A new report from the Office of the National Coordinator for Health IT (ONC) looks at two case studies of communities that have made significant investments to support accountable care in their transition away from the fee-for-service system.
Bangor, Maine, one of the 17 Beacon Communities funded by ONC under the American Recovery and Reinvestment Act program (ARRA), now hosts a number of value-based payment initiatives including federal ACO programs under Medicare and state initiatives leveraging the Maine Medicaid program to support advanced care delivery models in primary care. ACOs are implementing systems to improve care coordination across participating providers, while leveraging a variety of statewide resources to facilitate data aggregation and streamlined reporting, such as HealthInfoNet, the state’s health information exchange, and a robust network of organizations focused on quality reporting and metrics, according to the report’s highlights, which were included in an ONC blog post on Oct. 31.
Addtionally, in Austin, Texas, stakeholders have participated in the federal Medicare Shared Savings Program and Pioneer ACO programs, state efforts using Medicaid funding to incentivize quality improvement, as well as a wide ranging commercial health plan program around patient centered medical home models. In addition to organizations investing heavily in the use of EHRs, stakeholders are leveraging ICare, a regional HIE.
What’s more, these case studies highlight many of the challenges that stakeholders are facing on the ground in their efforts to develop new models of care. Challenges include evolving standards around interoperability; competitive pressures that reinforce fragmentation in the healthcare system and inhibit collaboration around shared assets; and limited access to claims and clinical data across settings and sources.
According to ONC, “These case studies will help to illuminate important examples of how stakeholders are coming together to ensure providers have access to the information, tools, and services they need to succeed in the accountable care environment. While there is widespread consensus that IT solutions are critical to enabling many of the capabilities needed for accountable care, providers, patients, payers, government entities, and others will need to work closely together to realize the vision of a truly patient-centered, value-oriented healthcare delivery system.”
The ONC blog post points out that ACOs have spread rapidly over the last several years: the Medicare Shared Savings Program now includes more than 360 ACOs serving over 5.3 million Medicare beneficiaries across the country. In addition, commercial payers such as UnitedHealthcare, Aetna, and others, are developing ACOs with providers in their networks.
However, as of late, ACOs have been under more scrutiny than ever. Recently, the Centers for Medicare and Medicaid Services (CMS) released the mixed financial results from years 1 and 2 of the Pioneer ACO program. In September, three ACOs announced their departures out of Medicare's Pioneer ACO program dropping the total to 19.
