Must-read ACO stories to help you track the new healthcare model

Accountable care organizations are a relatively new financial and healthcare delivery model that hinge on cooperation between providers and often ties financial performance to quality. Though the reviews are mixed, but most insist they are here to stay. So, to keep you informed on growth of ACOs, follow this running list of key news from 2015.

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Population health management is fast becoming a priority for healthcare providers, but many are still figuring out which technology partners are best suited to help them fuel data-driven initiatives, according to a new 2015 Population Health Study by HIMSS Analytics. Full story.

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The Centers for Medicare and Medicaid Services on Thursday updated the quality scores for 40,000 physicians who shared benchmarks under the Physician Quality Reporting System, despite outcry by the American Medical Association that the data is incomplete. Full story.

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Physician advocate Medical Advantage Group will partner with the Ohio State Medical Association in a marriage that both organizations expect to help physician members successfully transition to new payment models. Full story.

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The Centers for Medicare and Medicaid Services is asking healthcare providers for information to aid in the design of a new survey of patient experience in long-term care hospitals. Full story.

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Care New England and Southcoast Health have signed a letter of intent to merge and create an eight-hospital affiliation and a new parent organization overseeing both health systems. Full story.

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Humana will distribute $77.2 million in bonus payments to physician groups nationwide who participated in its Provider Quality Rewards Program last year, the Louisville, Kentucky-based health insurer recently announced. Full story.

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Tennessee-based IASIS Healthcare will roll out a Cerner electronic health record and revenue cycle system across all its hospitals, clinics and other provider facilities that together serve more than 1.1 million patients annually. Full story.

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Steward Health Care Network and Mount Auburn Cambridge Independent Practice in Massachusetts have joined a growing list of hospitals which are leaving the Pioneer accountable care organization model, according to The Boston Globe. Full story.

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For the fourth consecutive year, physician-owned hospitals are among the top performers in the Centers for Medicare and Medicaid Services value-based purchasing program, according to Physicians Hospitals of America. Full story.

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Aetna has signed accountable care organization agreements with systems affiliated with Trinity Health, the benefits company recently announced. Full story.

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A recent Black Book Market Research survey revealed hospitals are finding their C-suite is unprepared for the drastic technological innovations in healthcare and are seeking solutions. In fact, for the first time in 15 years, healthcare industry experience dropped from the top 10 desired skills of recruited executives. Full story.

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Dartmouth-Hitchcock Medical Center will abandon the Pioneer Accountable Care Organization program, the system confirmed Tuesday, after losing more than $3 million over the past two years in the Centers for Medicare and Medicaid model. Full story.

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A new report by the Health Research Institute of PricewaterhouseCoopers says the transformation from fee-for-service to value-based reimbursement will take longer than the ambitious timeline announced in January by Health and Human Services Secretary Sylvia Burwell. Full story.

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Dealing with patients suffering from drug overdoses is an old problem for hospitals. But as healthcare providers and government and private insurers put more emphasis on controlling costs, today the problem has a new urgency. Full story.

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Perhaps it's the hospitals that should be listening to doctors when it comes to managing an accountable care organization. Full story.

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The Centers for Medicare and Medicaid Services has launched a new accountable care model for kidney care companies, linking dialysis facilities, nephrologists, and other providers in more than a dozen ACOs that will share in the risk associated with treating Americans with end-stage renal disease. Full story.

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The Department of Health and Human Services awarded $685 million to 39 healthcare and support organizations to help them transform their businesses in October. Among the goals are reducing unnecessary testing, providing coaching, supporting peer-to-peer education and improving tools for patient communication. Full story.

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The CEOs of Aetna and Anthem defended their respective multi-billion dollar merger plans before a Senate Judiciary subcommittee this week, hoping to assuage concerns that the deals to consolidate Aetna and Humana and Anthem and Cigna would lessen competition and drive up costs. Full story.

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One of the main ways the Affordable Care Act seeks to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks that coordinate patient care and become eligible for bonuses when they deliver that care more efficiently. The law takes a carrot-and-stick approach by encouraging the formation of accountable care organizations (ACOs) in the Medicare program. Providers make more if they keep their patients healthy. About 6 million Medicare beneficiaries are now in an ACO, and, combined with the private sector, at least 744 organizations have become ACOs since 2011. An estimated 23.5 million Americans are now being served by an ACO. You may even be in one and not know it. Full story.

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Legislators were split on the Affordable Care Act's effect on provider and payer competition in the healthcare marketplace in the the first of several hearings to be held by the House Judiciary Subcommittee on Regulatory Reform, Commercial and Antitrust Law this September. Members and those who testified were divided on whether enactment of the ACA in 2010 has caused the dramatic increase in the number of mergers and acquisitions among providers and payers, and whether the M&A provides better quality healthcare or result in higher prices due to a lack of competition. Full story.

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Why did hospitals binge-buy doctor practices in recent years? To improve care coordination, lower costs and upgrade patient experiences, say hospitals. To raise costs, gain pricing power and steer patient referrals, say skeptics. Full story.

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Although many organizations participating in the Medicare Shared Savings and the Pioneer Accountable Care Organization programs failed to generate savings in 2014, Navigant Healthcare consultant Paul Keckley thinks the programs are here to stay despite several flaws. According to the most recent data released by the Centers for Medicare and Medicaid Services, nearly 28 percent of participating ACOs earned bonuses in 2014 for a total $456 million, though the bulk of those organizations have more experience in risk-sharing models. Full story.

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Another Pioneer ACO participant, Beacon Health in Maine, is considering exiting the Centers for Medicare and Medicaid Services program after being hit with millions in penalties two years in a row. Dartmouth-Hitchcock Medical Center in New Hampshire is also mulling whether to take a pause from the program in favor of CMS's Next Generation model in 2016, Healthcare Finance first reported. Full story.

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For Collaborative Health Systems, August's news was a big win for the manager of dozens of accountable care organizations. Nine ACOs that partner with CHS generated $27 million in the Medicare Shared Savings Program, according to the data released by the Centers for Medicare and Medicaid. CHS partners with primary care physicians in 23 shared savings ACOs in 2014, the most of any organization in the Medicare Shared Savings Program, according to the company. Full story.

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Facing losses for two years in a row, Dartmouth-Hitchcock Medical Center is considering pulling out of Pioneer ACO model, according to Dr. Robert A. Greene, executive vice president and chief population health management officer for the New Hampshire-based accountable care organization. "We'd really liked to stay in, but when you see two years in a row, see consistent losses by the CMS program methods, we really have to step back and reconsider," Greene said. "We haven't made a final decision but we're really thinking hard about whether to continue." Full story.

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Pioneer Accountable Care Organizations are expected to be the most experienced healthcare providers in the Centers for Medicare and Medicaid Services Innovation Model. But while several earned big payouts through cost savings in 2014, others face steep penalties for overspending. According to CMS, which released the data on August 25, 15 out of the 20 organizations in the program generated a total of $120 million in savings, while the remaining five had spending above benchmarks. Three of those will split nearly $9 million penalties. Full story.

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Two Pioneer Accountable Care Organizations, Montefiore Health and the Banner Health Network, recently touted their success in generating savings for the Centers for Medicare and Medicaid Services ACO model. Though other organizations in the group found little reason to celebrate. CMS released 2014 performance data on its Pioneer and Medicare Shared Savings Program ACOs. Full story.

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Shortly after the Centers for Medicare and Medicaid Services released its 2014 performance data for Medicare Shared Savings Program and Pioneer model accountable care organizations on August 25, healthcare experts and insiders took to social media to share their thoughts on the report. Here are some of the best tweets. We'll continue to add to this throughout the day. If you have an insight to add, tweet to @HenryPowderly with the #ACO hashtag and we'll add it to the list. Full story.

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While many accountable care organizations in Medicare's Shared Savings Program generated enough savings in 2014 to merit financial incentives, more than two-thirds fell below the payment threshold, the Centers for Medicare and Medicaid Services said on August 25. According to CMS, out of the 333 ACOs in the shared savings program, 92 of them reduced spending by a combined $806 million, resulting in more than $341 million in payouts among them. That represented an improvement compared to 2013, when 538 MSSP ACOs earned $315 million in shared savings. Full story.

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While accountable care organizations in Medicare's Shared Savings Program must publicly show not only the amount of savings they generate, but what they also plan to do with the cash, a new report published in the American Journal of Managed Care found that just over half of ACOs shared plans on how they'll allocate savings. At the same time, how ACOs spend their surpluses varies. Full story.

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Blue Cross and Blue Shield of Illinois has developed accountable care organizations with three more provider-partners, bringing the total number of ACOs under the insurer to five, the insurer announced in July. The organizations are Independent Physicians' ACO of Chicago, Northwest Community Healthcare and the Illinois Health Partners -- comprised Edward Hospital and Medical Group, Elmhurst Hospital and Medical Group and DuPage Medical Group. Full story.

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Hospital-based wellness centers, once seen as marketing tools for innovative health systems, have become a major part of a hospital's population health management program in the era of quality over quantity of care. "The wave of the future is to focus less on illness and more on prevention and wellness," said Joan Phillips, vice president of Clinical Services at Beaumont Health in Troy, Michigan. "Our community and our employees want and need a place to focus on both fitness and wellness." Full story.

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Less than two months after raising $30 million in Series B funding, Aledade, the physician-focused company launched by former National Coordinator Farzad Mostashari, MD, is set to launch new accountable care organizations in seven states. Mostashari, MD, started Aledade in 2014 soon after stepping down from his post as the ONC. He said then his goal in starting the company was to put doctors back at the center of healthcare, empowering them with cutting-edge technology. Full story.

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The Delaware Valley Accountable Care Organization, one of the largest of the Medicare Shared Savings Program ACOs, said it has signed a five-year deal with Wellcentive to provide analytics services to track data across the organization. The ACO is comprised of Thomas Jefferson University Health System, Main Line Health, Doylestown Health, Holy Redeemer Health System and Magee Rehabilitation Hospital, all located in the Philadelphia region. Full story.

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Participating healthcare providers say a proposed final rule for accountable care organizations taking part in the Medicare Shared Savings Program shows officials are listening to concerns, but many say it doesn't go far enough. On one hand, ACOs still getting their feet wet got some clarification. But for providers that are more seasoned, the June proposal by the Centers for Medicare & Medicaid Services left them wanting more. Full story.

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A former advisor to President Barack Obama is warning healthcare providers to embrace bundled payments as accountable care organizations fall behind in reaping savings from value-based payment models. According to Ezekiel Emanuel, MD, and Topher Spiro, accountable care organizations, the much-hoped-for drivers of delivery and payment transformation, aren’t working so well. Full story.

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New Mexico-based Presbyterian Healthcare Services and UnitedHealthcare this week said they will launch an accountable care organization. Presbyterian Healthcare Services, an integrated delivery system with eight hospitals, 700 physicians, 100-plus clinics and a 300,000-member health plan, will take on care coordination and prevention for more than 12,000 members in UnitedHealthcare’s employer-sponsored plans in New Mexico. Full story.

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Lancaster General Health this week struck an accountable care agreement with major insurer Humana in which the system’s ACO, Health Community Care Collaborative, will be accessible by the payer’s Medicare Advantage members in the region. ACOs operate beyond a traditional fee-for-service model, basing payment in quality of care as a way to improve patient health and rein in costs. Full story.

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The Centers for Medicare & Medicaid Services is offering more flexibility for accountable care organizations in its Medicare Shared Savings Program, a move intended to keep and grow provider participation. New rules released in June include a third track for providers to take on higher risk and to share in increased savings, according to CMS. Full story.

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The Centers for Medicare and Medicaid Services’ Pioneer ACO program has experienced notable financial success, but the number of Pioneer ACOs also has dropped from 32 original providers to 19 as of last fall. In the second performance year, Pioneer ACO participants generated an estimated total model savings of over $96 million, and qualified for shared savings payments of $68 million. Given the program’s departures, it’s important to ask how the remaining providers have been able to realize the financial successes that eluded those participants that withdrew. Full story.

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Dartmouth-Hitchcock Medical Center, located in rural Lebanon, New Hampshire, generates $1.3 billion in annual revenue operating in the northern corner of the state. And while it's not in an ideal location for a population health model, according to chief financial officer Robin Kilfeather-Mackey, 19-year veteran of the health system's finance department who assumed the CFO role in 2010, the world-class health systems is excelling as an accountable care organization. Full story.

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Forming an accountable care organization must not be a hasty decision. Before committing to partnerships within a parochial healthcare network, all the players must know the stakes, the options available and most importantly, the methodology for proceeding with a business model that is foreign to most provider organizations. Otherwise, experts say, decisions that are made without proper deliberation could turn out to be costly in more ways than one. Full story.

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