As the healthcare environment moves from fee-for-service to pay-for-performance and from fragmented to coordinated care, many healthcare providers are considering developing or joining accountable care organizations. Because of that dramatic shift in mindset these organizations require, not every ACO will succeed. In order to improve your ACOs chance for success, Terri Welter, principal at ECG Management Consultants, says ACOs should focus on five critical success factors.
http://www.beckershospitalreview.com/hospital-physician-relationships/5-critical-aco-success-factors.html
Accountable Care Organizations will be the nervous system of healthcare reform. Check back often to ACOinsight.com to stay abreast of all news and insight on ACOs.
Tuesday, November 16, 2010
Wednesday, November 10, 2010
St. Francis Health Network, Anthem Blue Cross and Blue Shield Team to Serve Hoosier Healthwise Members
INDIANAPOLIS, Nov. 10, 2010 /PRNewswire/ -- St. Francis Health Network (SFHN) and Anthem Blue Cross and Blue Shield (Anthem) announced today a new agreement that will provide members enrolled in Hoosier Healthwise and the Healthy Indiana Plan with access to a more integrated health system. The new contract has an effective date of Jan. 1, 2011, and will expand access for an estimated 28,000 Medicaid beneficiaries in south-central Indiana.
http://www.prnewswire.com/news-releases/st-francis-health-network-anthem-blue-cross-and-blue-shield-team-to-serve-hoosier-healthwise-members-107024533.html
http://www.prnewswire.com/news-releases/st-francis-health-network-anthem-blue-cross-and-blue-shield-team-to-serve-hoosier-healthwise-members-107024533.html
Norton, UKHealthCare become partners
Anticipating the changes coming with health care reform, UK HealthCare and Norton Healthcare are joining forces, hoping to improve care — especially in the areas of cancer, heart disease, stroke, organ transplants, diabetes and medical training — across the state.
Although the two groups have been in talks for about 18 months, exactly how the partnership will work is not set, said Dr. Michael Karpf, UK executive vice president for health affairs. Read more: http://www.kentucky.com/2010/11/09/1515969/norton-ukhealthcare-become-partners.html#ixzz14tkwthVh
Although the two groups have been in talks for about 18 months, exactly how the partnership will work is not set, said Dr. Michael Karpf, UK executive vice president for health affairs. Read more: http://www.kentucky.com/2010/11/09/1515969/norton-ukhealthcare-become-partners.html#ixzz14tkwthVh
Cleveland-Area Hospitals Strengthen Ties With Independent Physicians as They Prepare for ACOs
Cleveland-Area hospitals have recently made moves to strengthen their ties with independent physicians as they prepare for accountable care organizations, according to a Crain's Cleveland Business report.
Cleveland-based MetroHealth System, for example, is looking to employ or partner with physicians who wish to maintain independent. A representative for the system said it will consider aligning with as many high quality physicians as possible, according to the report.
http://www.beckershospitalreview.com/hospital-physician-relationships/cleveland-area-hospitals-strengthen-ties-with-independent-physicians-as-they-prepare-for-acos.html
Cleveland-based MetroHealth System, for example, is looking to employ or partner with physicians who wish to maintain independent. A representative for the system said it will consider aligning with as many high quality physicians as possible, according to the report.
http://www.beckershospitalreview.com/hospital-physician-relationships/cleveland-area-hospitals-strengthen-ties-with-independent-physicians-as-they-prepare-for-acos.html
Tuesday, November 2, 2010
6 Best Practices on Bringing Independent Physicians Into Hospital-Run ACOs
As hospitals gear up for accountable care organizations, independent physicians are "a hot commodity," says Mary C. Reed, vice president of Gateway Health in Cleveland. Ms. Reed, who is helping a number of organizations create ACOs, says non-employed physicians, who are often specialists, are sorely needed to make ACOs run, and they need to be treated well. She provided six tips on dealing with independent physicians at the recent National Accountable Care Organization Congress in Los Angeles.
http://www.beckershospitalreview.com/hospital-physician-relationships/6-best-practices-on-bringing-independent-physicians-into-hospital-run-acos.html
http://www.beckershospitalreview.com/hospital-physician-relationships/6-best-practices-on-bringing-independent-physicians-into-hospital-run-acos.html
8 Specific Ways to Launch an ACO Without Losing Money
Nancy J. Ham, president & CEO of MedVentive in Waltham, Mass., has more than 10 years experience preparing hospitals to launch ventures coordinating care with physicians and other providers. Lately much of her time is taken up with helping hospitals start accountable care organizations and similar ventures. Speaking at the National Accountable Care Organization Congress in Los Angeles, she offered eight specific ways to launch and run an ACO without losing money.
1. Squeeze funds out of your existing budget. An ACO takes a great deal of investment to get started, but there are ways to keep from borrowing all of it. "You can find lots of money in internal operations," Ms. Ham says. In one project she was involved in, the organization freed up $1 million by using existing funds in its budget. "You can find money just by focusing on your own shop," she says.
http://www.beckershospitalreview.com/hospital-physician-relationships/8-specific-ways-to-launch-an-aco-without-losing-money.html
1. Squeeze funds out of your existing budget. An ACO takes a great deal of investment to get started, but there are ways to keep from borrowing all of it. "You can find lots of money in internal operations," Ms. Ham says. In one project she was involved in, the organization freed up $1 million by using existing funds in its budget. "You can find money just by focusing on your own shop," she says.
http://www.beckershospitalreview.com/hospital-physician-relationships/8-specific-ways-to-launch-an-aco-without-losing-money.html
Friday, October 29, 2010
QCMS Creates Largest Accountable Care Organization
The Medical Society of the County of Queens has announced that it is creating one of the largest Physician Accountable Care Organizations (“ACO”) in New York. The ACO, with nearly 700 physician members, will be owned, comprised of and managed by physicians based in Queens. Authorized under the recent Federal healthcare reform legislation, the ACO will ultimately provide better and more efficient care to patients at a reduced cost.
http://www.qgazette.com/news/2010-10-27/Features/QCMS_Creates_Largest_Accountable_Care_Organization.html
http://www.qgazette.com/news/2010-10-27/Features/QCMS_Creates_Largest_Accountable_Care_Organization.html
While Health Reform Faces Challenge, Repeal of ACOs Unlikely
While ascendant GOP lawmakers and some 30 lawsuits seek to repeal the healthcare reform law, these efforts should not affect accountable care organizations, which are part of the law, according to speakers at the National Accountable Care Organization Congress in Los Angeles.
http://www.beckershospitalreview.com/hospital-physician-relationships/while-health-reform-faces-challenge-repeal-of-acos-unlikely.html
http://www.beckershospitalreview.com/hospital-physician-relationships/while-health-reform-faces-challenge-repeal-of-acos-unlikely.html
JOHNSON: Patient beware of accountable care organization
ANALYSIS/OPINION:
There is much to dislike about this year's massive federal overhaul of the nation's health care system. One of Obamacare's potentially most dangerous — and least discussed — features is its call for government-sponsored accountable care organizations (ACOs).
http://www.washingtontimes.com/news/2010/oct/27/patient-beware-of-accountable-care-organization/
There is much to dislike about this year's massive federal overhaul of the nation's health care system. One of Obamacare's potentially most dangerous — and least discussed — features is its call for government-sponsored accountable care organizations (ACOs).
http://www.washingtontimes.com/news/2010/oct/27/patient-beware-of-accountable-care-organization/
Friday, October 22, 2010
Killing Marcus Welby
If ObamaCare really called for the creation of "death panels," the first victim of these in vented tribunals would have been Marcus Welby MD, the character in the hit 1960s television show that followed the daily dramas of a small-town family doctor. Read more: http://www.nypost.com/p/news/opinion/opedcolumnists/killing_marcus_welby_FLnABqCKwpyF9j2i9YYpCP#ixzz137PaapNg
5 Key Questions on How ACOs Will Function: From Robert Betka at Catalyst Management Advisors
The transition to accountable care organizations and shared savings is looking to be as dramatic as hospitals' shift to DRGs in the early 1980s, says Robert Betka Jr., a consultant with Catalyst Management Advisors in Grand Rapids, Mich. "This is a very exciting time," he says, noting federal authorities, private payors and ultimately ACOs themselves will have to answer some key questions on how the new system will operate. Here are five such questions.
1. How will the ACO be governed? A governing board made up of representatives from each partner would run the ACO. Would seats on the board be distributed based on each partner's significance in the organization? And how would the board interact with the governing boards of each component organization?
2. How does the ACO divide up payments? Initially, each component of the ACO would be paid on a fee-for-service basis and then would share a certain amount of the savings created by the ACO. How would that payment be divided? To determine this, Mr. Betka thinks clinical representatives from each component would have to identify the whole continuum of care for each condition and assign a value for each step in the continuum. For example, bypass surgery would involve surgery, imaging, nursing, rehabilitation and other services, depending on a variety of circumstances. While initially only the shared savings would be apportioned this way, eventually the whole payment would be broken down, Mr. Betka believes. The goal is to pay the ACO one lump sum for the entire episode of care, like a bundled payment, he says.
3. What would be the payment for prevention? ACOs with lower rates of expensive procedures would reward the specific caregivers responsible for this improvement. Mr. Betka this would often involve focusing on what did not occur, such as fewer surgeries due to better preventive care. For example, the shared savings for a lower rate of bypass operations might be apportioned to primary care physicians, cardiologists, dieticians and others who prevented a bypass operation from happening, he says.
4. How would accountability be identified? If there were an inappropriate readmission or a quality problem, would the ACO identify what component was responsible and assign the penalty to that component?
5. What is the role of healthcare IT? Making determinations on how to divide up payments, assign accountability and make care more efficient and safe would require very sophisticated healthcare IT. Computer systems would need to implement cost accounting, identifying the components of patient care and provide decision-support tools to analyze trends. However, only 7 percent of hospitals now have comprehensive electronic medical record systems.
1. How will the ACO be governed? A governing board made up of representatives from each partner would run the ACO. Would seats on the board be distributed based on each partner's significance in the organization? And how would the board interact with the governing boards of each component organization?
2. How does the ACO divide up payments? Initially, each component of the ACO would be paid on a fee-for-service basis and then would share a certain amount of the savings created by the ACO. How would that payment be divided? To determine this, Mr. Betka thinks clinical representatives from each component would have to identify the whole continuum of care for each condition and assign a value for each step in the continuum. For example, bypass surgery would involve surgery, imaging, nursing, rehabilitation and other services, depending on a variety of circumstances. While initially only the shared savings would be apportioned this way, eventually the whole payment would be broken down, Mr. Betka believes. The goal is to pay the ACO one lump sum for the entire episode of care, like a bundled payment, he says.
3. What would be the payment for prevention? ACOs with lower rates of expensive procedures would reward the specific caregivers responsible for this improvement. Mr. Betka this would often involve focusing on what did not occur, such as fewer surgeries due to better preventive care. For example, the shared savings for a lower rate of bypass operations might be apportioned to primary care physicians, cardiologists, dieticians and others who prevented a bypass operation from happening, he says.
4. How would accountability be identified? If there were an inappropriate readmission or a quality problem, would the ACO identify what component was responsible and assign the penalty to that component?
5. What is the role of healthcare IT? Making determinations on how to divide up payments, assign accountability and make care more efficient and safe would require very sophisticated healthcare IT. Computer systems would need to implement cost accounting, identifying the components of patient care and provide decision-support tools to analyze trends. However, only 7 percent of hospitals now have comprehensive electronic medical record systems.
Southeastern Wisconsin Health System, IPA Launch Accountable Care Organization
Southeastern Wisconsin's ProHealth Care and the local independent physician association Waukesha (Wis.) Elmbrook Health Care have formed the first accountable care organization in southeast Wisconsin, according to a Business Journal report.
The ACO will be launched in Jan. 2011 and will be called ProHealth Solutions. It is designed to participate in Medicare's new Shared Saving Program under the Patient Protection and Affordable Care Act.
The ACO will be a virtual community with one electronic medical record, and will include a comprehensive quality improvement program with technology that measures specific clinical and efficiency outcomes for each physician. Read the Business Journal report on southeastern Wisconsin's first ACO.
The ACO will be launched in Jan. 2011 and will be called ProHealth Solutions. It is designed to participate in Medicare's new Shared Saving Program under the Patient Protection and Affordable Care Act.
The ACO will be a virtual community with one electronic medical record, and will include a comprehensive quality improvement program with technology that measures specific clinical and efficiency outcomes for each physician. Read the Business Journal report on southeastern Wisconsin's first ACO.
Understanding Accountable Care Organizations
By John D. Cacciamani, Jr., MD, MBA
I find that my physician colleagues, many of whom are busy with everyday caring for their patients, need some explanation when it comes to understanding Accountable Care Organizations [ACOs]. There is not now a unified definition for an ACO, but one is starting to take shape.
ACOs are healthcare delivery models composed of groups of providers responsible for managing a defined population of patients. These ACOs will be accountable for the quality and cost of care delivered to that population and will also need to distribute dollars equally across these providers.
http://www.physiciansnews.com/2010/10/13/understanding-accountable-care-organizations/
I find that my physician colleagues, many of whom are busy with everyday caring for their patients, need some explanation when it comes to understanding Accountable Care Organizations [ACOs]. There is not now a unified definition for an ACO, but one is starting to take shape.
ACOs are healthcare delivery models composed of groups of providers responsible for managing a defined population of patients. These ACOs will be accountable for the quality and cost of care delivered to that population and will also need to distribute dollars equally across these providers.
http://www.physiciansnews.com/2010/10/13/understanding-accountable-care-organizations/
Don Berwick Comments on Goals for ACOs and Role of Federal Oversight
Kicking off a day-long federal listening session with stakeholders, CMS Administrator Don Berwick, MD, outlined his concept of the accountable care organization and how federal agencies should oversee ACOs.
He said federal regulators tailoring antitrust and fraud and abuse laws to accommodate ACOs have a fine line to walk. The legal goals for ACOs should be "cooperation without corruption, aggregation without hegemony and synergy without collusion," he said. In return, ACOs need "clarity and predictability about the regulatory regime."
http://www.beckershospitalreview.com/hospital-physician-relationships/don-berwick-comments-on-goals-for-acos-and-role-of-federal-oversight.html?sms_ss=linkedin&at_xt=4cb86983d1ac3fa8,0&goback=%2Egde_35964_member_32366730
He said federal regulators tailoring antitrust and fraud and abuse laws to accommodate ACOs have a fine line to walk. The legal goals for ACOs should be "cooperation without corruption, aggregation without hegemony and synergy without collusion," he said. In return, ACOs need "clarity and predictability about the regulatory regime."
http://www.beckershospitalreview.com/hospital-physician-relationships/don-berwick-comments-on-goals-for-acos-and-role-of-federal-oversight.html?sms_ss=linkedin&at_xt=4cb86983d1ac3fa8,0&goback=%2Egde_35964_member_32366730
Tuesday, October 12, 2010
Beaumont to lay off up to 50 managers and administrators
Beaumont Hospitals is laying off 40 to 50 administrators and managers, a move that comes as some 17,400 employees — including those being laid off — just received bonus checks.
The three-hospital system expects to wrap up the layoffs by year’s end as part of a reorganization triggered by health care reform. The layoffs, announced in an Oct. 4 newsletter, will save Beaumont $3 million to $4 million a year, said Colette Stimmell, a Beaumont spokeswoman. From The Detroit News: http://www.detnews.com/article/20101012/BIZ/10120326/1001#ixzz12AGUAfSl
The three-hospital system expects to wrap up the layoffs by year’s end as part of a reorganization triggered by health care reform. The layoffs, announced in an Oct. 4 newsletter, will save Beaumont $3 million to $4 million a year, said Colette Stimmell, a Beaumont spokeswoman. From The Detroit News: http://www.detnews.com/article/20101012/BIZ/10120326/1001#ixzz12AGUAfSl
Community Health Systems Affiliate Acquires Home Health Company
An affiliate of Franklin-Tenn.-based Community Health Systems has acquired Lakeland, Fla.-based Advantage Home Health Services, according to a Ledger report.
The company has been renamed Florida's Choice Home Care. It provides home health services to patients in four Florida counties, according to the report.
The move may signal efforts by Community Health Systems to align with post-acute-care providers as payments systems move to include these services either as part of accountable care organizations or in bundled pricing arrangements.
http://www.beckershospitalreview.com/hospital-physician-relationships/community-health-systems-affiliate-acquires-home-health-company.html
The company has been renamed Florida's Choice Home Care. It provides home health services to patients in four Florida counties, according to the report.
The move may signal efforts by Community Health Systems to align with post-acute-care providers as payments systems move to include these services either as part of accountable care organizations or in bundled pricing arrangements.
http://www.beckershospitalreview.com/hospital-physician-relationships/community-health-systems-affiliate-acquires-home-health-company.html
Research and Markets: The Colorado Accountable Care Collaborative: Practical Lessons from an ACO
With a January 2011 go-live date for an accountable care organization pilot, the Colorado Department of Health Care Policy and Financing is entering into the final stages of an RFP process to identify regional organizations that will function as ACOs, the medical homes that will serve as providers within the ACO and a state-wide data and analytics vendor that will provide real-time data to the providers within the ACO.Read more: http://www.bradenton.com/2010/10/11/2645135/research-and-markets-the-colorado.html#ixzz12ADXfuZk
St. Joseph Mercy Health System to acquire IHA physicians organization
St. Joseph Mercy Health System in Ann Arbor has agreed to acquire IHA, an Ann Arbor-based physician organization with more than 150 physicians and 37 nurse practitioners for an unspecified amount.
Over the last year, St. Joseph Mercy has been restructuring its operations within its seven hospitals in Southeast Michigan to reduce costs and prepare for changes under health care reform, said Rob Casalou, CEO of St. Joseph Mercy hospitals in Ann Arbor, Saline and Howell in an interview with Crain's today.
http://www.crainsdetroit.com/article/20101005/FREE/101009942#
Over the last year, St. Joseph Mercy has been restructuring its operations within its seven hospitals in Southeast Michigan to reduce costs and prepare for changes under health care reform, said Rob Casalou, CEO of St. Joseph Mercy hospitals in Ann Arbor, Saline and Howell in an interview with Crain's today.
http://www.crainsdetroit.com/article/20101005/FREE/101009942#
7 Steps Hospitals Must Take to Embrace ACOs: From Kevin Brennan at Geisinger Health System
Geisinger Health System, an integrated network in Danville, Pa., served as one of the models for the new accountable care organization. The system participated in CMS' seminal Medicare Group Practice Demonstration, a precursor of the ACO, and recently CMS tapped Richard Gilfillan, the head of the Geisinger Health Plan, to run its Innovation Center, which is overseeing ACOs. Here Kevin Brennan, Geisinger's CFO, discusses seven steps hospitals can take to embrace the new era of accountable care.
http://www.beckershospitalreview.com/hospital-physician-relationships/7-steps-hospitals-must-take-to-embrace-acos-from-kevin-brennan-at-geisinger-health-system.html
http://www.beckershospitalreview.com/hospital-physician-relationships/7-steps-hospitals-must-take-to-embrace-acos-from-kevin-brennan-at-geisinger-health-system.html
Why Hospitals Are Beating the Bushes for Primary-Care Doctors
Hospitals are again snapping up primary care physicians as they prepare to become accountable care organizations (ACOs), says Becker’s Hospital Review. To qualify for Medicare’s future shared-savings program, ACOs must include a strong primary-care component, so PCPs are essential to this strategy. The result will be to drive more primary-care doctors into hospitals’ arms in search of higher pay than they can earn in private practice. And that adds to the evidence that the days of small independent practices are numbered.
http://www.bnet.com/blog/healthcare-business/why-hospitals-are-beating-the-bushes-for-primary-care-doctors/1846
http://www.bnet.com/blog/healthcare-business/why-hospitals-are-beating-the-bushes-for-primary-care-doctors/1846
Health Care Providers, Insurers Raise Questions, Concerns About ACOs
Physicians and hospitals are raising concerns that forming accountable care organizations, as promoted under the federal health reform law, might breach antitrust and anti-fraud laws, Kaiser Health News reports. Meanwhile, insurers are worried that ACOs could increase the cost of medical care.
Read more: http://www.californiahealthline.org/articles/2010/10/5/health-care-providers-insurers-raise-questions-concerns-about-acos.aspx#ixzz129zpWhpq
Read more: http://www.californiahealthline.org/articles/2010/10/5/health-care-providers-insurers-raise-questions-concerns-about-acos.aspx#ixzz129zpWhpq
Monday, October 4, 2010
ACOs good idea; doctor support will be critical
By Don Ammon
Former CEO, Adventist Health System West
In the early ‘70s, ‘80s and ‘90s we worked on a concept similar to accountable care organizations (ACOs) in California. We tried to establish a program that would cover risk for our patients’ care with a lot of enthusiasm and effort. But unfortunately, we had very little success. It was just so complicated and expensive to get the idea off the ground.
http://actionforbetterhealthcare.com/?p=1270
Former CEO, Adventist Health System West
In the early ‘70s, ‘80s and ‘90s we worked on a concept similar to accountable care organizations (ACOs) in California. We tried to establish a program that would cover risk for our patients’ care with a lot of enthusiasm and effort. But unfortunately, we had very little success. It was just so complicated and expensive to get the idea off the ground.
http://actionforbetterhealthcare.com/?p=1270
ACOs May Cause Healthcare Cost Inflation Rather than Savings
Rather than save money, some experts argue accountable care organizations will further inflate prices, as hospitals unite with physicians and other providers against private insurers, according to a report by the Washington Post.
In an article on the effect of hospital mergers on healthcare inflation, the Post referred to a study in the February issue of Health Affairs examining an alliance in California similar to an ACO. The study concluded that if ACOs are able to exert more market power in negotiations, "private insurers could wind up paying more, even if care is delivered more efficiently."
http://www.beckershospitalreview.com/hospital-physician-relationships/acos-may-cause-healthcare-cost-inflation-rather-than-savings.html
In an article on the effect of hospital mergers on healthcare inflation, the Post referred to a study in the February issue of Health Affairs examining an alliance in California similar to an ACO. The study concluded that if ACOs are able to exert more market power in negotiations, "private insurers could wind up paying more, even if care is delivered more efficiently."
http://www.beckershospitalreview.com/hospital-physician-relationships/acos-may-cause-healthcare-cost-inflation-rather-than-savings.html
AHA Shows How 4 Key Federal Enforcement Laws Impair ACOs
Four major federal enforcement laws, from the antitrust law to the anti-kickback law, will impede efforts by hospitals and other providers to create accountable care organizations, the AHA stated in a letter to CMS, the Federal Trade Commission and the HHS Inspector General.
http://www.beckershospitalreview.com/news-analysis/aha-shows-how-4-key-federal-enforcement-laws-impair-acos.html
http://www.beckershospitalreview.com/news-analysis/aha-shows-how-4-key-federal-enforcement-laws-impair-acos.html
ACOs: Danger lurks in health-care reform
Not many people outside of the health care world know what an Accountable Care Organization (ACO) is, or what it is supposed to do. Frankly, most health care insiders don’t know what an ACO is. The fact is that ACOs are an amorphous attempt to change the way health care is delivered and paid for and its implications are massive.
http://www.capitolweekly.net/article.php?_c=z62mjyg1hxl8cy&xid=z62a6g3jelt1zt&done=.z62mjyg1hya8cy
http://www.capitolweekly.net/article.php?_c=z62mjyg1hxl8cy&xid=z62a6g3jelt1zt&done=.z62mjyg1hya8cy
Thursday, September 23, 2010
Memorial Healthcare System (Hollywood, FL) joined Premier Inc's (Charlotte, NC) ACO Implementation Collaborative.
Memorial Healthcare System (Hollywood, FL) joined Premier Inc's (Charlotte, NC) ACO Implementation Collaborative, which includes 23 health systems representing more than 80 hospitals and 1.5 million patients nationwide. Memorial also joined Premier's QUEST®: High Performing Hospitals collaborative, a voluntary, three-year project designed to optimize hospital performance in five critical areas: cost-effectiveness, evidence-based care delivery, mortality reduction, harm reduction and patient satisfaction.
Building an ACO takes time and work
Many hospitals and healthcare systems across the country are beginning to put plans in place to launch Accountable Care Organizations (ACOs). This takes time, commitment and a great deal of work to put the appropriate pieces in place. The video below is a bit of a spoof on the topic but it drives home the point that creating an ACO cannot just happen overnight.
http://actionforbetterhealthcare.com/?p=1246
http://actionforbetterhealthcare.com/?p=1246
Can ACOs Crack the Healthcare Payment Code?
Whether it's called "healthcare reform" or "Obamacare," the multi-year march toward an overhaul of the nation's healthcare delivery system begins this week. Thoughtful people may agree to disagree on the merits of the Patient Protection and Affordable Care Act signed into law six months ago. But the effects it will have on physicians, hospitals, and payers will be stressful for all. Expect some discomfort.
http://healthplans.hcpro.com/content.cfm?topic=HEP&content_id=256778
http://healthplans.hcpro.com/content.cfm?topic=HEP&content_id=256778
Monday, September 20, 2010
Details on October Meeting About Legal Issues For ACOs Provided by Federal Enforcement Agencies
Federal enforcement agencies have released a preliminary agenda of an Oct. 5 workshop to gather industry-wide comments on possibly changing federal laws and regulations to protect accountable care organizations from prosecution, according to a notice in the Federal Register.
The day-long workshop will be held by the Federal Trade Commission, HHS Office of Inspector General and CMS at CMS offices in Baltimore and available by teleconference. It will address antitrust, physician self-referral, anti-kickback and civil monetary penalty issues.
http://www.beckershospitalreview.com/hospital-physician-relationships/details-on-october-meeting-about-legal-issues-for-acos-provided-by-federal-enforcement-agencies.html
The day-long workshop will be held by the Federal Trade Commission, HHS Office of Inspector General and CMS at CMS offices in Baltimore and available by teleconference. It will address antitrust, physician self-referral, anti-kickback and civil monetary penalty issues.
http://www.beckershospitalreview.com/hospital-physician-relationships/details-on-october-meeting-about-legal-issues-for-acos-provided-by-federal-enforcement-agencies.html
Wednesday, September 15, 2010
Indiana's Community Health Network Developing ACO
Indianapolis-based Community Health Network is in the processes of developing an accountable care organization, saying it has a head start on other hospitals in the Indianapolis market, according to an Indianapolis Business Journal report.
The hospital not only held on to the primary care physicians it acquired in the 1990s, but in the last two years also added another 350 physicians, including specialists. The hospitals now has 550 physicians, either employed or with integration contracts, who receive some sort of incentive payments from the hospital for meeting certain quality and communication measures, according to the report.
http://www.beckershospitalreview.com/hospital-physician-relationships/indianas-community-health-network-developing-aco.html
The hospital not only held on to the primary care physicians it acquired in the 1990s, but in the last two years also added another 350 physicians, including specialists. The hospitals now has 550 physicians, either employed or with integration contracts, who receive some sort of incentive payments from the hospital for meeting certain quality and communication measures, according to the report.
http://www.beckershospitalreview.com/hospital-physician-relationships/indianas-community-health-network-developing-aco.html
5 Key Regulatory Concerns for ACOs
Hospitals looking to develop accountable care organizations face the same regulatory concerns and hurdles that hospitals have long grappled with in their physician integration efforts. Specifically, ACOs must ensure that their agreements with physicians do not violate anti-kickback statutes, Stark Law, the Civil Monetary Penalty, tax-exemption laws and/or anti-trust regulations.
Previous and current Medicare demonstration projects involving bundled or incentive payments have granted exceptions to many of these regulations, and it is expected the Medicare ACO demonstration created by the Patient Protection and Affordable Care Act will do the same, although specific guidelines for the project will not be released until December. Given that specific guidelines are forthcoming, hospitals that develop ACOs must consider how their integration efforts will be viewed in light of these regulations.
http://www.beckershospitalreview.com/hospital-financial-and-business-news/5-key-regulatory-concerns-for-acos.html
Previous and current Medicare demonstration projects involving bundled or incentive payments have granted exceptions to many of these regulations, and it is expected the Medicare ACO demonstration created by the Patient Protection and Affordable Care Act will do the same, although specific guidelines for the project will not be released until December. Given that specific guidelines are forthcoming, hospitals that develop ACOs must consider how their integration efforts will be viewed in light of these regulations.
http://www.beckershospitalreview.com/hospital-financial-and-business-news/5-key-regulatory-concerns-for-acos.html
Tuesday, September 7, 2010
CIGNA and Piedmont Physicians Group Launch Accountable Care Organization Pilot Program in Atlanta for Better Care Coordination
BLOOMFIELD, Conn. & ATLANTA, Sep 07, 2010 (BUSINESS WIRE) -- --Program includes a registered nurse clinical care coordinator funded by CIGNA
--First accountable care organization in Georgia
CIGNA /quotes/comstock/13*!ci/quotes/nls/ci (CI 33.62, -0.14, -0.42%) and Piedmont Physicians Group, part of Atlanta-based Piedmont Healthcare, have launched an accountable care organization (ACO) pilot program. With a comprehensive, accountable and collaborative approach to medical care, the ACO pilot is expected to improve access to and quality of patient care, and provide better care coordination while lowering medical costs.
An ACO is a variation on the patient-centered medical home model of health care that rewards primary care doctors for improved outcomes and lower medical costs. CIGNA's program with Piedmont is one of the first patient-centered pilot programs in the Atlanta area involving a medical practice and a single private payer and is the first accountable care organization in Georgia.
http://www.marketwatch.com/story/cigna-and-piedmont-physicians-group-launch-accountable-care-organization-pilot-program-in-atlanta-for-better-care-coordination-2010-09-07?reflink=MW_news_stmp
--First accountable care organization in Georgia
CIGNA /quotes/comstock/13*!ci/quotes/nls/ci (CI 33.62, -0.14, -0.42%) and Piedmont Physicians Group, part of Atlanta-based Piedmont Healthcare, have launched an accountable care organization (ACO) pilot program. With a comprehensive, accountable and collaborative approach to medical care, the ACO pilot is expected to improve access to and quality of patient care, and provide better care coordination while lowering medical costs.
An ACO is a variation on the patient-centered medical home model of health care that rewards primary care doctors for improved outcomes and lower medical costs. CIGNA's program with Piedmont is one of the first patient-centered pilot programs in the Atlanta area involving a medical practice and a single private payer and is the first accountable care organization in Georgia.
http://www.marketwatch.com/story/cigna-and-piedmont-physicians-group-launch-accountable-care-organization-pilot-program-in-atlanta-for-better-care-coordination-2010-09-07?reflink=MW_news_stmp
Northwest Chicago finalizes merger with physician group
Arlington Heights-based Northwest Community Hospital said Wednesday it has finalized its acquisition of Riverwoods-based Affinity Healthcare, making the group's physicians and their staff direct employees of the hospital for the first time.
Northwest also is looking to acquire other physician groups as well, said Northwest spokesman Blaine Krage.
http://www.dailyherald.com/story/?id=405190
Northwest also is looking to acquire other physician groups as well, said Northwest spokesman Blaine Krage.
http://www.dailyherald.com/story/?id=405190
St. Francis Reinventing Itself
When St. Francis Hospital and Medical Center officials began mapping out a strategic plan about a year ago, the economy was still in shambles, sweeping health care reform was on the verge of passage and the future of the industry remained cloudy at best.
So how did the hospital’s CEO Christopher M. Dadlez prepare his top lieutenants for what seemed like an impossible task? He assigned them to read The Innovator’s Prescription, a popular book among health care visionaries that calls on the industry to completely transform itself.
http://www.hartfordbusiness.com/news14658.html
So how did the hospital’s CEO Christopher M. Dadlez prepare his top lieutenants for what seemed like an impossible task? He assigned them to read The Innovator’s Prescription, a popular book among health care visionaries that calls on the industry to completely transform itself.
http://www.hartfordbusiness.com/news14658.html
Tuesday, August 31, 2010
Great animation poking fun at Hospital Executives that have yet to learn about ACOs!
A must view to understand the level of insight around ACOs by Healthcare Executives!
http://www.youtube.com/watch?v=lF8bK7AJyL0
http://www.youtube.com/watch?v=lF8bK7AJyL0
19 Health Systems to Participate in AMGA Collaborative on Developing Accountable Care Organizations
5 Million Patients to Benefit from Improved Quality and Efficiency
Newswise — The American Medical Group Association (AMGA) today announced 19 leading medical groups and organized systems of care that will be participating in its ACO Development Collaborative, scheduled to have its first meeting in conjunction with the AMGA National Summit on Accountable Care Organizations (ACOs). These organizations represent more than 10,500 providers serving approximately 5 million patients in the United States.
http://www.newswise.com/articles/19-health-systems-to-participate-in-amga-collaborative-on-developing-accountable-care-organizations
Newswise — The American Medical Group Association (AMGA) today announced 19 leading medical groups and organized systems of care that will be participating in its ACO Development Collaborative, scheduled to have its first meeting in conjunction with the AMGA National Summit on Accountable Care Organizations (ACOs). These organizations represent more than 10,500 providers serving approximately 5 million patients in the United States.
http://www.newswise.com/articles/19-health-systems-to-participate-in-amga-collaborative-on-developing-accountable-care-organizations
Tuesday, August 17, 2010
Washington Post: Debate over whether big health systems help cut costs
In Roanoke, Va., one company owns the city's two hospitals and six others in a region of 250,000 residents, commanding the area's largest economic engine and a workforce that includes 550 doctors, The Washington Post reports. Carilion Clinic's consolidation has sparked a local row: Is this the future of integrated, efficient health care delivery, or is it a gilded-age style monopoly?
http://www.news-medical.net/news/20100816/Washington-Post-Debate-over-whether-big-health-systems-help-cut-costs.aspx
http://www.news-medical.net/news/20100816/Washington-Post-Debate-over-whether-big-health-systems-help-cut-costs.aspx
Hospital CFOs as Quality Leaders
When Paul Weygandt was presenting to a room full of hospital CFOs about the potential ramifications of the not-yet-passed healthcare reform legislation last year, he asked for a show of hands of how many in the room were involved in their organization’s clinical quality program. Not many went up.
http://www.healthleadersmedia.com/content/FIN-255173/Hospital-CFOs-as-Quality-Leaders##
http://www.healthleadersmedia.com/content/FIN-255173/Hospital-CFOs-as-Quality-Leaders##
Insights From the Model for ACOs: Q&A With Harold Dash of Everett Clinic on the Medicare Physician Group Practice Demonstration Project
Harold Dash, MD, a cardiologist, is president of the Everett (Wash.) Clinic, a group practice with more than 300 physicians. Here Dr. Dash discusses Everett's participation in the Medicare Physician Group Practice Demonstration Project, the model for the accountable care organization, a new system that bundles charges for hospitals, physician and other providers.
Question: What was the goal of the Medicare Physician Group Practice Demonstration?Harold
Dash: The goal was to lower costs and improve the quality of patient care. It involved 10 large physician groups across the country serving a total of 223,203 Medicare fee-for-service patients. Some of the practices are freestanding like Everett and some are integrated into health systems. The project lasted five years, ending this spring. Participants received the usual fee-for-service payments and then were eligible for cost performance payments and quality performance payments.
http://www.beckershospitalreview.com/hospital-physician-relationships/insights-from-the-model-for-acos-qaa-with-harold-dash-of-everett-clinic-on-the-medicare-physician-group-practice-demonstration-project.html
Question: What was the goal of the Medicare Physician Group Practice Demonstration?Harold
Dash: The goal was to lower costs and improve the quality of patient care. It involved 10 large physician groups across the country serving a total of 223,203 Medicare fee-for-service patients. Some of the practices are freestanding like Everett and some are integrated into health systems. The project lasted five years, ending this spring. Participants received the usual fee-for-service payments and then were eligible for cost performance payments and quality performance payments.
http://www.beckershospitalreview.com/hospital-physician-relationships/insights-from-the-model-for-acos-qaa-with-harold-dash-of-everett-clinic-on-the-medicare-physician-group-practice-demonstration-project.html
Thursday, August 12, 2010
Columbia, S.C.-Area Health Systems Poised to Expand Despite High Unemployment and Uninsured Rates
Columbia Market Overview Now Available from HealthLeaders-InterStudy
NASHVILLE, Tenn., Aug. 12 /PRNewswire/ -- HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that despite the state's high unemployment rate and an increasing number of uninsured residents in the Columbia, S.C. market, health systems will likely expand over the coming 12 months. According to the recent Columbia Market Overview, Palmetto Health, Lexington Medical Center and Sisters of Charity Providence Hospitals have brokered a deal that should allow each to expand services and facilities free from the presence of drawn-out certificate-of-need appeals.
http://www.prnewswire.com/news-releases/columbia-sc-area-health-systems-poised-to-expand-despite-high-unemployment-and-uninsured-rates-100532729.html
NASHVILLE, Tenn., Aug. 12 /PRNewswire/ -- HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that despite the state's high unemployment rate and an increasing number of uninsured residents in the Columbia, S.C. market, health systems will likely expand over the coming 12 months. According to the recent Columbia Market Overview, Palmetto Health, Lexington Medical Center and Sisters of Charity Providence Hospitals have brokered a deal that should allow each to expand services and facilities free from the presence of drawn-out certificate-of-need appeals.
http://www.prnewswire.com/news-releases/columbia-sc-area-health-systems-poised-to-expand-despite-high-unemployment-and-uninsured-rates-100532729.html
The Coming Challenges—and Opportunities—of Value-Based Purchasing
The Coming Challenges—and Opportunities—of Value-Based Purchasing
The Patient Protection and Affordable Care Act was signed into law in March, furthering the federal government’s commitment to increasing the efficiency of the U.S. healthcare system by decreasing cost and improving quality. An expansion of the “value-based purchasing” model, this law mandates that ratings and reimbursements to physicians and hospitals be increasingly tied to measured quality of care.
http://www.the-hospitalist.org/details/article/764899/The_Coming_Challengesand_Opportunitiesof_Value-Based_Purchasing.html
The Patient Protection and Affordable Care Act was signed into law in March, furthering the federal government’s commitment to increasing the efficiency of the U.S. healthcare system by decreasing cost and improving quality. An expansion of the “value-based purchasing” model, this law mandates that ratings and reimbursements to physicians and hospitals be increasingly tied to measured quality of care.
http://www.the-hospitalist.org/details/article/764899/The_Coming_Challengesand_Opportunitiesof_Value-Based_Purchasing.html
Health Care Transformation Leader to Present at Harvard Meeting
Taconic Health Information Network and Community's Susan Stuard will present building blocks for transformation Aug. 18 at Ninth National Quality Colloquium in Cambridge, Mass.
FISHKILL, N.Y., Aug. 12 /PRNewswire-USNewswire/ -- Across the nation, the changing health care environment is challenging physicians and other providers to redefine their roles within new models of care. The potential relationship between two models, the patient-centered medical home (PCMH) and the accountable care organization (ACO) will be explored by Susan Stuard, executive director of the Taconic Health Information Network and Community (THINC) at a meeting of quality leaders at Harvard University Aug. 16-19, 2010.
http://www.prnewswire.com/news-releases/hudson-valley-initiative-health-care-transformation-leader-to-present-at-harvard-meeting-100526509.html
FISHKILL, N.Y., Aug. 12 /PRNewswire-USNewswire/ -- Across the nation, the changing health care environment is challenging physicians and other providers to redefine their roles within new models of care. The potential relationship between two models, the patient-centered medical home (PCMH) and the accountable care organization (ACO) will be explored by Susan Stuard, executive director of the Taconic Health Information Network and Community (THINC) at a meeting of quality leaders at Harvard University Aug. 16-19, 2010.
http://www.prnewswire.com/news-releases/hudson-valley-initiative-health-care-transformation-leader-to-present-at-harvard-meeting-100526509.html
Wednesday, August 11, 2010
Aurora joins accountability collaborative
Aurora Health Care has joined 50 other health care providers in a collaborative designed to boost accountability in health care.
Aurora said it joined the Accountable Care Organization Readiness Collaborative of Premier, a Charlotte, N.C.-based performance improvement alliance of more than 2,400 U.S. hospitals and 69,000-plus other health care sites working together to achieve quality, cost-effective care.Read more: Aurora joins accountability collaborative - The Business Journal of Milwaukee
Aurora said it joined the Accountable Care Organization Readiness Collaborative of Premier, a Charlotte, N.C.-based performance improvement alliance of more than 2,400 U.S. hospitals and 69,000-plus other health care sites working together to achieve quality, cost-effective care.Read more: Aurora joins accountability collaborative - The Business Journal of Milwaukee
Health Care Administrators Discuss Accountable Care at AMGA Meeting
Youtube video discussing ACOs at AMGA meeting.
http://www.youtube.com/watch?v=i0PgsH8QOoc&feature=related
http://www.youtube.com/watch?v=i0PgsH8QOoc&feature=related
Tuesday, August 10, 2010
Health reform will save Medicare billions, CMS says
Despite skepticism from Republicans, a new report concludes that the health system overhaul will more than double the life of the program.
By Chris Silva, amednews staff. Posted Aug. 10, 2010.
http://www.ama-assn.org/amednews/2010/08/09/gvsd0810.htm
By Chris Silva, amednews staff. Posted Aug. 10, 2010.
http://www.ama-assn.org/amednews/2010/08/09/gvsd0810.htm
New Collaboratives Getting Health Systems Ready for ACOs: Q&A With Blair Childs at Premier
Blair G. Childs, senior vice president for public policy at Premier Inc., explains how Premier's new accountable care collaboratives are helping health systems to get ready to launch accountable care organizations.
Question: Nineteen health systems are in Premier's Implementation Collaborative. What criteria have they met?
Blair Childs: These health systems are pretty much ready to begin implementing an ACO. They have executive sponsorship and participation, a payor partner is participating and the physician network has a sufficient population base, at least 5,000 lives. There is transparency and acceptance of common cost and quality metrics, such as QUEST or HEDIS. The system has population health data infrastructure through an EHR and is linked with the payor. Going forward, these systems must participate in work groups and meetings. They need to set up a legal entity that will function as an ACO contracting vehicle.
http://www.beckershospitalreview.com/hospital-physician-relationships/new-collaboratives-getting-health-systems-ready-for-acos-qaa-with-blair-childs-at-premier.html
Question: Nineteen health systems are in Premier's Implementation Collaborative. What criteria have they met?
Blair Childs: These health systems are pretty much ready to begin implementing an ACO. They have executive sponsorship and participation, a payor partner is participating and the physician network has a sufficient population base, at least 5,000 lives. There is transparency and acceptance of common cost and quality metrics, such as QUEST or HEDIS. The system has population health data infrastructure through an EHR and is linked with the payor. Going forward, these systems must participate in work groups and meetings. They need to set up a legal entity that will function as an ACO contracting vehicle.
http://www.beckershospitalreview.com/hospital-physician-relationships/new-collaboratives-getting-health-systems-ready-for-acos-qaa-with-blair-childs-at-premier.html
BACON: A half-trillion-dollar delusion
After a three-month delay, the trustees of the Social Security and Medicare trust funds have finally published their annual report. Now we have an explanation for the wait. Thanks to program changes made by the Affordable Care Act (aka Obamacare), the report summary says, "The outlook for Medicare has improved substantially."
http://www.washingtontimes.com/news/2010/aug/6/a-half-trillion-dollar-delusion/
http://www.washingtontimes.com/news/2010/aug/6/a-half-trillion-dollar-delusion/
The Role of Physician-Directed Best Practices in Creating Successful Accountable Care Organizations
The economic challenges of the past decade have placed hospitals under unrelenting pressures to reduce costs while maintaining quality. With most of the stray dollars already found, any further cost cutting initiatives will likely bring with them the danger of compromised quality of care.
What healthcare organizations need to successfully respond to these challenges are new tools and new thinking with which they can maintain or increase their clinical quality and efficiencies. And more than ever before, physicians are the key. The next stage of improvement must be a collaborative effort among physicians, clinical staff members and executives, working together to develop innovative ways to improve patient care.
http://www.beckershospitalreview.com/hospital-physician-relationships/the-role-of-physician-directed-best-practices-in-creating-successful-accountable-care-organizations.html
What healthcare organizations need to successfully respond to these challenges are new tools and new thinking with which they can maintain or increase their clinical quality and efficiencies. And more than ever before, physicians are the key. The next stage of improvement must be a collaborative effort among physicians, clinical staff members and executives, working together to develop innovative ways to improve patient care.
http://www.beckershospitalreview.com/hospital-physician-relationships/the-role-of-physician-directed-best-practices-in-creating-successful-accountable-care-organizations.html
5 Tips on Preparing for Accountable Care Organizations
In order to qualify as an ACO, an organization must:
1. Have a formal legal structure to receive and distribute shared savings.
2. Have at least 5,000 beneficiaries.
3. Participate in the program for at least three years.
4. Have sufficient information on participating ACO healthcare professionals.
5. Have a leadership and management structure that includes clinical and administrative systems.
6. Have defined processes to promote evidence-based medicine, report data to evaluate quality and cost measures and coordinate care.
7. Demonstrate that it meets patient-centered criteria.
http://www.beckershospitalreview.com/hospital-financial-and-business-news/5-tips-on-preparing-for-accountable-care-organizations.html
1. Have a formal legal structure to receive and distribute shared savings.
2. Have at least 5,000 beneficiaries.
3. Participate in the program for at least three years.
4. Have sufficient information on participating ACO healthcare professionals.
5. Have a leadership and management structure that includes clinical and administrative systems.
6. Have defined processes to promote evidence-based medicine, report data to evaluate quality and cost measures and coordinate care.
7. Demonstrate that it meets patient-centered criteria.
http://www.beckershospitalreview.com/hospital-financial-and-business-news/5-tips-on-preparing-for-accountable-care-organizations.html
Monday, August 9, 2010
Wednesday, August 4, 2010
Three Tiers of Accountable Care Organizations
If you've seen 1 ACO you have seen 1 ACO. See how they differ here...
http://healthcare-economist.com/2010/08/04/three-tiers-of-accountable-care-organizations/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+HealthcareEconomist+%28Healthcare+Economist%29
http://healthcare-economist.com/2010/08/04/three-tiers-of-accountable-care-organizations/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+HealthcareEconomist+%28Healthcare+Economist%29
Kaiser Health News-8/3/10 Transcript
Transcript: Health On The Hill - August 3, 2010
var addthis_pub = "kaiserfamily";
var addthis_hover_delay = 200;
var addthis_options = 'buzz, delicious, digg, facebook, google, myspace, reddit';
Topics: Medicaid, Health Reform, States, Politics
Aug 03, 2010
A Senate vote could come as early as Wednesday on a $16 billion Medicaid package for states. Meanwhile, a U.S. District Court judge has allowed a Virginia lawsuit challenging the health law’s requirement that individuals purchase health insurance to continue in the courts. A Missouri state ballot referendum to nullify the health law’s individual mandate is expected to pass today, although the measure is viewed as largely symbolic.
Watch video interview or Listen to audio version (.mp3)
Transcript:
LAURIE MCGINLEY: Good day. I am Laurie McGinley with Kaiser Health News, and this is Health on the Hill, where we discuss recent developments involving health care policy. Joining me today are Mary Agnes Carey with Kaiser Health News and Noam Levey with the L.A. Times/Tribune – Washington Bureau. Thank you both for joining us.
Mary Agnes, let’s start with you. Things have been pretty busy on the Hill, considering these are the dog days of August. There has been a lot of debate lately about Medicaid and whether Congress should provide the states with additional aid to Medicaid, considering the states’ budget problems, can you tell us where that stands at this point?
MARY AGNES CAREY: Senate Majority Leader, Harry Reid, is trying once again to pass a Medicaid package; we are talking about $16 billion that would extend the additional funding that was passed last year in the economic stimulus package for another six months.
Senator Reid had hoped to bring the Bill to a floor vote yesterday, but he found out a Congressional Budget Office score found that the bill would cost $5 billion more than they had realized. They are going to go back and they want to make it budget-neutral, so his hope is that he can bring the package to the floor as early as Wednesday for a vote.
LAURIE MCGINLEY: And if it comes to the floor, Noam, do you think it’s going to pass? How close will it be?
NOAM LEVEY: You know, they didn’t have the votes yesterday morning. They were working pretty hard to round them up. I think they think that they can get there if they come up with the offsets to actually make it budget-neutral.
The question then becomes when it goes, it has to go back to the House, can they round up the votes there? Because some of the offsets are going to be controversial with either liberals, cutbacks in some of the programs for helping the poor, or some of the taxes can be controversial as well, so I think that may be a big test as well.
LAURIE MCGINLEY: And if it doesn’t get wrapped up in the Senate this week, what is the likelihood it comes back in the fall after Labor Day?
MARY AGNES CAREY: I think it’s going to be a constant part of the discussion. I mean we have seen governors come to Washington, Democratic governors, Republican governors saying our budget started July 1st, we need this money. Several states have already included it in their budgets, and so you can continue the drum beat, the pressure from the governors to do this, and of course if it isn’t done before they adjourn for the elections, they being Congress, we could certainly see this in a lame duck session this fall.
LAURIE MCGINLEY: Noam, yesterday in terms of health care reform law, there was an important decision in Virginia, could you tell us a little bit about that court decision and what the implications are?
NOAM LEVEY: Sure. So this is the lawsuit that the state of Virginia filed challenging the new health care law, which is one of two legal challenges going on right now to the law. The decision yesterday was on a procedural question. The federal government, the Obama administration had moved to dismiss it, arguing that the state of Virginia didn’t have standing to challenge it, and that it was premature to do this.
Had the Obama administration prevailed in that, it sort of would have swept aside kind of this early legal test of the new law. The opposite happened. The judge in a fairly strongly-worded opinion said no. In fact, the state of Virginia’s case can go forward. The state has standing to do it. And there are some very big constitutional questions that this case raises.
Essentially what the judge signaled I think is that he doesn’t want to dismiss this case. He wants to have a full legal debate about whether congress can mandate people to buy health insurance, which of course is the central and very controversial question at the core of the health care reform bill.
LAURIE MCGINLEY: What was the reaction from both sides, from both supporters of the law and critics of the law?
NOAM LEVEY: Well, I mean, fairly predictable. The supporters, of course, the Virginia Attorney General, Ken Cuccinelli, who has sort of made himself into one of the leading critics of the bill, celebrated this as sort of a validation of his argument that this was constitutional overreach by the Obama administration and the Democratic congress.
The National Federation of Independent Business, a conservative advocate for small business groups, which has signed on to the second lawsuit I mentioned, which is going forward in a federal court in Florida involving other states, also celebrate it. The Obama administration interestingly sort of took I think two attacks.
One was to say look, this is just a procedural ruling, so let’s not get too excited, but I think almost more interestingly they made the argument against the overall lawsuit, arguing if this thing gets thrown out, here’s what is going to get thrown out as well, all of the benefits that we have sort of heart talked about in the past few months about aid for small business, helping people get insurance, so they are sort of I think trying to take a larger political view of this as well, perhaps in anticipation that this is going to be a long, drawn-out legal fight.
LAURIE MCGINLEY: Which probably ends up in the Supreme Court.
NOAM LEVEY: Very well may.
LAURIE MCGINLEY: Mary Agnes, the health care law faces another type of test in Missouri today, can you tell us about this, about the ballot referendum on the law?
MARY AGNES CAREY: Right. It is the first state ballot referendum talking about the individual mandate, the same issue. They want to change state law to say that no individual in Missouri would have to purchase insurance, nor could you be fined if you didn’t purchase it. It is viewed as a largely symbolic measure. They expect very heavy turnout for the Republican primaries. They expect this ballot measure to pass, but at this point it is viewed by many as it won’t have any legal standing. It is more symbolic than anything.
LAURIE MCGINLEY: And there are several more of these referendums coming down the pike, I understand.
MARY AGNES CAREY: Right. There are going to be other states that will try to enact the same thing. I mean, I think it is part of the ongoing view, the political view of this, and what is the role of federal government, what is the role of the state government? As we know, states have this really broad role in implementing the health care law, and I think that you are going to see this discussion continue all over the country.
LAURIE MCGINLEY: Meanwhile, Noam, as the debate goes on about the law, there are things that are happening outside the bell way, on the ground, in the marketplace, you had a very interesting story out of San Antonio, Texas about hospitals and doctors getting together as a result of the health care law, can you tell us about that and what the implications are?
NOAM LEVEY: Sure. I mean, you may recall during the health care debate, there was a lot of talk about whether this bill would do enough to change the way health care was delivered to make it more efficient, to get doctors, hospitals, other providers to work together, and a common critique of the bill was that the efforts to do that in the bill were small. They were not far reaching at all, and they were ultimately inadequate. to make the system more efficient and to really improve the quality of care than Americans get.
Interestingly, out in health care world, outside of Washington, some interesting things I think have been going on, where hospitals and doctors are actually very aggressively sort of courting one another in this sort of courtship dance in which they are talking about can they work together, can they form partnerships? Can they form these what are called accountable care organizations where they can work together to coordinate care better. And you see physician practices selling out to hospitals, insurance companies even getting involved in this, and at a rate that is much more quick than I think many people thought, and ultimately we don’t know what the upshot of this will be. I mean, there simply may be more consolidation in the health care industry that may mean just higher costs, more monopolies, etc.
But on the other side, there are some people who sort of think you know what, this is actually a hopeful sign that people in health care are reading the tea leaves, seeing that the system is going to change and they should figure out a way to work together to potentially provide better, cheaper care. So, we will see what happens.
LAURIE MCGINLEY: Does this raise antitrust issues?
NOAM LEVEY: It may. It may very well and the Department of Justice has actually sort of looked at this, is beginning to look at this. There are a number of discussions underway by national law firms as well as consulting firms trying to advise hospitals and physician groups about how to avoid antitrust issues.
You mentioned I was in San Antonio, if you have a major hospital system in a city buying up all the primary care doctors or all the cardiologists, I mean you could very well end up with a situation where patients have less choice and ultimately that probably means higher costs.
var addthis_pub = "kaiserfamily";
var addthis_hover_delay = 200;
var addthis_options = 'buzz, delicious, digg, facebook, google, myspace, reddit';
Topics: Medicaid, Health Reform, States, Politics
Aug 03, 2010
A Senate vote could come as early as Wednesday on a $16 billion Medicaid package for states. Meanwhile, a U.S. District Court judge has allowed a Virginia lawsuit challenging the health law’s requirement that individuals purchase health insurance to continue in the courts. A Missouri state ballot referendum to nullify the health law’s individual mandate is expected to pass today, although the measure is viewed as largely symbolic.
Watch video interview or Listen to audio version (.mp3)
Transcript:
LAURIE MCGINLEY: Good day. I am Laurie McGinley with Kaiser Health News, and this is Health on the Hill, where we discuss recent developments involving health care policy. Joining me today are Mary Agnes Carey with Kaiser Health News and Noam Levey with the L.A. Times/Tribune – Washington Bureau. Thank you both for joining us.
Mary Agnes, let’s start with you. Things have been pretty busy on the Hill, considering these are the dog days of August. There has been a lot of debate lately about Medicaid and whether Congress should provide the states with additional aid to Medicaid, considering the states’ budget problems, can you tell us where that stands at this point?
MARY AGNES CAREY: Senate Majority Leader, Harry Reid, is trying once again to pass a Medicaid package; we are talking about $16 billion that would extend the additional funding that was passed last year in the economic stimulus package for another six months.
Senator Reid had hoped to bring the Bill to a floor vote yesterday, but he found out a Congressional Budget Office score found that the bill would cost $5 billion more than they had realized. They are going to go back and they want to make it budget-neutral, so his hope is that he can bring the package to the floor as early as Wednesday for a vote.
LAURIE MCGINLEY: And if it comes to the floor, Noam, do you think it’s going to pass? How close will it be?
NOAM LEVEY: You know, they didn’t have the votes yesterday morning. They were working pretty hard to round them up. I think they think that they can get there if they come up with the offsets to actually make it budget-neutral.
The question then becomes when it goes, it has to go back to the House, can they round up the votes there? Because some of the offsets are going to be controversial with either liberals, cutbacks in some of the programs for helping the poor, or some of the taxes can be controversial as well, so I think that may be a big test as well.
LAURIE MCGINLEY: And if it doesn’t get wrapped up in the Senate this week, what is the likelihood it comes back in the fall after Labor Day?
MARY AGNES CAREY: I think it’s going to be a constant part of the discussion. I mean we have seen governors come to Washington, Democratic governors, Republican governors saying our budget started July 1st, we need this money. Several states have already included it in their budgets, and so you can continue the drum beat, the pressure from the governors to do this, and of course if it isn’t done before they adjourn for the elections, they being Congress, we could certainly see this in a lame duck session this fall.
LAURIE MCGINLEY: Noam, yesterday in terms of health care reform law, there was an important decision in Virginia, could you tell us a little bit about that court decision and what the implications are?
NOAM LEVEY: Sure. So this is the lawsuit that the state of Virginia filed challenging the new health care law, which is one of two legal challenges going on right now to the law. The decision yesterday was on a procedural question. The federal government, the Obama administration had moved to dismiss it, arguing that the state of Virginia didn’t have standing to challenge it, and that it was premature to do this.
Had the Obama administration prevailed in that, it sort of would have swept aside kind of this early legal test of the new law. The opposite happened. The judge in a fairly strongly-worded opinion said no. In fact, the state of Virginia’s case can go forward. The state has standing to do it. And there are some very big constitutional questions that this case raises.
Essentially what the judge signaled I think is that he doesn’t want to dismiss this case. He wants to have a full legal debate about whether congress can mandate people to buy health insurance, which of course is the central and very controversial question at the core of the health care reform bill.
LAURIE MCGINLEY: What was the reaction from both sides, from both supporters of the law and critics of the law?
NOAM LEVEY: Well, I mean, fairly predictable. The supporters, of course, the Virginia Attorney General, Ken Cuccinelli, who has sort of made himself into one of the leading critics of the bill, celebrated this as sort of a validation of his argument that this was constitutional overreach by the Obama administration and the Democratic congress.
The National Federation of Independent Business, a conservative advocate for small business groups, which has signed on to the second lawsuit I mentioned, which is going forward in a federal court in Florida involving other states, also celebrate it. The Obama administration interestingly sort of took I think two attacks.
One was to say look, this is just a procedural ruling, so let’s not get too excited, but I think almost more interestingly they made the argument against the overall lawsuit, arguing if this thing gets thrown out, here’s what is going to get thrown out as well, all of the benefits that we have sort of heart talked about in the past few months about aid for small business, helping people get insurance, so they are sort of I think trying to take a larger political view of this as well, perhaps in anticipation that this is going to be a long, drawn-out legal fight.
LAURIE MCGINLEY: Which probably ends up in the Supreme Court.
NOAM LEVEY: Very well may.
LAURIE MCGINLEY: Mary Agnes, the health care law faces another type of test in Missouri today, can you tell us about this, about the ballot referendum on the law?
MARY AGNES CAREY: Right. It is the first state ballot referendum talking about the individual mandate, the same issue. They want to change state law to say that no individual in Missouri would have to purchase insurance, nor could you be fined if you didn’t purchase it. It is viewed as a largely symbolic measure. They expect very heavy turnout for the Republican primaries. They expect this ballot measure to pass, but at this point it is viewed by many as it won’t have any legal standing. It is more symbolic than anything.
LAURIE MCGINLEY: And there are several more of these referendums coming down the pike, I understand.
MARY AGNES CAREY: Right. There are going to be other states that will try to enact the same thing. I mean, I think it is part of the ongoing view, the political view of this, and what is the role of federal government, what is the role of the state government? As we know, states have this really broad role in implementing the health care law, and I think that you are going to see this discussion continue all over the country.
LAURIE MCGINLEY: Meanwhile, Noam, as the debate goes on about the law, there are things that are happening outside the bell way, on the ground, in the marketplace, you had a very interesting story out of San Antonio, Texas about hospitals and doctors getting together as a result of the health care law, can you tell us about that and what the implications are?
NOAM LEVEY: Sure. I mean, you may recall during the health care debate, there was a lot of talk about whether this bill would do enough to change the way health care was delivered to make it more efficient, to get doctors, hospitals, other providers to work together, and a common critique of the bill was that the efforts to do that in the bill were small. They were not far reaching at all, and they were ultimately inadequate. to make the system more efficient and to really improve the quality of care than Americans get.
Interestingly, out in health care world, outside of Washington, some interesting things I think have been going on, where hospitals and doctors are actually very aggressively sort of courting one another in this sort of courtship dance in which they are talking about can they work together, can they form partnerships? Can they form these what are called accountable care organizations where they can work together to coordinate care better. And you see physician practices selling out to hospitals, insurance companies even getting involved in this, and at a rate that is much more quick than I think many people thought, and ultimately we don’t know what the upshot of this will be. I mean, there simply may be more consolidation in the health care industry that may mean just higher costs, more monopolies, etc.
But on the other side, there are some people who sort of think you know what, this is actually a hopeful sign that people in health care are reading the tea leaves, seeing that the system is going to change and they should figure out a way to work together to potentially provide better, cheaper care. So, we will see what happens.
LAURIE MCGINLEY: Does this raise antitrust issues?
NOAM LEVEY: It may. It may very well and the Department of Justice has actually sort of looked at this, is beginning to look at this. There are a number of discussions underway by national law firms as well as consulting firms trying to advise hospitals and physician groups about how to avoid antitrust issues.
You mentioned I was in San Antonio, if you have a major hospital system in a city buying up all the primary care doctors or all the cardiologists, I mean you could very well end up with a situation where patients have less choice and ultimately that probably means higher costs.
Healthcare Innovation Impact Debated at Health Quality Metrics Event
Stakeholders from the hospital and care provider communities are sharing the podium with health insurance and IT system companies at the 8th Annual Health Care Quality Congress in Boston from August 2 through August 4. Over 200 Congress participants are debating the dual impact of government reform, broader technology adoption and “a new generation of payment models and incentives” on healthcare quality, clinical outcomes, and cost-effective delivery of care.
http://medhealth.tmcnet.com/topics/healthcare-innovation/articles/94093-healthcare-innovation-impact-debated-health-quality-metrics-event.htm
http://medhealth.tmcnet.com/topics/healthcare-innovation/articles/94093-healthcare-innovation-impact-debated-health-quality-metrics-event.htm
Tuesday, August 3, 2010
Reform Law Includes Large New Fraud Enforcement Powers, but Many Provisions Are Unclear
By James Gutman, Managing Editor (jgutman@aispub.com)
Some of the least publicized but perhaps most far-reaching provisions of the new health reform law relate to fraud-and-abuse enforcement. The law grants the federal government dramatic new powers — many of them not clearly defined or in partial conflict with other statutes — to pursue both providers and health plans.
http://www.aishealth.com/Bnow/hbd080310.html
Some of the least publicized but perhaps most far-reaching provisions of the new health reform law relate to fraud-and-abuse enforcement. The law grants the federal government dramatic new powers — many of them not clearly defined or in partial conflict with other statutes — to pursue both providers and health plans.
http://www.aishealth.com/Bnow/hbd080310.html
Health pilot eyes a new approach to reimbursement
Friday, July 30, 2010 By Cindy Kibbe
Pay-for-performance may be coming to New Hampshire’s health-care industry.Under a five-year pilot program unveiled earlier in July by Gov.John Lynch, health-care providers will be compensated based ontheir quality of care instead of the current fee-for-service model.
http://www.nhbr.com/business/healthcare/807581-276/health-pilot-eyes-a-new-approach-to.html
Pay-for-performance may be coming to New Hampshire’s health-care industry.Under a five-year pilot program unveiled earlier in July by Gov.John Lynch, health-care providers will be compensated based ontheir quality of care instead of the current fee-for-service model.
http://www.nhbr.com/business/healthcare/807581-276/health-pilot-eyes-a-new-approach-to.html
Monday, August 2, 2010
A New Concept in Health Care
By REED ABELSON
It’s one of the hottest concepts to emerge from the discussions about how best to overhaul the nation’s health care system: accountable care organizations. The idea is to encourage groups of doctors or hospitals to work together to oversee medical care so quality improves and costs go down. Having captured the fancy of Washington, the organizations are even a part of the new health care law.
http://prescriptions.blogs.nytimes.com/2010/07/28/a-new-concept-in-health-care/
It’s one of the hottest concepts to emerge from the discussions about how best to overhaul the nation’s health care system: accountable care organizations. The idea is to encourage groups of doctors or hospitals to work together to oversee medical care so quality improves and costs go down. Having captured the fancy of Washington, the organizations are even a part of the new health care law.
http://prescriptions.blogs.nytimes.com/2010/07/28/a-new-concept-in-health-care/
Under the health reform law, Medicare will be able to contract with these to provide care to enrollees. What are they and how will they work?
What's the issue?
The health care reform legislation enacted in March 2010 authorizes the Medicare program to contract with accountable care organizations (ACOs). These are networks of physicians and other providers that could work together to improve the quality of health care services and reduce costs for a defined patient population. This brief describes the ACO concept as set forth in the new legislation, discusses how ACOs might evolve over time, and reviews the challenges and opportunities facing health systems, physicians, administrators, insurers, patients, and policy makers as ACOs take shape.
http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=20
The health care reform legislation enacted in March 2010 authorizes the Medicare program to contract with accountable care organizations (ACOs). These are networks of physicians and other providers that could work together to improve the quality of health care services and reduce costs for a defined patient population. This brief describes the ACO concept as set forth in the new legislation, discusses how ACOs might evolve over time, and reviews the challenges and opportunities facing health systems, physicians, administrators, insurers, patients, and policy makers as ACOs take shape.
http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=20
Pilots key to ACO implementation
Clinical integration just the beginning of this emerging delivery model
Aug 1, 2010By: Jamie J. GoochManaged Healthcare Executive
NATIONAL REPORTS—Accountable care organizations (ACOs) have become a hot commodity since the Patient Protection and Affordable Care Act opened the door for health plans to contract through an ACO for commercial enrollees. With federal money becoming available as soon as 2012, and the promise of better quality healthcare via vertical integration, the momentum of ACOs will likely increase.
http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Pilots-key-to-ACO-implementation/ArticleStandard/Article/detail/680531?contextCategoryId=39911
Aug 1, 2010By: Jamie J. GoochManaged Healthcare Executive
NATIONAL REPORTS—Accountable care organizations (ACOs) have become a hot commodity since the Patient Protection and Affordable Care Act opened the door for health plans to contract through an ACO for commercial enrollees. With federal money becoming available as soon as 2012, and the promise of better quality healthcare via vertical integration, the momentum of ACOs will likely increase.
http://managedhealthcareexecutive.modernmedicine.com/mhe/News+Analysis/Pilots-key-to-ACO-implementation/ArticleStandard/Article/detail/680531?contextCategoryId=39911
Exeter Health Resources' pilot program envisions future of health care
By JOSHUA CLARK
jclark@seacoastonline.com
August 01, 2010 2:00 AM
EXETER — As one of five New Hampshire providers working to improve patient care and lower costs by becoming an "accountable care organization," Exeter Health Resources aims to pave the way for what may be the future of health care.
http://www.seacoastonline.com/articles/20100801-NEWS-8010317
jclark@seacoastonline.com
August 01, 2010 2:00 AM
EXETER — As one of five New Hampshire providers working to improve patient care and lower costs by becoming an "accountable care organization," Exeter Health Resources aims to pave the way for what may be the future of health care.
http://www.seacoastonline.com/articles/20100801-NEWS-8010317
Christus Santa Rosa forming an ACO
SAN ANTONIO -- There could soon be some big health care changes coming, and a local hospital is leading the way.Christus Santa Rosa Health System is developing a plan that it hopes will become a model for the future of health care. It would change the way we choose our doctors. Right now, many patients do what Chris Singer has done.
http://www.woai.com/content/health/story/Local-health-care-plan-may-become-model-for-nation/_R6Y9nMtfUSVLDUQhJM2UQ.cspx
http://www.woai.com/content/health/story/Local-health-care-plan-may-become-model-for-nation/_R6Y9nMtfUSVLDUQhJM2UQ.cspx
Healthcare law has more doctors teaming up
Reporting from San Antonio — Tribune Washington BureauAs Congress debated the healthcare bill, many critics lamented it would do little to transform a system in which doctors and hospitals bounce patients around in an uncoordinated, costly, sometimes tragic process.
http://www.latimes.com/news/health/la-na-health-doctors-20100728,0,1991432.story
http://www.latimes.com/news/health/la-na-health-doctors-20100728,0,1991432.story
Tuesday, July 27, 2010
HANYS Co-Hosts Program on Strategies for Successful Hospital-Physician Alignment
HANYS will co-host a program exploring ways physicians and hospitals in New York can form practice entities that benefit physicians, hospitals, and patients. The program, co-hosted by the New York Society for Health Planning and Academy of Medicine of Queens County, will review the financial, organizational, legal, and accounting issues critical to successful alignment.
http://www.hanys.org/news/index.cfm?storyid=1687
http://www.hanys.org/news/index.cfm?storyid=1687
Experts Believe Lack Of Incentives And Financial Interests Are Barriers To Integrated And Accountable Care
Nearly nine of 10 leaders in health care and health care policy think that the lack of incentives and current financial interests of providers and other stakeholders are barriers to moving health care toward more integrated and accountable delivery models. The latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey, published yesterday, asked leaders their views on barriers to delivery system innovation and strategies for fostering more accountability and coordination among health care providers.
http://www.medicalnewstoday.com/articles/195949.php
http://www.medicalnewstoday.com/articles/195949.php
Primary care vital for patients
Now that the Patient Protection and Affordable Care Act is law, federal agencies are developing the policies, regulations and funding that will implement many of its provisions.
It is estimated that 32 million additional Americans will become insured when the law's mandated insurance provision, along with federal subsidies for low-income individuals, take effect in 2014. This influx of newly-insured individuals is expected to substantially increase demand for health care, especially primary care.
Effective primary care improves health and helps to control care costs. Primary care is the ideal entry point into the health care system, rather than costly hospital emergency departments. Primary care encompasses disease screening, diagnosis and treatment of many medical conditions, education of patients, and management of some chronic illnesses as well as when to refer a patient to a specialist. From The Detroit News: http://www.detnews.com/article/20100727/OPINION01/7270315/1008/opinion01/Primary-care-vital-for-patients#ixzz0uudrRsMM
It is estimated that 32 million additional Americans will become insured when the law's mandated insurance provision, along with federal subsidies for low-income individuals, take effect in 2014. This influx of newly-insured individuals is expected to substantially increase demand for health care, especially primary care.
Effective primary care improves health and helps to control care costs. Primary care is the ideal entry point into the health care system, rather than costly hospital emergency departments. Primary care encompasses disease screening, diagnosis and treatment of many medical conditions, education of patients, and management of some chronic illnesses as well as when to refer a patient to a specialist. From The Detroit News: http://www.detnews.com/article/20100727/OPINION01/7270315/1008/opinion01/Primary-care-vital-for-patients#ixzz0uudrRsMM
The Hospital, Your Care Coordinator
Hospitals aren't known for making house calls. Once patients get their discharge papers, they take their chances with a family doctor or staffers at a clinic who may or may not know what happened inside the hospital's walls. So Margaret Bennett's experience is pretty rare. Bennett, 84, who had a stroke 11 years ago and colon cancer in 2007, recently spent two weeks at Montefiore Medical Center in the Bronx because of a blood clot in her leg. In many places, such a frail and elderly patient might be hospitalized for weeks or even months, but Bennett's doctor now comes to her.
http://health.usnews.com/health-news/best-hospitals/articles/2010/07/26/the-hospital-your-care-coordinator.html
http://health.usnews.com/health-news/best-hospitals/articles/2010/07/26/the-hospital-your-care-coordinator.html
SCCIPA Expands Use of the Health Access Solutions Multidisciplinary Care Coordination Platform
Integrated Solution to Accelerate Progress towards the Patient-Centered Medical Home and Support the Individual Practice Association’s Goal of Becoming a Tier 3 Accountable Care Organization
FOSTER CITY, Calif.--(BUSINESS WIRE)--Health Access Solutions, offering a multidisciplinary care coordination platform, today announced that the Individual Practice Association Medical Group of Santa Clara County, Inc. (SCCIPA) will significantly expand its use of Health Access Solutions applications. The extended solution enables emerging patient-centric models such as medical homes and accountable care initiatives.
http://www.businesswire.com/portal/site/home/permalink/?ndmViewId=news_view&newsId=20100722006590&newsLang=en
FOSTER CITY, Calif.--(BUSINESS WIRE)--Health Access Solutions, offering a multidisciplinary care coordination platform, today announced that the Individual Practice Association Medical Group of Santa Clara County, Inc. (SCCIPA) will significantly expand its use of Health Access Solutions applications. The extended solution enables emerging patient-centric models such as medical homes and accountable care initiatives.
http://www.businesswire.com/portal/site/home/permalink/?ndmViewId=news_view&newsId=20100722006590&newsLang=en
Accountable Care Organizations Can Increase Profitable Patient Volume
There is still much we do not know about the effect of health reform, but one thing that seems certain is that some form of accountable care is coming.
What is an Accountable Care Organization?
Here is the shortest version:
Payers, employers, the government will assign patients to health care organizations and make them accountable for the health and wellness of that population.
So right now we get paid by episodes of care. We drive high-contribution services and DRG’s into the hospital.
http://www.turnupyourvolume.com/2010/07/13/accountable-care-organizations-can-create-profitable-patient-volume/
What is an Accountable Care Organization?
Here is the shortest version:
Payers, employers, the government will assign patients to health care organizations and make them accountable for the health and wellness of that population.
So right now we get paid by episodes of care. We drive high-contribution services and DRG’s into the hospital.
http://www.turnupyourvolume.com/2010/07/13/accountable-care-organizations-can-create-profitable-patient-volume/
Monday, July 26, 2010
Carilion closing in on new health care approach
Carilion Clinic's efforts to systematically change the way it provides health care are coming into sharper focus.
The region's largest health care provider is pulling data and inking plans to help patients establish stronger relationships with their primary care doctors in an effort to keep patients out of the hospital and away from the emergency room. At the same time, Carilion's executives say they are closer to signing a deal with private insurance companies to establish a new payment system that rewards keeping patients healthy.
http://www.roanoke.com/news/roanoke/wb/254765
The region's largest health care provider is pulling data and inking plans to help patients establish stronger relationships with their primary care doctors in an effort to keep patients out of the hospital and away from the emergency room. At the same time, Carilion's executives say they are closer to signing a deal with private insurance companies to establish a new payment system that rewards keeping patients healthy.
http://www.roanoke.com/news/roanoke/wb/254765
Five Reasons Why Group Practices, Not Hospitals, Will Run ACOs
The American Medical Group Association, representing large group practices, played a central role in shaping accountable care organizations and sees group practices, and not hospitals, as the mainstay of ACOs, according to Chet Speed, vice president of public policy for AMGA. In ACOs' evolution, "we were there at the beginning," he says. CMS' five-year-long Physician Group Practice Demonstration, which sought to improve efficiency at group practices by coordinating care, was winding down when the healthcare reform bill was being drafted. AMGA, which claimed nine of the project's 10 participating group practices as members, proposed a new program based on the demonstration to Senate staffers.
http://www.beckershospitalreview.com/hospital-physician-relationships/five-reasons-why-group-practices-not-hospitals-will-run-acos.html
http://www.beckershospitalreview.com/hospital-physician-relationships/five-reasons-why-group-practices-not-hospitals-will-run-acos.html
Thursday, July 22, 2010
A five-year project aimed at keeping New Hampshire patients healthier
Five groups of hospitals and other health care facilities, including Exeter Health Resources, will become “accountable care organizations” in a project that attempts to tackle what many consider to be a big problem in the current system: having accountability spread across hospitals, doctors' offices, insurance carriers and employers with no one group responsible for the overall management of care.
http://www.fosters.com/apps/pbcs.dll/article?AID=/20100722/GJOPINION_01/707229872
http://www.fosters.com/apps/pbcs.dll/article?AID=/20100722/GJOPINION_01/707229872
Investors expect healthcare M&A uptick through 2Q 2011 because of ACO formation
Merger-and-acquisition (M&A) activity across the entire healthcare industry is likely to become even more frenzied--or at least sustain its current increased pace--over the next year, according to the "Life Sciences & Healthcare Sector Forecast" from the M&A intelligence service mergermarket, the law firm Epstein Becker & Green, P.C., and the investment bank Rodman & Renshaw. The forecast is based on second-quarter 2010 interviews with more than 75 U.S.-based healthcare investors.
http://www.fiercehealthfinance.com/story/investors-expect-healthcare-m-uptick-through-2q-2011/2010-07-21
http://www.fiercehealthfinance.com/story/investors-expect-healthcare-m-uptick-through-2q-2011/2010-07-21
Medicare driving health care hookups-ACOs
The scramble by local hospitals to form their physicians and facilities into “clinically integrated” networks that can do business with employers and health insurers has another huge motivating factor: Beginning January 2012, they can also do business with Medicare, the massive federal program for seniors.
http://www.ibj.com/new-medicare-contracts-drive-health-care-hookups/PARAMS/article/21197
http://www.ibj.com/new-medicare-contracts-drive-health-care-hookups/PARAMS/article/21197
MedAssets Addresses Payment Reform with Bundled Reimbursement Solution
MedAssets, Inc. /quotes/comstock/15*!mdas/quotes/nls/mdas (MDAS 23.45, +0.30, +1.30%) announced today that it has launched a bundled reimbursement solution to help healthcare providers and payors transform their delivery models in order to succeed in a reformed healthcare environment where development of Accountable Care Organizations (ACOs) and bundled payment strategies is a necessity.
http://www.marketwatch.com/story/medassets-addresses-payment-reform-with-bundled-reimbursement-solution-2010-07-21?reflink=MW_news_stmp
http://www.marketwatch.com/story/medassets-addresses-payment-reform-with-bundled-reimbursement-solution-2010-07-21?reflink=MW_news_stmp
Wednesday, July 21, 2010
Building an Accountable Care Organization
A glance at the headlines shows how badly healthcare needs to become more efficient. Healthcare spending in the United States rose 5.7 percent in 2009, to $2.5 trillion. It now commands 17.3 percent of the gross domestic product, up from 16.2 percent in 2008. That's the fastest one-year increase since 1960.
Our healthcare system is galloping away from us. We spend more than $7,000 per person on medical care, much more than any other country we compete with in the global market. China, for example, spends $600 a year. How can we as a nation keep this up? The economic burden of our healthcare system is simply unsustainable.
Enter the Accountable Care Organization
Hospitals need to become more efficient and control costs. I believe this can be done through accountable care organizations. ACOs will coordinate all the care a patient receives, both inside and outside the hospital, in a certain region. For example, an ACO in my part of Wisconsin might serve 800,000 to 1 million people. The ACO would bring together hospitals, physicians and other providers into coordinated systems that can be more efficient and safer, too.
http://www.beckershospitalreview.com/hospital-physician-relationships/building-an-accountable-care-organization.html
Our healthcare system is galloping away from us. We spend more than $7,000 per person on medical care, much more than any other country we compete with in the global market. China, for example, spends $600 a year. How can we as a nation keep this up? The economic burden of our healthcare system is simply unsustainable.
Enter the Accountable Care Organization
Hospitals need to become more efficient and control costs. I believe this can be done through accountable care organizations. ACOs will coordinate all the care a patient receives, both inside and outside the hospital, in a certain region. For example, an ACO in my part of Wisconsin might serve 800,000 to 1 million people. The ACO would bring together hospitals, physicians and other providers into coordinated systems that can be more efficient and safer, too.
http://www.beckershospitalreview.com/hospital-physician-relationships/building-an-accountable-care-organization.html
Tuesday, July 20, 2010
What ACOs Mean for Hospitals: Q&A with Dr. Marc Bard of Navigant Consulting
Q: What role do accountable care organizations play in healthcare reform?
Dr. Marc Bard: ACOs make up only a small portion of the reform law, way out of proportion to the interest and enthusiasm they have garnered from healthcare leaders. The law makes just 14 stipulations about ACOs. They have to bring together "groups of providers of services and suppliers meeting criteria specified by the [HHS] Secretary"; they have to be "willing to become accountable for the quality, cost and overall care of the Medicare fee-for-service beneficiaries assigned to it"; and they have to enter into a three-year agreement at minimum.
http://www.beckershospitalreview.com/hospital-physician-relationships/what-acos-mean-for-hospitals-qaa-with-dr-marc-bard-of-navigant-consulting.html
Dr. Marc Bard: ACOs make up only a small portion of the reform law, way out of proportion to the interest and enthusiasm they have garnered from healthcare leaders. The law makes just 14 stipulations about ACOs. They have to bring together "groups of providers of services and suppliers meeting criteria specified by the [HHS] Secretary"; they have to be "willing to become accountable for the quality, cost and overall care of the Medicare fee-for-service beneficiaries assigned to it"; and they have to enter into a three-year agreement at minimum.
http://www.beckershospitalreview.com/hospital-physician-relationships/what-acos-mean-for-hospitals-qaa-with-dr-marc-bard-of-navigant-consulting.html
Craig N. Melin is president and chief executive officer of Cooley Dickinson Hospital, Northampton, Mass. weighs in on ACOs
There are four critical components to this future: quality, safety, health focus, and value. Some of the critical components are tougher to achieve in the current fee-for-service environment, but we at Cooley Dickinson are focused on them nonetheless.
http://www.masslive.com/opinion/index.ssf/2010/07/viewpoint_cooley-dickinson_hos.html
http://www.masslive.com/opinion/index.ssf/2010/07/viewpoint_cooley-dickinson_hos.html
What reform means to an Indiana town and ACOs will contribute
Q: What other problems do you think the new law will potentially solve?
White: If we think about it long and hard, we probably could see some advantages in increasing quality, having more providers working together for the good of patient care. There is a model out there called an Accountable Care Organization that has the potential of rewarding (health care) providers for delivering very, very good care in the most efficient way. That doesn't mean cheap — it means efficiency. Now, the Department of Justice and everybody else has to weigh in on this, but you will hear more about an Accountable Care Organization, an ACO. ... So if we can align the quality incentives and the financial incentives, I see some opportunities. It's going to be a lot of work.
http://www.courierpress.com/news/2010/jul/17/health-systems-eyeing-incoming-reforms/
White: If we think about it long and hard, we probably could see some advantages in increasing quality, having more providers working together for the good of patient care. There is a model out there called an Accountable Care Organization that has the potential of rewarding (health care) providers for delivering very, very good care in the most efficient way. That doesn't mean cheap — it means efficiency. Now, the Department of Justice and everybody else has to weigh in on this, but you will hear more about an Accountable Care Organization, an ACO. ... So if we can align the quality incentives and the financial incentives, I see some opportunities. It's going to be a lot of work.
http://www.courierpress.com/news/2010/jul/17/health-systems-eyeing-incoming-reforms/
Robert J. Samuelson writes of Newsweek weighs in on what to expect from ACOs
If you want a preview of President Barack Obama’s health-care “reform,” take a look at Massachusetts. In 2006, it enacted a “reform” that became a model for Obama. The state did the easy part: expanding state-subsidized insurance coverage. It evaded the hard part: controlling costs and ensuring that spending improves people’s health. Unfortunately, Obama has done the same.
http://www.dispatch.com/live/content/editorials/stories/2010/07/18/massachusetts-acts-as-health-care-crystal-ball.html?sid=101
http://www.dispatch.com/live/content/editorials/stories/2010/07/18/massachusetts-acts-as-health-care-crystal-ball.html?sid=101
Clayton Christensen weighs in on Reform and ACOs possible contribution
Clayton M. Christensen: Health Insurance Rate Wars – Are We Focused on the Right Fight?
http://www.investingcontrarian.com/financial-news-network/clayton-m-christensen-health-insurance-rate-wars-are-we-focused-on-the-right-fight/
http://www.investingcontrarian.com/financial-news-network/clayton-m-christensen-health-insurance-rate-wars-are-we-focused-on-the-right-fight/
New Hampshire facilities forming an ACO
The five sites will become "accountable care organizations" in a project that attempts to tackle what many consider to be a big problem in the current system: having accountability spread across hospitals, doctors' offices, insurance carriers and employers with no one group responsible for the overall management of care.
http://www.businessweek.com/ap/financialnews/D9GVLM8O1.htm
http://www.businessweek.com/ap/financialnews/D9GVLM8O1.htm
Michigan hospitals move towards an ACO
Superior Health Partners trustees have finalized the formal affiliation agreement that went into effect on July 1 between Marquette General Hospital and Bell Hospital in Michigan's Upper Peninsula. Elected board officers are outlining initial priorities for the accountable care organization, the health system announced today.
http://www.healthleadersmedia.com/content/FIN-253833/Marquette-General-Health-Bell-Hospital-Affiliation-Now-Official
http://www.healthleadersmedia.com/content/FIN-253833/Marquette-General-Health-Bell-Hospital-Affiliation-Now-Official
Maine's mental health caregives moving into an ACO
As the law presently reads, health care in Maine -- and the nation -- will need to be accessible to more and delivered less expensively, yet more effectively, than it is today.
One of the key assumptions of health care reform is that the creation of Accountable Care Organizations will improve the health care system.
http://www.pressherald.com/opinion/local-caregivers-ready-for-reform-of-the-mental-health-care-system_2010-07-15.html
One of the key assumptions of health care reform is that the creation of Accountable Care Organizations will improve the health care system.
http://www.pressherald.com/opinion/local-caregivers-ready-for-reform-of-the-mental-health-care-system_2010-07-15.html
From Siloed Care to Systems-Based Accountable Care Networks: Hope For The Safety Net?
A recent independent assessment and analysis of the Los Angeles County Department of Health Services Office of Managed Care by Health Management Associates (HMA) provides a clear blueprint for the successful transformation of an uncoordinated safety net to an integrated and coherent health care delivery system. I am convinced that the challenge of retaining current Medi-Cal patients, recruiting new patients, and providing cost effective services to the remaining indigent population in Los Angeles County (as mandated by California Law) can be achieved over the next 5 years.
http://www.huffingtonpost.com/brian-prestwich/from-siloed-care-to-syste_b_646599.html
http://www.huffingtonpost.com/brian-prestwich/from-siloed-care-to-syste_b_646599.html
Wednesday, July 14, 2010
Palmetto Health Forms Accountable Care Organization Called Palmetto Health Quality Collaborative
COLUMBIA, S.C., July 13 /PRNewswire-USNewswire/ -- The Palmetto Health Board of Directors has unanimously approved the establishment of Palmetto Health Quality Collaborative, LLC, often referred to as an accountable care organization (ACO). The Quality Collaborative will be a physician-led, patient-centered, interdependent medical entity that focuses on best practices in clinical outcomes and evidence-based care. Palmetto Health will soon begin offering the more than 1,000 physicians on its medical staff an opportunity to join.
http://www.prnewswire.com/news-releases/palmetto-health-forms-accountable-care-organization-called-palmetto-health-quality-collaborative-98359734.html
http://www.prnewswire.com/news-releases/palmetto-health-forms-accountable-care-organization-called-palmetto-health-quality-collaborative-98359734.html
Tuesday, July 13, 2010
How can hospitals prepare for ACOs
How Hospitals Can Prepare for Accountable Care Organizations: Q&A With Robert Baudino of Baudino Law Group
http://www.beckershospitalreview.com/hospital-physician-relationships/how-hospitals-can-prepare-for-accountable-care-organizations-qaa-with-robert-baudino-of-baudino-law-group.html?sms_ss=twitter
http://www.beckershospitalreview.com/hospital-physician-relationships/how-hospitals-can-prepare-for-accountable-care-organizations-qaa-with-robert-baudino-of-baudino-law-group.html?sms_ss=twitter
Very Interesting Take on ACOs
This video, by healthcare consultant Anthony Cirillo, offers a neat suggestion — why not sic Steve Jobs on the accountable care organization model? As Cirillo sees it, Jobs is one of few execs out there who really understands how to build complex things in a lean, functional way.
http://coolweather.dreamhosters.com/general/video-accountable-care-organizations-the-steve-jobs-way.html?utm_source=twitterfeed&utm_medium=twitter
http://coolweather.dreamhosters.com/general/video-accountable-care-organizations-the-steve-jobs-way.html?utm_source=twitterfeed&utm_medium=twitter
More on the accountable care front
Atlantic Information Services’ Health Business Daily reported that at the Accountable Care Organization (ACO) Summit in Washington, D.C. on June 8, attorney Noah Rosenberg commented, “Everyone wants to form one, and they don’t know what it is, and neither do I.” Rosenberg is a former Health and Human Services general counsel.
http://blogs.hcpro.com/mdscentral/2010/07/more-on-the-accountable-care-front/
http://blogs.hcpro.com/mdscentral/2010/07/more-on-the-accountable-care-front/
What to do with the hospital D.C. now owns? Creat an ACO?
The District could create accountable-care organizations consisting of primary-care physicians, specialists and at least one hospital. In such an ACO, providers would be responsible for achieving high-quality care based on improvements that can be measured, leading to reduced spending growth.
http://www.washingtonpost.com/wp-dyn/content/article/2010/07/10/AR2010071002539.html
http://www.washingtonpost.com/wp-dyn/content/article/2010/07/10/AR2010071002539.html
Will insurers control healthcare costs better?
Growing supply-side concentration. Over the past decade, the supply side of the health care sector in many localities has become ever more concentrated, as hospitals formed systems and physicians joined together in larger groups. The current nouvelle vague – so-called Accountable Care Organizations (ACOs) – will only further encourage that concentration. I find it hard to believe that, in the face of this trend, fragmenting the buy side of health care even more would serve the goal of cost containment.
http://healthaffairs.org/blog/2010/07/09/will-more-insurers-control-health-care-costs-better/
http://healthaffairs.org/blog/2010/07/09/will-more-insurers-control-health-care-costs-better/
Pharmacists should get in on ground floor of ACOs
ACOs need flexible models, payment approaches, and a learning system, Health Affairs paper recommends.
Under the Affordable Care Act, accountable care organizations (ACOs) will be tested starting in January, and now is the time for pharmacists to be figuring out how they will be involved at the local level, a former CMS official said. "Pharmacists can and should be a part of this," S. Lawrence Kocot, MPA, JD, LLM, Deputy Director of the Engelberg Center for Health Care Reform at the Brookings Institution in Washington, DC, and Senior Counsel at Sonnenschein, Nath and Rosenthal, said when he addressed APhA’s Academy Leadership Meeting in April.
http://www.pharmpro.com/News/Feeds/2010/07/agencies-and-organizations-american-pharmacists-association-pharmacists-should-get-in-on-ground-floor-of-acos/
Under the Affordable Care Act, accountable care organizations (ACOs) will be tested starting in January, and now is the time for pharmacists to be figuring out how they will be involved at the local level, a former CMS official said. "Pharmacists can and should be a part of this," S. Lawrence Kocot, MPA, JD, LLM, Deputy Director of the Engelberg Center for Health Care Reform at the Brookings Institution in Washington, DC, and Senior Counsel at Sonnenschein, Nath and Rosenthal, said when he addressed APhA’s Academy Leadership Meeting in April.
http://www.pharmpro.com/News/Feeds/2010/07/agencies-and-organizations-american-pharmacists-association-pharmacists-should-get-in-on-ground-floor-of-acos/
Ensuring Your Hospital Thrives as an Accountable Care Organization
ACOs are the future of health care. A five-step plan will prepare your organization for upcoming changes.
http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/07JUL2010/071210HHN_Weekly_Silverstein&domain=HHNMAG
http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/07JUL2010/071210HHN_Weekly_Silverstein&domain=HHNMAG
Come 2012, Clinical Pathology Laboratories Will Need to Support Accountable Care Organizations
Pathologists and clinical laboratories are positioned to benefit from the provision in the Affordable Care Act of 2010 that is intended to reduce the cost of healthcare. It is the provision which authorizes the use of “accountable care organizations” (ACOs) and will be triggered in 2012.
http://www.darkdaily.com/come-2012-clinical-pathology-laboratories-will-neet-to-support-accountable-care-organizations-071210
http://www.darkdaily.com/come-2012-clinical-pathology-laboratories-will-neet-to-support-accountable-care-organizations-071210
Tuesday, July 6, 2010
Marquette General Hospital and Bell Hospital formalize affiliation as they move towards ACO model.
“With the legal documents signed, our new board officers in place and our strategic plan outlined, we can move forward with plans to create an Accountable Care Organization, which relies on close hospital partnerships, collaborative alignment with physicians, robust information technology infrastructure and operational expense management,” said Larson, who also serves as Marquette General Health System Board chairman.
http://www.uppermichiganssource.com/news/story.aspx?list=~%5Chome%5Clists%5Csearch&id=477921
http://www.uppermichiganssource.com/news/story.aspx?list=~%5Chome%5Clists%5Csearch&id=477921
American Medical Group Association ACO Readiness Assesment
The Readiness Assessment Tool is provided by AMGA to assist healthcare
organizations in evaluating their readiness to succeed as an Accountable Care
Organization (ACO). In order to produce successful clinical and financial
outcomes, the elements of organizational structure, governance, and care
coordination all must be robust and systematically working together to
manage patient care from a population perspective.
http://www.amga.org/Research/Research/ACO/assessTool.pdf
organizations in evaluating their readiness to succeed as an Accountable Care
Organization (ACO). In order to produce successful clinical and financial
outcomes, the elements of organizational structure, governance, and care
coordination all must be robust and systematically working together to
manage patient care from a population perspective.
http://www.amga.org/Research/Research/ACO/assessTool.pdf
ACO Conundrum: Everybody Wants in the Game, but Nobody Knows the Rules
Preparations among would-be participants in Medicare Accountable Care Organizations (ACOs) under the health reform law now are at a critical but semi-impossible stage, based on comments at a major conference June 7-9.
http://www.aishealth.com/Bnow/hbd070110.html
http://www.aishealth.com/Bnow/hbd070110.html
Wednesday, June 30, 2010
An HMO by any other name, except Medicare beneficiaries won’t have a choice-Accountable Care Organizations and Community Health Teams
Coordinated, managed care is a good thing and something that is sorely lacking.
However, the government should tell people the truth about Accountable Care Organizations (ACO) and Community Health Teams rather than burying the ACO in the PPACA or just alluding to the health teams in a Joe Biden e-mail. The goal of PPACA is to greatly change not only the way health care is paid for, but how it is delivered. This effort is not new, the concept of the pure HMO was tried forty years ago (HMOs for the most part are no longer true coordinated care organizations). I say tried because the goal of managing care through coordination among physicians in a somewhat closed environment was roundly rejected by both physicians and Americans. That is not to say the concept is bad, in fact the opposite is true.
http://quinnscommentary.com/2010/06/30/an-hmo-by-any-other-name-except-medicare-beneficiaries-wont-have-a-choice-accountable-care-organizations-and-community-health-teams/
However, the government should tell people the truth about Accountable Care Organizations (ACO) and Community Health Teams rather than burying the ACO in the PPACA or just alluding to the health teams in a Joe Biden e-mail. The goal of PPACA is to greatly change not only the way health care is paid for, but how it is delivered. This effort is not new, the concept of the pure HMO was tried forty years ago (HMOs for the most part are no longer true coordinated care organizations). I say tried because the goal of managing care through coordination among physicians in a somewhat closed environment was roundly rejected by both physicians and Americans. That is not to say the concept is bad, in fact the opposite is true.
http://quinnscommentary.com/2010/06/30/an-hmo-by-any-other-name-except-medicare-beneficiaries-wont-have-a-choice-accountable-care-organizations-and-community-health-teams/
Tuesday, June 29, 2010
Making sure accountable care organizations flourish
At a high level, the concept of an accountable care organization (ACO) certainly holds great promise for bringing all the various components of the care delivery system together to serve a defined population of people. In terms of implementation, a couple issues stand out in my mind that will need to be addressed in order to get the maximum positive impact from the accountable care organization initiative.
http://actionforbetterhealthcare.com/?p=805
http://actionforbetterhealthcare.com/?p=805
Meetings Feature "Real-World" Examples on How to Develop and Maintain Accountable Care Organizations
Newswise — The American Medical Group Association announced that the most recent in a series of regional meetings focused on accountable care organizations (ACOs), hosted by Summit Medical Group in Berkeley Heights, New Jersey, continued to build on the success of previous meetings in the series. This is the final regional meeting in the series, which culminates this fall at the AMGA National Summit on ACOs.
http://www.newswise.com/articles/nationwide-series-of-meetings-on-groundbreaking-delivery-system-reform-draws-medical-group-leaders-in-northeast
http://www.newswise.com/articles/nationwide-series-of-meetings-on-groundbreaking-delivery-system-reform-draws-medical-group-leaders-in-northeast
ACOs - Accountable Care Organizations: Now and in the Future
Because Accountable Care Organizations (ACOs) promise to reduce costs and improve quality it seems like everyone is talking about them as the solution for what ails the US healthcare system.
http://www.healthpolcom.com/blog/2010/06/28/acos-accountable-care-organizations-now-and-in-the-future/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+TIENewsLinks+%28The+Incidental+Economist+%28News+%26+Links%29%29
http://www.healthpolcom.com/blog/2010/06/28/acos-accountable-care-organizations-now-and-in-the-future/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+TIENewsLinks+%28The+Incidental+Economist+%28News+%26+Links%29%29
Monday, June 28, 2010
Make Medicare GME formula more accountable, MedPAC says
Washington -- Medicare financing of graduate medical education must be overhauled as part of the broader goal of health delivery reform, says the Medicare Payment Advisory Commission.
http://www.ama-assn.org/amednews/2010/06/28/gvsb0628.htm
http://www.ama-assn.org/amednews/2010/06/28/gvsb0628.htm
Mercy's approach 'proactive, preventive'
SPRINGFIELD - Mercy Medical Center believes it has in place something that provides high-quality health care while having reduced costs.
The model is known as an accountable care organization - an ACO in the health-care industry lingo - and it is a collaboration between the medical center and Hampden County Physician Associates.
http://www.masslive.com/springfield/republican/index.ssf?/base/news-29/127770932090540.xml&coll=1
The model is known as an accountable care organization - an ACO in the health-care industry lingo - and it is a collaboration between the medical center and Hampden County Physician Associates.
http://www.masslive.com/springfield/republican/index.ssf?/base/news-29/127770932090540.xml&coll=1
Insurer sees coming health insurer 'oligopoly,' doctors band together on system changes
Bloomberg Businessweek reports that health insurer WellPoint's investor-relations chief said Thursday that health insurers are "moving towards an oligopoly" accelerated by the new law. "New regulations on administrative spending and premium increases will push some independent insurers out of business or into deals with bigger rivals, said Michael Kleinman, vice president for investor relations, at a Wells Fargo & Co. conference in Boston. …
http://www.news-medical.net/news/20100628/Insurer-sees-coming-health-insurer-oligopoly-doctors-band-together-on-system-changes.aspx
http://www.news-medical.net/news/20100628/Insurer-sees-coming-health-insurer-oligopoly-doctors-band-together-on-system-changes.aspx
Treat Your Doctors Like Pilots
As many of you loyal readers know, I spent the early part of this week at HFMA's Annual National Institute in Las Vegas. One of the things I like to do at these shows is talk to vendors and their customers about what's bothering them and what's been successful in their efforts to improve their organizations—mostly hospitals and health systems.
http://www.healthleadersmedia.com/content/LED-253024/Treat-Your-Doctors-Like-Pilots##
http://www.healthleadersmedia.com/content/LED-253024/Treat-Your-Doctors-Like-Pilots##
In Focus: Building Accountable Care Organizations That Improve Quality and Lower Costs—A View from the Field
Summary: In less than 18 months, Medicare will launch a shared savings program to reward primary care physicians, specialists, and hospitals that form accountable care organizations and collaborate in the redesign of care processes, improve care coordination, and promote high-quality, cost-efficient care. To receive payment, providers must demonstrate the impact their efforts have on specific quality-of-care and cost-reduction goals. Doing so is no small task. Quality Matters asked organizations that have been working toward these goals what advice they have for others.
http://www.commonwealthfund.org/Content/Newsletters/Quality-Matters/2010/June-July-2010/In-Focus.aspx
http://www.commonwealthfund.org/Content/Newsletters/Quality-Matters/2010/June-July-2010/In-Focus.aspx
Medical Homes versus Accountable Care Organizations
Like many of us who are still digesting the rather lengthy new health care reform law, I find myself in over my head on certain elements of it pertaining to newly-derived complex schemes to deliver and pay for health care services that optimize patient outcomes and bend the almighty cost curve. Two very popular and promising models are the medical home and accountable care organizations.
http://ashpblog.squarespace.com/blog/2010/6/25/medical-homes-versus-accountable-care-organizations.html
http://ashpblog.squarespace.com/blog/2010/6/25/medical-homes-versus-accountable-care-organizations.html
11 Things to Know About Accountable Care Organizations
1. Time to start is now. ACOs must be organized before 2012, when one ACO will be designated in each region, with each region having no less than 5,000 Medicare beneficiaries who have signed up for an ACO. The first organization up and running will have an advantage, because no hospital, physician or other provider can be involved in more than one ACO.
2. Goal is clinical integration. The ACO is expected to save money by integrating care. Providers will need to work closely with each other on the full spectrum of care for each patient.
http://www.beckershospitalreview.com/news-analysis/11-things-to-know-about-accountable-care-organizations.html?sms_ss=twitter
2. Goal is clinical integration. The ACO is expected to save money by integrating care. Providers will need to work closely with each other on the full spectrum of care for each patient.
http://www.beckershospitalreview.com/news-analysis/11-things-to-know-about-accountable-care-organizations.html?sms_ss=twitter
A Guide to Accountable Care Organizations, and Their Role in the Senate’s Health Reform Bill
The accountable care organization has been a model for health care reform, yet its modest success has been limited to a handful of health care systems across the country. However, the accountable care organization model has recently taken on far greater significance since being introduced as one of Medicare’s pilot programs in the Senate’s health reform bill.
http://www.healthreformwatch.com/2010/03/11/a-guide-to-accountable-care-organizations-and-their-role-in-the-senates-health-reform-bill/
http://www.healthreformwatch.com/2010/03/11/a-guide-to-accountable-care-organizations-and-their-role-in-the-senates-health-reform-bill/
Accountable Care Organizations: Scrambling to Get Ready Now
SUMMARY: There's a scramble going on in cities all across the country as physicians, hospitals and other providers organize themselves into "accountable care organizations" in order to capture future financial rewards.
http://www.jdsupra.com/post/documentViewer.aspx?fid=09e8fc2e-f7b2-4328-881e-446d1d9402c4
http://www.jdsupra.com/post/documentViewer.aspx?fid=09e8fc2e-f7b2-4328-881e-446d1d9402c4
Subscribe to:
Posts (Atom)