Accountable Care Organizations (ACOs) have the potential to help move the system away from the outdated fee-for-service system to one that incentivizes quality, value and better health outcomes for patients.
Health plans all across the country have partnered with providers to change payment models to promote and reward safe, high-quality, patient-centered care. By establishing clear quality goals, tracking progress and rewarding success, these programs are yielding significant results: better outcomes and lower costs for patients and employers.
Through the CMS Innovation Center, there is an opportunity for Medicare and Medicaid to begin to build 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.
Unfortunately, the ACO program’s current design is being built on the failed fee-for-service payment model. Moreover, the current ACO regulations could accelerate the trend of provider consolidation that drives up medical prices and results in additional cost-shifting to families and employers with private coverage.
Provider Consolidation Infographic
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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models, utilize the programs health plans have implemented to transform the delivery system, transition away from the outdated fee-for-service system, and avoid increasing provider consolidation and cost-shifting that would lead to higher costs for consumers.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.