Pilots key to ACO implementation

NATIONAL REPORTS-Accountable care organizations (ACOs) have become a hot commodity since the Patient Protection and Affordable Care Act opened the door for health plans to contract through an ACO for commercial enrollees. With federal money becoming available as soon as 2012, and the promise of better quality healthcare via vertical integration, the momentum of ACOs will likely increase.

For example, in May, the Detroit-based Henry Ford Health System began a recruiting campaign to tempt private practice doctors to join the ACO it founded in April. According to The Detroit News, the health system sent 2,000 letters to private practice doctors who have admitting privileges at its hospitals, hoping to recruit them.

Premier, a healthcare performance-improvement alliance, is working on an even larger scale. It's organizing a nationwide collaborative to share best practices for creating ACOs. It already includes 19 health system members with more than 70 hospitals in 15 states.

Pilot programs will be critical to finding practical ACO models because there are such a broad range of variables to test before best practices emerge. Chief among them: Different groups will arrive at ACO systems in different ways.

"The key attribute for ACOs is clinical integration, which might be achievable in several forms," says Paul Keckley, executive director of the Deloitte Center for Health Solutions.

Specifically, he sees the clinical-integration options as: a medical group practice; networks of individual practices; partnerships or joint ventures between a hospital and practicing physicians; hospitals with an employed group of physicians; and other arrangements deemed appropriate by the Secretary of Health and Human Services.

"The law does not limit an ACO to Medicare enrollees nor does it stipulate that plans may not use a similar contracting arrangement with a provider organization," he says.

WORK YOUR WAY UP TO ACOS

While the law's wide net provides the freedom to experiment with many different structures of ACOs, it could cause confusion as various groups try to build the infrastructure needed to create an effective ACO. Health plans should take care not to be caught up in the wave of ACOs without first doing their homework.

Starting small and working with strong partners will allow health plans to determine whether ACOs can improve the quality of care and save costs. From there, plans can decide whether to expand their work with ACOs.

Requirements of a Medicare Accountable Care Organization

Source: Centers for Medicare and Medicaid Services