The momentum around accountable care organizations is growing, although the pace might be slower than imagined given the buzz around the emerging payment and delivery model.
Less than a quarter of providers are expected to have formed or joined an ACO by the end of 2013, even though participation quadrupled since last year, according to data from Premier's 2013 Economic Outlook, which drew on responses from 115 C-level executives in 35 states.
More than three-quarters of respondents said they have plans to eventually join the estimated 500 existing ACOs, according to Premier.
Yet the survey also revealed some discrepancy between intentions and actions. In Premier's 2012 Economic Outlook, about half of the executives who responded to the survey said their organizations were planning to create or join an ACO by the end of 2013—but as the year draws to a close, that number remains under 25%.
Once again, this year's survey indicates that ACO participation could meet the 50% mark by the end of next year, if executives follow through with their plans.
The outlook is more optimistic than another recent survey of 200 healthcare executives conducted by Purdue Healthcare Advisors, a not-for-profit consulting firm. Nearly half of those respondents had no plans for an ACO—with most waiting to get more answers on how the model will work in practice.
Given the large investments in technology and personnel needed to form an ACO, the Premier survey found that providers most likely to be involved are those that are part of a larger system and located in a non-rural area. Standalone hospitals were most likely to say they have no future plans for an ACO, at 27.4% compared with 18.9% for hospitals that are part of larger networks.
Across the board, the most common payment structure was an upside-only shared savings program rather than one that carries downside risk for failing to meet quality and cost targets. Midsized hospitals were most likely to partner with Medicare and Medicaid, while large hospitals were more likely to form ACOs with commercial insurers.
The most common investment providers had made was in health and wellness coaching (71.6%) followed by patient-centered medical homes (62.4%).
A good example of the experiment so far is Roanoke, Va.-based Carilion Clinic, which has both rural and non-rural hospitals and is participating in two ACOs. It has 3,000 participants in a shared-savings ACO with Aetna, which was formed in 2011. And in January, it enrolled in the Medicare Shared Savings Program with 46,200 Medicare beneficiaries.
The centerpiece of Carilion's efforts are the 40 care coordinators who work on improving care transitions and making sure patients remain compliant with their treatment plans. Starting in 2008, it has also invested in a systemwide electronic health-record system, a data warehouse and data analytics.
The efforts have yielded some early successes. Compared with 2011, patients in the Aetna ACO in 2012-13 saw 6% fewer inpatient days and had 23% fewer avoidable emergency department visits and 10% fewer high-tech imaging scans. The ACO reduced its readmission rate to 4.9% from 5.6%.
The total investment, meanwhile, has been “multimillion dollars,” according to Dr. Stephen Morgan, senior vice president and chief medical information officer, who acknowledged that it's still difficult to quantify the return on investment.
“We really are focused on what's best for the patient,” he said. “Our thought is (if we do that) the cost will follow.”
Follow Beth Kutscher on Twitter: @MHbkutscher
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