3 Hospital Leaders Discuss Unintended Consequences of the Affordable Care Act
Becker’s Hospital Review - Molly Gamble - May 18, 2012
At the Becker's Hospital Review Annual Meeting in Chicago on May 17, Ed Lovern, executive vice president and chief administrative officer of Atlanta-based Piedmont Healthcare, Andrea Price, CEO of the Mercy Northern Region in Toledo, and Ken Hanover, CEO of Beverly, Mass.-based Northeast Health System, discussed the unintended consequences from the Patient Protection and Affordable Care Act.
ACO model may improve populations-based outcomes for pain management
News Medical - May 18, 2012
How will pain care be influenced by the anticipated reforms in the U.S. healthcare system? Current models of healthcare delivery offer both obstacles and opportunities for achieving quality and effectiveness in pain-related care, according to Daniel Carr, MD, Tufts University in his keynote address at the American Pain Society Annual Scientific Meeting.
Partnering with Rehabilitation Services is a “Win-Win,” For Senior Housing
Senior Housing News - Alyssa Gerace - May 16, 2012
Establishing partnerships between assisted living and other post-acute care providers—particularly rehabilitative services—is essential going forward in the senior living industry, a panel of senior care executives told attendees of ALFA Community 2012 session in Dallas on Wednesday.
Leading the way in accountable care
Boston Globe - Lois Simon, Tom Reiter - May 16, 2012
These days, there is no hotter concept in the health care world than that of the Accountable Care Organization, a more coordinated approach to health care. The Centers for Medicare and Medicaid Innovation recently designated five organizations in Massachusetts as Pioneer ACOs.
5 Keys to California ACO's Early Success
Becker’s Hospital Review - Bob Spoerl - May 16, 2012
Leaders in an accountable care model in Sacramento, Calif. — including Blue Shield of California, the California Public Employees Retirement System (the purchaser), Hill Physicians Medical Group and Sacramento-area hospitals owned by San Francisco-based Dignity Health (formerly Catholic Healthcare West) — recently shared insight into how they established their integrated care model in a Health Affairs interview.
Team Care Lowers ESRD Costs
Medpage Today - Kristina Fiore - May 16, 2012
A pilot program focused on collaborative care may improve outcomes and reduce costs associated with end-stage renal disease (ESRD), researchers found.
'Medical home' is a team approach
Delaware Online - Kelly April Tyrrell - May 16, 2012
Lower costs, better care are the goals
Healthcare Leaders’ Latest Book Examines Keys to IT Governance Success
PRweb - May 16, 2012
A new book co-authored by principal Guy Scalzi and Dr. Roger Kropf, a Professor in the Health Policy and Management Program at New York University’s Robert F. Wagner Graduate School of Public Service offers a practical “how to” guide to creating an information technology governance structure that ensures that IT projects supporting a hospital’s or health system’s strategy are completed on time and on budget.
Obamacare Affordable Care Organizations Should Be Expanded Nationwide
Policymic - Kate Lawrenz - May 15, 2012
The United States should expand incentives for Accountable Care Organizations throughout the health care system, as they represent a necessary shift from our country’s current fee-for-service policy.
Early Lessons From A Shared Risk, Integrated Care Organization Serving A Commercial Population
Health Affairs - Glenn Melnick, Lois Green - May 15, 2012
Senior management and architects from the partner organizations of this ground-breaking commercial ACO-like project discuss the affordability crisis that precipitated a new price-based premium setting strategy and an unprecedented commitment to CalPERS for a zero percent 2010 premium increase for pilot participants.
Accountable Care Organizations in 2012
Health Intelligence Network - 2012
Complete this year's Accountable Care Organization annual survey — you have until this Wednesday, May 16th, to complete the survey and be eligible to receive a free executive summary of the survey results once they are compiled.
Not retiring at 65: Physician goes from anti-EHR to pro-ACO
Healthcare Payer News - Diana Manos - May 14, 2012
Jeffrey Selwyn, an internist at New Pueblo Medicine in Tucson, Ariz., is 65, but he says he's nowhere near retiring. Unlike many docs his age who are throwing in the towel due to the increased pressures on physicians to use EHRs, Selwyn is excited. He wasn't always a fan, however.
ACO Blueprints: Options in Accountability
HealthLeaders Media - Margaret Dick Tocknell - May 14, 2012
It seems like each week brings yet another announcement about some combination of physicians, hospitals, and even health plans that are forming collaborations or partnerships, and calling them accountable care organizations. The ACO moniker carries a lot of weight these days. It signals that providers and payers are committed to coordinating healthcare to achieve the vaunted triple aim of improving the experience of care, improving the health of populations, and reducing per capita costs of care.
Health care lessons from Weld
Boston Globe - Michael Dukakis - May 13, 2012
Bill Weld and I didn’t agree on much, but he did something in his first term as Massachusetts governor that should be required reading for anybody involved in the current debate over how to control health costs in the Commonwealth.
6 Ways to Enhance Physician Communication, Alignment
Beckers Hospital Review - Bob Spoerl - May 11, 2012
To keep physicians happy in a rapidly evolving era of healthcare, hospitals need to evaluate its relationships with their physicians — something that is easier said than done.
AHA pushes IRS to update private-use rules so ACOs, bundled payments are not hampered
Inside Health Policy - May 11, 2012
The American Hospital Association is telling the Internal Revenue Service that significant obstacles have arisen in attempts to implement new models such as accountable care organizations and bundled payments because of limitations imposed on the use of tax-exempt bond financed facilities, according to a letter sent Friday (May 11).
4 Keys to Engage Patients and Operate in an Outcomes-Based Reimbursement Environment
Becker’s Hospital Review - Benjamin Littenberg, James Rose - May 11, 2012
The more engaged and involved patients are in managing their conditions, the greater the likelihood that they will experience better outcomes and satisfaction while avoiding adverse events, such as readmissions, that negatively impact their health as well as the hospital or health system. Here are four strategies and tools to help realize those goals.
Aetna equips Arizona ACO with mobile tools, HIE
Mobihealthnews - Brian Dolan - May 10, 2012
Aetna is building on its relationship with Arizona’s Banner Health Network, one of 32 organizations chosen by CMS last year to participate in the new Pioneer Accountable Care Organizations (ACOs) initiative, by equipping the health system with technology offerings from its subsidiaries: Health information exchange technology from Medicity, Active CareTeam clinical decision support tools, and smartphone-enabled appointment setting and pre-registration activities from iTriage.
Payer-provider data transparency key to ACO success
Fierce Health Payer - Dina Overland - May 10, 2012
In order for accountable care organizations (ACO) to successfully reduce costs and increase collaboration, insurers and providers must both develop more transparent policies and procedures for analyzing business and clinical data.
Location may affect ACO bonuses, penalties: report
Modern Healthcare - Melanie Evans - May 10, 2012
Where Medicare accountable care organizations are located may influence whether hospitals and doctors earn bonuses or pay penalties, regardless of what providers do to curb spending, a report said.
Aetna and Banner Health Expand Accountable Care Relationship to Support More Than 200,000 Patients
Market Watch - May 10, 2012
Aetna Implementing Integrated Technology to Support Clinical Integration, Population Health Management and Patient Services
ACOs, clinical integration and managing antitrust risk
Venable LLP - Andrew Bigart, Robert P. Davis , Lisa Jose Fales, Leonard L. Gordon - May 9, 2012
Last week, at the Antitrust in Healthcare Conference held by the American Bar Association (ABA), the Federal Trade Commission (FTC) and the Department of Justice (DOJ) affirmed their commitment to monitoring the competitive effects of accountable care organizations (ACOs).
Senate expected to roll out health-savings plan
MetroWest Daily News - Matt Murphy - May 9, 2012
House bill aims to rein-in health care costs BOSTON — With steam gathering behind an effort to control health care costs through a dramatic overhaul of the health care industry in Massachusetts, Senate leaders today plan to unveil a bill they say will cut costs by $150 billion over the next 15 years by cutting medical inflation almost in half.
Health Insurers Proceed On IT Aspects Of 'Obamacare'
InformationWeek - Nicole Lewis - May 9, 2012
Regardless of the Supreme Court's decision on the Affordable Care Act, health plans likely will implement the technology needed to meet its objectives, predicts one prominent IT consultant.
Health care law increases payments to doctors for primary care
HHS - May 9, 2012
Primary care providers received additional Medicare payments in 2011; will receive boost in Medicaid funding in 2013 and 2014.
ACOs Need Better Data Transparency, Management
InformationWeek - Nicole Lewis - May 8, 2012
Healthcare providers and insurers partnering in accountable care organizations must work to avoid data wars, says IDC analyst.
Dual-Eligible Patients a Top Opportunity for Care Management and Care Coordination
PR Web - Julie Cash - May 8, 2012
Industry Brief Examines Accountable Care, PCMH and Health Home Initiatives
Experts express different views of EHRs' future in accountable care
FierceHealth It - Ken Terry - May 7, 2012
Not all health IT experts see eye-to-eye on the role of technology in accountable care. Case in point, while a HIT consultant argued in a recent commentary that technology creation hasn't matured past the fee-for-service stage, a hospital system CIO said in a recent interview that she believes today's tools will be crucial to the future of ACOs.
Recasting clinical documentation as a strategic initiative
Healthcare Finance News - Paul Weygandt - May 7, 2012
Decreasing cost while improving quality is a delicate balancing act, and of primary concern to any financial officer looking to participate in an ACO model. In order to achieve this balance, ACOs need to manage their populations in an optimal way and that will mean being able to proactively severity adjust and stratify patients.
The Future of the American Hospital: Role and Relevancy in the Next Decade
Becker’s Hospital Review - Molly Gamble - May 7, 2012
If predictions ever hold weight, they certainly don't in the healthcare industry. Too much is prone to change — like the Patient Protection and Affordable Care Act, which awaits its summer Supreme Court ruling. When components of an industry as large as its entire reform law aren't even certain, it's tough to say what is.
LMI Continues CMS Support with $58.7 Million in New Contracts
Market Watch - May 7, 2012
Decade Spent Earning CMS' Confidence Results in New Work
Applying to the Next Round of CMS' Shared Savings Program? 8 Things to Know
Beckers Hospital Review - Bob Spoerl - May 7, 2012
CMS announced in April its list of the 27 inaugural accountable care organizations participating in the Medicare Shared Savings Program, adding to the 32 Pioneer ACOs that preceded the MSSP participants. While the March 30 deadline to apply for the second round of the MSSP has passed, accountable care organizations looking to become a part of the program — thereby taking on the challenge of meeting quality metrics while reducing costs and potentially sharing the money saved — should start gearing up to file a notice of intent with CMS for the third round.
The Need for Balance
Boston Herald - Editorial Staff - May 7, 2012
House leaders have made it clear: They’re embarking on another phase of health care reform in Massachusetts, to address the unsustainable growth in the cost of care. But they say they aren’t prepared to simply drop the regulatory hammer on one of the commonwealth’s most important industries, not while it is beginning to develop cost-saving innovations on its own.
Off-trail in Oregon: Armed with CMS grant, Ore. lawmakers aim to cut Medicaid costs with coordinated ACO
Modern Healthcare - Andis Robeznieks - May 5, 2012
Facing crushing healthcare costs, Oregon lawmakers found the political will to transform the state's Medicaid program by creating a system in which competing providers and payers voluntarily collaborate under per-member, per-month global budgets with the potential for shared savings and financial risk.
Vermont, Minnesota move ahead with payment reforms
Healthcare Payer News - Mary Mosquera - May, 4 2012
While most states are waiting for the Supreme Court to decide the fate of the Affordable Care Act, two states – Vermont and Minnesota – are already harnessing it to both establish health insurance exchanges and to drive healthcare delivery and payment reforms.
Massachusetts Lawmakers Unveil Ambitious Plan To Cut Health Care Costs
Kaiser Health - AHN - May 4, 2012
When Massachusetts passed sweeping health insurance reform in 2006, a crucial piece was missing from the landmark legislation: how to control rising medical costs. Today, state lawmakers announced a new proposal to do just that, including new ways to pay doctors and hospitals, a specific cap on health-care spending tethered to economic growth and a tax on the state’s most expensive hospitals if they can’t justify their prices.
Embracing Accountable Care: 5 Tips From Tucson Medical Center CEO Judy Rich
Beckers Hospital Review - Bob Spoerl - May 4, 2012
CMS announced last month its anticipated list of the first 27 accountable care organizations selected for the Medicare Shared Saving Program. CEO Judy Rich of Tucson (Ariz.) Medical Center, the medical center in Arizona Connected Care, one of the 27 original CMS MSSP participants, shares five points for leaders who are either part of a newly formed ACO or looking to form one in the near future.
Accountable Care Organizations Sprouting From Healthcare Reform
Insure Me Kevin - Kevin Knauss - May 4, 2012
The fragmented and independent pieces that make up our healthcare system can bring unimaginable pain to the patients. From doctors, hospitals and labs to phamarcies and health insurance companies, there has been widespread recognition that a lack of coordination hinders people getting healthy in a timely manner.
Three Organizations Awarded for Accountable Care Initiatives
Healthcare Informatics - May 3, 2012
Share | Print The Advisory Board Company, a global consulting firm partnered with thousands of healthcare organizations, is awarding two hospitals and one health system for their work in delivering improved clinical outcomes at lower cost. The organizations did so through a focus on accountable care, which Advisory Board says promotes hospital-physician collaboration and leverages physician-level cost and quality performance data.
MSSP’s Initial 27 Applicants Draw Cautious Optimism, Show Variety of Approaches
ACO Business News – May 2, 2012
CMS’s selection of 27 initial participants in the Medicare Shared Savings Program (MSSP) on April 10 drew cautious optimism from the health care industry. As one consultant says, the agency was careful to pick organizations that have a good chance of success in the first round of this program. “They certainly want to show a successful launch to this program. I also think that’s why there were only 27 selected,” says Erik Johnson, senior vice president at Avalere Health LLC.
ACO Payments May Hinge More on Geography than Quality
HealthLeaders Media - John Commins - May 2, 2012
Location! Location! Location! When it comes to Accountable Care Organizations, the federal government is borrowing the adage from realtors that says it’s not so much the house as the neighborhood.
Will ACOs Push The Health System To Pay For Making Patients Better?
Kaiser Health News - Michael L. Millenson - May 2, 2012
A radical change just getting under way in the U.S. health system could transform how medical treatment has been paid for since Hippocrates made his first house call. But the new payment method faces conflicting dangers: either it won't be strong enough to upend entrenched incentives or it will be so successful it will prove too politically disruptive to survive.
Aetna Whole Health(TM) Introduces Individual Plans
Market Watch - Walt Cherniak - May 2, 2012
Expanding the reach of its accountable care initiative (ACO) with Carilion Clinic, Aetna has begun offering an array of affordable individual insurance plans in the Roanoke area.
Payment reform is working in Massachusetts
The Boston Globe - Gene Lindsey - May 1, 2012
With a real understanding of the challenges we face, Massachusetts health care organizations large and small have begun to take real action to find new ways to deliver better coordinated care while working hard to hold costs in check.
7 Steps to Navigate Payment Allocation Under ACOs
Beckers Hospital Review - Sabrina Rodak - May 1, 2012
The question of how to allocate payments in an ACO is one of the most difficult questions facing healthcare leaders. Here are seven steps to follow when deciding how to share payments fairly while maintaining a profit.
Cleveland Clinic Florida gets head start on Accountable Care Organization concept
Nurse.com - Chad Johnson - May 1, 2012
When Cleveland Clinic incorporated Cleveland Clinic Florida in Weston into its system in 2007, it not only established a presence in a key Southern state, but it also introduced a unique team-based management philosophy that gave the organization a head start on providing accountable care, a goal many leading health systems adopted only after the passage of the Affordable Care Act in 2010.
Johns Hopkins: How ACA will bolster population health
Government Health IT - David Bodycombe - April 30, 2012
One of the biggest, yet perhaps not fully appreciated, ramifications of health care reform is a major focus on population health, assigning responsibility for the care of groups to Accountable Care Organizations (ACOs) and expanding coverage to a broader segment of the uninsured.
11 Best Practices for Commercial Payor Negotiations on New Payment Models
Becker's Hospital Review - Kathleen Roney - April 30, 2012
New models of payment support new models of care intended to achieve efficient, cost-effective and excellent health outcomes. As the industry moves to innovative payments, providers need to be proactive.
The Michigan Pioneer ACO in Affiliation with the Detroit Medical Center Introduces Personalized Care at Home
PRNewswire - April 30, 2012
The Michigan Pioneer ACO in affiliation with the Detroit Medical Center has a remedy for patients living with chronic illnesses - Personalized Care at Home. This innovative program provides physicians a way to enhance care for patients between appointments and after hospitalizations.
In Hopeful Sign, Health Spending Is Flattening Out
New York Times - Annie Lowrey - April 28, 2012
The growth of health spending has slowed substantially in the last few years, surprising experts and offering some fuel for optimism about the federal government’s long-term fiscal performance.
Don’t bet the ranch on ACOs
The Journal of Family Practice - Jeff Unger - April 2012
I am amazed by the excitement surrounding the push for primary care physicians to join the Accountable Care Organization (ACO) bandwagon. Before my peers take out loans so they can do so—and see their credit scores decline as a result—I’d like to examine the facts behind this government-sponsored initiative and explain why I believe it is doomed to fail.
Research: Accountable Care Organizations and Health IT
Information Week - Andrew Principe - April 27, 2012
The ongoing healthcare data revolution continues to change the way payers and providers leverage health data to improve clinical outcomes and reduce costs. As providers take the early steps at driving toward an integrated data ecosystem, several factors are accelerating and justifying the need for them to invest in a strong IT infrastructure.
8 Biggest Mistakes an ACO Can Make
Becker’s Hospital Review - Bob Spoerl - April 27, 2012
As more hospitals, physicians and payors nationwide enter into integrated care models, the time is ripe for hospital leaders to consider issues ACOs will face during formation, in order to address the biggest mistakes they might make on the path to starting one.
Private Health Insurance: Estimates of Individuals with Pre-Existing Conditions Range from 36 Million to 122 Million
GAO-March 27, 2012
Individuals who buy coverage directly from a health insurer are often denied coverage due to a pre-existing condition during a process called medical underwriting, which assesses an applicant’s health status and other risk factors. Beginning January 1, 2014, the Patient Protection and Affordable Care Act (PPACA) prohibits health insurers in the individual market from denying coverage, increasing premiums, or restricting benefits because of a pre-existing condition. GAO was asked to examine the effect of this provision on adults who are 19-64 years old.
HHS announces new Affordable Care Act options for community-based care
HHS - April 26, 2012
New opportunities in Medicaid and Medicare that will allow people to more easily receive care and services in their communities rather than being admitted to a hospital or nursing home were announced today by Health and Human Services Secretary Kathleen Sebelius.
The ABCs of Becoming an ACO
Hospitals and Health Networks - Matthew Weinstock - April 26, 2012
We media types, consultants and a bevy of other experts have written a lot about what it means to be an accountable care organization, but there's very little information out there about what it takes to become an accountable care organization.
Physician groups take up the ACO baton, while hospitals wait on the sidelines
Health Leaders Inter Study - Mark Cherry - April 25, 2012
What we are seeing now are smaller, physician-led ACOs dotting the country, more grass-roots than trickle down. With many health systems shunning CMS-approved ACO projects, does this mean the end of accountable care as envisioned by the Affordable Care Act?
Five IT Tactics of an Accountable Care Organization
Life as a Healthcare CIO - John D. Halamka - April 25, 2012
Five priorities to create a foundation for care management and population health
ACOs, Quality Control and Custom Surgical Centers: 4 Key Trends Impacting Outpatient Surgery Centers in 2012
Becker’s ASC Review - Robert Henry - April 25, 2012
Robert Henry, Senior Vice President of Development at Symbion Healthcare, discusses four trends for physician groups in outpatient surgery centers.
Rise of ACOs leads to AAAHC reorganization
Healthcare Business News - Andis Robeznieks - April 24, 2012
The rise of accountable care organizations and continued healthcare consolidation have led to a plan to reorganize the Skokie, Ill.-based Accreditation Association for Ambulatory Health Care, which includes splitting the organization into two parts and launching a pilot program to accredit small hospitals.
Accountable Care Organizations and Radiology: Communication Key to Opening New Doors
Corepoint Health - Chad Johnson - April 24, 2012
Many radiology department and practices are proactively embracing the change toward accountable care and realize that if they don’t voice their concerns now, their financial futures will truly be left for someone else to decide. Improving communication and beginning an active dialogue with the hospital community are key first steps to securing radiology’s position within the new model.
The ACO Game of Wealth, Power and Local Politics
Becker's Hospital Review - Adam F. Dorin - April 24, 2012
The better way to implement healthcare reform would have been to do what both Hillary-care and Obamacare both failed to do: Empower doctors themselves to create new ways to increase access and decrease costs and waste. Since the AMA represents only a minority of community physician members, and has existing conflicts of interest due to tens of millions of dollars annually in federal-protected copyrights on medical billing codes, they were not an honest broker in the PPACA's creation.
Effect of Clinical Decision-Support Systems: A Systematic Review
Annals of Internal Medicine - Bright TJ, Wong A, Dhurjati R, Bristow E, Bastian L, Coeytaux RR, Samsa G, Hasselblad V, Williams JW, Musty MD, Wing L, Kendrick AS, Sanders GD, Lobach D – April 23, 2012
This report evaluates the effect of CDSSs on clinical outcomes, health care processes, workload and efficiency, patient satisfaction, cost, and provider use and implementation.
Coker Group Provides ACO Strategies for Hospital, Physician Practice Executives in New Book
Businesswire - April 23, 2012
In their latest book, Coker Group, a national healthcare advisory firm, shows healthcare executives how to evaluate the opportunities and challenges that accountable care presents. The Healthcare Executive’s Guide to ACO Strategy provides the tools that enable healthcare executives to build an accountable care strategy that fits their organization’s market, history and competitive position.
ACOEM Advocates for Widespread Implementation of ACOs, PCHMs
Becker’s Hospital Report - Bob Spoerl - April 23, 2012
The American College of Occupational and Environmental Medicine is encouraging workplace health programs to adopt elements of accountable care organizations and patient-centered medical homes in a position statement that appears in the April issue of the Journal of Occupational and Environmental Medicine.
More physicians calling the shots in latest round of ACOs
Amednews - Charles Fiegl - April 23, 2012
Most of the new accountable care organizations approved by Medicare are led by doctors, who can share bonuses for keeping patients healthy and cutting costs.
Hospice unit gets contract to manage ACO's sickest DMC looks to cut costs, improve care
Crain’s Detroit Business - Jay Greene - April 22, 2012
A subsidiary of Detroit-based Hospice of Michigan has signed a three-year contract to help manage the sickest patients in Detroit Medical Center's new accountable-care organization, Michigan Pioneer ACO.
No ROI in ACO: Risk, expense of Medicare program has most for-profit groups shying away
Modern Healthcare - Beth Kutscher - April 21, 2012
The healthcare reform law created a flurry of activity among hospitals and systems laying the groundwork to get in on Medicare's new incentive programs for accountable care organizations
What Hospitals Want: Positioning SNFs for Accountable Care Partnerships
Senior Housing News - Alyssa Gerace - April 19, 2012
Starting October 1, hospitals in the bottom quartile for readmissions will get across-the-board reimbursement cuts from Medicare, and skilled nursing facilities should capitalize on their data to become attractive partners to either hospitals in trouble, or well-performing hospitals that want to stay on top, says Teresa Chase, President and CEO of American HealthTech in her recent white paper on how hospitals measure SNF performance.
Preliminary Data From ACO Models Show Improving Quality; Some Question Results
ACO Business News - Jennifer Lubell - April 19, 2012
In answering one of the most anticipated questions about the accountable care movement — can ACOs reduce costs and improve quality? — some developers in releasing preliminary data say they’re hitting these targets by reducing or avoiding hospital stays and doing a better job of monitoring chronic illnesses. However, some health care observers emphasize that these results can’t just be about driving down utilization. Some pieces are missing.
Guest commentary: No doctor left behind
Stl Today - Jerold J. Kreisman - April 19, 2012
Payers, (such as government and insurers) not participants (such as hospitals, doctors, or patients) determine medical costs. "Allowable charges" established by Medicare, Medicaid, Blue Cross and other payers are what are paid; not charges submitted. But, naturally, those who pay the bills want to determine the quality of the services rendered.
Crystal Run's ACO Puts Physicians in Driver's Seat
HealthLeaders Media - Margaret Dick Tocknell - April 18, 2012
Crystal Run Healthcare learned last week that it is among 27 healthcare organizations selected to participate as an accountable care organization in the federal Medicare Shared Savings Program
ACOs must choose how to cover potential losses: CMS’ shared savings program requires assurance that money will be returned
Amed News - Victoria Stagg Elliott - April 17, 2012
Accountable care organizations going for higher bonuses from the Centers for Medicare & Medicaid Services are having to consider various mechanisms to cover losses that may result.
How to Optimize Your Transition to an Accountable Care Organization (ACO)
Anicca Media - Russell Faust - April 17, 2012
Surviving under the new model of healthcare will require a new culture for your institution. A culture that integrates a social connection with your community into existing programs, and a culture that uses that connection to bring your community to health, and to keep them healthy. Nobody does this better – connecting with their patients community, and keeping them healthy – than Integrative Medicine Centers.
Hospitals Scrutinize ACOs
HealthLeaders Media - Margaret Dick Tocknell - April 16, 2012
While ACOs hold the promise of retooling the industry into a leaner, meaner cost-cutting, care-improving machine, there's still plenty of doubt that ACOs are the way to go, according to results from the 2012 HealthLeaders Media Accountable Care Organization Survey.
60 Accountable Care Organizations to Know
Beckers Hospital Review - Molly Gamble - April 16, 2012
Accountable care organizations have proliferated in the past three years. The increase has been spurred by private payors' interest in coordinated care management and the Patient Protection and Affordable Care Act, which introduced the Medicare Shared Savings Program.
Medicare moves to tie doctors’ pay to quality and cost of care
Washington Post - Jordan Rau - April 14, 2012
Physicians in four Midwest states received a glimpse into their financial future last month. Landing in their e-mail inboxes were links to reports from Medicare showing the amount their patients cost on average as well as the quality of the care they provided. The reports also showed how Medicare spending on each doctor’s patients compared with their peers in Kansas, Iowa, Missouri and Nebraska.
Doctors on deck: ACOs led by doctors seek to manage costs, quality and hospital relationships
Modern Healthcare - Melanie Evans - April 14, 2012
The latest crop of hospitals, medical groups and clinics that agreed to try out the payment model known as accountable care—the third group to date—was dominated by doctors without any formal ties to hospitals, some with as few as 30 to 50 physicians. That's in contrast to early participants in different programs, announced late last year, which included prominent health systems and major medical groups such as Geisinger Health System and Monarch HealthCare.
Medicare shared savings program fraud and abuse waivers: common questions and concerns
Bricker & Eckler LLP - Claire Turcotte - April 12 2012
On November 2, 2011, the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (together, the “Agencies”) published an Interim Final Rule with Comment (IFC) creating five types of waivers from specified federal fraud and abuse laws for Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program (MSSP).
Providers favoring ACOs charge ahead
Fierce Healthcare - Karen M. Cheung - April 12, 2012
Although some healthcare leaders remain uncertain about accountable care organizations, the providers that are interested in ACOs are on the fast track to implementing the new care model, according to a HealthLeaders
New Model Of Health Care Taking Root, Whether Or Not Obamacare Survives
Forbes - Bruce Japsen - April 11, 2012
No matter what happens to President Obama’s health care law sitting before the Supreme Court, fee-for-service medicine may still morph into a new model of health care delivery his administration is pushing that rewards doctors and hospitals for working together to improve quality.
AMA, AHA weigh in on shared-savings ACOs
Modern Healthcare - Andis Robeznieks - April 11, 2012
The American Medical Association applauded physicians' leading role in many of the 27 healthcare organizations designated as the first Medicare Shared Savings Program accountable care organizations, while the American Hospital Association expressed support for accountable care's expansion.
CMS Taps 27 ACOs to Start Shared Savings Program
HealthLeaders Media - Cheryl Clark - April 11, 2012
Centers for Medicare & Medicaid Services executive on Tuesday named 27 accountable care organizations to begin the Medicare Shared Savings Program.
ACOmentum?
The Washington Post - Sarah Kliff – April 10, 2012
A crucial health-care regulation is starting to win over some of its most important skeptics.
Only Two ACOs Chose Model With Penalties For Missing Cost, Quality Goals
Inside Health Policy - John Wilkerson - April 10, 2012
Of the 27 ACOs that CMS announced on Tuesday (April 10), only two chose the model that penalizes accountable care organizations for not meeting cost and quality measures in exchange for bigger bonuses when they do achieve those benchmarks.
CMS unveils 27 Medicare ACOs
Fierce Healthcare - Karen M. Cheung - April 10, 2012
The Centers for Medicare & Medicaid Services today announced its long-awaited list of 27 Accountable Care Organizations (ACO) under the Medicare Shared Savings Program, as well as five Advance Payment ACOs, both beginning April 1.
Six Key Technologies to Support Accountable Care
Hospitals & Health Networks - John Glaser - April 10, 2012
Fundamental accountable care processes will require a range of information technology components and capabilities — some of which will introduce new competencies for many providers.
Cigna Works with Physicians to Bring Accountable Care to 65,000 More Individuals From Maine to TexasCigna Corporation - Mark Slitt - April 09, 2012
Cigna has expanded its collaborative accountable care program through 10 new initiatives with physician groups in seven states – Colorado, Maine, New York, North Carolina, Tennessee, Texas and Virginia.
America's Accountable Care Organizations
The Affordable Care Act (commonly known as the health reform law) encourages the formation of “medical homes” and “accountable care organizations” (ACOs), in the belief that they will improve health care quality and slow the growth of health care spending in America. By organizing health care teams, technology and knowledge around patient needs, Accountable Care can help the system realize its full potential. This site provides information about the development of these health care delivery models and addresses the most pressing policy issues surrounding this model of care.
Blazing a trail: Pioneer ACOs test strategies with five pay options
Modern Healthcare - Melanie Evans - April 7, 2012
The various payment models allow Pioneer ACOs to choose a payment model, and the approach allows the Innovation Center to “diversify” its opportunity to study accountable care.
A Path to Accountable Care
Institute of Medicine - Bruce Bodaken - April 6, 2012
With all the attention being paid to emerging accountable care organizations throughout the country, a California model is delivering measurable results. Catholic Healthcare West (CHW) (now Dignity Health), Hill Physicians Medical Group, and Blue Shield of California had preliminary conversations in early 2007 to find ways to work together that could lead to material improvements in the delivery system.
Iowa providers' collaboration plans include ACO
Modern Healthcare - Joe Carlson - April 6, 2012
Two of Iowa's largest healthcare providers—University of Iowa Health Care in Iowa City and Mercy Medical Center in Cedar Rapids—announced plans to form an accountable care organization as part of a wider collaboration.
Path Set for Accountable Care Organizations in Healthcare Delivery
Insurance Journal - Stephanie K. Jones - April 3, 2012
Even if the U.S. Supreme Court strikes down the Obama administration-backed healthcare reform legislation, accountable care organizations (ACOs) are likely to survive, say a panel of experts in healthcare liability issues.
'Accountable care' apt to grow even if Obamacare is struck down
Omaha World-Herald - April 1, 2012
This extra attention is part of a new trend, called "accountable care," a radical departure from traditional fee-for-service medicine. It's gaining momentum partly because of Obama- care and is likely to keep growing even if the U.S. Supreme Court, after hearing arguments last week, strikes down the health care law in June.
Oregon waits to see how many providers want to try coordinated care
Associated Press - April 1, 2012
The Oregon Legislature has bought into Gov. John Kitzhaber's ideas for redesigning the state's healthcare system for low-income patients. Now, it's about to become plain how many Oregon doctors, hospitals and other care providers are ready to put his vision into practice.
Physicians Post-PPACA: Not Going Bust At The Healthcare Buffet (Conclusion)
Physicians News - David W Hilgers, Sidney S. Welch - April 1, 2012
The passage of the Patient Protection and Accountable Care Act (“PPACA”) has already had a substantial impact on American medicine. Whatever repeals, reformations, defundings, or modifications lie in the future for healthcare reform, the concepts and trends represented by this legislation and its progeny clearly will have an enormous impact on healthcare delivery and the entire healthcare industry.
Madison Healthcare Insurance Services Announces New ACO Reinsurance Product
PRWeb – March 30, 2012
ACO Reinsurance is now available nationwide for Accountable Care Organizations. Madison is currently working on ACO Reinsurance placements and has been at the forefront of this product since its inception.
5 New ACOs Announced This Year; What Does the Future Hold for Accountable Care?
Becker’s Hospital Review - Molly Gamble - March 29, 2012
Commercial accountable care organizations are continually popping up across the country, and Medicare ACOs are not far behind. Despite developments, however, there remains some uncertainty and ill-preparedness among both providers and payors. Here's an 11-point briefing on commercial ACOs so far in 2012.
UC-Berkeley releases ACO readiness survey
UC-Berkeley School of Public Health - Stephen M. Shortell, Sarah Weinberger - March 28, 2012
The University of California at Berkeley has released an accountable care organization readiness survey for safety net providers.
The Pioneers Q&A
ACO Insights - March 28, 2012
ACO Insights asked Stan Dennis, senior vice president & chief revenue officer for Texas Health Resources, about the decision to apply for the Pioneer ACO.
Nurses are the Linchpin in ACOs
AIS Health - Jennifer Lubell - March 27, 2012
As early results continue to trickle in on ACO models improving quality and reducing costs, more times than not, the developer in question cites “embedded nurses” or “nurse case managers” as the linchpin for achieving these results.
Value is Paramount for Healthcare Companies in California
Market Watch - Kristi Guillemette - March 26, 2012
Commercial enrollment in California declined slightly for many MCOs during the first half of 2011. For example, Anthem Blue Cross and Blue Shield of California has launched a line of commercial PPO products tied to its accountable care organizations and plans to expand such programs state wide. Blue Shield of California followed suit with its own ACO-based portfolio, which includes PPO and HMO options.
Antitrust Enforcement Policy for Accountable Care Organizations
Axley - Guy DuBeau - March 26, 2012
Late last year, the Federal Trade Commission and the Department of Justice issued a joint statement of antitrust enforcement policy regarding accountable care organizations (ACO’s). Under a rule of reason analysis the agencies will evaluate whether a particular collaboration is likely to have anti-competitive effect.
As U.S. Supreme Court prepares to hear arguments on health care bill, industry says it's already reformed
Star Ledger - Seth Augenstein, Susan Livio, Jenna Portnoy - March 25, 2012
President Obama’s health care reform bill goes on trial tomorrow before the nation’s highest court, but most New Jersey health care leaders invested in its future don’t seem worried.
Heal thyself: Obamacare at two
The Economist - Mar 24, 2012
No matter what happens to Barack Obama’s law, American health care is changing for good
At Affordable Care Act's second anniversary, more work needed on health care reform
Star Ledger - Robert A. Marino - March 23, 2012
This week marks the second anniversary of the enactment of the Affordable Care Act, the federal health care reform law. Although two years have passed, health care reform is far from complete. Many challenges remain, but we are happy to report progress is being made.
Don't Fear the Payor: Why Hospitals Should Begin ACO Talks With Insurers
Becker’s Hospital Review - Molly Gamble - March 22, 2012
Health plans are looking for partners in care coordination, and hospitals should be at the table with payors and engaged in finding solutions to reduce costs and increase quality, according to a recent webinar from Care Team Connect.
California Company offering ACO reinsurance
Modern Healthcare - Beth Kutscher - March 22, 2012
HCP National Insurance Services, Aliso Viejo, Calif., is now offering accountable care organization reinsurance for participants in the Medicare Shared Savings Program.
ACO planned in suburban New York
Healthcare Business News - Jaimy Lee - March 20, 2012
Westmed Medical Group, a multispecialty group medical practice based in Purchase, N.Y., said it is collaborating with UnitedHealth Group to form an accountable care organization.
Mass Docs Not Exactly Ready For Global Payments, Survey Finds
Common Health - Rachel Zimmerman - March 20, 2012
There’s a sense of inevitability about global payments here in Massachusetts. While intense debate continues about how effective this lump-sum, per-patient budgeting system really is, there’s no doubt that it’s starting to take hold.
Stay away: Changing reimbursement models strive to keep patients out of the hospital, with healthcare savings coming at a cost for some providers
Modern Healthcare - Melanie Evans - March 17, 2012
The California Public Employees' Retirement System happily ended 2010 with insurance rates $15 million lower than they might have been, thanks to aggressive efforts by hospitals and doctors to curb medical expenses.
Accountability care organizations need good data
Indianapolis Business Journal - Michelle Burton - March 17, 2012
In order for ACO’s to be successful they need access to clean, useful, easy-to-access data.
Additional guidance for Medicare Shared Savings Program Accountable Care Organization (ACO) applicants
Medicare Shared Savings Program - March 16, 2012
This memo summarizes some of the requirements you have attested to or will attest to in your application, and the requirements you will be agreeing to if you are selected and choose to sign a participation agreement with the Centers for Medicare & Medicaid Services (CMS).
Standards Related to Reinsurance, Risk Corridors and Risk Adjustment Final Rule
Healthcare.gov - March 16, 2012
The Affordable Care Act creates three programs to eliminate incentives for health insurance plans to avoid insuring people with pre-existing conditions or those who are in poor health, and to reduce uncertainty that could increase premiums when Affordable Insurance Exchanges begin. The three programs are risk adjustment, reinsurance, and risk corridors. These programs will help ensure that insurance plans compete on the basis of quality and service and not on attracting the healthiest individuals.
Improving collaboration between RNs and LPNs could reduce medication errors in nursing homes, study finds
McKnight's - March 15, 2012
The federal government announced a new program intended to reduce hospital readmissions on Thursday. The Centers for Medicare & Medicaid Services is setting aside $128 million for organizations that collaborate with nursing homes to establish programs that prevent residents from going back to hospitals within a month. Physician groups, accountable care organizations and other independent entities would be eligible.
Cigna CEO Cordani Says Court Won’t Derail Health-Care Shift
Bloomberg - Alex Nussbaum and Alex Wayne - Mar 15, 2012
Supreme Court (1000L) ruling on whether the U.S. health-care law is constitutional won’t stop market forces transforming how Americans get their medical care, said Cigna Corp. (CI)’s chief executive officer.
Boston Healthcare Market Moves Rapidly toward Global Payments
HealthLeaders-InterStudy - Kristi Guillemette - March 14, 2012
Boston Leads Innovation with Five of the 32 Medicare Pioneer Accountable Care Organizations, According to a New Report from HealthLeaders-InterStudy
ACOs changing economics
Fierce Healthcare - Karen M. Cheung - March 14, 2012
Could health reform, and more specifically, accountable care organizations be slowing down healthcare spending? That's the hope, and for some, evidenced by recent data, Think Progress noted.
ObamaCare's Bogus Cost Savings
Wall Street Journal - Daniel P. Kessler - March 14, 2012
The evidence mounts that the health law won't make care more efficient or more affordable.
Quality Missing from ACO Equation?
Fierce Healthcare - Karen M. Cheung - March 13, 2012
Although most often applied to the Medicare Shared Savings Program or the Pioneer Accountable Care Organization, the term ACO has far-reaching applications, including those outside of the federal programs. But critics argue that perhaps the ACO term is used too liberally.
Small-Picture Approach Flips Medical Economics
New York Times - Bruce Jaspen - March 12, 201
A.C.O.’s, as they are known, are collections of medical providers who band together under one business umbrella. The difference is in how these providers are paid: Instead of an insurance company or the government reimbursing each provider for each service provided to each patient, the A.C.O. is paid simply to care for a group of patients.
The ACO Trajectory: Better Care, Lower Costs, Massive Undertaking
HIT Exchange - Frank Jossi - March 12, 2012
The dawn of the ACO age promises dramatic improvements for healthcare delivery—but first, networks must allocate sufficient resources and embrace cultural change.
The gamble of the ACO monopoly game
Policy - Kunmi Sobowale - March 12, 2012
Healthcare reform has brought many players to the table. And the “game” is bound to have winners and losers. This game is analogous to the board game Monopoly — a number of health care companies are buying up property to position themselves as winners in the new shared savings payment structure proposed in the health care reform law.
Private-Sector Insurers Tap Health IT To Support Accountable Care
I-HealthBeat - Brian Ahier - March 08, 2012
Health IT is a key enabler of new payment models that pay for health care value, rather than for each incidence of care.
Can Accountable Care Organizations Save the Commons?
Wing of Zock - Michael R. Weitekamp - March 8, 2012
Can Accountable Care Organizations (ACOs) as envisioned in the Affordable Care Act of 2010 provide a technical solution to a tragedy of the health care commons? As is so often the case with complex issues, it depends.
New Insurer-Hospital ACO Touts Early Success
Kaiser Health News - Jay Hancock - March 8, 2012
Six months of operating data in hand, Advocate and partner Blue Cross Blue Shield of Illinois claim spending reductions that are greater than those for patients outside the network.
Clock starts ticking for comments on MU rule
Healthcare IT News - Mary Mosquera - March 8, 2012
Both the meaningful use and health IT standards and certification proposed rules officially appeared in the Federal Register March 7, which automatically launched the countdown for public comments for 60 days. The public may comment on the proposed rule online through May 6.
California Glitch Spurs Additional CMS Oversight Of ACO Provider Lists
Inside Health Policy - Amy Lotven - March 8, 2012
CMS asked all Pioneer Accountable Care Organization participants to review their provider lists and submit a final, correct list to the agency by mid-February following an incident in which two California participants sent letters to Medicare patients of several providers who had not agreed to join the ACO, according to documents obtained by Inside Health Policy.
Insurers Reveal 2012 Roadmaps
Health Leaders Media - Margaret Dick Tocknell - March 7, 2012
The major national health plans are each gravitating toward many of the same projects according to information revealed by executives during fourth-quarter earnings calls. Look for accountable care organizations to play a growing role as health plans try to rein in costs and direct quality and clinical goals
CMS Innovation Chief Sees Opportunity For LTC
Provider Magazine - Patrick Connole - March 7, 2012
For more than a year, the Center for Medicare & Medicaid Innovation (CMMI) has worked to improve health care and reduce costs through a number of demonstration projects and programs that will increasingly need input from the long term care community to fully succeed.
Health Care Reform Driving Physicians Together
California Healthline - Sarah O'Hara - March 7, 2012
Trends indicate that the physician marketplace is shifting rapidly toward an environment more dominated by large health care provider networks. Whether this is a good thing or a bad thing depends on your perspective -- many providers assert that increased collaboration is best for patients, but purchasers warn that consolidation could lead to higher overall health care costs.
Massachusetts Healthcare Law Highlights Implications for National Healthcare Reform
The Hospitalist - Christopher Guadagnino - March 2012
The Massachusetts experience represents a microcosm of what might be expected on a national scale with the Affordable Care Act: success in covering the uninsured, but persistent access and cost challenges that can only be overcome with fundamental payment reform.
New Oregon Healthcare Law May Be a New Promising Model
The Politics of Health Care - Michael LaMagna - March 6, 2012
Oregon Governor John Kitzhaber signed a new Health Care Initiative aimed at significantly decreasing Medicaid expenditures. The new health plan utilizes an Accountable Care Organization approach, by using the coordination of care amongst many providers, including physicians, nurses, mental, dental and health providers, to ensure better communication and outcomes.
Status of ACOs in New York
Healthcare Information and Management Systems Society - Thomas S. Keefe - March 6, 2012
Anticipating the federal Shared Savings Program, the State of New York has enacted a law to help develop ACOs within the state. The law authorizes the New York State Department of Health to approve up to seven ACOs between now and December 2015.
Vendors see increased demand from state and regional HIEs
Fierce Health IT - Ken Terry - March 5, 2012
Public health information exchange vendors such as Medicity, Axolotl and Orion continue to see their businesses surge because of statewide and regional HIE initiatives.
Forget MSSP, You've Already Started a Commercial ACO
HealthLeaders Media - Karen Minich-Pourshadi - March 5, 2012
It seems that many healthcare leaders may not recognize they already have the foundation in place for a commercial ACO that could prove more lucrative than the MSSP.
TMC, others join in new health venture
The Arizona Daily Star - Stephanie Innes - March 5, 2012
Tucson Medical Center, three community health centers and more than 150 local doctors have invested in a new business they're touting as an answer to the fiscal crisis in U.S. health care
Camden Coalition tackles high cost of health care
Courier Post - Eileen Stilwell - March 4, 2012
Funded by grants and contributions from four hospitals, the Coalition hopes to become New Jersey’s first accountable care organization, or ACO, a model of care created through legislation last year.
To stay fiscally healthy, state's hospitals want fewer patients
Los Angeles Times - Anna Gorman - March 4, 2012
Healthcare reforms will mandate more treatment in doctors' offices and clinics. The changes take effect in 2014, but some California institutions are trying to get an early start.
Medicare Shared Savings Program and Advance Payment Model Application Process National Provider Call
Medicare Shared Savings Program - Moderator: Leah Nguyen - March 1, 2012
A Transcript of the March 1st call outlining the application process for the Medicare Shared Savings Program and Advance Payment Model
Value-based Physician Reimbursement Gains Momentum
Physicians Practice - Aubrey Westgate - March 1, 2012
UnitedHealth Group is joining the growing pack of insurers beginning to compensate physicians for value in addition to volume of services. The payer says it will start offering at least 50 percent to 70 percent of its physician’s bonuses for reaching cost and quality targets and/or participating in new care models, according to American Medical News.
Are ACOs Casting a Wide Net for Patients?
California Healthline - Rivka Friedman - February 29, 2012
CMS has required Pioneer ACOs to notify patients that their providers are participating in the model. Following orders, Pioneer ACOs across the country have been sending letters to patients explaining the new initiative and detailing its implications. Unfortunately, some patients received entirely the wrong message
Pharmacists Pursue Legislative, Contractual Strategies To Gain Key Role In ACOs
Inside Health Policy - Michelle M. Stein - February 29, 2012
Pharmacists are pursuing a three-pronged strategy in their bid to gain an integral role in accountable care organizations by providing medication therapy management and other services, pharmacy sources say. In addition to endorsing legislative or administrative changes that would recognize pharmacists as health care “providers,” pharmacists are also seeking to contract directly with ACOs under arrangements where they would share in savings and to become key players in medical homes.
ACO's: Why Home Care Is Essential?
Seniors Home Care - Ryan Whittington - February 28, 2012
By providing services like medication reminders, home care of people suffering from dementia and providing trained and compassionate personnel for continued companionship, the ACO and private duty home care providers are creating a win-win situation for the patients as well as themselves.
Turning Healthcare’s Business Model Inside Out
Healthcare Informatics - Jennifer Prestigiacomo - February 27, 2012
A big part of building ACOs will be extending the patient-physician interaction beyond the office visit using telemedicine tools, as well as using health information exchange (HIE) to aggregate data from multiple sources. Population health analytic solutions will be a key foundational element for these accountable care collaborations, but these care coordination tools can only be implemented after incentives are aligned between payers and providers.
Hospitals ramp up physician training for leadership roles
American Medical News - Victoria Stagg Elliott - February 23, 2012
Interest grows as health systems employ more doctors and prepare them for increased responsibilities as part of health system reform.
NJ Insurers Tie Doctors’ Payments to Quality of Care
NJ Spotlight - Beth Fitzgerald - February 23, 2012
New models are being piloted with incentives for improving, coordinating healthcare
Antitrust Issues for ACOs: 4 Things to Know
Becker’s Orthopedic and Spine - Lindsey Dunn - February 22, 2012
In October, HHS released its final rule for ACOs, and the Federal Trade Commission and the Department of Justice filed suit by publishing a final antitrust enforcement policy statement for these organizations. The policy statement provides four key areas of guidance for hospitals, physicians and other ACO participants.
Accountable care organizations: Extending the techniques nationwide
Society of Actuaries - Greger Vigen - February 22, 2012
Given rising health costs and continuing uneven quality, major players in the health care industry are spending significant energy to develop solutions. Many of these programs are called Accountable Care Organizations or Patient-Centered Medical Homes. There are hundreds of these initiatives currently underway across the country.
Title 45: Public Welfare: PART 158—Issuer Use Of Premium Revenue: Reporting And Rebate Requirements: Subpart A—Disclosure and Reporting
Federal Digital System - February 21, 2012
CMS posted additional sub-regulatory guidance regarding the Medicare Loss Ratio (MLR) under Section 2718 of the Public Health Service Act, as added by the Affordable Care Act (ACA).CMS posted additional sub-regulatory guidance regarding the Medicare Loss Ratio (MLR) under Section 2718 of the Public Health Service Act, as added by the Affordable Care Act (ACA). This addresses the question of whether "payments by issuers to clinical risk-bearing entities, such as Independent Practice Associations (IPAs), Physician Hospital Organizations (PHOs), and Accountable Care Organizations (ACOs), are incurred claims under 45 CFR 158.140."
HIMSS Analytics Survey Demonstrates Awareness and Usage of Remote Health Monitoring Devices
Market Watch - February 21, 2012
Survey of Consumers and Health IT Executives Notes Benefits of Leveraging Mobile Health Care Devices and Barriers to Overcome in Consumer Perception
Getting Up to Speed
Modern Healthcare - Melanie Evans - February 18, 2012
Healthcare executives detail IT needs, investments required to support an ACO
Rules of the road: Annual survey highlights execs' priorities as they try to steer through the shifting regulatory landscape for health IT
Modern Healthcare - Joseph Conn - February 18, 2012
Meaningful use is once again the main concern of hospital and medical group practice leaders in the information technology sphere as expressed by those who participated in the 22nd annual Modern Healthcare/Modern Physician Survey of Executive Opinions on Key Information Technology Issues. But the regulatory backdrops for meaningful use and another major issue measured on this year's survey—achieving compliance with the ICD-10 code sets—remain in flux.
Data is key to population health management
Healthcare IT News - John Andrews - February 17, 2012
There are many ways to go about addressing the issue of population health management, but the starting point is with information technology and data, says Carol Cassell, client services executive with Buffalo, N.Y.-based CTG.
ACOs And Inequity: Lessons From No Child Left Behind
Health Affairs Blog - Abdulrahman El-Sayed - February 17, 2012
Policy analysts contend that ACOs can contain costs and promote good outcomes because they align patient and practitioner incentives. By rewarding outcomes rather than the volume of health services performed, providers maximize their profits by improving patient health, which avoids unnecessary health services that increase cost. At once cutting costs and improving outcomes, ACOs seem like the magic bullet. But there’s a catch: ACOs do little to address a crucial third issue in the healthcare dilemma—health equity. In fact, they may even exacerbate the problem.
15 Tough Questions Doctors Ask About ACOs
Medscape - Wayne J. Guglielmo - February 16, 2012
Many hospitals, health centers, large physician groups, and insurers are working toward or considering forming ACOs, and physicians are being approached to participate. But although the final rule eased the requirements, doctors still have some skeptical questions about how ACOs will work, how physicians will be paid, and how compensation gets decided, among other matters. To sift through these complexities, Medscape spoke to Anders M. Gilberg, senior vice president of Government Affairs, Medical Group Management Association (MGMA).
Sharp's Pioneering ACO May Raise Bar in San Diego
California Healthline - Lisa Zamosky - February 16, 2012
Sharp HealthCare's selection as the only San Diego-based provider and one of six in California to participate in the federal Pioneer Accountable Care Organization program could raise the bar for health care providers throughout San Diego County.
Reform Of the Health Care System That Is Overdue
Forbes - William Winkenwerder - February 15, 2012
Health care expert William Winkenwerder seeks a better incentive structure in the health care system as a way of increasing efficiency, lowering costs, and achieving better health outcomes.
Prince George’s County survey intended to gauge state of health care
Washington Post - Miranda S. Spivack - February 15, 2012
A survey is underway in Prince George’s County, MD. Officials expect the data to give them a detailed look at the state of health and health care in the county, where conditions such as diabetes and heart disease are much more common than in the rest of the region and most of the state. At the same time, they hope that the information will help determine how to build a new regional hospital and primary-care network that would attract residents from a broad range of incomes and ethnic backgrounds.
Partners at the ACO table: Pharmacists to play integral role in these new provider models
Drug Topics - Monica Shah - February 15, 2012
The diversity in the organization of U.S. healthcare often leads to fragmented patient care, payment, and delivery systems. In many settings, the responsibility of steering the health of a community or a patient is disseminated across many sites. One potential solution is the accountable care organization (ACO), a new form of provider, which was established with the passage of the Affordable Care Act.
Healthcare Reform Is Here, Like It Or Not
InformationWeek - Marianne Kolbasuk McGee - February 15, 2012
Participation in new accountable care organizations isn't for the faint of heart. But healthcare providers that have their IT acts together have a good head start.
Blues, UnitedHealth launch IT initiatives for ACOs, cloud computing
Fierce Health IT- Dan Bowman - February 14, 2012
Looking to increase relationships among patients, payers and providers, health IT vendor Lumeris and three Blues plans--Highmark, Horizon Blue Cross Blue Shield of New Jersey and Independence Blue Cross--announced today an agreement to purchase healthcare communication network NaviNet.
ACO models pass on CMS Shared Savings Program
Fierce Healthcare - Karen M. Cheung - February 14, 2012
Most accountable care organization models are hesitant to apply for the Centers for Medicare & Medicaid Services' Medicare Shared Savings Program, according to a survey released last week from health IT nonprofit eHealth Initiative.
The Future of American Healthcare Transformation; Accountable Care in Context
ACODatabase - Robert Bond - February 13, 2012
Breakthroughs in information technology, telecommunications, and medical science have set the stage for a dramatic transformation of healthcare. The realities of large numbers of aging, chronically ill people will spark a crisis that will galvanize public opinion and lead to rapid change. Accountable care organization (ACO), medical homes, and health reform are just the beginning. Here’s what you should know regarding challenges and opportunities in the new landscape.
10 Evolving Issues for Hospitals, Health Systems, Physicians & ACOs
Becker's ASC Review - Scott Becker, Drew E. McCormick, Allison L. Harms, Samuel C. Bernstein - February 13, 2012
This article briefly discusses 10 emerging healthcare issues for 2012, focusing principally on hospital and physician issues
Giving Providers a Head Start with ACOs
Health Data Management - February 12, 2012
Anthem Blue Cross Blue Shield has five large medical groups participating in its ACO efforts. As a first step in launching the projects, the payer took three years of claims data and downloaded it to the respective databases of the groups
Cartoon Solves Health Care Puzzler: What The Heck Is An ACO?
CommonHealth - Carey Goldberg - February 10, 2012
WBUR’s CommonHealth blog has put together a video animation that walks viewers through how ACOs work and what that means for consumers.
Support for Accountable Care: Recommended Health IT Infrastructure
E-Health Initiative - February 2012
This report aims to inform the field of accountable care by identifying trends and supporting the development of a robust health information technology infrastructure that supports the needs of an Accountable Care Organizational Model.
Are Health CIOs Ready For Pay For Performance?
InformationWeek - Nicole Lewis – February 9, 2012
With Meaningful Use Stage 2 requirements just around the corner, a CSC report says IT managers should prepare with a more robust system that addresses care coordination and patient engagement.
HIMSS: The Garden State and ACOs
Government Health IT - Thomas S. Keefe - February 9, 2012
The signing of S2443, a bill creating a Medicaid Accountable Care Organization Demonstration Project in the Department of Human Services, gives New Jersey a step forward in the development of ACOs, a key component of healthcare reform.
Nurses, Care Coordinators Are Gaining Importance in ACOs
ACO Business News - Jennifer Lubell – February 9, 2012
Health plans and providers alike have been touting the benefits of incorporating “embedded nurses” or care coordinators into their ACO framework, reporting that they contribute to improved patient outcomes by providing a significant communication link between the patient and physician. In unveiling recent ACO ventures or achievements in both the Medicare and commercial space, insurers such as Aetna Inc. and Cigna Corp. have highlighted these caregivers as pivotal to the success of their accountable care models.
New Way to Pay Doctors
Wall Street Journal - Anna Wilde Mathews – February 9, 2012
Efforts to change how Americans pay for health care are gathering momentum on a national scale as UnitedHealth Group Inc., the largest U.S. health insurer, becomes the latest carrier to say it is overhauling its fees for medical providers.
AMA Survey Reveals That Physician Interest Lags In ACO Participation
Dark Daily - Pamela Scherer McLeod - February 8th 2012
The American Medical Association (AMA) reports a lagging interest by physicians when they are asked about their participation in an accountable care organization (ACO). Many physicians say they lack specific details about the care model and how it will reimburse providers. This survey found that—although many physicians are familiar with the concept—a significant number of them indicate they will either opt out of an ACO or unsure whether they will participate in an ACO.
A Peek into the ACO Crystal Ball
Healthcare Informatics - Jennifer Prestigiacomo - February 8, 2012
Healthcare Informatics Associate Editor Jennifer Prestigiacomo spoke with American Medical Group Association’s John Cuddeback, M.D., Ph.D., chief medical informatics officer of Anceta, AMGA’s collaborative data warehouse, to see what was in store for development of accountable care organizations (ACOs) this year and what care coordination tools will be necessary to lay the groundwork.
Pioneer ACO Update: Q&A With Health IT Leaders from Eastern Maine Healthcare System
Healthcare IT News - Chad Johnson - February 7, 2012
IT leaders from Pioneer ACO Eastern Maine Healthcare System share their experiences participating in the program, about the IT infrastructure they have in place to coordinate the delivery of care, and any advice they would give other health IT professionals working toward creating an ACO.
A Tale of Two ACOs
NJ Spotlight - Joel C. Cantor - February 7, 2012
New Jersey and the federal government have very different takes on ACOs, but both are tasked with driving down the cost of healthcare.
Multi-Stakeholder Group Weighs-in on Quality Measures for Use in Federal Healthcare Programs
PRWeb - February 02, 2012
At the request of the Department of Health and Human Services (HHS), the Measure Applications Partnership (MAP) has submitted its first annual review of performance measures being considered this year for use in federal rulemaking. The measures evaluated by MAP will be used in public reporting and performance-based payment programs that help drive system-wide quality improvement and accountability. The measures apply to nearly 20 different federal healthcare programs.
Building Connections on the Care Continuum
Health Data Management - Gary Baldwin - February 1, 2012
For Micky Tripathi, the CEO of the Massachusetts e-Health Collaborative, the longevity of the accountable care organization model-the industry's latest effort to contain costs and improve outcomes by shifting financial incentives-is anyone's guess. "It's a real question mark of whether or not the ACO will work," he says. "The 'AC' part has momentum, but there are open questions around the 'O.'"
The End of Health Insurance Companies
New York Times - Ezekiel J. Emanuel, Jeffrey B. Liebman - January 30, 2012
Here’s a bold prediction for the new year. By 2020, the American health insurance industry will be extinct. Insurance companies will be replaced by accountable care organizations — groups of doctors, hospitals and other health care providers who come together to provide the full range of medical care for patients.
Accountable Care Organizations & Patient-Centered Medical Homes
Cappleaders - Norman Chenven - January 27, 2012
Over the past 30 years the business model of the Austin Regional Clinic (ARC) has been driven by the payment models of employers, commercial health plans and government programs. There have been dramatic changes over that timeframe as payers have experimented hoping to encourage and reward hospitals and providers for providing increased value for the health care dollar. Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs) should be viewed and understood in the context of this long history of seeking increased value.
Health Insurer WellPoint to Revamp Payment for Primary Care
Associated Press - January 27, 2012
Health insurer WellPoint Inc. plans to improve primary care reimbursement and start paying for care management that it doesn't currently cover, changes that could give patients more quality time with their doctors.
Can Accountable-Care Organizations Improve Health Care While Reducing Costs?
Wall Street Journal - Anna Wilde Mathews – January 23, 2012
A diverse group of health-care policy experts discuss whether ACOs are an answer to what ails the health-care system. The panelists include Donald M. Berwick, who stepped down Dec. 2 as administrator of the Centers for Medicare and Medicaid Services; Tom Scully, the Center for Medicare and Medicaid Services administrator from 2001 to 2004; and Jeff Goldsmith who serves as president of Health Futures Inc., a health-care consulting firm, and an associate professor of public-health sciences at the University of Virginia, in Charlottesville.
The HIT of ACOs, part 3: Tapping IT to put patients front-and-center
Government Health IT - John Loonsk - January 18, 2012
This article focuses on the patient’s IT view on the ACO and the need to bring together coordinated communications, health record, and care support services. The patient view may include a provider-supported patient portal, patient mobile health tools, home monitoring systems, and communications tools that face the patient as they interact with providers, provider data, and the provision of care.
Sincerest form of flattery: Mimicking Medicare, states want to try accountable care models for Medicaid
Modern Healthcare - Rich Daly - January 9, 2012
At least 11 states are adding initiatives resembling accountable care organizations to their Medicaid programs. And many providers who shied away from the Medicare ACO models are interested in the state versions, many of which lack sanctions for providers who fall short of quality and cost benchmarks.
Eight reasons payer interoperability and data sharing are essential in ACOs
Health Management Technology - Shefali Mookencherry - January, 2012
Payers and providers should commit to reasonable clinical and cost goals, and share resources to minimize expenses and financial risks. It is in the interest of payers to work closely with providers on risk-management strategies because insurers need synergy with ACOs to remain cost competitive. Furthermore, it is in the interest of ACOs to work collaboratively with payers early on to develop reasonable and effective performance benchmarks.
Learning Network Co-Chairs Drs. Mark McClellan and Elliott Fisher Submit Comments on Proposed Rulemaking for ACOs
June 6, 2011 - Today the Engelberg Center for Health Care Reform at the Brookings Institution and the Dartmouth Institute for Health Policy & Clinical Practice submitted our comments to CMS on the Medicare Shared Savings Program Notice for Proposed Rule Making (NPRM) and on the waiver designs in connection with the Medicare Shared Savings Program and the Innovation Center. Our comments were based on our work, research, and discussions with our five ACO pilots sites and with many of our ACO Learning Network members.
We have long advocated for the development of new payment models – including the concept of accountable care organizations (ACOs) – in order to support providers deliver better care to patients. We believe the NPRM released by CMS on April 7th represents a comprehensive and thoughtful effort to identify and address a wide range of key issues for Medicare ACOs. Our comments below to CMS and OIG include a number of substantive recommendations to improve the Medicare Shared Savings Program:
Healthcare Associations Submit Comments on Proposed ACO Regulations
- AARP
- American Academy of Actuaries
- American Hospital Association (AHA)
- American Health Care Association (AHCA)
- America's Health Insurance Plans (AHIP)
- American Medical Association (AMA)
- American Medical Group Association (AMGA)
- Campaign for Better Care
- Federation of American Hospitals (FAH)
- Integrated Healthcare Association (IHA)
- Medicare Payment Advisory Commission (MedPAC)
- Medical Group Management Association (MGMA)
- Robert Wood Johnson Foundation
Center for Medicare & Medicaid Innovation (CMMI) Announces Upcoming Open Door Forums
Tuesday, June 7, 2011 at 12:00 p.m. EDT
A review of the Pioneer ACO Model Request for Application
Full transcript available here.
Tuesday, June 14, 2011 from 2:00-3:00 p.m. EDT
Advance Payment Initiative for ACO's entering the Medicare Shared Savings Program
Full transcript available here.
Monarch HealthCare, Anthem Release Patient Notification Letters
May 5, 2011 - Monarch HealthCare and Anthem have sent the first patient notification letters to PPO patients that will participate in an ACO, marking the first ACO patient notification by any of the Brookings-Dartmouth pilot sites. Read the letter and FAQs
Drs. Mark McClellan and Elliott Fisher Provide Initial Reactions to Proposed ACO Regulations in Health Affairs Blog
Washington, D.C. (March 31, 2011) - Dr. Mark McClellan, Director of the Engelberg Center for Health Care Reform at The Brookings Institution, and Dr. Elliott Fisher, Director for Population Health & Policy at The Dartmouth Institute for Health Policy & Clinical Practice, provided their initial reactions to the proposed regulations for Accountable Care Organizations today in a Health Affairs Blog post. Read the commentary
Related content:
The U.S. Department of Health and Human Services has released proposed new rules for the Medicare Shared Savings program, designed to help doctors, hospitals, and other providers form ACOs. CMS has worked closely with other federal agencies, including the HHS Office of the Inspector General, the Department of Justice, the Federal Trade Commission, and the Internal Revenue Service to ensure that providers and suppliers have the clear and practical guidance they need to form ACOs without running afoul of the fraud and abuse, antitrust, and tax laws. These agencies have released concurrent publications alongside the proposed rules addressing these specific issues, available below.
- Proposed rules for the Medicare Shared Savings Program
- Federal Trade Commission/Department of Justice Proposed Statement of Enforcement Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program
- Office of the Inspector General's Waiver Designs in Connection with the Medicare Shared Savings Program and the Innovation Center
- Internal Revenue Service Notice 2011-20 Requests for Comments on Need for Guidance on Participation by Tax-Exempt Organizations in the Medicare Shared Savings Program
Read CMS Administrator Don Berwick's perspective on launching accountable care organizations in The New England Journal of Medicine
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National Quality Forum Names Norton Healthcare Winner of 2011 NQF National Quality Healthcare Award
Washington, D.C. (March 28, 2011) – The National Quality Forum (NQF) announced today that Norton Healthcare has been named the recipient of the 2011 NQF National Quality Healthcare Award for its exceptional organizational leadership and innovation to achieve quality improvement. The award will be presented in partnership with Modern Healthcare on Sept. 15 at the NQF Leadership Colloquium in Washington, D.C. Read the full release