As health insurers began buying health systems and partnering on accountable care products, the fate of one alternative remained in question. Would ACOs offer their own health plan independent of insurers or partner with third party administrators?
The first organization the National Committee on Quality Assurance accredited as an ACO, Houston's Kelsey-Seybold Clinic, has an answer. The 20-location multispecialty practice has partnered with Texas TPA Boon-Chapman to offer self-funded plans under the KelseyCare banner.
Open to groups of 50 or more, KelseyCare could make a splash when coverage mandates begin in 2014. With more insurers partnering on accountable care-based plans, advanced ACOs could emerge as strong alternates for employers. Given Kelsey-Seybold's capitated structure, the potential for lower costs and better health outcomes should attract employers.
Many providers shed their health plans after the 1990s HMO bust. At a much slower pace, providers now seem willing to build health plans around accountable care. Other providers are developing their own ACO-based plans, including northern California's Sutter Health, New York's North Shore-Long Island Jewish Health System and Atlanta's Piedmont Healthcare and WellStar Health System.
Kelsey-Seybold stands out as a medical practice operating a health plan. The clinic is no managed care novice. It has championed capitation and runs the highest rated Medicare Advantage plan in Texas (KelseyCare Advantage earned 4.5 stars from the Centers for Medicare & Medicaid Services for the third consecutive year.)
With more physicians leading ACOs in the Medicare Shared Savings program, those experienced with managed care could adopt their own health plans. For ACOs with NCQA accreditation, working with a TPA could be especially attractive.
This won?t mark an end to accountable care ties between providers and insurers. Not a week goes by without Cigna announcing another collaboration (Kelsey-Seybold is one of them). Aetna continues to roll out its WholeHealth plans, and most other national insurers are building these relationships. North of Kelsey-Seybold's coverage area, Blue Cross and Blue Shield of Texas and the 25-hospital Texas Health Resources have plans for an ACO to manage care for 50,000 individuals. But this provider group-TPA model could emerge as a strong alternative.
Kelsey-Seybold will continue its partnership with Cigna (KelseyCare powered by Cigna), a narrow-network for fully and self-insured groups that includes the city of Houston employees among its participants. Kelsey-Seybold accepts all major insurers except for Aetna and traditional Medicare (because of its capitated setup, beneficiaries must belong to KelseyCare Advantage and SelectCare TexanPlus).
For Kelsey-Seybold, offering its own commercial plan marks the next logical step, and other advanced medical practices looking to capitalize on their accountable care acumen may follow the same path.
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