ACO ‘Pioneers’ Provide Lessons for Future Participants

January 4, 2012
Aubrey Westgate

You might want to jot down some notes from those already embarking into new reimbursement territory.

If your practice expects to affiliate with or form an ACO in the coming months, you might want to jot down some notes from those already embarking into new reimbursement territory. 

HHS recently unveiled 32 medical groups, health systems, and hospitals selected to participate in the Pioneer Accountable Care Organizations (ACOs) initiative. And it appears that many of the pioneers are jumpstarting their participation by adding staff members to their organizations.

The Pioneer ACO program operates under the same premise as the Medicare Shared Savings Program - improving quality of care while reducing cost - but is “designed specifically for groups of providers with experience working together to coordinate care for patients,” according to HHS.

The program also differs in that participants will experience higher levels of risk and reward than those in the shared savings program. For instance, in performance period one (the first year of participation), the pioneers can share in up to 70 percent of shared savings and losses. The most shared savings and losses participants in the shared savings program can assume is 60 percent.

In addition, in the third year of participation, the pioneers that successfully create savings in their first two years of involvement will be eligible to move to a population-based payment model. This will be a per-beneficiary monthly payment amount.

If successful, the pioneer ACOs will likely represent a key turning point for physicians: the shift from volume to value reimbursements - from traditional fee-for-service to reimbursement based on quality of care.

Practices considering participating in the shared savings program should watch these pioneers carefully to see what works for them and what doesn’t, as they all have the common goal of improved healthcare quality at lower cost.

It’s likely the investments and infrastructure the pioneers find successful will also be successful in the shared savings program.

The first year of the pioneer program began January 1, and according to Modern Healthcare, experts say it’s still “too soon to tell what new investments the initiative will require.”

But it appears that one trend is emerging: Many of the pioneers are already adding staff members to their organizations, or have plans to do so shortly, according to Modern Healthcare.

• Irvine, Calif.-based Monarch HealthCare added a vice president of accountable care. Other staff members are likely to be added soon, including patient coordinators, a data analyst, and another IT staff member.

• Torrance, Calif.-based HealthCare Partners Medical Group plans to hire consultants to help analyze data and develop plans. The group also expects to hire care managers.

• Brown & Toland Physicians, an independent practice association in San Francisco, said it is “prepared” to increase its staff if necessary.

If these pioneers who are already experienced in care coordination need to acquire new staff to help them transition into a full-scale ACO model, it’s likely your practice may also need to add staff in order to experience success in shared savings.

Is that an option for you? If not, is it an option for a larger healthcare system that will be part of your ACO? If not, you may need to consider whether ACO participation is even a smart move for your practice to consider.

Do you plan on participating in an ACO? What do you think is the biggest barrier to your participation?