ACO 2.0 – The Emergence Of Derivative Models

Recently, Victoria Elliott, Senior Reporter at American Medical News, asked me if I was surprised that payers in Florida were collaborating with providers to establish cancer-focused ACOs. From my experience with and ongoing research on the topic, I would anticipate that payers, especially commercial payers, will continue to pilot multiple variations of ACO-like ventures as they attempt to find reliable models to pursue on a grander scale. I would expect an increasing number of disease-specific accountable care ventures to develop over time. These ventures would focus on conditions that are: chronic; high cost; highly prevalent in our society; and place a high burden on patients’ quality of life. Conditions which have, or lend themselves to the development of, coordinated and comprehensive care models would be expected to proliferate at a more rapid rate.

In my opinion, cancer care is especially well suited to an ACO-like or bundled payment arrangement due to the high cost and current variability in clinical practice. In addition, compared to other chronic conditions like diabetes or heart failure, cancer patients tend to be more loyal to their chosen provider and are more likely remain within one system of care. This allows a coordinated system like the ones you referenced a greater ability to impact the overall cost and quality of care provided to patients.

Disease specific ACOs are not the predominant model at this time but I would anticipate that payers across the country will be more likely to enter into similar oncologic ventures in the coming years. If they are implemented appropriately, and the clinicians are appropriately engaged and incented, they may have a dramatic effect in not only decreasing the overall cost of cancer care but also in improving patient care through: the development and dissemination of evidence-based protocols and the ongoing monitoring and reporting of clinical quality and patient experience information. Over time, and depending on the success of the pilot ventures, I could see similar models being developed for other chronic conditions like renal disease, diabetes, heart failure, etc. Before this would be possible, this would require many providers (hospitals, health systems, etc.) to redesign their delivery systems to ensure that the patient stays within the system of care. -Dr. John Redding

31
Jan
Comments Off