The 12 remaining pioneer accountable care organizations chose one of three core options that vary the possible risk and potential financial gain. Eligible savings range from 50% to 75% of the amount providers save, as long as they save at least 1%.
In Wisconsin, officials with Bellin Health Systems and ThedaCare chose the core option with the largest bonus and loss potential because “we are confident that we can succeed in this model,” said Dr. David Krueger, medical director for the organizations' joint accountable care organization. “We're putting our selves at greater risk because we think we can accomplish the goals,” he said.
After analyzing Medicare spending data and experience with Medicare managed care, Atrius Health, which operates an ACO with five Massachusetts medical groups, also selected the core option with the largest bonus and potential loss, said Dr. Rick Lopez, the group's medical director.
The pioneer accountable care effort will more than double the number of Medicare enrollees that qualify for pharmacy and nurse management already used to manage care for Atrius' Medicare managed-care patients.
Atrius' accountable care organization is expected to include 25,000 Medicare patients, Lopez said. The physician group also provides care for 22,000 Medicaid managed-care enrollees. Atrius officials must expand quality measures to include some, such as depression screening, the physician groups don't measure but must report as a pioneer ACO. Officials met for a day last week to discuss managing care for high-risk and chronic disease patients, he said.
Atrius physicians have experience managing care, he said, but nonetheless have work to do to prepare. “We have been actively planning about what needs to be put in place as soon as possible,” he said.
Keith Pugliese, vice president of accountable care and public policy for Brown & Toland, an independent practice association in San Francisco, said prior technology investments and existing chronic disease programs would support its Medicare accountable care effort. The physician group may expand is staff to meet the need of 17,500 Medicare enrollees expected to receive care from the ACO, he said. “We're prepared,” he said.