Managed Care Organization ACO Initiatives; Provider Reimbursement Shift

Managed care organizations’ adoption of accountable care goes well beyond the accountable care organization (ACO) initiatives of caring for the Medicare population.

Health plans see the potential of ACOs in terms of the quality of care and reimbursement models.

Among the managed care organizations partnering with providers to launch ACOs are UnitedHealth Group, Aetna, Humana, Cigna, Highmark and others.

For instance, Cigna is involved in 86 collaborative accountable care initiatives in 27 states. These programs encompass more than 880,000 commercial customers and more than 35,000 doctors, including more than 16,000 primary care physicians and more than 19,000 specialists, Cigna said.

The health plan’s goal is to have 100 accountable care relationships reaching one million customers in 2014.

UnitedHealth Group has ACO initiatives underway in eight states.  And, $28 billion of the company’s reimbursement to hospitals, physicians and ancillary care is tied to its accountable care initiatives, the company said.

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Plans are that by the end of 2018, the company expects accountable care contracts to total $65 billion.

The company said its accountable care programs are “designed according to five ‘value levers’: evolved care management programs; high-performing networks; value-based contracting; value-based benefits; and transparency.

Humana distributed $60 million to physicians across the U.S. who participate in Humana’s Provider Quality Rewards Program, part of Humana’s Accountable Care Continuum. The ACO continuum is a pay-for-value system “focused on promoting evidence-based, high quality care.”

The program recognizes practice complexity by offering several levels of participation through pay-for-value programs including: Star Rewards, Model Practice, Medical Home and bonus programs for risk providers, Humana said.

The health plan reported that it awarded some 3,000 physician practices payments in recognition of performance improvements their practices made during 2012 related to improved outcomes for Humana’s Medicare members.

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