Hi-R-Ed Online

Where Do We Go From Here (what conclusions can we draw)?
So, Accountable Care Organizations are up and running, Medicare and some Medicaid states and commercial payers are seeing the adoption of shared savings programs, with the resultant incentives being paid out to the majority of participants, and more ACOs participating each year. So what’s next and how will this system evolve? And what is the end goal?
The next 10 years are expected to see an increase in health spending of 6% annually. This will prompt close attention to the effectiveness of ACOs as a vehicle for reducing cost. Those ACOs that utilize standardized care and have incentives for their clinicians linked to cost savings will do the best down the road. Those organizations that do not may fail. And as hospital systems, providers and their networks consolidate, so will ACOs. Sophisticated ACOs will do the best, as will those large enough to:

--be able to afford the required serious investments into ongoing data harvesting, and to
--sustain the ups and downs of risk-based payment arrangements.33

The centerpiece for successful ACOs will be a comprehensive network of physical and behavioral health, pharmacy, dental, vision and nutrition services (utilizing health coaches) who can change patient behavior. It’s no longer about primary care visits; it’s about primary care-driven care coordination. And from these successful, sophisticated, large scale organizations we may see the advent of virtual ACOs that incorporate teleconnectivity and clinical modeling (that includes social determinants of health--as well as the usual demographics) in assessing risks and care coordination to better serve rural populations.

Yearly health spending increases
Large ACOs will do best
Participating comprehensive networks will emerge

Expect MSSP's to change to reflect new rules. The Medicare Shared Savings Program will change as providers become more savvy. Some quality measures likely will change. Various Shared Savings Program formulas will change as well. Some MSSP ACOs have discussed sharing their savings with their patient populations as rewards for medication adherence and self-care management. CMS is expected to simplify its reporting requirements as a way to lure yet more ACOs into participating, and providers will focus on formulary design and medication management, care coordination after the acute care episode has ended, digital connectivity (both for rural populations now, and for diabetes, COPD and other self-management intensive conditions in the future) and self-monitoring in order to achieve savings.

Medicaid ACOs will evolve. These entities will become an area of focus for providers. As CMS relinquishes control for Medicaid populations in their respective states via block grants or capitated payments, ACOs already familiar with the landscape of at-risk shared savings programs will be well positioned to jump in first.34