What’s the Difference Between ACOs and “AC-Like” Arrangements?

Vince Kuraitis

Posted 3/09/12 on the e-CareManagement Blog

A lot. AC-Like arrangements will be MUCH simpler to create and maintain.

The health care market is moving toward accountable care. There are at least two broad paths forward:

1) Formal Accountable Care Organizations (ACOs) by which care providers contract with Medicare

2) Informal Accountable Care-Like (AC-Like) arrangements between care providers and commercial health plans

What are the differences between these routes? I see at least 5 factors at play:

  • Transaction costs
  • Timing
  • Incrementalism
  • Flexibility
  • Capital cost

Continue reading “What’s the Difference Between ACOs and “AC-Like” Arrangements?”

Getting An EPIC Opinion Off My Chest

Vince Kuraitis

Posted 12/1/11 on e-CareManagement Blog

We need to be far more explicit in asking a subtle but critical question

What are acceptable bases of competition in health care?

My sense is that the distinctions here are not well understood and often go undiscussed, so I’ll quickly get to the point:

It’s OK for care providers to compete on the bases of quality, price, patient satisfaction, and many other factors

Continue reading “Getting An EPIC Opinion Off My Chest”

The Leavitt ACO Report: Does it Overstate or Understate Accountable Care Activity?

Vince Kuraitis

Posted 11/30/11 on the e-CareManagement Blog

Accountable Care Organizations (ACOs) have been likened to

unicorn — a fantastic creature that is vested with mythical powers. But no one has actually seen one.

camel — a horse designed by a committee, one that already has its nose in the tent

With this background, you can begin to appreciate the difficulty of conducting an accurate census of ACO animals in the wilderness.  Yet, this is exactly the task undertaken in the excellent Leavitt Partners report measuring ACO activity in the US.

As I will explain, the Leavitt report has the potential both to overestimate and underestimate ACO and accountable care-like activities. In my judgment, however, it’s far more likely to be understating just how much accountable care activity actually is going on.

Continue reading “The Leavitt ACO Report: Does it Overstate or Understate Accountable Care Activity?”

The EHR|HIE Interoperability Workgroup — Potentially Earth-Shattering

Vince Kuraitis

Posted 11/09/11 on the eCareManagement Blog

Yesterday’s announcement of  “Standard Health Data Connectivity Specifications” by the EHR|HIE Interoperability Workgroup (EHR|HIE WG) is potentially earth-shattering.

My mom would not know what I mean by “Standard Health Data Connectivity Specifications,” so I’ll try to write this in plain English.

Who Are These Guys? The EHR|HIE Interoperability Workgroup

The workgroup consists of HIEs (Health Information Exchanges) representing seven of the largest states, eight EHR vendors, and three HIE software/services vendors.

Continue reading “The EHR|HIE Interoperability Workgroup — Potentially Earth-Shattering”

Employers Perceive that Health Plans Add Value to ACOs

Vince Kuraitis

First posted 9/29/11 on e-CareManagement Blog

A just released study from Aon Hewitt and Polakoff Boland — 2011 Employer Driven Accountable Care Organizations Survey Report— examines employer attitudes toward ACOs.  The report provides useful insights into an area that hasn’t yet received much attention.

A couple tables in particular caught my attention.

(click on the graphic to view a larger version)

Key findings in this table include:

  • Hospitals come out lowest (employers are only 30% very/somewhat confident in hospital driven ACOs)
  • Large medical groups come out slightly higher (31% very/somewhat confident)
  • Involving a health plan significantly increases employer confidence for both hospitals and large physician group ACOs:
    • Confidence in a hospital/health plan ACO increases to 48% very/somewhat confident (up from 30% with hospital alone)
    • Confidence in a medical group/health plan ACO increases to 53% very/somewhat confident (up from 31% with medical group alone)
  • A large percentage (25–26% answered Do Not Know) to all options

Continue reading “Employers Perceive that Health Plans Add Value to ACOs”

The Practice of Medicine: From Marcus Welby to ???

Jaan Sidorov and Vince Kuraitis

First posted 8/17/11 on e-CareManagement Blog

Physicians face great uncertainty. According to a survey conducted byThe Physicians Foundation, the great majority of physicians (89%) believe the traditional model of independent private practice is either “on shaky ground” or “is a dinosaur soon to go extinct.”

In the face of this uncertainty, many physicians are jumping to a conclusion that “I have to sell my practice to the hospital.” In this post of our series on The 100 Year Shift, we will examine physician practice.  We’ll show that the economic and clinical environment  is changing rapidly and that selling to the hospital is one option. However, it is not the only option.

Continue reading “The Practice of Medicine: From Marcus Welby to ???”

Six Quick First Impressions of CMS’ Bundled Payment for Care Improvement Initiative (BPCII)

Vince Kuraitis

First posted 8/23/11 on e-CareManagement Blog

This afternoon CMS announced the Bundled Payments for Care Improvement Initiative (BPCII). For details, start reading here.

Here are six quick first impressions:

1. It’s very creative and innovative. CMS has demonstrated out-of-the-box thinking and leaves a lot of room for applicants to propose their own approaches. Expect to have to read the materials 2-3 times to wrap your thinking around it.

Unlike the Medicare Shared Savings ACO rule, the BPCII is flexible. Expect some innovative and non-traditional proposals from diverse applicants. Unlike the Medicare ACO Shared Savings rule, the BPCII invites flexibility in:

  • Definition of care bundles
  • Proposal of specific financial terms
  • Participation by diverse care providers (see below)
  • Risk adjustment of beneficiaries

Continue reading “Six Quick First Impressions of CMS’ Bundled Payment for Care Improvement Initiative (BPCII)”