October 17, 2015 01:00 AM

Providers and insurers must help ACOs reach their goals

Modern Healthcare

Providers and insurers need to do a better job of reaching patients and employers to help private accountable care organizations achieve lower costs and higher quality, according to physician executives at four large health insurance companies. Their experiences reflect that ACOs are still a new structure, and building a new payment and care model as complex as an ACO is not easy to roll out. Dr. Alan Muney, chief medical officer at Cigna Corp., said his company has more than 130 large-group ACOs. Only 58% have both lowered costs and improved quality. Part of the problem, he said, is that so many doctors are still paid on a volume basis. Successful ACOs have tied payment to measures of quality, safety and patient satisfaction, and hospitals and doctors were on board with that.

Drug giant AstraZeneca was denied approval of a diabetes drug combination treatment by the Food and Drug Administration, which is requesting more clinical data on previously approved therapies saxagliptin and dapagliflozin, known by their brand names as Onglyza and Farxiga. AstraZeneca stated that the data requested included information from “ongoing and completed studies and may require information from new studies.” AstraZeneca has speculated annual sales of up to $3 billion from its combination product. A delay in its approval could set the company back in its efforts to grab a sizeable share of a market that, with the introduction of several blockbuster drugs, has become increasingly competitive in recent years.

Acute-care hospital stocks took a hit last week after HCA previewed third-quarter earnings results that were below expectations. Nashville-based HCA, the largest hospital chain by revenue, typically has the strongest performance in its peer group, and its quarterly earnings previews are considered a bellwether for the sector. Labor costs were the primary drag on earnings, but investors also focused on another metric: a small increase in the number of uninsured admissions. Same-hospital uninsured admissions made up 8% of the total in the third quarter, compared with 7.3% during the same period last year. Managed-care admissions declined to 28.5% of the total, down from 28.9%.

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