The Progress and Promise of ACOs

May 14, 2012 by Leave a Comment

By Mike Cassidy, Esq.

Since Accountable Care Organizations (“ACO”) are one of the featured topics for the May edition of Hospital News, I thought it would be appropriate to revisit the progress and evaluate the promise of ACOs to date.

I last wrote on this topic in the December 2011 Thought Leader column, and indicated there had been little progress, at least with the federal ACO model, which is the Medicare Shared Savings Program as of that time.  I also cited a study done by Leavitt Partners in November 2011 entitled the “Growth and Dispersion of Accountable Care Organizations.”

The key findings of the Leavitt study stated there were 164 ACOs being developed, 99 by hospitals, 38 by physician groups and 28 by insurers.  Most of these commercial products were concentrated in higher income/higher population areas with the majority of the ACOs being concentrated in just eight states, the leader of which was California.

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Filed Under: Accountable Care, Legal

How Public Health Experts Can Help Hospitals Meet the Community Health Needs Assessment Requirements of the Affordable Care Act

December 6, 2011 by Leave a Comment

By George A. Huber, JD, MSIE, MSSM

The Affordable Care Act added section 501(r) to the United States Internal Revenue Code which requires each tax-exempt hospital to conduct community health needs assessments (CHNAs) every three years.  These assessments must take into account input from persons with a broad range of interests in the communities the hospitals serve including individuals with expertise in public health.  The assessments are to be the basis for each hospital’s planning for its community benefit program.

Some hospitals have already been doing variations of the CHNA requirement.  However, most hospitals are primarily concerned about having the right services in place to address individual patient treatment needs.  Most hospitals have been understandably cautions about venturing into the broad un-reimbursable field of public health and, specifically, community health.

Health care is only one of many determinants of the health of a population.  Other determinants include individual behavior, social factors, physical environment, and genetics as they all relate to morbidity, mortality, quality of life, and health disparities.  From many hospitals’ historical perspective, these have been fields better left to government and other community organizations to address.

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Filed Under: Accountable Care Tagged With: ,

The National Significance of the Highmark and West Penn Allegheny Merger

September 23, 2011 by Leave a Comment

James T. Parker

By James T. Parker

A health-care transformation is unfolding in Pittsburgh that has national implications for health care. Recently, Pittsburgh-based Highmark announced its purchase of West Penn Allegheny Health System (WPAHS), a five-hospital, health system that’s the second largest health system in the Pittsburgh area.

With this announcement, the two organizations have begun to create a preview for what the future of health care may look like.  In fact, the merger of these two organizations offers a glimpse into the challenges that await health-care organizations that take bold steps to reposition themselves into the future.

Others are better positioned to ascribe the true catalysts behind this acquisition.  Nonetheless, it’s entirely plausible to suggest that Highmark was driven to this acquisition out of a fear that UPMC was simply becoming too large a force in the Pittsburgh health-care market.  If that’s the case, Highmark’s move can be seen as a defensive counter-response.  Having said that, Highmark and West Penn Allegheny describe another motive for coming together, one that is more far-reaching and significant.  Together, they describe their desire to create an integrated health-care system that marries the financing and delivery of care.

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Filed Under: Accountable Care Tagged With: , , ,

Easier Softer ACOs

May 31, 2011 by Leave a Comment

Mike Cassidy

Although the ink is barely dry on the proposed regulations for Accountable Care Organizations (ACOs), there are already harbingers that ACOs may not be the Health Care Reform savior they were intended to be.

First, a study by the American Hospital Association states that the estimate initially made by CMS for the cost of establishing an ACO, which was $1.8 million, is significantly understated.  The AHA has estimated that a 200 bed single hospital system would need $1.6 to create an ACO and that a five hospital system with 1,200 beds would need $26.1 million to create this larger version of the ACO.

Second, CMS is already offering easier softer versions of ACOs, and have issued a press release announcing the following:

Pioneer ACOs:  The Pioneer ACO process is intended to entice existing integrated systems which have already adopted significant care coordination processes to move further and faster into seamless coordinated care by utilizing the new ACO payment methodology.

  • Advanced Payment ACOs:  This model would give certain ACOs participating in the Medicare Shared Savings program access to their shared savings upfront, which is intended to assist with the now presumably greater investment necessary to establish the ACO.
  • Accelerated Development Learning Sessions:  This initiative is a free program funded by CMS to educate providers regarding the ACO process.

For more information or to contact Mike Cassidy, visit his Featured Thought Leader Page on this site.

Filed Under: Accountable Care Tagged With: ,

Western PA HFMA Event: Challenges Facing Physician Leaders

May 4, 2011 by Leave a Comment

May 12th: Challenges Facing Physician Leaders: Transitioning Through a Very Difficult Regulatory Environment to the Vision of ACO’s and Bundled Payments

Location: Renaissance Hotel, Downtown Pittsburgh (download the agenda for more information).

This is going to be a great session with nationally recognized speaker Dr. Paul Weygandt from JA Thomas to discuss how such topics as Health Care Reform, ICD-10, Value Based Purchasing and Denials will impact the physician community. We also have Dr. Ralph Smeltz to discuss the state of medicine in Pennsylvania as well as other speakers covering EHR’s and Practice Management. Don’t miss out, sign up today.

Filed Under: Accountable Care, Events Tagged With: , ,

ACOs Will Need Automation Tools To Do Population Health Management

May 3, 2011 by Leave a Comment

By Richard Hodach

The rising interest in accountable care organizations (ACOs) springs from two factors: the Medicare shared-savings program for ACOs, which begins in 2012, and healthcare providers’ belief that major changes in reimbursement methods lie just ahead. But what most hospitals and doctors still haven’t come to grips with is how their entire business model must change to accommodate the requirements of ACOs.

To build a successful ACO, providers must collaborate to coordinate care and to maintain or improve the health of all of their patients. Achieving these goals depends on the ability of providers to become clinically integrated and to manage population health at the physician practice level.

Both of these capabilities require the use of health information technology that goes beyond electronic health records. Supplemental technologies will use the data in EHRs and other information systems for tracking, monitoring, educating, and proactively reaching out to patients. The aim is to engage all patients—regardless of the state of their health—and to ensure that they receive the recommended preventive and chronic care.

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Filed Under: Accountable Care Tagged With: ,

Celtic Healthcare Announces New Virtual Care Division

April 28, 2011 by Leave a Comment

Answering the call for accountable care, Celtic Healthcare is helping physicians, hospitals and insurers through our unique Celtic Virtual Care Division and Disease Management Programs.

Celtic Virtual Care has codified nearly two decades of chronic homecare mastery into our Virtual Chronic Care™ methodology. Using our program and principles, healthcare organizations can achieve significant reductions in preventable patient re-admissions and care delivery expenses. Accountable, coordinated care can be more affordable, manageable and seamless than ever before.

Using a detailed, sequential process of Care Transition Management, Medication and Lifestyle Management, and Daily Symptom Management, significant measurable outcomes can be achieved.

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Filed Under: Accountable Care