EMERYVILLE, Calif., May 13, 2013 /PRNewswire/ -- "ACOs are an inexorable part of the "fee-for-value train" that has left the station," Ken Perez, MedeAnalytics' senior vice president of marketing and director of healthcare policy, told a gathering of executives at the 4th Annual Becker's Hospital Review Annual Meeting held May 9-11 at the Westin Michigan Avenue, Chicago. "They're here to stay, but it remains to be seen how successful they will be in achieving the dual aims of reducing cost and improving the quality of care." MedeAnalytics is a leading provider of healthcare performance management solutions.
In his detailed, broad-ranging presentation, "Accountable Care Organizations: The State of the Union," Perez reviewed the macro context for ACOs; provided a brief update on health reform in the U.K.; assessed the state of the market; shared a number of ACO success stories; and concluded with thoughts about where ACOs are ultimately headed.
- Spiraling healthcare costs—driven in large measure by a lack of accountability—contribute significantly to the growing federal deficit and make American products less competitive in world markets.
- Like the U.S., the U.K., which spends about half of what we spend on a per capita basis, is also undertaking major health reforms largely aimed at improving the quality of care, with a real focus on meeting the needs of a defined local population, just like our ACOs.
- Citing a number of credible sources, Perez told the audience there are over 250 Medicare ACOs today, with more in the pipeline—and commercial ACOs, led by many of the largest health plans, are even more numerous and proliferating. Current covered population is estimated to be 2.4 million patients in Medicare ACOs; 8 to 14 million commercially insured patients in non-Medicare ACOs; and 15 million non-Medicare patients are receiving care within a medical practice that is part of a Medicare ACO.
- Cause for pause: While the ACO-covered population numbers and growth trends are encouraging, the 2.4 million beneficiaries in Medicare ACOs represent only five percent of the 49 million people who depend on Medicare; there are as yet no financial results from any of the current Medicare ACOs, and in February of this year, 30 of the 32 Pioneer ACOs asked CMS to maintain quality reporting-only status for 2013 and delay quality performance-based status until 2014.
- Multi-payer ACOs involving both public and private payers are the future. This allows the benefits and costs of the ACO to be spread across a broader population and, without cost shifting, helps reduce societal costs of healthcare, not just the costs for Medicare and Medicaid.
- In terms of a technology roadmap for ACOs, the basic, essential building blocks are: 1) Electronic health records; 2) Some sort of ability to exchange health information; and 3) Data analytics. With these building blocks in place, the next layer of technology will be practical applications for population health management, care coordination and cost reduction.
- What the future holds: Given the different types of ACO programs, the unique needs of each community, and multiplicity of areas to improve quality and reduce cost, the American ACO landscape will most likely end up looking like a patchwork quilt.
MedeAnalytics' Groundbreaking Market Research Report Cited
As part of his update, Perez shared findings from MedeAnalytics' groundbreaking market research report, "Analysis of Commercial, Medicare and NCQA Metrics," released earlier this year and now available from MedeAnalytics' Accountable Care Organization Resource Center. The study, believed to be the first of its kind, identified ACO metrics and disease focus areas common to Medicare and commercial ACOs, as well as NCQA ACO certification criteria.
Founded in 1994, MedeAnalytics delivers performance management solutions across the healthcare system—including hospitals, physician practices and payers—to ensure accountability and improve financial, operational and clinical outcomes. For more information, visit www.medeanalytics.com.
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