management blog

Since the expansion of our blogs almost a year ago, we’ve been constantly looking for ways to continue to keep independent physicians and the healthcare community at-large informed and in the know about some of the most impactful areas of healthcare.

With care management being a growing area of interest among physicians and healthcare administrators, we’re excited to launch a blog solely focused on bringing information to you that can help reduce care gaps and improve care coordination.

From chronic disease management to independent physician associations (IPAs), and even accountable care organizations (ACOs), we’re dedicated to posting timely and relevant information to empower care managers at all levels to administer high-quality, coordinated care.

Interested in learning more about our blogs? Subscribe here.

Nick Dealtry
March 14, 2018

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