Model of Highly Coordinated Care Begun By Aetna, Baptist Memorial Health Care

Employers and their workers will get access to what is described as highly coordinated care from physicians and facilities in the Baptist Select Health Alliance, under terms of a collaborative care agreement between Aetna and Baptist Memorial Health Care,  Memphis.

Aim of the collaboration is to bring a “new health care model” to Aetna members and introduce Aetna Whole HealthSM, a commercial health care product, officials said.

The Baptist Select Health Alliance is a clinically Continue reading

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Accountable Care Organizations Getting More Scrutiny

A number of independent practice associations (IPAs) and other physician organizations – PHOs, multi-specialty medical groups and hospitals have created new accountable care organizations.

Because we produce the National Directory of Physician Organizations, we naturally are following ACO developments.

ACOs are very much top-of-mind as ACO numbers grow. And with that awareness comes increased attention. Continue reading

SCOTUS Decision From the Payer and Provider Perspective

By Bob Jenkins

All sides of the health industry universe had ‘skin in the game’ riding on the US Supreme Court decision announced today.

“Health-Care Industry Gains Clarity” was the Wall Street Journal headline.

The upshot for the health-care industry: an influx of more than 30 million newly covered people with the means to pay for care. But there is also a cost, with an array of cutbacks to government reimbursement, new fees and taxes, and pressure to move to new payment models that boost efficiency and quality.

The court’s decision may also spark an effort to “get a bit more realistic about what can happen in the time frame” set out by the law, said Vicky Gregg, chief executive of BlueCross  BlueShield of Tennessee. Many states have stalled on implementing key provisions of the federal law, including the creation of the new marketplaces, known as exchanges, where consumers and small businesses will be able to buy health plans. http://online.wsj.com/article/SB10001424052702304441404577479042245939300.html

American College of Cardiology

“As we sort through the ramifications of this decision, it is important to remain focused on patients and overall health care delivery,” commented American College of Cardiology President William Zoghbi, MD, FACC, following the decision. “The goal should be a sustainable health care system that rewards quality and that allows physicians and their patients to determine together what is the most appropriate care. The American College of Cardiology believes a system that measures performance and rewards quality is the best way to improve public health and reduce costs.”

Hill Physicians Medical Group

The U.S. Supreme Court ruling is one that “clears away doubt, ” said Darryl Cardoza, CEO of Hill Physicians Medical Group, believed to be the largest IPA in the U.S.

“Over the last two years, many healthcare organizations have been working to respond to the new environment created by the reform legislation,” said  Cardoza.

“All that work has been done under a cloud of uncertainty about whether the law would be upheld. Today’s court ruling clears away that doubt. Everyone in health insurance and healthcare delivery now shares a common understanding of what’s expected.

It’s gratifying to know that millions more Americans soon will have access to care, and that doctors, hospitals, plans, employers and consumers now can work together to create more affordable care for everyone.”

AHIP

Maintaining the link between market reforms and universal coverage is essential to avoiding significant cost increases and loss of choice for consumers and employers, said America’s Health Insurance Plans’ (AHIP) President and CEO Karen Ignagni.

“As the reform law is implemented, health plans will continue to focus on promoting affordability and peace of mind for their beneficiaries.  The law expands coverage to millions of Americans, a goal health plans have long supported, but major provisions, such as the premium tax, will have the unintended consequences of raising costs and disrupting coverage unless they are addressed.

“Health plans will continue to work with policymakers on both sides of the aisle to make coverage more affordable, give families and employers peace of mind, and promote choice and competition.  Health plans also will continue to lead efforts to reform the payment and delivery system to promote prevention and wellness, help patients and physicians manage chronic disease, and reward quality care.”

Medicaid Health Plan Industry

“We commend the Supreme Court for keeping in place key elements of this historic legislation. MHPA and its member health plans remain committed to a strong partnership with the states and CMS to find a way to cover this population in need,” said Thomas L. Johnson, president and CEO of Medicaid Health Plans of America (MHPA).

The Medicaid health plan industry has been growing and will continue to grow as states continue to see Medicaid health plans as part of the solution to their budget woes, whether or not they participate in the expansion of Medicaid.

“We are pleased that the Medicaid drug rebate equalization policy included in the ACA remains intact. This provision that extended rebates to pharmaceuticals provided to Medicaid managed care enrollees represents a tremendous improvement in the administration of state Medicaid programs. The result will be improved care coordination and quality of care for beneficiaries enrolled in Medicaid health plans.

What the Supreme Court decision means for insurers, hospitals and drugmakers

Major health insurance stocks plummeted right after the ruling but have been edging upwards over the morning. That might reflect the market girding for the individual mandate being overturned (earlier this morning, InTrade had pegged the odds at 79 percent). That didn’t happen though – and that likely has insurance companies breathing a sigh of relief.

The big fear on the part of health insurance companies was that the individual mandate would get overturned, and people would only buy health insurance when they needed it. That would cause premiums to rise and enrollment to shrink.

Stocks of major hospital companies spiked after the Supreme Court decision, and with good reason: For decades they have been the ones who have covered the costs of providing health care to the uninsured. A federal law requires emergency rooms to provide stabilizing care to anyone whose life or bodily function may be threatened. It’s hospitals that often get stuck with that bill.

The Affordable Care Act will change that by expanding health insurance to about 30 million more Americans and making insurance companies responsible for paying their bills.

Pharmaceutical companies may be one of the industries least impacted by today’s news. About 4 percent of the industry’s revenue over the next eight years depends on the Affordable Care Act, according to the Bloomberg Government report.

Source Washing Post Wonk Blog http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/06/28/what-the-supreme-court-decision-means-for-insurers-hospitals-and-drugmakers/

From US News
The Unintended Consequences of the Supreme Court’s Decision

The Supreme Court settled one matter when it upheld the Patient Protection and Affordable Care Act: President Barack Obama’s landmark health reform law is constitutional and will go into effect as originally planned.  But a wide range of unintended consequences could ripple outward from the court’s historic decision.

  • Economic issues take a back seat
  • Consumers end up even more confused
  • Americans trust government even less

http://www.usnews.com/news/blogs/rick-newman/2012/06/28/the-unintended-consequences-of-the-supreme-courts-healthcare-ruling?google_editors_picks=true

Stocks of hospital companies rose sharply, and insurance companies fell immediately after the decision was announced that Americans must carry health insurance or pay a penalty.   http://www.gazette.com/articles/high-140946-ruling-care.html#ixzz1z7EGSLFi

Bob Jenkins is CEO of the Managed Care Information Center

Will large numbers of physician organizations or physician groups develop an accountable care organization?

Will large numbers of physician organizations or physician groups develop an accountable care organization?

“No.  Although an important component to a successful ACO, physicians will not have the infrastructure needed to develop an ACO,” a Regional Network Manager with a health plan told us in our Managed Care Leadership Survey.

“Physicians want to own healthcare but they have no infrastructure or expertise on the risk side of healthcare,” a consultant said.

“The emphasis on integration, EMR, quality and payment require a solid infrastructure which is beyond the capacity of most physicians per se,” said another consultant.

Said another respondent: “Most do not have the infrastructure, resources or expertise necessary to lead the development.” Few have the motivation.”

“We need provider buy-in and that doesn’t happen quickly,” according to a health plan manager of strategic growth.

Only a small number of physician organizations/groups “have the capital to develop an ACO without getting into the pockets of insurance companies,” said another senior consultant.

The survey is conducted by the Managed Care Information Center, which produces the National Directory of Physician Organizations Database.

http://wp.me/pHknO-v

ACOs Give New Life And Seen As A Second Chance For IPAs

A news article in the latest edition of American Medical News looks at the state of independent practice associations (IPAs.)

“After going bust in the 1990s, independent practice associations have become more appealing to physicians,” wrote reporter Victoria Stagg Elliott.

The article, using IPA data provided by the Managed Care Information Center, said “Independent practice associations are poised for a comeback as physicians seek to unite with larger systems, particularly for the purpose of forming accountable care organizations.”

There are a total of some 500 IPAs, that MCIC research has uncovered and 570 physician hospital organizations (PHOs), according to research for the National Directory of Physician Organizations Database.

The database also include business information and contact details on 85 primary care networks and 131 multi-specialty medical groups, said Robert Jenkins, CEO of the MCIC.

IPA physician membership across the country is 128,329 primary care physicians and 144,080 specialists, according to MCIC data.

PHO membership, meanwhile, includes 151549 primary care physicians and 76,946 specialists, the research found.

                 “Physicians need to be in charge of this”

“People in the IPA industry say the number of such organizations is going up in part because of interest from some doctors. These physicians don’t want to give up control by selling their practices to a hospital or a larger practice, but want some of the benefits of a larger organization,” said the American Medical News article.

For the full article, visit: http://www.ama-assn.org/amednews/2011/06/06/bisb0606.htm

For details on the National Directory of Physician Organizations Database visit: http://www.healthresourcesonline.com/payer-provider-data/the-national-directory-of-physician-organizations-database-on-cd-rom.html

Accountable Care Organizations – Shaking up the Medicare Reimbursement Status Quo Big Time

CMS is supposed to issue proposed regs governing ACOs this fall.

Then, expect the first ACOs to begin operating in January 2010 – just 15 months away!

We have organized an education program on ACOs this Thursday. Should be an eye opener.

Healthcare providers, hospitals, PHOs and IPAs and others, payers and even vendors need to be aware of the implications for the market and competition in the new ‘hot issue’ era of ACOs.

Hospitals, PHOs, IPAs and other physician organizations, networks or group practices need to make some quick decisions about ACOs.

If your organization is considering creating an ACO, you have no time to lose.

About the program – “Accountable Care Organizations: The Opportunities and the Risks,” a new management education audio webcast briefing, this Thursday, Sept. 30, 2010 from 1:30 PM – 2:30 PM EDT.

For details click on: http://www.healthresourcesonline.com/edu/Accountable-care-Organizations.htm