Accountable Care Organizations (ACOs) have the potential to
help move the current system away from the outdated fee-for-service structure
to one that incentivizes quality, value and better health outcomes for
Health plans continue to lead and collaborate in efforts
with providers, hospitals, and health systems to reform payment and the delivery
of care to promote prevention and wellness, help patients and physicians manage
chronic disease, and reward quality care. These initiatives have demonstrated better
health outcomes, improved patient safety, fewer preventable hospital
readmissions, and lower health care costs.
As ACOs mature, policymakers and regulators will need to
monitor potential unintended consequences and adverse effects such as provider
consolidation, which may drive up medical prices and result in additional
cost-shifting to families and employers with private insurance coverage.
Through the CMS Innovation Center ACO demonstrations and
initiatives, there are opportunities for Medicare and Medicaid to begin building
on the successes of the innovative payment systems that exist in the private
marketplace today. If implemented as intended, ACOs could improve the
quality and safety of patient care and help put our system on a sustainable path.
Provider Consolidation Infographic
(click thumbnails to view larger images)
A new study in Health Affairs authored by researchers at America’s Health Insurance Plans (AHIP) offers one of the first systematic assessments of health plans’ use of performance measures in payment and delivery models.
Map of the U.S. showing private sector alternative delivery and payment activity by state – patient centered medical home, accountable care arrangements, bundled or episode of care, and comprehensive global payment models.
As payment and delivery system reform expands across the country, it is critical that public sector initiatives complement and build upon the successful efforts currently underway in the private sector, according to an article in the latest edition of Health Affairs.
This Point of View examines key steps payers must take to establish and successfully manage ACOs — enhancing their ability to remain competitive through 2012 and beyond.
New health care delivery and payment models in the private sector are being shaped by active collaboration between health insurance plans and providers, according to a new study by America’s Health Insurance Plans (AHIP) that appears in the September edition of Health Affairs.
In its letter to HHS, AHIP recommends that the ACO regulation build on private-sector accountable care models, utilize the programs health plans have implemented to transform the delivery system, transition away from the outdated fee-for-service system, and avoid increasing provider consolidation and cost-shifting that would lead to higher costs for consumers.
America’s Health Insurance Plans’ (AHIP) President and CEO Karen Ignagni released the following statement on the proposed regulations released today by the Department of Health and Human Services on accountable care organizations (ACOs).
an effort to assist policymakers, regulators, providers, health plans, and
others in considering the rules and regulations that are being formulated for ACOs,
AHIP hosted a forum on ACOs on September 23, 2010, in Washington, DC that
included a panel of four experts who provided guidance on the implementation of
the Shared Savings Program and discussed various aspects of market power
and antitrust concerns as they relate to ACOs.
This paper summarizes the key lessons and themes discussed by the
presenters as well as the participants.
the public and private sectors are exploring and implementing innovative care
and payment models designed to improve delivery of care and encourage Americans
to stay healthy. This white paper examines
the concept of Accountable Care Organizations (ACOs), often defined as
organizations of health care providers that agree to be held accountable for the quality, cost and overall
care for a defined population of patients and that seek to receive shared
savings if they meet certain quality and costs goals.