Monday, February 4, 2013

Go Triple Aim !!


Accountable Care Organizations

I received my first copy of Accountable Care News for January 2013 Volume 4, No 1. Judging from the Volume number I have missed three years of activity among ACO proponents.  Judging from my experience the vast majority of providers know little about ACOs.

Headlining the first page in the Banner is The Results of the Annual Accountable Care ePoll

According to ACN there are 150 ACOs participating in the Medicare Shared Savings Initiative serving more than 2.4 Million Medicare beneficiaries.

During early December 2012 Payers, Providers, MCOL and ACN sponsored a survey asking industry stakeholders their perspective on ACOs.

As in most new initiatives there are uncertainties as to how the new organizations will grow, and operate. The survey indicates some differences between 2011 and 2013. The survey which had a n=103 did not include anyone not already in an ACO, which highly biases the outcome.

In 2013 those who had the most optimistic outlook of ACO impact in the marketplace were vendors, with 56.7% saying that ACOs have or will have a significant market impact. 46 % of purchasers and providers felt the impact would be significant in the market place.

Will ACOs actually generate the necessary savings? Only 40% were confident while 31.8% were doubtful or very doubtful. Surprisingly providers had the greatest confidence levels 43.6%.

The “Triple Aim” a term bandied about now much like the DRG of the 1980s is a term coined by the Medical Advantage Group (MAG) to ascertain ACO readiness. Their criteria are developed from experience in developing one of the largest patient-centered provider network in Michigan. MAG

Triple Aim “ was developed by the Institute for Healthcare Improvement (IHI and has become the framework for the NQ strategy of the U.S. Dept of HHS and the Centers for Medicare and Medicaid services

Triple Aim combines the pursuits of improving population health, improving patient experience of care, and reducing per capita costs.

1.Population health

2.Patient experience of care.

3. Reduction of per capita costs.

This term encompasses a vast collection of related and unrelated activities governed by the goal of 'Triple Aim”. Whether or not this term will be meaningful in the long run will be open to analysis as time goes on. Whether the criteria are called the Triple Aim or something else is moot. It seems more of a 'mantra' or cheer leading statement. For me it conj-ours up the spectacle of a thousand practice management experts at the next MGMA meeting chanting “triple aim.triple aim....triple aim and the next keynote speech of Donald Berwick (note: this writer does not intend to besmirch Dr. Berwick's stellar credentials and reputation as former head of CMS.

Let it be said however, that those following the 'enlightened path' should be cautious and analytical as the 'system'' becomes operative and adjust it accordingly. ACOs may very well fail to produce their intentions, however may be so thoroughly engrained in health systems that they will survive, with many 'workarounds' for it to operate at all. Defective organizations often survive in this manner, such as HHS, CMS and countless other inspired organizations.

There will be all sorts, sizes and shapes of ACOs…One model will not fill all. Some regions will be fertile ground for ACOs and in other regions ACOs will be inappropriate and fail to become established.

ACN goes on to say that there may be unintentional consequences in the market place. The growth of larger and larger provider organizations, stifling competition, and the acceleration of hospitals acquiring physician practices. Lawrence P. Casalino M.D.,PhD., M.P.H. elaborates his hopes for a pluralistic system with many choices for patients and providers.

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