New: Medicare Pioneer ACO: Case Study on Atrius Health’s Focus on the Triple Aim

By applying an “ACO magnifying glass” to high-risk patients and high-cost events, and using an organizational background in rapid cycle improvement, Atrius Health has developed focused interventions to
hit Triple Aim goals within their Medicare’s Pioneer ACO model. 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

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.

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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