The feds waited until the last day of the first quarter to drop healthcare's most anticipated set of regulations. Accountable care organizations have a little more structure now, although most decisions still lie with providers. With the Department of Health and Human Services predicting a range of 75 to 150 ACOs joining the shared savings program for Medicare beneficiaries, some providers already aligned with ACO principles instantly move to the head of the pack.

Integrated health systems such as Geisinger in central Pennsylvania, Dean Health Plan in Wisconsin and Scott & White Healthcare in Texas possess advanced IT and care-management capabilities and streamlined systems. These organizations must still pass legal muster, but they already have the requisite technology, physicians and beneficiaries to become ACOs.

The rules outline a two-tiered savings program. ACOs can accept rewards and losses for all three years and receive higher rewards. ACOs can also choose a lower return rate in exchange for not sharing in losses for the first two years, but by year three they must agree to share in losses.

The structure mimics the collaboratives created by Premier Inc., a nonprofit group working with providers that want to be ACOs. Premier has an implementation collaborative for organizations further into ACO adoption and a development collaborative for organizations newer to adoption. (Texas Health Resources in Dallas is an example of the former, and Mission Health System in Asheville N.C., an example of the latter.) Premier's partners should be able to ramp up for both tracks of shared savings.

The Medicare ACOs are built around the fee-for-service population, but managed care organizations can also play in this space (as well as take the concept to the commercial segment). CIGNA HealthCare has re-branded its medical home pilots under an accountable care banner. Its medical group in Phoenix would have the easiest time transitioning to an ACO CIGNA operates 17 clinics with on-site pharmacies, labs and imaging centers in Arizona, as well as urgent care and outpatient surgery centers.

The scale of ACOs means smaller and less technologically savvy providers will have trouble adapting. But those groups could find a path for ACO adoption. The rules outline acceptable models and leave the door open for innovative alternatives not yet defined.

DRG becomes Clarivate

View Now