Healthcare organizations that are adept at handling stressful situations can often be the most successful ACOs because of the initial risk and new environment, which can quickly sink other organizations more likely to seek the status quo.
That’s according to Hoangmai Pham, director of Seamless Care Models Groups for the CMS Innovation Center, speaking on a panel at ENGAGE on a panel discussing ACOs.
“If your organization hasn’t recently been under stress, you’re going to find it challenging because you can’t translate to the traditional Medicare population,” from other patient populations, she said.
It’s only been a few years since ACOs were launched by the Centers for Medicaid and Medicare as part of the broader attempt at care coordination, and CMS is pleased with both the level of adoption and the outcomes, although there’s been ups and downs, according to Pham.
“We always expected there would be a significant ramp up period,” she said. “It’s always harder than people will think it will be. There’s a lot of infrastructure that needs to happen before savings and results.” Of the organizations that dropped out, she said “We’re actually OK with that. We have no interest in pushing providers over a financial cliff.”
While the risk is still being differently by organizations, there are advantages to creating ACOs, especially now that some of the dust has settled, particularly for hospitals focused on keeping readmission rates down.
“The reality faced by a lot of hospital management teams is the more people in your brick and mortar buildings, it doesn’t mean you’re doing well financially,” said Lisa Hahn, a partner at Jones/Day that has helped providers follow the legal guidelines around establishing an ACO.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Johns Hopkins recently jumped into the ACO game, forming its organization in January. It’s among the first academic medical centers to join the fray, doing so with 2,800 providers treating 36,000 Medicare beneficiaries across five hospitals.
“We’re relatively new entrants, but the work to become more accountable has been ongoing for several years,” said Scott Berkowitz, medical director for accountable care. “We saw it as an opportunity to further integrate … and trying to provide care collectively there is the potential to get shared savings that you can reinvest into care.”
Yet in order to be successful, ACOs will need quality data to accurately gauge the patient needs, and that has been a challenge, according to Lee Barrett, executive director of the Electronic Healthcare Network Accreditation Commission, which assists HIEs and ACOs with secure sharing.
“We have spent the past sis months with 40 different organizations that have worked to create this for ACOs,” he said of secure data sharing. “I think it’s all about whether or not an ACO or HIE , its really about stakeholder trust and the appropriate policies to control where the data is sent.”
