Carolinas HealthCare System said an ACO was under evaluation as officials monitor the results of one of its bolder affiliates that has entered into an accountable care contract. Phoebe Putney Health System, a four-hospital system based in Albany, Ga., continues to analyze the option. Tanner Health System has hired a consultant to weigh an ACO for the three-hospital system based in Carrollton, Ga. Wheaton Franciscan Healthcare, with 14 hospitals in Illinois, Iowa and Wisconsin, has not ruled it out and Yale New Haven (Conn.) Health System said its developing ACO is not yet ready.
But even at systems not starting ACOs, the push to revamp the delivery system to improve quality and eliminate waste is gathering steam, especially now that Medicare is adjusting payments based on adherence to quality indicators and limiting hospital 30-day readmissions.
And some, even if they don't adopt the ACO form, are using the accountability label. Intermountain's Poulsen said a pilot of the health system's alternative to ACOs, the shared-accountability model, began this spring with 300 doctors and will continue through the middle of next year.
Intermountain's effort relies on patient education, shared decisionmaking between the provider and patient, and insurance benefit design to engage patients in carefully considering the potential outcomes, alternatives and cost of treatments. Shared decisionmaking may results in patients choosing the less expensive physical therapy over orthopedic surgery. Appropriate insurance design can encourage patients to use urgent-care centers over pricey visits to the emergency room.
Pouslen said the pilot will also test new physician reimbursement models to ensure new financial incentives aren't misconstrued or twisted. Three-quarters of physician pay will be fee-for-service, and the remaining quarter will be tied to quality and medical cost performance.
In a few cases where survey respondents reported no Medicare ACO, the systems reported they were entering into shared-savings contracts with private insurers that mimic the ACO payment model. Shared-savings contracts allow providers to financially benefit from the lower spending associated with higher quality performance and better patient outcomes.
Clearly, the lines are blurring between ACOs and other payment reform models. That could be seen in South Dakota, where Sanford Health officials believed the risk was too great to enter into an accountable care contract under Medicare.