Providers and private payers have scant experience sharing financial risk for patient populations in accountable care models of healthcare delivery and payment, according to a survey of the landscape led by Suzanne Delbanco, executive director of Catalyst for Payment Reform.
Study notes lack of experience in key component of ACOs: risk sharing
The authors of the paper, published by the Commonwealth Fund, identified eight models with a risk-sharing component, a full continuum of patient services and quality incentives. Catalyst for Payment Reform is a coalition of corporations and other large healthcare purchasers.
Most of the examples identified were still in development or at an early stage of development and none moves away from what the paper refers to as the fee-for-service “chassis” by building a program on bundled payments or global budgets that make providers fully responsible for managing the financial risk.
Some of the initiatives are expected to incorporate additional risk-sharing as they develop, according to the executive summary, which notes that “these burgeoning models and the experiments they embody will inevitably instruct us.”
The ACOs discussed in the paper involve Aetna; Anthem/WellPoint; Blue Cross and Blue Shield of Illinois; Blue Cross and Blue Shield of Massachusetts; Blue Cross and Blue Shield of North Carolina; Horizon Blue Cross Blue Shield of New Jersey; Medica Health Plan; and Maine State Employee Health Commission and MaineGeneral Health.
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