Expectations were high that accountable care organizations (ACOs) could offer greater care coordination at a much lower cost, and experts at a forum this month noted that their effect on patient care delivery is already visible.
Aledade CEO Farzad Mostashari, M.D., M.P.H., discusses the performance of accountable care organizations during a forum hosted by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.
ACOs are encouraging physician practices to make the transition away from heavy reliance on fee-for-service office visits toward value-based payment systems. The Robert Graham Center for Policy Studies in Family Medicine and Primary Care invited ACO leaders to address the performance of the model at the forum, titled Beyond the Tipping Point: What Can Accountable Care Organizations Teach Us About the Future of Value-based Payment?(www.graham-center.org)
The number of ACOs has grown substantially from 146 organizations in 2012 to 460 in 2016. On the whole, they have reported mixed results in terms of savings, but they have helped physician practices change their operations to meet patient needs.
"While not perfect, they have shifted the conversation to, 'How can we do things differently?" said Michael Coffey, M.D., president of the Collaborative Health ACO based in Natick, Mass.
- Accountable care organization (ACO) leaders discussed at a forum this month how ACOs are improving patient care delivery.
- ACOs managed by primary care practices greatly outperformed those managed by large hospitals or health systems in terms of savings, a panelist said.
- Primary care practices need time to adjust to managing patients differently when they transition to the ACO model.
For instance, practices can break their reliance on fee-for-service office visits if they receive a monthly payment for each patient, said Coffey, citing the Comprehensive Primary Care Plus model launched by CMS this year as the most promising example.
"You don't want to make 25 people come into the office if you don't have to," he said. "(But) if they come into the office, you can charge $100, or you can do it over the phone for free. But if you have a (prospective) payment you can count on, then you can slow down the hamster wheel."
Farzad Mostashari, M.D., M.P.H., CEO of Bethesda, Md.-based Aledade, which helped launch 15 ACOs that include 1,000 primary care physicians and 200,000 patients, said that even the most efficient primary care practices need time to adjust to managing patients differently when they transition to the ACO model. Among other changes, they have to keep open slots in the appointment calendar for patients who need care immediately and offer some kind of triage on evenings and weekends.
Also, primary care practices should call their patients who have been discharged from the hospital as soon as possible to reduce readmissions, said Mostashari. Practices affiliated with Aledade reduced ER visits by 10 percent and hospital readmissions by 15 percent. Such coordinated care steps are "basic stuff," he acknowledged, but many practices were unaware that patients had been recently discharged.
ACOs managed by primary care practices greatly outperformed those managed by large hospitals or health systems in terms of costs, according to Mostashari. The former have demonstrated savings of 4 percent, while hospital-based ACOs have not realized significant savings.
"The benefits of primary care ACOs are real, undercounted and will grow over time," Mostashari said.
He said one impediment to expanding practice-led ACOs is the ongoing specter of small physician practices being purchased by hospitals. This trend of consolidation is also working against attempts to reduce total cost of care.
"It's not good for health care costs," Mostashari explained. "You don't have a market if you have a monopoly. We have to do something about consolidation."
ACOs are often discussed as a gateway to risk-sharing payment models, but insurers and physicians are still working out how much risk practices should be accountable for. The panelists agreed that a primary care physician should not be responsible for total cost of care because that is outside any single physician's control.
If insurers committed to investing more of the nation's health care spending in primary care, the result would likely reduce the total cost of care, panelists said.
"If 10 percent was spent on primary (care), or even 8 percent, and we were paid differently, we could lower health care costs dramatically," Coffey said.
Finally, attendees asked what President-elect Donald Trump might do about the new payment models that were introduced by the Obama administration.
"Will the new administration dismantle ACOs? No," Coffey responded.
Mostashari agreed, and he predicted that the incoming president is likely to embrace the path to new payment models outlined in the Medicare Access and CHIP Reauthorization Act.
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