Accountable Care Organizations
ACOs receive a prospective budget for serving a defined population and agree to achieve specified financial and quality outcomes. This structure, if correctly designed, creates incentives for the ACO to ensure that care is coordinated across sectors.
*Milestone details:
*Full name: Develop state policies for accountable care organizations.
*Relevance to the ACA:
The ACA does not require states to establish ACOs or develop ACO-related policies. However, the ACA does provide states with opportunities to establish and fund ACOs. In addition, states interested in promoting ACOs may help groups of providers organize themselves to take advantage of these initiatives and others (including the new Medicare ACO program created by the ACA).
§2706 – Medicaid and CHIP programs may establish ACOs with pediatric providers.
§3021, §10306 – States may be eligible for funding to test ACOs through the new Center for Medicare and Medicaid Innovation.
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Maine
The attached link will take you to NASHP’s new State ‘Accountable Care’ Activity Map. With the support of The Commonwealth Fund, NASHP is tracking state efforts to lead or participate in accountable care models that include Medicaid and Children’s Health Insurance Program Populations. Currently the map features information for 5 states (Colorado, Maine, Minnesota, New Jersey, Oregon), and will updated periodically with more information from these states and others.
State accountable care activity is characterized on this map along seven domains: Project scope, Authority, Governance, Criteria for participation, Payment, Support for infrastructure, and Measurement and evaluation. Within these domains there are many resources including links to state program web pages, fact sheets, and legislation. For more information, and to learn about state efforts, please follow the link to view the map.
Kentucky
Scott Leitz highlighted integrated systems in Minnesota. Shared savings program to be embedded in managed care structure that already exists. Passed a statewide quality measurement bill that might be of interest to other states. ACO development to provide framework of accountability that provides multiple opportunities for innovation.
Kentucky
Laurel Karabatsos highlighted Colorado's Accountable Care Collaborative. The ACC is a central part of Medicaid reform that changes the incentives and health care delivery processes for providers from one that rewards a high volume of services to one that holds them accountable for health outcomes.
Kentucky
Richard Slusky, VT spoke at NASHP Conference about Vermont Health Care Reform - changing culture to align incentives for an integrated delivery system. Green Mountain Care Board a leader on payment reform pilot projects.
District of Columbia
Those interested in this topic may wish to see these recent announcements from CMS:
- Guidance on integrated care models: http://www.statereforum.org/discussions/care-coordination-financing#comm...
- State Innovation Models Initiative: http://www.statereforum.org/discussions/medicaid#comment-11127
New Jersey
Here is a link to a draft article that explores two possible responses to antitrust concerns raised regarding New Jersey's pilot Medicaid ACOs, clinical integration and the state action doctrine:
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2066019
District of Columbia
Here is the implementation legislation and implementation plan for Oregon's Coordinated Care Organization (CCO) model.
Tennessee
Governor Bill Haslam signed Senate Bill 484 by Senator Doug Overbey into law on April 28th, 2011. The bill, known as the "Tennessee Patient Safety and Quality Improvement Act of 2011", expands the scope and improves the efficacy of Quality Improvement Committees (QICs).
California
This report, “Accountable Care Organization for PPO Patients: Challenge and Opportunity in California,” published by the Integrated Healthcare Association, describes how California health plans and physician organizations are leveraging ACO principles developed for cost-effective care management, typically associated with HMOs, with their commercial PPO clients.
Connecticut
Mentioned briefly here:
http://www.cga.ct.gov/2011/TOB/S/2011SB-01154-R00-SB.htm
Utah
HB 450--Hospital Provider Tax Amendments
State of Utah 2011 General Session
District of Columbia
This October 2011 presentation by Sue Birch describes the role of Regional Care Collaborative Organizations in Colorado.
District of Columbia
Signed into law June 2, 2011. Accountable care organizations must be studied or implemented in the state of Colorado.
District of Columbia
Families USA has recently released the first of a series of briefs looking at the challenges of developing ACOs from the perspective of health care consumers and advocates. I'm happy to post it here and would welcome further discussion.
Oregon
Oregon's action Plan for Health
New Jersey
Thanks for the overview. The Camden Coalition of Healthcare Providers is a nine year old citywide organization focused on improving care and reducing costs in one of America's poorest cities. My board members are the three highly competitive local hospitals, 2 FQHC's, solo-practice primary care offices, social service providers, behavioral health providers, and two community residents. This governance model has been a stable structure to encourage data sharing, joint care coordination projects, and primary care capacity building.
Below is data making the case for multi-hospital, community-based, geographic ACOs in underserved communities. The data shows that high cost, complex patients are highly mobile and move from ER to ER and hospital to hospital. In communities like Camden, NJ, three competing, hospital-drive ACOs would be a failure.
The overuse is being driven by the cracks and fragmentation between the primary care providers, hospitals, homeless shelters, behavioral health providers, etc. Unnecessary utilization is a citywide, system-wide phenomenon that requires a community-level intermediary.
The data below is drawn from the state UB-92 hospital discharge database in NJ. It shows the top 1% of ER high utilization from 2007 in Camden, Trenton, and Newark. The data shows statistically how mobile the patients are.
The attribution model being proposed by Medicare will not work for underserved communities. Safety Net ACOs should use a population denominator and encourage multi-stakeholder collaboration. In some cases this will mean multiple competing hospitals collaborating under one non-profit structure, which is what we have in Camden.
Emergency Department High Utilizers
Top 1% 2007
Camden
Patients 386
Visits 5169
Visits/Patient 13.4
% visiting more than one hospital 80.6%
Trenton
Patients 504
Visits 7616
Visits/Patient 15.1
% visiting more than one hospital 78.2%
Newark
Patients 928
Visits 14367
Visits/Patient 15.5
% visiting more than one hospital 71.1%
Jeffrey Brenner, MD
Executive Director
Camden Coalition of Healthcare Providers
http://www.camdenhealth.org
District of Columbia
The State Refor(u)m blog post for June 15, 2011 discusses some state and local ACO developments. Read it here, http://www.statereforum.org/blog/accountable-care-organizations, and add your comments.
Rhode Island
The Payment and Delivery Reform Workgroup of the Rhode Island Healthcare Reform Commission recently discussed Accountable Care Organizations, the Medicare Shared Savings Program and potential steps that Rhode island could take to encourage ACO development.
Maine
This is an excellent introduction -- thanks so much for sharing, Dan! Rhode Island has a history of being at the forefront of new approaches to payment, so it will be especially interesting to see what comes next.
Other users, please feel free to use this page to share information about ACOs in Rhode Island, ask questions, or offer your thoughts.
Maine
This presentation reviews ACA provisions related to payment reform, discusses payment reform efforts already underway in Maine, and analyzes risks and opportunities for payment reform going forward.
Access the presentation here:
http://www.statereforum.org/sites/default/files/me_paymt_reform_pres.pdf
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