In response to rising healthcare costs, providers have been pushed to take on responsibility for the health of their patients and be rewarded for outcomes rather than volume through the creation of accountable care organizations (ACOs). As Medicare forces ACOs to speed up this transition, researchers writing in the October issue of The American Journal of Managed Care the suggest that it might be helpful to examine the capabilities of physician practices that intended to join Medicare ACOs early on, discovering that these practices had greater capabilities and experience to manage risk than practices that decided not to join.
Early ACO programs attracted practices that already had strong capabilities in health information technology (HIT), care management processes (CMP), and quality improvement (QI) methods; however, even those practices were not implementing all of the recommended actions available to them, according to lead author Stephen M. Shortell, PhD, MPH, MBA, of the University of California, Berkeley School of Public Health, and fellow co-authors. They found that practices scoring in the top quartile of the QI index and the CMP index were using less than half of the available recommended capabilities; practices in the top quartile of the HIT index were using only half of the HIT capabilities.
Those practices already doing well, or that at least believe that they have the QI, HIT, and CMP capabilities to do so, have the opportunity to get paid for continuing to do well, the authors wrote. Those practices that have fewer resources to invest in such capabilities are likely to fall further behind, potentially exacerbating possible disparities in patient care.
The findings have implications for future physician practice selection into ACOs, the authors wrote, especially as ACOs across the country grapple with a planned change from CMS, which announced it will reduce the amount of time it allows an ACO to stay in a one-sided risk arrangement. The authors wrote that catch-up policies and practices may be needed, including technical assistance programs and, Shortell adds, various partnerships with hospitals, insurers, and non-provider organizations that can help accelerate the rate of learning required for new entrants to succeed.
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The American Journal of Managed Care (AJMC) is a peer-reviewed, MEDLINE-indexed journal that keeps readers on the forefront of health policy by publishing research relevant to industry decision makers as they work to promote the efficient delivery of high-quality care. AJMC.com is the essential website for managed care professionals, distributing industry updates daily to leading stakeholders. Other titles in the AJMC family include The American Journal of Accountable Care, and two evidence-based series, Evidence-Based Oncologyand Evidence-Based Diabetes Management„¢. These comprehensive offerings bring together stakeholder views from payers, providers, policymakers and other industry leaders in managed care. To order reprints of articles appearing in AJMC publications, please contact Gil Hernandez at 609-716-7777, ext. 139.