Lawn service. Financial planning. eBay middle men. Virtually every area of our lives is supported by a service industry an entity that will help us do the stuff we don't have time for or just don't want to. And so it goes with accountable care organizations and the growing number of facilitators that are supporting ACO operations.

Nearly two years after the Centers for Medicare & Medicaid Services launched the Pioneer ACO program, big names are helping smaller names start or support an ACO. The latest Farzad Mostashari's Aledade. If the name Aledade doesn't sound familiar, Mostashari should. The former National Coordinator for Health Information Technology is putting his tech chops on the table, forming Aledade to help independent primary-care physicians form accountable care organizations.

Before Mostashari's venture, MDs seeking ACOs had a friend in Collaborative Health Systems. The company is a subsidiary of Universal American, a Medicare Advantage carrier that formed CHS to do exactly what Aledade is doing: partnering with physicians to form ACOs not only in technology services but also administrative, analytic and care coordination services. In the case of CHS, these ACOs are joint ventures with physicians where CHS ownership ranges from 51 percent to 100.

Universal American calls to mind another insurer burning both ends of the healthcare reform candle: Aetna. The third-largest insurer in the United States has more accountable care collaborations than it does pure-play ACOs. It is tailoring its approach based on market and provider dynamics, and using its Accountable Care Solutions division to improve care coordination, largely for its Medicare Advantage members. Again, the focus is on HIT support. Accountable Care Solutions is a popular moniker. UnitedHealth Group's division of the same name, under the Optum umbrella, is yet another example of an insurer aiding providers with tech and analytics.

But facilitation isn't just a payer gig. UPMC, The University of Pittsburgh Medical Center, has a consulting arm to help providers launch their own health plans. Called Evolvent, it could help the already powerful academic medical center expand its influence. Tenet Health and Geisinger Health System are two other integrated delivery networks that have gotten into the service game.

So what's it mean? For payers and providers alike, building business through HIT analytics could be a profitable venture. And for pharmaceutical companies, there are now even more opportunities and challenges for engaging these new facilitators. As ACOs continue to evolve, the path to ultimate success requires a marriage with technology, not simply a flirtation.

Follow Laura Beerman on Twitter @LauraBeermanDRG

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