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ACO
A 6th Difference Between ACOs and “AC-Like” Arrangements
Last week I wrote about five key differences between formal ACOs (mainly care providers contracting with Medicare) Â and informal Accountable Care-Like (AC-Like) arrangements between care providers and commercial health plans.
Transaction costs
Timing
Incrementalism
Flexibility
Capital cost
There’s an important  6th difference worth noting:
Visibility
Formal ACOs will be visible from miles away — think elephants on the Serengeti.
An ACO that wants to contract with Medicare must establish itself as a corporation. The Medicare ACO models have substantial disclosure and reporting requirements. We won’t know […]
Platform Failure and Success: Lessons from Outside Healthcare
Healthcare is just starting down the road of adopting platform technology and business models. What lessons can we learn from other industries?
A recent article by Andreas Constantinou in Vision Mobile blog provides guidance. The article lists a Dead Platform Graveyard from the past 10 years — you will probably recognize some of the names: Meego (Nokia/Intel), Palm 5/6, Symbian OS (Nokia) WebOS (HP), Windows Mobile (Microsoft). Blackberry RIM is a candidate to make next year’s list.
Software platforms have failed for a […]
Leavitt ACO Report: Overstating or Understating Accountable Care Activity?
Accountable Care Organizations (ACOs) have been likened to
a unicorn — a fantastic creature that is vested with mythical powers. But no one has actually seen one.
a camel — a horse designed by a committee, one that already has its nose in the tent
With this background, you can begin to appreciate the difficulty of conducting an accurate census of ACO animals in the wilderness. Yet, this is exactly the task undertaken in the excellent Leavitt Partners report measuring ACO activity in the US.
As I […]
The EHR|HIE Interoperability Workgroup — Potentially Earth-Shattering
Yesterday’s announcement of “Standard Health Data Connectivity Specifications” by the EHR|HIE Interoperability Workgroup (EHR|HIE WG) is potentially earth-shattering.
My mom would not know what I mean by “Standard Health Data Connectivity Specifications,” so I’ll try to write this in plain English.
Who Are These Guys? The EHR|HIE Interoperability Workgroup
The workgroup consists of HIEs (Health Information Exchanges) representing seven of the largest states, eight EHR vendors, and three HIE software/services vendors.
Employers Perceive that Health Plans Add Value to ACOs
A just released study from Aon Hewitt and Polakoff Boland — 2011 Employer Driven Accountable Care Organizations Survey Report — examines employer attitudes toward ACOs. The report provides useful insights into an area that hasn’t yet received much attention.
A couple tables in particular caught my attention.
(click on the graphic to view a larger version)
Key findings in this table include:
Six Quick First Impressions of the CMS Bundled Payments for Care Improvement Initiative (BPCII)
This afternoon CMS announced the Bundled Payments for Care Improvement Initiative (BPCII). For details, start reading here.
Here are six quick first impressions:
1. It’s very creative and innovative. CMS has demonstrated out-of-the-box thinking and leaves a lot of room for applicants to propose their own approaches. Expect to have to read the materials 2-3 times to wrap your thinking around it.
Unlike the Medicare Shared Savings ACO rule, the BPCII is flexible. Anticipate some innovative and non-traditional proposals from diverse applicants. Unlike […]
Physician-Hospital Relationships: The Hospital Morphs from Revenue Center to Cost Center
by Vince Kuraitis JD, MBA and Jaan Sidorov MD, MHSA, FACP
In our introductory posting of this series, we noted that economic incentives previously aligning doctor-hospital interests were changing. This creates the potential for The 100 Year Shift – physicians awakening to possibilities for stronger partnerships with payers than with hospitals.
In this post, we will zero in on the changing economic position of hospitals and the effect this is having on physician-hospital relationships. We will examine the […]
Google+ Shines the Light on the Value of Data Portability
It’s understandable that a healthcare delivery system would have a mindset and business objective to keep referrals within its network of care providers. Businesses have a right and an obligation to try to hang on to their customers.
It’s a different issue whether closed or walled garden HIT is an acceptable means toward that end.
Outside of healthcare, we understand and can accept that businesses used closed, proprietary IT as part of their business model. Apple has designed their […]
Payment Transformation: From Volume to Value
by Jaan Sidorov MD, MHSA, FACP and Vince Kuraitis JD, MBA
In our introductory posting, we suggested that a huge shift is underway in the health care industry. Decades of hospital-physician cooperation are not only eroding, we suggest this trend could accelerate. Instead of a natural clinical and economic affinity with hospitals, we foresee the potential for physicians forming a new dyad with insurer-buyers.
In this post, we will examine what we and many other commentators view as inevitable: the demise of […]
Patient “Leakage”: Rethinking Two Field of Dreams Assumptions About ACOs
A study released last week by the Massachusetts Attorney General contains surprising data to challenge two commonly held ACO (accountable care organization) “Field of Dreams” assumptions. These assumptions relate to patient “leakage” — out-of-network patient care and referrals.
1) Hospital administrators assume that tighter physician-hospital integration (e.g., through employment of physicians) will result in “captive referrals” by physicians back to the mother-ship hospital.
2) Medicare administrators are assuming that Medicare Shared Savings ACOs will be able to coordinate patient care even without limitations on patients’Â choice to go […]
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