ACOs may stay afloat even if health reform law goes under


The ACO provision of the Affordable Care Act is creaking on thin ice. Of course, the Supreme Court’s ruling on the constitutionality of the individual mandate – and, really, the entire outline of the act moving forward — is slated to solidify any day now. By July, the ice will either thicken or break.

In the meantime, how are ACOs holding up? The Health Intelligence Network (HIN), a healthcare advisory service, addressed this in its “Second Annual Look at ACO Adoption and Activity.” The report aggregates replies from 200 organizations that responded to HIN’s second annual ACO readiness assessment conducted in May 2012.

The results outline the current state of ACOs, and help to forecast the future condition of these organizations – even if the Supreme Court spikes the ACA, or parts of it.

“Participation in accountable care initiatives has more than doubled in the last 12 months,” according to the survey data. Indeed, HIN found that nearly a third of its respondents participate in an ACO, in contrast to 14 percent of 2011 participants.

The look of the ACO is changing, too. The HIN survey found that the number of ACOs headed by a hospital has dropped from 32 percent in 2011 to 5 percent presently. Instead, physician-led organizations are increasingly filling today’s ACO mold. Their size has fluctuated as well: 27 percent of the survey respondents reported ACOs of 100-500 physicians, versus half of last year’s participants

HIN’s five highlights on ACO adoption included:

  • The greatest challenges faced during the ACO creation process are staff management and buy-in, say 21 percent of the respondents.
  • Organizations have become more efficient in ACO creation: 41 percent say it took less than a year to launch the ACO, up from 25 percent in 2011.
  • The use of electronic health records, already vigorous in 2011 at 92 percent, is now universal, with all active ACOs using this population health management tool.
  • This year’s ACOs are taking patient satisfaction more seriously, with 88 percent using this metric to evaluate ACO success.
  • This year’s ACOs favor the Healthcare Effectiveness Data and Information Set (HEDIS) and Physician Quality Reporting System measures over the Consumer Assessment of Healthcare Providers and Systems (CAHPS) metrics.

The survey also outlined main ACO-related results, reimbursement and ROI figures:

  • Patient satisfaction and then clinical outcomes are the most frequently used metrics to evaluate ACO success.
  • Shared savings is still the most common reimbursement used by ACOs, but its popularity has dropped from 40 percent in 2011 to 33 percent in 2012.
  • Nine percent of respondents in ACOs report ROI between 2:1 and 3:1 from accountable care initiatives.

HIN’s main ACO program components included:

  • One-third of ACOs have between one and 100 physicians participating.
  • Nurse case managers are present in 95 percent of ACOs.
  • More than 76 percent of ACOs include Medicare beneficiaries, but the number of ACOs with Medicaid participants dropped from 44 percent in 2011 to 22 percent in 2012.
  • Beyond staff buy-in, the greatest challenges tied to ACO creation are cost and clinical integration.

The survey also gathered remarks from respondents regarding early ACO successes. Participants said they found “improved clinical and financial integration,” “physician understanding and engagement,” and “higher quality and lower costs [anticipated]” through their ACO model.

“The last 12 months have been a hotbed of ACO activity,” the survey determined. “Respondents say care coordination has improved as a result of ACO activity, and hospital readmissions for patients in ACOs has declined.”

To that end, what does the survey foretell if the impending SCOTUS ruling doesn’t uphold the ACA?

The respondents, overall, see a bright future for the care model. Two-thirds of them indicated that ACOs will continue even if the U.S. Supreme Court votes down the ACA, HIN reported in the survey overview.

If the ice snaps, ACOs might make it to shore.

Image courtesy of Patrick Mackie. 

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