Implementation of accountable care organizations (ACOs) has continued to advance rapidly in the past year. The National Accountable Care Organization Summit (www.ACOSummit.com), scheduled for June 6 - 8 in Washington, D.C. will provide an unprecedented opportunity to discuss remaining barriers to widespread ACO implementation and strategies to overcome them. The Summit brings together leading policymakers, experts, and ACO implementers to provide unique and in-depth insights on ACO implementation and ongoing health care reform. The Summit will explore how organizations can align public and private sector ACO initiatives, align quality improvement and cost reduction efforts across different payment reforms, implement private sector and multi-payer ACOs, effectively participate in the Medicare Shared Savings Program and learn from the experiences of organizations in the Pioneer ACO Model.
What is an ACO?
ACOs are groups of physicians, hospitals, and other providers that receive financial rewards for achieving continually advancing patient-focused quality targets and demonstrating reductions in overall spending growth for their defined patient population. ACOs can be organized in a number of ways, ranging from fully integrated delivery systems to networked models within which physicians in small office practices can work together to improve quality, coordinate care, and reduce costs. ACOs can also feature different payment incentives, ranging from "one-sided" shared savings within a fee-for-service environment to a range of capitation arrangements with quality bonuses. In addition, ACOs are compatible with a range of other payment reforms, such as medical homes and bundled payments; they can help assure that these reforms lead to sustainable quality improvements and cost reductions. In sum, ACOs provide an ideal mechanism to transition from paying for volume and intensity to paying for value.
How is ACO Implementation Proceeding Across the Country?
In October, the Centers for Medicare & Medicaid Services (CMS) released the final rule for the Medicare Shared Savings Program. In addition, many providers who are already well on their way to implementing private sector ACOs have applied to the Pioneer ACO program, which offers greater potential rewards to provider organizations that are willing to bear financial risk for both Medicare beneficiaries and other patients. CMS has also proposed a number of pilot programs under the Innovation Center that will encourage collaboration among providers in more focused areas, including a bundled payment initiative to improve coordination within certain types of specialty care and an all-payer medical home demonstration to improve coordination in primary care.
Beyond Medicare ACO initiatives, interest and participation in accountable care reforms has been growing both in states and in the private sector. At least 27 states introduced bills referring to accountable care during the 2011 legislative session alone, and 12 states have already passed legislation intended to support the transition toward ACO-like models for either their Medicaid programs or state employees. In the private sector, all of the major private health plans have begun implementing payment reforms similar to the ACO model; like ACOs, these payment reforms include accountability for the full continuum of patients' care, payment contingent upon improving the quality and coordination of care, and responsibility for cost management within a target budget. In tandem with the Medicare Shared Savings Program, the Pioneer ACO Model, and other innovative programs in Medicare, these private sector efforts will be instrumental in moving ACO implementation forward as health care reform progresses.
